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Nintedanib in Treating Patients With Recurrent or Persistent Endometrial Cancer

Phase 2
Completed
Conditions
Endometrial Undifferentiated Carcinoma
Endometrial Adenocarcinoma
Endometrial Clear Cell Adenocarcinoma
Endometrial Serous Adenocarcinoma
Endometrial Transitional Cell Carcinoma
Endometrial Squamous Cell Carcinoma
Malignant Uterine Corpus Mixed Epithelial and Mesenchymal Neoplasm
Endometrial Mucinous Adenocarcinoma
Recurrent Uterine Corpus Carcinoma
Interventions
Registration Number
NCT01225887
Lead Sponsor
Gynecologic Oncology Group
Brief Summary

This phase II trial studies the side effects and how well nintedanib works in treating patients with endometrial cancer that has come back. Nintedanib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth or by blocking blood flow to the tumor.

Detailed Description

PRIMARY OBJECTIVES:

I. To estimate the proportion of patients with persistent or recurrent endometrial cancer, who survive progression-free without going on a subsequent therapy against the disease for at least 6 months and the proportion of patients who have objective tumor response (complete or partial), treated with BIBF 1120 (nintedanib).

II. To determine the nature and degree of toxicity of BIBF 1120 in this cohort of patients.

SECONDARY OBJECTIVES:

I. To estimate the progression-free survival (PFS) and overall survival (OS) of patients with persistent or recurrent endometrial cancer treated with BIBF 1120.

OUTLINE:

Patients receive nintedanib orally (PO) twice daily (BID) on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

