Pilot Study of Weekly EZN-2208 (Pegylated SN-38) in Combination With Bevacizumab in Refractory Solid Tumors
Background
One reason postulated for the limited efficacy of anti-angiogenic or anti-VEGF agents such
as bevacizumab is that they cause intra-tumoral hypoxia, resulting in the induction and
up-regulation of hypoxia-inducible factors (HIF) such as HIF-1Alpha. These in turn play a
central role in tumor progression by acting as master regulators of how cancer cells adapt
to hypoxic conditions. HIF-1Alpha therefore represents an attractive target in oncology.
Camptothecin analogues (including SN-38, topotecan, and irinotecan) have been shown to
consistently reduce the translation, expression, and transcriptional activity of HIF-1Alpha
in vitro and in vivo, and therefore have the potential to inhibit the HIF-1? induction that
occurs with anti-angiogenic agents.
The central rationale of this study is that HIF-1alpha induction by bevacizumab will be
offset by weekly administration of EZN-2208 (PEGylated SN-38), and that this will result in
synergistic anti-tumor effects.
Objectives
Determine the modulation of HIF-1alpha protein (by ELISA) in solid tumors after treatment
with EZN-2208 and bevacizumab.
Determine the safety and tolerability of the combination of EZN-2208 and bevacizumab with
EZN-2208 administered weekly times 3 (Days 1, 8, and 15) and bevacizumab administered every
2 weeks in 28-day cycles.
Perform correlative studies to assess changes in angiogenesis in tumor tissue.
Evaluate antitumor responses as determined by RECIST.
Eligibility
Adults with histologically documented solid tumors, whose disease has progressed following
standard therapy or who have no acceptable standard treatment.
Performance status ECOG 0-2; adequate organ function; life expectancy at least 3 months; no
major surgery, radiation or chemotherapy within 4 weeks prior to study enrollment; recovered
from toxicities of prior therapies to at least eligibility levels.
Willingness to undergo tumor biopsies for research purposes.
Study Design
This is a single-arm pilot study.
Patients will receive EZN-2208 IV on Day 1, 8, and 15 of a 28-day cycle at a dose of 9
mg/m(2); bevacizumab will be administered IV every 2 weeks at a dose of 5 mg/kg.
For cycle 1: Bevacizumab will be administered on Day -7 (i.e., 1 week prior to EZN-2208) and
Day 15.
For subsequent cycles: Bevacizumab will be administered on Day 1 and 15.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Determine the modulation of HIF-1Alpha protein (by ELISA) in solid tumors after treatment with EZN-2208 and bevacizumab.
Shivaani Kummar, M.D.
Principal Investigator
National Cancer Institute (NCI)
United States: Federal Government
110042
NCT01251926
November 2010
Name | Location |
---|---|
National Institutes of Health Clinical Center, 9000 Rockville Pike | Bethesda, Maryland 20892 |