Sunitinib malate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. This phase II trial is studying the side effects and how well sunitinib malate works in treating patients with Kaposi sarcoma.
PRIMARY OBJECTIVES: I. Determine the clinical response of sunitinib malate in patients with Kaposi sarcoma (KS) in Uganda and Kenya. II. Compare clinical response rates in endemic versus epidemic (AIDS) KS. III. Determine the safety and tolerability of sunitinib malate in patients with endemic or epidemic (AIDS) KS. SECONDARY OBJECTIVES: I Monitor the impact of sunitinib malate on underlying HIV-1 and Kaposi sarcoma-associated herpesvirus (KSHV) viral infection (HIV-1 plasma RNA and KSHV cell-associated DNA). II. Evaluate morphological changes in KS lesions after treatment. III. Determine the pharmacokinetic profile of sunitinib malate in patients with KS. IV Evaluate KSHV gene expression in endemic and epidemic KS lesions in patients in Uganda and Kenya. OUTLINE: This is a multicenter study. Patients are stratified according to HIV-serostatus (endemic \[HIV-seronegative\] vs epidemic \[HIV-seropositive/AIDS\] kaposi sarcoma). Patients receive oral sunitinib malate 50 mg once daily for 4 weeks. Treatment repeats every 6 weeks in the absence of disease progression or unacceptable toxicity. Patients undergo tumor tissue and blood sample collection periodically for correlative and pharmacokinetic studies. Samples are analyzed for CD4 lymphocyte counts, HIV-1 plasma RNA levels, KSHV specific antibodies, expression pattern of KSHV in vitro and in vivo, expression of latently versus lytically expressed genes in tumor tissue, and plasma concentrations of sunitinib malate and its active metabolite, SU12662. After completion of study treatment, patients are followed every 6 weeks.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Given orally
Correlative study
Correlative study
Response rate
The true response rate will be estimated based on the number of responses using a binomial distribution. The confidence intervals for them can be estimated using same distribution. Chi-square test or Fisher's exact test will be used to examine the difference of response rate between the two cohorts and log-rank test for the difference of survival outcomes.
Time frame: Up to 11 months
Overall survival
Will be estimated by Kaplan-Meier method.
Time frame: From the date of treatment to date of death, assessed up to 11 months
Progression-free survival
Will be estimated by Kaplan-Meier method.
Time frame: From the date of treatment to date of death or date of disease progression, assessed up to 11 months
Levels of plasma-associated HIV-1 RNA viral load and cell-associated KSHV DNA viral load
Multivariate analysis will be performed using the Cox proportional hazards model. The effects of CD4+ lymphocyte counts, plasma HIV-1 RNA viral load and KSHV DNA level on the objective response rate will be evaluated using multivariate logistic regression.
Time frame: Up to 11 months
Changes in CD4+ and CD8+ cell counts, levels of plasma-associated HIV-1 RNA, and cell-associated KSHV DNA load
For each treatment cohort and for all groups combined, the Wilcoxon signed rank test (the non-parametric version of paired T-test) will be used to evaluate the changes.
Time frame: Baseline and 6 weeks
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