Kidney Cancer Clinical Trial

Sorafenib Tosylate in Treating Younger Patients With Relapsed or Refractory Rhabdomyosarcoma, Wilms Tumor, Liver Cancer, or Thyroid Cancer

Summary

This phase II trial studies how well sorafenib tosylate works in treating younger patients with relapsed or refractory rhabdomyosarcoma, Wilms tumor, liver cancer, or thyroid cancer. Sorafenib tosylate may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.

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Full Description

PRIMARY OBJECTIVES:

I. To determine the objective response rate to sorafenib tosylate (sorafenib) in children with relapsed or refractory rhabdomyosarcoma, Wilms tumor, hepatocellular carcinoma (HCC), or papillary thyroid carcinoma (PTC).

SECONDARY OBJECTIVES:

I. To further define and describe the toxicities of sorafenib administered on an oral, twice-daily continuous schedule.

II. To further characterize the pharmacokinetics of sorafenib in children with refractory cancer.

III. To estimate the progression-free survival on sorafenib for rhabdomyosarcoma, Wilms tumor, and hepatocellular carcinoma and compare to a group of patients enrolled on selected closed Phase II studies of Children Oncology Group (COG).

IV. To assess the biologic activity of sorafenib on vascular endothelial growth factor (VEGF) and soluble vascular endothelial growth factor receptor-2 (VEGFR-2) in peripheral blood samples. (Exploratory) V. To evaluate the presence of BRAF mutations and RET/PTC rearrangements in patients with PTC. (Exploratory)

OUTLINE: This is a multicenter study. Patients are stratified according to diagnosis (rhabdomyosarcoma vs Wilms tumor vs hepatocellular carcinoma vs papillary thyroid carcinoma).

Patients receive sorafenib tosylate orally (PO) twice daily (BID) on days 1-28. Treatment repeats every 28 days for up to 24 courses in the absence of disease progression or unacceptable toxicity.

Patients undergo blood sample collection at baseline and periodically during study for pharmacokinetic studies, and VEGF and VEGFR-2 analysis by ELISA. Previously collected formalin-fixed paraffin-embedded tissue samples, from patients with papillary thyroid carcinoma, are also analyzed for BRAF mutation and RET/PTC rearrangements by PCR.

After completion of study treatment, patients are followed up for up to 5 years.

View Eligibility Criteria

Eligibility Criteria

Inclusion Criteria:

Patients must have had histologic verification of one of the malignancies listed below at original diagnosis or at relapse:

Rhabdomyosarcoma (RMS)
Wilms tumor
Hepatocellular carcinoma (HCC)
Papillary thyroid carcinoma (PTC)

Patients must have relapsed or refractory disease (RMS, Wilms tumor, HCC, PTC)

Patients must have radiographically measurable disease; measurable disease is defined as the presence of at least one lesion on magnetic resonance imaging (MRI) or computed tomography (CT) scan that can be accurately measured with the longest diameter a minimum of 10 mm in at least one dimension (CT scan slice thickness no greater than 5 mm)

The following do not qualify as measurable disease:

Malignant fluid collections (e.g., ascites, pleural effusions)
Bone marrow infiltration
Lesions only detected by nuclear medicine studies (e.g., bone, gallium, or positron emission tomography [PET] scans)
Elevated tumor markers in plasma or cerebrospinal fluid(CSF)
Previously radiated lesions that have not demonstrated clear progression post radiation
Leptomeningeal lesions that do not meet the requirements noted above
Patients with HCC must be relapsed or refractory to conventional chemotherapy
Patients with PTC must be refractory to radioactive iodine (RAI)
Patient's current disease state must be one for which there is no known curative therapy or therapy proven to prolong survival with an acceptable quality of life
Patients with known metastasis to the brain will be excluded from trial participation unless treated surgically or with radiotherapy and stable with no recurrent lesions for at least 3 months
Rhabdomyosarcoma and Wilms strata: patients must be ≥ 24 months and ≤ 30 years of age at study enrollment
Hepatocellular carcinoma (HCC): patients must be ≥ 24 months and < 18 years of age at study enrollment
Papillary thyroid carcinoma (PTC): patients must be ≥ 24 months and ≤ 21 years of age at study enrollment