Recruitment & Eligibility

Status
COMPLETED
Sex
Female
Target Recruitment
37
Inclusion Criteria
  • Patients must have recurrent or persistent endometrial carcinoma, which is refractory to curative therapy or established treatments; histologic confirmation of the original primary tumor is required; patients with the following histologic epithelial cell types are eligible: endometrioid adenocarcinoma, serous adenocarcinoma, undifferentiated carcinoma, clear cell adenocarcinoma, mixed epithelial carcinoma, adenocarcinoma not otherwise specified (N.O.S.), mucinous adenocarcinoma, squamous cell carcinoma, and transitional cell carcinoma
  • All patients must have measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1; measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded); each lesion must be >= 10 mm when measured by computed tomography (CT), magnetic resonance imaging (MRI) or caliper measurement 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 or MRI
  • Patient must have at least one "target lesion" to be used to assess response on this protocol as defined by RECIST 1.1; 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 at least 90 days following completion of radiation therapy
  • Patients must not be eligible for a higher priority Gynecologic Oncology Group (GOG) protocol, if one exists; in general, this would refer to any active GOG Phase III protocol or Rare Tumor protocol for the same patient population
  • Patients must have a GOG performance status of 0, 1, or 2
  • Patients must have normal thyroid function; patients with a history of hypothyroidism are eligible, provided it is well controlled on medication
  • Recovery from effects of recent surgery, radiotherapy, or chemotherapy
  • Patients should be free of active infection requiring antibiotics (with the exception of uncomplicated urinary tract infection)
  • Any hormonal therapy directed at the malignant tumor must be discontinued at least one week prior to registration
  • Any other prior therapy directed at the malignant tumor, including chemotherapy and immunologic agents, must be discontinued at least three weeks prior to registration
  • Any prior radiation therapy must be completed at least 4 weeks prior to registration
  • Patients must have had one prior chemotherapeutic regimen for management of endometrial carcinoma; chemotherapy administered in conjunction with primary radiation as a radio-sensitizer will be counted as a systemic chemotherapy regimen
  • Patients are allowed to receive, but are not required to receive, one additional cytotoxic regimen for management of recurrent or persistent disease
  • Patients must have NOT received any non-cytotoxic (biologic or targeted) agents, as part of their primary treatment or for management of recurrent or persistent disease; non-cytotoxic (biologic or targeted) agents include (but are not limited to) monoclonal antibodies, cytokines, and small-molecule inhibitors of signal transduction; prior hormonal therapy is allowed; there is no limit on the number of prior hormonal therapies allowed
  • Absolute neutrophil count (ANC) greater than or equal to 1,500/mcl
  • Platelets greater than or equal to 100,000/mcl
  • Creatinine less than or equal to 1.5 x institutional upper limit normal (ULN)
  • Urine protein creatinine (UPC) ratio must be < 1.0 gm; if UPC ratio >= 1, collection of 24-hour urine measurement of urine protein is recommended
  • Bilirubin must be less than 1.5 X ULN
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) must be less than 3 X ULN
  • Alkaline phosphatase must be less than 2.5 X ULN
  • Prothrombin time (PT) such that international normalized ratio (INR) is =< 1.5 x ULN (or an in-range INR, usually between 2 and 3, if a patient is on a stable dose of therapeutic warfarin) and a partial thromboplastin time (PTT) =< 1.5 times the institutional upper limit of normal
  • Electrocardiogram (EKG) must have corrected QT interval (QTc) < 450 msec without evidence of serious ventricular arrhythmia (ventricular tachycardia lasting more than 3 beats or ventricular fibrillation)
  • Patients must have signed an approved informed consent and authorization permitting release of personal health information
  • Patients must meet pre-entry requirements
  • Patients of childbearing potential must have a negative serum pregnancy test prior to the study entry; women of child-bearing potential must agree to use adequate contraception (two barrier methods of birth control) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she is to inform her treating physician immediately; all patients must be willing to take contraception up to three months after the final dose of BIBF 1120
Exclusion Criteria
  • Patients who have had prior therapy with BIBF 1120
  • Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancer and other specific malignancies, are excluded if there is any evidence of other malignancy being present within the last three years; patients are also excluded if their previous cancer treatment contraindicates this protocol therapy
  • Patients who have received prior radiotherapy to any portion of the abdominal cavity or pelvis OTHER THAN for the treatment of endometrial cancer within the last three years are excluded; prior radiation for localized cancer of the breast, head and neck, or skin is permitted, provided that it was completed more than three years prior to registration, and the patient remains free of recurrent or metastatic disease
  • Patients who have received prior chemotherapy for any abdominal or pelvic tumor OTHER THAN for the treatment of endometrial cancer within the last three years are excluded; patients may have received prior adjuvant chemotherapy for localized breast cancer, provided that it was completed more than three years prior to registration, and that the patient remains free of recurrent or metastatic disease
  • Patients with serious, non-healing wound, ulcer, or bone fracture; this includes history of abdominal fistula, gastrointestinal perforation or intra-abdominal abscess within 28 days prior to the start date of treatment; patients with underlying lesions that caused the fistula or perforation in the past that have not been corrected
  • Patients with active bleeding or pathologic conditions that carry high risk of bleeding, such as known bleeding disorder, coagulopathy, or tumor involving major vessels
  • Patients with history of brain metastases, or evidence upon physical examination of active central nervous system (CNS) disease, including primary brain tumor, seizures not controlled with standard medical therapy or any brain metastases
  • Uncontrolled hypertension, defined as systolic >= 150 mm Hg or diastolic >= 90 mm Hg
  • Myocardial infarction or unstable angina within 6 months of study treatment
  • New York Heart Association (NYHA) class II or greater congestive heart failure
  • Women with an ejection fraction < institutional lower limit of normal (LLN)
  • History of serious ventricular arrhythmia (i.e., ventricular tachycardia or ventricular fibrillation) or cardiac arrhythmias requiring anti-arrhythmic medications (except for atrial fibrillation that is well controlled with anti-arrhythmic medication)
  • Common Terminology Criteria for Adverse Events (CTCAE) grade 2 or greater peripheral vascular disease
  • History of cerebrovascular accident (CVA, stroke), transient ischemic attack (TIA) or subarachnoid hemorrhage within six months of study treatment
  • Patients undergoing invasive procedures as defined below: major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to the first date of treatment; major surgical procedure anticipated during the course of the study; minor surgical procedures, fine needle aspirates, or core biopsies within 7 days prior to the first date of therapy
  • Patients who are pregnant or nursing
  • Patients with a history of major thromboembolic event defined as: symptomatic pulmonary embolism (PE), recurrent asymptomatic PE, or recurrent deep venous thrombosis
  • Prior thrombosis or thromboembolic event due to a known inherited coagulopathy (i.e., antithrombin-III deficiency, protein C or protein S deficiency, factor V Leiden mutation presence, prothrombin G20210A mutation)
  • Serious infections requiring systemic antibiotics or antiviral therapy including: known active hepatitis B or C infection; known human immunodeficiency virus (HIV) infection
  • Gastrointestinal (GI) or other medical disorders that would impact ingestion or absorption of the drug
  • Patients with a history of photosensitivity or who must take agents which increase photosensitivity, e.g. topical retinoids and doxycycline
  • Patients who are unable to swallow capsules

