Octreotide Acetate and Recombinant Interferon Alfa-2b or Bevacizumab in Treating Patients With Metastatic or Locally Advanced, High-Risk Neuroendocrine Tumor
Basic Trial Information
|Phase III||Treatment||Closed||Not specified||NCI||NCI-2009-00778|
CDR0000579151, SWOG-S0518, S0518, U10CA032102, NCT00569127
This randomized phase III trial is studying giving octreotide acetate together with recombinant interferon alfa-2b to see how well it works compared with giving octreotide acetate together with bevacizumab in treating patients with metastatic or locally advanced, high-risk neuroendocrine tumor. Octreotide acetate and recombinant interferon alfa-2b may interfere with the growth of tumor cells and slow the growth of cancer. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. It is not yet known whether giving octreotide acetate together with recombinant interferon alfa-2b is more effective than giving octreotide acetate together with bevacizumab in treating patients with neuroendocrine tumor.
Further Study Information
I. To compare central review-based progression-free survival in poor prognosis carcinoid patients treated with either depot octreotide (octreotide acetate) plus bevacizumab, or depot octreotide plus interferon (recombinant interferon alfa-2b).
II. To compare overall survival, time to treatment failure and traditionally reported progression-free survival in poor prognosis carcinoid patients treated with either depot octreotide plus bevacizumab, or depot octreotide plus interferon.
III. To compare objective response (confirmed and unconfirmed CR and PR) in poor prognosis carcinoid patients treated with either depot octreotide plus bevacizumab, or depot octreotide plus interferon.
IV. To compare the toxicity profile of patients treated with these two regimens.
V. To assess the prognostic and predictive value of VEGF expression in relation to progression-free survival and treatment effect.
VI. To compare response of 5HIAA, chromogranin A and neuronspecific enolase among patients with elevated levels at baseline between patients treated with octreotide plus interferon versus octreotide plus bevacizumab.
VII. To assess and compare the prognostic and predictive value of the combination of In-111 pentetreotide somatostatin-receptor scintigraphy (SRS) and CT vs. CT in relation to progression-free survival (PFS).
VIII. To assess and compare the prognostic and predictive value of the combination of SRS and CT vs. CT in relation to overall survival (OS) and time to treatment failure (TTF).
OUTLINE: This is a multicenter study. Patients are stratified according to site of disease (small bowel vs cecum vs appendix vs other site), disease progression after initial diagnosis (yes or no), histologic grade (low vs intermediate [atypical]), and prior octreotide acetate therapy within the past 2 months (yes vs no). Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive depot octreotide acetate intramuscularly (IM) and bevacizumab intravenously (IV) over 30-90 minutes on day 1.
ARM II: Patients receive octreotide acetate IM as in arm I on day 1 and recombinant interferon alfa-2b subcutaneously (SC) on days 1, 3, 5, 8, 10, 12, 15, 17, and 19.
Treatment in both arms repeats every 21 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed every 2-6 months for up to 3 years.
- Diagnosis of unresectable metastatic or locally advanced, low- or intermediate-grade neuroendocrine carcinoma, including the following subtypes:
- Carcinoid tumor, low-grade or well differentiated neuroendocrine carcinoma
- Atypical carcinoid tumor, intermediate-grade or moderately differentiated neuroendocrine carcinoma
- High-risk disease as defined by at least one of the following:
- Progressive disease
- Refractory carcinoid syndrome while receiving octreotide acetate (i.e., defined by > 2 flushing episodes/day or > 4 bowel movements/day)
- Atypical histology and more than 6 lesions
- Metastatic colorectal carcinoid tumor
- Patients with metastatic cecal or appendiceal carcinoid tumor are not eligible unless they fit other mentioned high-risk features
- Metastatic gastric carcinoid tumor
- Measurable disease
- Patients with poorly differentiated neuroendocrine carcinoma, high-grade neuroendocrine carcinoma, adenocarcinoid tumor, or goblet cell carcinoid tumor are not eligible
- Osseous metastasis as only site of disease
- Medullary thyroid carcinoma or islet cell carcinoma
- History of primary brain tumor or metastatic cancer to the brain
- Zubrod performance status 0-2
- Platelet count > 100,000/mm³
- ANC > 1,500/mm³
- Hemoglobin > 8 g/dL
- Serum bilirubin < 1.5 times upper limit of normal (ULN)
