A Pilot Study of Weekly EZN-2208 (PEGylated SN-38) in Combination With Bevacizumab in Refractory Solid Tumors
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed solid tumors
- Metastatic or unresectable disease for which standard therapies do not exist or
are no longer effective
- No known CNS disease
- Treated brain metastasis not requiring steroids and with no evidence of
progression or hemorrhage after treatment for ≥ 3 months, as ascertained by
clinical examination and brain imaging (MRI or CT scan), allowed
- Treatment for brain metastases may include whole-brain radiotherapy (WBRT),
radiosurgery (RS; Gamma Knife, LINAC, or equivalent), or a combination as
deemed appropriate by the treating physician
PATIENT CHARACTERISTICS:
- ECOG performance status 0-2 (Karnofsky 60-100%)
- Life expectancy > 3 months
- WBC ≥ 3,000/mm³
- ANC ≥ 1,500/mm³
- Platelet count ≥ 100,000/mm³
- Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
- AST and ALT ≤ 2.5 times ULN
- Creatinine ≤ 1.5 times ULN OR creatinine clearance ≥ 60 mL/min
- Urine protein: proteinuria 2+ OR < 1,000 mg on 24-hour urine collection
- Fertile patients must use effective contraception (hormonal, barrier method of birth
control, or abstinence) prior to, during, and for 3 months after completion of study
- Not pregnant or nursing
- No history of allergic reactions attributed to compounds of similar chemical or
biologic composition to polyethyleneglycol-7-ethyl-10-hydroxycamptothecin (EZN-2208)
or bevacizumab
- No uncontrolled intercurrent illness including, but not limited to, any of the
following:
- Clinically significant cardiovascular disease
- Inadequately controlled hypertension (systolic BP > 160 mm Hg and/or
diastolic BP > 90 mm Hg despite antihypertensive medication)
- History of stroke and/or cerebrovascular accident within the past 6 months
- Myocardial infarction or unstable angina within the past 6 months
- NYHA grade II-IV congestive heart failure
- Serious and inadequately controlled cardiac arrhythmia
- Significant vascular disease (e.g., aortic aneurysm, history of aortic
dissection)
- Clinically significant peripheral vascular disease
- Psychiatric illness/social situations that would limit compliance with study
requirements
- No serious or non-healing wound, ulcer, or bone fracture
- No history of abdominal fistula, gastrointestinal perforation, or intra-abdominal
abscess within the past 6 months
- No significant vascular disease (e.g., aortic aneurysm, requiring surgical repair or
recent peripheral arterial thrombosis) within the past 6 months
- No evidence of bleeding diathesis or coagulopathy
- No known hypersensitivity to Chinese hamster ovary cell products or other recombinant
human antibodies
PRIOR CONCURRENT THERAPY:
- More than 4 weeks since prior chemotherapy or radiotherapy (6 weeks for nitrosoureas
or mitomycin C) and recovered
- There are no restrictions on prior therapy
- At least 2 weeks since receiving study drug as a participant in a phase 0 study
(or early phase I)
- No major surgical procedure, open biopsy, or significant traumatic injury within the
past 28 days, and no anticipation of need for major surgical procedures during the
course of the study
- No other concurrent investigational agents
- No other concurrent chemotherapy
- No concurrent combination antiretroviral therapy for HIV-positive patients
- No concurrent enzyme-inducing anti-epileptic drugs (EIAED)
- Patients on non-EIAED allowed at the discretion of principal investigator
- No concurrent anticoagulation therapy