RATIONALE: Drugs used in chemotherapy, such as fluorouracil, leucovorin, and oxaliplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. 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. Bevacizumab may also stop the growth of neuroendocrine tumors by blocking blood flow to the tumor. Giving combination chemotherapy together with bevacizumab may kill more tumor cells. PURPOSE: This phase I/II trial is studying the side effects of giving combination chemotherapy together with bevacizumab and to see how well it works in treating patients with advanced neuroendocrine tumors.
OBJECTIVES: Primary * Determine the safety of fluorouracil, leucovorin calcium, and oxaliplatin (FOLFOX) with bevacizumab in patients with advanced neuroendocrine tumors. * Determine the best overall response rate in patients treated with this regimen. Secondary * Determine the overall survival of patients treated with this regimen. * Determine the time to treatment failure and progression in patients treated with this regimen. * Determine the biochemical marker response in patients treated with this regimen. OUTLINE: This is an open-label, pilot study. Patients are stratified according to tumor type (carcinoid vs islet cell vs poorly differentiated neuroendocrine). Patients receive oxaliplatin IV over 2 hours and leucovorin calcium IV over 2 hours on day 1 and fluorouracil IV continuously over 46-48 hours beginning on day 1. Patients also receive bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 14 days for up to 26 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed every 3 months. PROJECTED ACCRUAL: A total of 39-102 patients (13-34 per stratum) will be accrued for this study.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
36
5mg/kg IV q 2 wk on day 1. Initial study drug dose will be delivered over 90 +/- 15 minutes x1. If the first infusion is tolerated without fever/chills, the second infusion may be delivered over 60 +/- 10 minutes. If 60 minutes infusion is well tolerated, all subsequent infusions maybe be delivered over 30 +/- 10 minutes.
2400mg/m2 CIV over 46-48 hours D1-2 q2 weeks.
200mg/m2 IV q2 wk on day 1 over a 2-hour period.
200mg/m2 IV q 2 wk on day 1 over a 2-hour period
Univeristy of California, San Francisco
San Francisco, California, United States
Kaiser Permanente Medical Center - Vallejo
Vallejo, California, United States
Rate of Discontinuation Due to Adverse Events Possibly Related to Study Treatment
Rates of discontinuation were calculated as counts and percentages of patients whom discontinued treatment due to adverse events possibly related to the investigational treatments not including neuropathy.
Time frame: From beginning of treatment up to 18 months; Post-study survival follow-up up to 8 years
Best Objective Response
Best Objective Response by RECIST with Exact 95% Binomial CIs across all tumor types. The patient's best response assignment will depend on the achievement of both measurement and confirmation criteria Target lesions response + Non-Target lesions response + Evaluation of non-target lesions (Yes / No) = Overall response
Time frame: From Baseline until disease progression, up to 8 years
Time to Progression
Time to disease progression will be defined as the time from baseline until documented disease progression or death (whichever occurs first).
Time frame: From beginning of treatment up to 18 months; Post-study survival follow-up up to 8 years
Overall Median Survival
The overall survival is defined as the time from baseline until death (Carcinoid, PNET, PDNEC) using Kaplan-Meier Survival analysis methods.
Time frame: until death, up to 8 years
Overall Time to Treatment Failure
Time to treatment failure is defined as the time from the initial complete or partial response to documented disease progression or death (whichever occurs first) across treatment groups and inclusive of drug holidays and estimated using Kaplan-Meier survival analysis methods
Time frame: From initial complete or partial response to disease progression, up to 8 years
Biochemical Marker Response
Biochemical marker response is defined as \>=50% reduction in marker or hormone(s) that were elevated at baseline. Markers/hormones tested are: Chromagranin A (CGA), 5-HIAA, Insulin, Proinsulin, C-peptide, Pancreatic polypeptide, Gastrin, Glucagon, and Vasointestinal Peptide.
Time frame: From Baseline until end of treatment, up to 8 years
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