Patients must have a Lansky or Karnofsky performance status score of ≥ 50%, corresponding to ECOG categories 0, 1, or 2

Use Karnofsky for patients > 16 years of age and Lansky for patients ≤ 16 years of age
Patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score
Peripheral absolute neutrophil count (ANC) ≥ 1,000/μL
Platelet count ≥ 75,000/μL (transfusion independent, defined as not receiving platelet transfusions within a 7-day period prior to enrollment)
Hemoglobin 8.0 g/dL (may receive red blood cell[RBC] transfusions)

Creatinine clearance or radioisotope glomerular filtration rate(GFR) 70 mL/min OR a serum creatinine based on age/gender as follows:

0.8 mg/dL (2 to < 6 years of age)
1.0 mg/dL (6 to < 10 years of age)
1.2 mg/dL (10 to < 13 years of age)
1.5 mg/dL (male) or 1.4 mg/dL (female) (13 to < 16 years of age)
1.7 mg/dL (male) or 1.4 mg/dL (female) (≥ 16 years of age)
Total bilirubin ≤ 1.5 times upper limit of normal (ULN) for age
SGPT (ALT) ≤ 135 U/L (for the purpose of this study, the ULN for SGPT is 45 U/L)
PT, PTT, and INR < 1.5 times ULN
Normal serum lipase and amylase (per institutional normal values)
No evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry > 94% if there is clinical indication for determination
A blood pressure (BP) ≤ the 95^th percentile for age, height, and gender; and not receiving medication for treatment of hypertension
Patients who are pregnant or breast-feeding are not eligible
Negative pregnancy tests must be obtained in girls who are post-menarchal
Males or females of reproductive potential may not participate unless they have agreed to use an effective contraceptive method beginning at the signing of the informed consent until at least 30 days after the last dose of the study drug
Patients with clinical symptoms of hepatic encephalopathy or ascites are not eligible
Patients who have an uncontrolled infection are not eligible
Patients with evidence of bleeding diathesis are not eligible
Patients with known Gilbert syndrome are not eligible
Patients who, in the opinion of the investigator, may not be able to comply with the safety-monitoring requirements of the study are not eligible
No concurrent chemotherapy, radiation therapy, immunomodulating agents, or other investigational agents
Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study
Patients with solid tumors must not have received myelosuppressive chemotherapy within 3 weeks of enrollment onto this study (6 weeks if prior nitrosourea)
At least 7 days must have elapsed since the completion of therapy with a growth factor (at least 14 days must have elapsed after receiving pegfilgrastim)

At least 7 days must have elapsed since completion of therapy with a biologic agent;

For agents that have known adverse events occurring beyond 7 days after administration, this period prior to enrollment must be extended beyond the time during which adverse events are known to occur
At least 3 half-lives must have elapsed since prior therapy that included a monoclonal antibody
At least 2 weeks must have elapsed since local palliative radiotherapy (XRT) (small port); ≥ 3 months must have elapsed if prior craniospinal XRT was received, if ≥ 50% of the pelvis was irradiated, or if TBI was received; ≥ 6 weeks must have elapsed if other substantial bone marrow irradiation was given
No evidence of active graft-vs-host disease and ≥ 2 months must have elapsed since transplant (stem cell transplant or rescue without total-body irradiation)
For patients with papillary thyroid carcinoma (PTC) only: ≥ 3 weeks from prior radioiodine (RAI) treatment
Patients requiring corticosteroids that have not been on a stable or decreasing dose of corticosteroid for 7 days prior to enrollment are not eligible
Patients who are currently receiving another investigational drug are not eligible
Patients who are currently receiving other anti-cancer agents are not eligible
Patients who are receiving cyclosporine, tacrolimus or other agents to prevent either graft-versus-host disease post bone marrow transplant or organ rejection post transplant are not eligible for this trial
Patients who take cytochrome P450 enzyme-inducing anti-epileptic drugs (phenytoin, carbamazepine, or phenobarbital), rifampin, grapefruit juice, or St. Johns wort will not be eligible for the trial
Patients who have received prior treatment with sorafenib are not eligible

