A Phase II Evaluation of SU11248 (Sunitinib Malate) (IND #74019, NSC #736511) in the Treatment of Persistent or Recurrent Clear Cell Ovarian Carcinoma
Inclusion Criteria:
- Diagnosis of recurrent or persistent clear cell ovarian cancer, meeting 1 of the
following criteria:
- Primary tumor with ≥ 50% clear cell histomorphology
- Histologically confirmed recurrence with ≥ 50% clear cell histomorphology
- Tumors must be negative for expression of WT-1 antigen and estrogen receptor antigen
by IHC
- If the primary tumor had ≥ 50% clear cell histomorphology, a biopsy of the
recurrent or persistent tumor is not required
- If the primary tumor had < 50% clear cell histomorphology (or if slides of the
primary tumor are not available), a biopsy of the recurrent or persistent tumor
is required
- Measurable disease, defined as ≥ 1 lesion that can be accurately measured in ≥ 1
dimension (longest diameter to be recorded)
- Each lesion must be ≥ 10 mm when measured by CT scan, MRI, or calipers by
clinical exam OR ≥ 20 mm when measured by chest x-ray
- Lymph nodes must be ≥ 15 mm in short axis when measured by CT scan or MRI
- Must have ≥ 1 "target lesion" to be used to assess response as defined by RECIST
criteria
- Tumors within a previously irradiated field will be designated as "non-target"
lesions unless progression is documented or a biopsy is obtained to confirm
persistence ≥ 90 days after completion of radiotherapy
- Must have received one prior platinum-based chemotherapeutic regimen containing
carboplatin, cisplatin, or another organoplatinum compound for management of primary
disease
- Initial treatment may have included intraperitoneal therapy, consolidation
therapy, or extended therapy administered after surgical or non-surgical
assessment
- Must have a platinum-free interval of < 12 months, have progressed during
platinum-based therapy, or have persistent disease after platinum-based therapy
- One additional cytotoxic regimen for management of recurrent or persistent
disease allowed
- No primary peritoneal or fallopian tube cancer
- No history or evidence of CNS disease, including primary brain tumor or brain
metastases, by physical exam
- Not eligible for a higher priority (e.g., Phase III) GOG clinical trial for the same
population, if one exists
- GOG performance status (PS) 0-2 (for patients who received one prior regimen) OR GOG
PS 0-1 (for patients who received 2 prior regimens)
- ANC ≥ 1,500/mm^3
- Platelet count ≥ 100,000/mm^3
- Creatinine ≤ 1.5 times upper limit of normal (ULN)
- Bilirubin ≤ 1.5 times ULN
- AST and ALT ≤ 2.5 times ULN (or ≤ 5 times ULN for patients with liver metastases)
- Urine protein < 1+ by urine dipstick OR < 1,000 mg by 24-hour urine collection
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for ≥ 3 months after
completion of study therapy
- No active infection requiring antibiotics except uncomplicated urinary tract
infection
- No serious non-healing wound, ulcer, or bone fracture
- No significant traumatic injury within the past 28 days
- No active bleeding or pathological condition that carries a high risk of bleeding
(e.g., known bleeding disorder, coagulopathy, or tumor involving major vessels)
- No seizures not controlled with standard medical therapy
- No cerebrovascular accident (stroke), transient ischemic attack, or subarachnoid
hemorrhage within the past 6months
- No clinically significant cardiovascular disease, including any of the following:
- Poorly controlled hypertension (e.g., systolic BP ≥ 140 mm Hg or diastolic BP ≥
90 mm Hg)
- Myocardial infarction or unstable angina within the past 6 months
- NYHA class II-IV congestive heart failure
- Cardiac arrhythmia requiring medication
- Peripheral vascular disease ≥ grade II (e.g., ischemic rest pain, minor tissue
loss, ulceration, or gangrene) according to NCI CTC criteria
- No QTc prolongation (> 500 msec)
- No clinically significant peripheral artery disease (e.g., claudication within the
past 6 months)
- No pre-existing thyroid abnormality for which thyroid function is unable to be
maintained in the normal range with medication
- History of hypothyroidism allowed provided patient is currently euthyroid
- No other invasive malignancies within the past 5 years except nonmelanoma skin cancer
- No circumstance that does not permit completion of study therapy or required
follow-up
- No concurrent amifostine
- Prior biologics allowed, with the exception of anti-angiogenic agents that target
VEGF or PDGF
- No prior non-cytotoxic therapy (e.g., VEGF inhibitors, including bevacizumab) for
management of recurrent or persistent disease
- No prior sunitinib malate
- No prior cancer treatment that would contraindicate study therapy
- At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C)
or radiotherapy
- At least 3 weeks since any other prior therapy directed at the malignant tumor,
including immunologic agents or tamoxifen
- At least 28 days since prior surgery and recovered
- More than 7 days since prior placement of vascular access device or core biopsy
- At least 7 days since prior and no concurrent potent CYP3A4 inhibitors
- At least 12 days since prior and no concurrent potent CYP3A4 inducers
- No concurrent therapeutic doses of Coumadin-derivative anticoagulants (e.g.,
warfarin)
- Warfarin administered at doses of ≤ 2 mg daily allowed for prophylaxis of
thrombosis
- Low molecular weight heparin allowed provided PT/INR ≤ 1.5
- No concurrent major surgical procedure