Study & Design

Study Type
INTERVENTIONAL
Study Design
SINGLE_GROUP
Arm && Interventions
GroupInterventionDescription
Treatment (nintedanib)NintedanibPatients receive nintedanib PO BID on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Primary Outcome Measures
NameTimeMethod
Number of Participants With Adverse EventsUp to 5 years

The incidence of adverse events (grade 3 or higher) as assessed by the National Cancer Institute CTCAE version 4.0

Objective Tumor ResponseFor disease that can be evaluated by physical exam,response was assessed prior to each cycle CT scan or MRI if used to follow lesion for measurable disease every other cycle up to 5 years.

Complete and Partial Tumor Response by RECIST 1.1

Progression-free Survival > 6 Monthsfor disease that can be evaluated by physical exam, progression was assessed prior to each cycle. CT scan or MRI if used to follow lesion for measurable disease every other cycle up to 5 years.

Whether or not the patient survived progression-free for at least 6 months.

Secondary Outcome Measures
NameTimeMethod
Progression Free SurvivalThe duration of time from study entry to time of progression or death, whichever occurs first, assessed up to 5 years

the period of progression free survival for patients with persistent or recurrent endometrial cancer treated with study drug.

Overall SurvivalFrom study entry to death or last contact, up to 5 years

The observed length of life from entry into the study to death or the date of last contact.

Trial Locations

Locations (59)