Patients must not be on therapeutic anti-coagulation;

Prophylactic anticoagulation (i.e., low-dose warfarin) of venous or arterial devices is allowed provided that the requirements for prothrombin time(PT), partial thromboplastin time(PTT), and international normalized ratio(INR) are met

Study is for people with:

Kidney Cancer

Phase:

Phase 2

Estimated Enrollment:

20

Study ID:

NCT01502410

Recruitment Status:

Completed

Sponsor:

National Cancer Institute (NCI)

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There are 89 Locations for this study

See Locations Near You

Children's Hospital of Alabama
Birmingham Alabama, 35233, United States
University of Alabama at Birmingham
Birmingham Alabama, 35294, United States
University of Arkansas for Medical Sciences
Little Rock Arkansas, 72205, United States
Southern California Permanente Medical Group
Downey California, 90242, United States
Miller Children's Hospital
Long Beach California, 90806, United States
Children's Hospital Los Angeles
Los Angeles California, 90027, United States
Children's Hospital Central California
Madera California, 93636, United States
Childrens Hospital of Orange County
Orange California, 92868, United States
Rady Children's Hospital - San Diego
San Diego California, 92123, United States
University of California San Francisco Medical Center-Parnassus
San Francisco California, 94143, United States
Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
Denver Colorado, 80218, United States
Connecticut Children's Medical Center
Hartford Connecticut, 06106, United States
Alfred I duPont Hospital for Children
Wilmington Delaware, 19803, United States
Children's National Medical Center
Washington District of Columbia, 20010, United States
Lee Memorial Health System
Fort Myers Florida, 33901, United States
Nemours Children's Clinic - Jacksonville
Jacksonville Florida, 32207, United States
Florida Hospital
Orlando Florida, 32803, United States
Nemours Children's Clinic - Orlando
Orlando Florida, 32806, United States
Nemours Children's Clinic - Pensacola
Pensacola Florida, 32504, United States
All Children's Hospital
Saint Petersburg Florida, 33701, United States
Saint Joseph Children's Hospital of Tampa
Tampa Florida, 33607, United States
Children's Healthcare of Atlanta - Egleston
Atlanta Georgia, 30322, United States
University of Hawaii
Honolulu Hawaii, 96813, United States
Saint Luke's Mountain States Tumor Institute
Boise Idaho, 83712, United States
Lurie Children's Hospital-Chicago
Chicago Illinois, 60611, United States
University of Illinois
Chicago Illinois, 60612, United States
University of Chicago
Chicago Illinois, 60637, United States
Saint Jude Midwest Affiliate
Peoria Illinois, 61602, United States
Southern Illinois University
Springfield Illinois, 62702, United States
Riley Hospital for Children
Indianapolis Indiana, 46202, United States
University of Kentucky
Lexington Kentucky, 40536, United States
Kosair Children's Hospital
Louisville Kentucky, 40202, United States
Tulane University Health Sciences Center
New Orleans Louisiana, 70112, United States
Sinai Hospital of Baltimore
Baltimore Maryland, 21215, United States
Mark O Hatfield-Warren Grant Magnuson Clinical Center
Bethesda Maryland, 20892, United States
Dana-Farber Cancer Institute
Boston Massachusetts, 02115, United States
Dana-Farber Harvard Cancer Center
Boston Massachusetts, 02115, United States
Wayne State University/Karmanos Cancer Institute
Detroit Michigan, 48201, United States
Bronson Methodist Hospital
Kalamazoo Michigan, 49007, United States
University of Minnesota Medical Center-Fairview
Minneapolis Minnesota, 55455, United States
Mayo Clinic
Rochester Minnesota, 55905, United States
University of Mississippi Medical Center
Jackson Mississippi, 39216, United States
The Childrens Mercy Hospital
Kansas City Missouri, 64108, United States
Washington University School of Medicine
Saint Louis Missouri, 63110, United States
Children's Hospital and Medical Center of Omaha
