Pegylated Liposomal Doxorubicin Hydrochloride and Bevacizumab in Treating Patients with Advanced Kaposi Sarcoma
Basic Trial Information
This pilot phase II trial studies pegylated liposomal doxorubicin hydrochloride and bevacizumab in treating patients with Kaposi sarcoma that has spread to other places in the body and usually cannot be cured or controlled with treatment. Drugs used in chemotherapy, such as pegylated liposomal doxorubicin hydrochloride, work in different ways to stop the growth of tumor cells, either by killing the cells, or stopping them from dividing, or by stopping them from spreading. Pegylated liposomal doxorubicin hydrochloride may also stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Bevacizumab may stop the growth of Kaposi sarcoma by blocking the growth of new blood vessels necessary for tumor growth. Giving pegylated liposomal doxorubicin hydrochloride with bevacizumab may be a better treatment for Kaposi sarcoma.
Further Study Information
I. Estimate the overall response rate of liposomal doxorubicin (pegylated liposomal doxorubicin hydrochloride) combined with bevacizumab after six 3-week cycles in patients with advanced Kaposi sarcoma (KS).
I. Assess the safety and toxicities of liposomal doxorubicin combined with bevacizumab in patients with advanced KS.
II. Estimate the complete response rate of liposomal doxorubicin combined with bevacizumab after six 3-week cycles in evaluable patients with advanced KS.
III. Estimate the median number of cycles of liposomal doxorubicin combined with bevacizumab followed by bevacizumab alone required to achieve a partial response in evaluable patients with advanced KS.
IV. Estimate 12-month progression-free survival in evaluable patients with advanced KS treated with liposomal doxorubicin combined with bevacizumab followed by 11 cycles of bevacizumab.
V. Evaluate the impact of liposomal doxorubicin combined with bevacizumab on cluster of differentiation (CD)4 counts.
VI. Evaluate the impact of liposomal doxorubicin combined with bevacizumab, followed by 11 cycles of bevacizumab maintenance, on peripheral blood mononuclear cell (PBMC) and saliva Kaposi's sarcoma-associated herpesvirus (KSHV) viral load.
VII. Explore the short-term effects of bevacizumab and intermediate and long term effects of the combination of bevacizumab and liposomal doxorubicin on blood flow to cutaneous KS lesions using non-invasive imaging techniques.
INDUCTION PHASE: Patients receive bevacizumab intravenously (IV) over 90 minutes on day 1 and over 60 minutes on day 8 of course 1, and over 30 minutes on day 1 of courses 2-6. Patients also receive pegylated liposomal doxorubicin hydrochloride IV over 30 minutes on day 8. Treatment repeats every 3 weeks for up to 6 courses in the absence of disease progression or unacceptable toxicity.
MAINTENANCE PHASE: Patients achieving stable disease, partial response or complete response after induction therapy receive bevacizumab IV over 30 minutes on day 1. Treatment repeats every 3 weeks for up to 11 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up at 4 weeks and then every 3 months for up to 2 years.
