Multicenter Randomized Phase II Trial of Docetaxel With/Without VANDETANIB for Advanced Gastroesophageal Cancer
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed gastric adenocarcinoma or gastroesophageal junction cancer
- Metastatic disease
- Measurable disease
- No symptomatic CNS metastases
PATIENT CHARACTERISTICS:
Inclusion criteria:
- ECOG performance status 0-1
- Life expectancy ≥ 3 months
- ANC ≥ 1,500/µL
- Platelet count ≥ 100,000/µL
- Bilirubin ≤ 1.5 times upper limit of normal (ULN)
- Creatinine < 1.5 times ULN OR creatinine clearance ≥ 50 mL/min
- Potassium ≥ 4.0 mEq/L (supplementation allowed) and ≤ the CTCAE grade 1 upper limit
- Magnesium normal (supplementation allowed) and ≤ the CTCAE grade 1 upper limit
- Calcium normal and corrected serum calcium ≤ the CTCAE grade 1 upper limit
- In cases where the serum calcium is below the normal range, calcium (adjusted
for albumin) normal OR ionized calcium normal
- ALT and AST ≤ 2.5 times ULN
- Alkaline phosphatase ≤ 2.5 times ULN
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for up to 12 weeks after
completion of study therapy
- Atrial fibrillation allowed if controlled by medication
- LVEF ≥ 45% by MUGA or ECHO
Exclusion criteria:
- Evidence of severe or uncontrolled systemic disease
- Any concurrent condition which makes it undesirable for the patient to participate in
the trial or which would jeopardize study compliance, in the Investigator's opinion
- Uncontrolled infection
- Coagulopathy (including warfarin or anti-coagulant related) or bleeding disorder
- Peripheral neuropathy ≥ grade 2
- Clinically significant cardiac event, including myocardial infarction or New York
Heart Association class II-IV heart disease within the past 3 months
- Presence of cardiac disease that, in the opinion of the Investigator, increases the
risk of ventricular arrhythmia
- History of arrhythmia (i.e., multifocal premature ventricular contractions, bigeminy,
trigeminy, ventricular tachycardia, or uncontrolled atrial fibrillation) which is
symptomatic or requires treatment (CTCAE grade 3) OR asymptomatic sustained
ventricular tachycardia
- History of QTc prolongation as a result of other medication that required
discontinuation of that medication
- Congenital long QT syndrome or a first degree relative with unexplained sudden death
under 40 years of age
- Presence of left bundle branch block
- QTc with Bazett's correction that is unmeasurable or ≥ 480 msec on screening ECG
- If a patient has QTc ≥ 480 msec on screening ECG, the screen ECG may be repeated
twice (at least 24 hours apart)
- The average OTc from the three screening ECGs must be < 480 msec in order for
the patient to be eligible for the study
- Hypertension not controlled by medical therapy (systolic blood pressure [BP] > 160 mm
Hg or diastolic BP > 100 mm Hg)
- Currently active diarrhea (≥ grade 2) that may affect the ability of the patient to
absorb vandetanib
- Previous or current malignancies of other histologies within the past 5 years, with
the exception of cervical carcinoma in situ and adequately treated basal cell or
squamous cell carcinoma of the skin
PRIOR CONCURRENT THERAPY:
- Recovered from all prior therapy
- At least 4 weeks since prior chemotherapy or radiotherapy
- No more than one prior chemotherapy regimen for metastatic disease
- Prior adjuvant therapy, including chemoradiotherapy, allowed
- At least 2 weeks since prior palliative radiotherapy
- Up to 3750 cGy palliative radiotherapy to the stomach allowed
- No prior therapy with docetaxel
- More than 30 days since prior investigational agents
- More than 4 weeks since prior and no concurrent or planned participation in another
experimental drug study
- More than 4 weeks since prior major surgery and recovered
- More than 2 weeks since prior and no concurrent medication that may cause QTc
prolongation or induce Torsades de Pointes
- No concurrent amiodarone
- No concurrent potent inducers of CYP3A4 function (e.g., rifampicin, rifabutin,
phenytoin, carbamazepine, barbiturates, or Hypericum perforatum [St. John wort])
- No prior enrollment or randomization to treatment in the present study