Omaha Nebraska, 68114, United States
Hackensack University Medical Center
Hackensack New Jersey, 07601, United States
Morristown Memorial Hospital
Morristown New Jersey, 07962, United States
UMDNJ - Robert Wood Johnson University Hospital
New Brunswick New Jersey, 08903, United States
Overlook Hospital
Summit New Jersey, 07902, United States
University of New Mexico Cancer Center
Albuquerque New Mexico, 87106, United States
Montefiore Medical Center - Moses Campus
Bronx New York, 10467, United States
Roswell Park Cancer Institute
Buffalo New York, 14263, United States
Columbia University Medical Center
New York New York, 10032, United States
Memorial Sloan-Kettering Cancer Center
New York New York, 10065, United States
University of Rochester
Rochester New York, 14642, United States
State University of New York Upstate Medical University
Syracuse New York, 13210, United States
University of North Carolina
Chapel Hill North Carolina, 27599, United States
Carolinas Medical Center
Charlotte North Carolina, 28203, United States
Novant Health Presbyterian Medical Center
Charlotte North Carolina, 28204, United States
Wake Forest University Health Sciences
Winston-Salem North Carolina, 27157, United States
Children's Hospital Medical Center of Akron
Akron Ohio, 44308, United States
Cincinnati Children's Hospital Medical Center
Cincinnati Ohio, 45229, United States
Rainbow Babies and Childrens Hospital
Cleveland Ohio, 44106, United States
Nationwide Children's Hospital
Columbus Ohio, 43205, United States
Dayton Children's Hospital
Dayton Ohio, 45404, United States
University of Oklahoma Health Sciences Center
Oklahoma City Oklahoma, 73104, United States
Oregon Health and Science University
Portland Oregon, 97239, United States
Children's Hospital of Philadelphia
Philadelphia Pennsylvania, 19104, United States
Children's Oncology Group
Philadelphia Pennsylvania, 19104, United States
Children's Hospital of Pittsburgh of UPMC
Pittsburgh Pennsylvania, 15224, United States
BI-LO Charities Children's Cancer Center
Greenville South Carolina, 29605, United States
Greenville Cancer Treatment Center
Greenville South Carolina, 29605, United States
East Tennessee Childrens Hospital
Knoxville Tennessee, 37916, United States
Vanderbilt-Ingram Cancer Center
Nashville Tennessee, 37232, United States
Driscoll Children's Hospital
Corpus Christi Texas, 78411, United States
Medical City Dallas Hospital
Dallas Texas, 75230, United States
University of Texas Southwestern Medical Center
Dallas Texas, 75390, United States
Cook Children's Medical Center
Fort Worth Texas, 76104, United States
Baylor College of Medicine
Houston Texas, 77030, United States
Childrens Hospital-King's Daughters
Norfolk Virginia, 23507, United States
Seattle Children's Hospital
Seattle Washington, 98105, United States
Providence Sacred Heart Medical Center and Children's Hospital
Spokane Washington, 99204, United States
Midwest Children's Cancer Center
Milwaukee Wisconsin, 53226, United States
Sydney Children's Hospital
Randwick New South Wales, 2031, Australia
Princess Margaret Hospital for Children
Perth Western Australia, 6008, Australia
British Columbia Children's Hospital
Vancouver British Columbia, V6H 3, Canada
IWK Health Centre
Halifax Nova Scotia, B3J 3, Canada
McMaster Children's Hospital at Hamilton Health Sciences
Hamilton Ontario, L8N 3, Canada
Hospital for Sick Children
Toronto Ontario, M5G 1, Canada
The Montreal Children's Hospital of the MUHC
Montreal Quebec, H3H 1, Canada
Centre Hospitalier Universitaire Sainte-Justine
Montreal Quebec, H3T 1, Canada
Centre Hospitalier Universitaire de Quebec
Ste-Foy Quebec, G1V 4, Canada

How clear is this clinincal trial information?

Study is for people with:

Kidney Cancer

Phase:

Phase 2

Estimated Enrollment:

20

Study ID:

NCT01502410

Recruitment Status:

Completed

Sponsor:


National Cancer Institute (NCI)

How clear is this clinincal trial information?

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