MedStar Franklin Square Medical Center/Weinberg Cancer Institute

🇺🇸

Baltimore, Maryland, United States

Riverside Methodist Hospital

🇺🇸

Columbus, Ohio, United States

Bay Area Medical Center

🇺🇸

Marinette, Wisconsin, United States

Cleveland Clinic Cancer Center/Fairview Hospital

🇺🇸

Cleveland, Ohio, United States

Cleveland Clinic Foundation

🇺🇸

Cleveland, Ohio, United States

Pacific Gynecology Specialists

🇺🇸

Seattle, Washington, United States

Fred Hutchinson Cancer Research Center

🇺🇸

Seattle, Washington, United States

Swedish Medical Center-First Hill

🇺🇸

Seattle, Washington, United States

Northwest Hospital

🇺🇸

Seattle, Washington, United States

University of Washington Medical Center

🇺🇸

Seattle, Washington, United States

Greater Baltimore Medical Center

🇺🇸

Baltimore, Maryland, United States

Women and Infants Hospital

🇺🇸

Providence, Rhode Island, United States

Seattle Cancer Care Alliance

🇺🇸

Seattle, Washington, United States

Saint Vincent Hospital

🇺🇸

Green Bay, Wisconsin, United States

University of Wisconsin Hospital and Clinics

🇺🇸

Madison, Wisconsin, United States

Holy Family Memorial Hospital

🇺🇸

Manitowoc, Wisconsin, United States

Providence Saint Joseph Medical Center/Disney Family Cancer Center

🇺🇸

Burbank, California, United States

Northwestern University

🇺🇸

Chicago, Illinois, United States

Memorial University Medical Center

🇺🇸

Savannah, Georgia, United States

NorthShore University HealthSystem-Evanston Hospital

🇺🇸

Evanston, Illinois, United States

Indiana University/Melvin and Bren Simon Cancer Center

🇺🇸

Indianapolis, Indiana, United States

Saint Vincent Oncology Center

🇺🇸

Indianapolis, Indiana, United States

Sudarshan K Sharma MD Limted-Gynecologic Oncology

🇺🇸

Hinsdale, Illinois, United States

University of Iowa/Holden Comprehensive Cancer Center

🇺🇸

Iowa City, Iowa, United States

Washington University School of Medicine

🇺🇸

Saint Louis, Missouri, United States

Mercy Hospital Springfield

🇺🇸

Springfield, Missouri, United States

CoxHealth South Hospital

🇺🇸

Springfield, Missouri, United States

Case Western Reserve University

🇺🇸

Cleveland, Ohio, United States

MetroHealth Medical Center

🇺🇸

Cleveland, Ohio, United States

Stony Brook University Medical Center

🇺🇸

Stony Brook, New York, United States

Carolinas Medical Center/Levine Cancer Institute

🇺🇸

Charlotte, North Carolina, United States

Akron General Medical Center

🇺🇸

Akron, Ohio, United States

Carolinas HealthCare System NorthEast

🇺🇸

Concord, North Carolina, United States

Abington Memorial Hospital

🇺🇸

Abington, Pennsylvania, United States

Thomas Jefferson University Hospital

🇺🇸

Philadelphia, Pennsylvania, United States

Oklahoma Cancer Specialists and Research Institute-Tulsa

🇺🇸

Tulsa, Oklahoma, United States

Lake University Ireland Cancer Center

🇺🇸

Mentor, Ohio, United States

Hillcrest Hospital Cancer Center

🇺🇸

Mayfield Heights, Ohio, United States

UT Southwestern/Simmons Cancer Center-Dallas

🇺🇸

Dallas, Texas, United States

Lankenau Medical Center

🇺🇸

Wynnewood, Pennsylvania, United States

University of Mississippi Medical Center

🇺🇸

Jackson, Mississippi, United States

University of Oklahoma Health Sciences Center

🇺🇸

Oklahoma City, Oklahoma, United States

Green Bay Oncology Limited at Saint Mary's Hospital

🇺🇸

Green Bay, Wisconsin, United States

Borgess Medical Center

🇺🇸

Kalamazoo, Michigan, United States

Allegiance Health

🇺🇸

Jackson, Michigan, United States

Green Bay Oncology at Saint Vincent Hospital

🇺🇸

Green Bay, Wisconsin, United States

Hurley Medical Center

🇺🇸

Flint, Michigan, United States

West Michigan Cancer Center

🇺🇸

Kalamazoo, Michigan, United States

Saint Mary Mercy Hospital

🇺🇸

Livonia, Michigan, United States

Women's Cancer Center of Nevada

🇺🇸

Las Vegas, Nevada, United States

Saint Alphonsus Cancer Care Center-Boise

🇺🇸

Boise, Idaho, United States

Bronson Methodist Hospital

🇺🇸

Kalamazoo, Michigan, United States

Saint Joseph Mercy Port Huron

🇺🇸

Port Huron, Michigan, United States

Smilow Cancer Hospital Care Center at Saint Francis

🇺🇸

Hartford, Connecticut, United States

Genesys Regional Medical Center

🇺🇸

Grand Blanc, Michigan, United States

University of Colorado Cancer Center - Anschutz Cancer Pavilion

🇺🇸

Aurora, Colorado, United States

Saint Joseph Mercy Hospital

🇺🇸

Ann Arbor, Michigan, United States

Michigan Cancer Research Consortium NCORP

🇺🇸

Ann Arbor, Michigan, United States

Nebraska Methodist Hospital

🇺🇸

Omaha, Nebraska, United States

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