- SGOT and SGPT ≤ 2.5 times ULN
- Serum creatinine < 1.5 mg/dL
- 24-hour urine protein < 1,000 mg if urine protein:creatinine ratio > 0.5
- PT and PTT ≤ 1.1 times ULN
- History of hypertension must be well controlled (i.e., blood pressure < 150/90 mm Hg) on a stable regimen of antihypertensive therapy
- Not pregnant or nursing
- Fertile patients must use effective barrier method contraception during and for 6 months after completion of study treatment
- History or evidence of clinically significant peripheral vascular disease (e.g., non-healing peripheral ulcers or claudication)
- Abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 28 days
- Bleeding diathesis or coagulopathy that results in spontaneous bleeding (in the absence of trauma) requiring red blood cell transfusion within the past 5 years
- Serious (i.e., requiring active medical therapy with medication or medical device under the supervision of a physician) non-healing wound, ulcer, or bone fracture
- Recent history (i.e., within the past 6 months) of any of the following arterial thromboembolic events:
- Transient ischemic attack
- Cerebrovascular accident
- Unstable angina
- Myocardial infarction
- New York Heart Association class II or higher congestive heart failure
- Hemoglobinopathies (e.g., Thalassemia) or any other cause of hemolytic anemia
- Pregnant or nursing
- Any other prior malignancy within the past 5 years except for adequately treated basal cell or squamous cell skin cancer, or other adequately treated in situ cancer
- Any immunologically mediated disease, including any of the following:
- Inflammatory bowel disease (Crohn disease, ulcerative colitis)
- Rheumatoid arthritis
- Idiopathic thrombocytopenia purpura
- Systemic lupus erythematosus
- Autoimmune hemolytic anemia
- Severe psoriasis
- Any serious intercurrent infections or nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by the complications of this treatment
- Psychiatric disorders rendering patient incapable of complying with the requirements of the protocol
- Recovered from all prior therapy
- At least 28 days since and no more than 1 prior regimen of cytotoxic chemotherapy
- At least 28 days since prior hepatic artery embolization provided there is residual measurable disease
- Chemoembolization is considered as 1 prior chemotherapy regimen
- No prior interferon, bevacizumab, or any other therapy targeting VEGF or VEGF receptors (e.g., SU11248, PTK/ZK, sorafenib tosylate, or pazopanib hydrochloride)
- Prior therapy targeting c-kit, abl, PDGFR, mTOR, and somatostatin receptors allowed
- At least 28 days since prior radiotherapy
- Target lesions must have shown disease progression if therapy included peptide receptor radiotherapy
- At least 1 week since prior minor surgery
- At least 4 weeks since prior major surgery
- At least 21 days since prior octreotide acetate therapy
- Concurrent full-dose anticoagulation (warfarin or low molecular weight heparin) allowed provided the following criteria are met:
- In-range INR (e.g., between 2 and 3) on a stable dose of oral anticoagulant or on a stable dose of low molecular weight heparin
- No active bleeding or pathological condition that carries a high risk of bleeding (e.g., varices)
- No concurrent interferon to control carcinoid syndrome for patients receiving bevacizumab
- Other supportive care medication (e.g., short acting octreotide acetate) allowed
- No other concurrent chemotherapy, immunotherapy, radiotherapy, hepatic artery embolization, hepatic artery chemoembolization, radiofrequency ablation, or other tumor ablative procedure
- No other investigational or commercial agents
Trial Contact Information
Trial Lead Organizations/Sponsors
National Cancer Institute
Kaiser Permanente Medical Center - Los Angeles
Han A Koh
Kaiser Permanente - Mission
Han A Koh
Holden Comprehensive Cancer Center at University of Iowa
Thorvardur R Halfdanarson
Methodist Estabrook Cancer Center
Robert M. Langdon
McLeod Regional Medical Center
Link to the current ClinicalTrials.gov record.
NLM Identifier NCT00569127
ClinicalTrials.gov processed this data on January 06, 2015
Note: Information about this trial is from the ClinicalTrials.gov database. The versions designated for health professionals and patients contain the same text. Minor changes may be made to the ClinicalTrials.gov record to standardize the names of study sponsors, sites, and contacts. Cancer.gov only lists sites that are recruiting patients for active trials, whereas ClinicalTrials.gov lists all sites for all trials. Questions and comments regarding the presented information should be directed to ClinicalTrials.gov.