Kaposi’s sarcoma pathologically confirmed by Center for Cancer Research (CCR) pathology
Evaluable KS involving the skin and/or viscera, including at least one of the following:
KS of the skin with >= 5 KS lesions that are evaluable by non-invasive methods that have not been treated with local therapeutic modalities
Pulmonary KS evaluable by computed tomography (CT) scan
Gastrointestinal KS evaluable by direct visualization or fiberoptic instrumentation
Biopsy proven lymph node involvement measurable by CT scan
Eastern Cooperative Oncology Group (ECOG) performance status =< 2
Life expectancy > 6 months
At least one of the following indications for therapy:
Substantial lymph node involvement
Decreased range of joint motion due to KS
Multiple lesions not amenable to local therapy
Significant psychological impact leading to social withdrawal
Patients with human immunodeficiency virus (HIV) infection must be willing to comply with a regimen of highly active antiretroviral therapy (HAART)
Patients may have received any number of prior therapies, including monotherapy with liposomal doxorubicin or bevacizumab
Systolic blood pressure (SBP) < 150 mm/Hg
Diastolic blood pressure (DBP) < 90 mm/Hg
Patients receiving anti-hypertensive medicines must be on a stable regimen for at least 1 month
Ejection fraction (EF) > 50% by multi gated acquisition scan (MUGA)
Hemoglobin > 9 g/dl
White blood cell (WBC) > 1000/mm^3
Absolute neutrophil count (ANC) > 750/mm^3
Platelets > 75,000/mm^3
Prothrombin time (PT) and partial thromboplastin time (PTT) =< 120% of control, unless patient has the presence of a lupus anticoagulant
Bilirubin =< 1.5 X upper limit of normal (ULN) unless the patient is receiving protease inhibitor therapy (i.e. indinavir, ritonavir, nelfinavir, and atazanavir) known to be associated with increased bilirubin: in this case total bilirubin =< 7.5 mg/dl and the direct fraction is =< 0.7 mg/dl
Aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase (SGOT) =< 2.5 times the upper limit of normal
Either serum creatinine =< 1.5 mg/dL or measured creatinine clearance >= 60 mL/min
Either urine protein < 1+ or measured 24 hour urine protein < 500 milligram
Able to take aspirin 81 mg daily
Study participant must use birth control measure prior to study entry (during screening), during study participation, and for 12 weeks after bevacizumab is discontinued
Inclusion of women and minorities: both men and women and members of all races and ethnic groups are eligible for this trial
Inability to provide informed consent
KS therapy other than HAART within 3 weeks
History of cumulative doxorubicin or liposomal doxorubicin dose > 430 mg/m^2
Supraphysiologic doses of corticosteroids within 3 weeks
Major surgical procedure (including periodontal) within 4 weeks
Surgical or other non-healing wounds, other than KS ulcers
Has an uncontrolled illness including, but not limited to, ongoing or active infection requiring IV antibiotics, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, cirrhosis, or psychiatric illness/social situations that would limit adherence to study requirements
Past or present history of malignant tumors other than KS unless: a) in a complete remission for >= 1 year from the time a response was first documented; b) completely resected basal cell carcinoma; or c) in situ squamous cell carcinoma of the cervix or anus
Severe or life-threatening infection within 2 weeks of entry onto the study
History of deep venous or arterial thrombotic disease (including but not limited to, acute myocardial infarction due to coronary thrombosis, ischemic stroke, and peripheral arterial disease), unless:
Line-related thrombosis without embolus
Occurring >= 1 year prior to screening
Known procoagulant disorder including prothrombin gene mutation 20210, antithrombin III deficiency, protein C deficiency, protein S deficiency and antiphospholipid syndrome but not including heterozygosity for the Factor V Leiden mutation or the presence of a lupus anticoagulant in the absence of other criteria for the antiphospholipid syndrome
Known bleeding diathesis
History of severe gastrointestinal bleeding within 6 months; patients with gastrointestinal blood loss due to KS may be included
Hemoptysis within 4 weeks
Substantial central nervous system (CNS) disease including
History of CNS bleeding
Mass lesions in the brain
Uncontrolled seizure disorder
Recent history of cerebrovascular accident (CVA) (e.g. within the past 6 months)
Proteinuria > 500 mg/24hrs
Patients with any other abnormality that would be scored as a grade 3 or greater toxicity, except:
Direct manifestations of KS
Direct manifestation of HIV
Direct manifestation of HIV therapy (i.e. hyperbilirubinemia associated with protease inhibitors)
Previous bevacizumab within 6 weeks prior to enrollment
Known hypersensitivity to bevacizumab, Chinese hamster ovary cell products, or other recombinant human or humanized antibodies
Any condition, including the presence of laboratory abnormalities, which in the opinion of the principal investigator or lead associate investigator places the subject at unacceptable risk if they were to participate in the study or confounds the ability to interpret data from the study
Trial Contact Information
Trial Lead Organizations / Sponsors / Collaborators
NCI - Center for Cancer Research
Robert Yarchoan, Principal Investigator
National Institutes of Health Clinical Center
Link to the current ClinicalTrials.gov record.
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