This multi-institutional phase I/II clinical trial will test the tolerability and efficacy of the combination sorafenib and topotecan in patients with recurrent ovarian cancer, which is platinum-resistant (recurrence within 6 months from completing platinum based therapy) or refractory (progressive disease during platinum based therapy).
OUTLINE: This is a multi-center study. * Topotecan: 4mg/m2 weekly, 3 weeks on and one week off. * Sorafenib: Assigned cohort dose for phase I (up to 12 patients) Maximum tolerated dose for phase II (21 total patients) Cycles will consist of 4 weeks (28 days) with disease evaluations every 8 weeks. Non-PD and acceptable toxicity: Patients will continue protocol therapy PD or unacceptable toxicity: Patients will discontinue protocol therapy ECOG performance status 0-1 Life expectancy: Three (3) months Hematopoietic: * White blood cell count (WBC) \> 3 K/mm3 * Hemoglobin (Hgb) \> 9 g/dL * Platelets \> 100 K/mm3 * Absolute neutrophil count (ANC) \> 1.5 K/mm3 * INR \< 1.5 or a PTT within normal limits. NOTE: Patients receiving anti-coagulation treatment with an agent such as warfarin or heparin may be allowed to participate. * No evidence or history of bleeding diathesis or coagulopathy. Hepatic: * Bilirubin \< 1.5 x ULN * Aspartate aminotransferase (AST, SGOT) \< 2.5 x ULN * Alanine aminotransferase (ALT, SGPT) \< 2.5 x ULN * Alkaline phosphate \< 2.5 x ULN Renal: * Creatinine \< 1.5 x ULN Cardiovascular: * No history of myocardial infarction or angina pectoris or angina equivalent within 6 months prior to registration for protocol therapy (the patient may not be on anti-anginal or anti-arrhythmic medications), or have uncontrolled hypertension or congestive heart failure \> class II NYHA Pulmonary: * No thrombolic or embolic events such as a cerebrovascular accident, including transient ischemic attacks within the past 6 months. * No pulmonary hemorrhage/bleeding event \> CTCAE Grade 2 within 28 days prior to registration for protocol therapy. * No non-pulmonary hemorrhage/bleeding event \> CTCAE Grade 3 within 28 days prior to registration for protocol therapy.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Medical & Surgical Specialists, LLC
Galesburg, Illinois, United States
Oncology Hematology Associates of SW Indiana
Evansville, Indiana, United States
Fort Wayne Oncology & Hematology, Inc
Fort Wayne, Indiana, United States
Indiana University Simon Cancer Center
Maximum Tolerated Dose (MTD)
An initial 3 patients will be enrolled at dose level 1. If all 3 patients in dose level 1 complete the first cycle of therapy without a dose limiting toxicity (DLT), 3 patients will be enrolled at dose level 2. If 0 of 3 or 1 of 6 patients in dose level 2 experience a DLT, all subsequent patients will be enrolled in the Phase II cohort at dose level 2. If 2 of the first 3 or 2 of the total 6 patients experience DLT at dose level 2, then dose level 1 will be considered the MTD and used in the second phase.
Time frame: Each participant was treated at their assigned dose level on 28 day cycles until disease progression or unacceptable toxicity. Participants were evaluated for toxicity every two weeks.
Percentage of Participants With Response
To assess response in patients with recurrent or resistant epithelial ovarian cancer treated with Sorafenib plus Topotecan. Reponse evaluated per RECIST criteria where: Complete Response (CR): Disappearance of all target lesions Partial Response (PR): At least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LD Progressive Disease (PD): At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started
Time frame: Disease assessments were conducted on the 8th week (Cycle 2, Week 4) and every eight weeks there after, until treatment discontinuation
Progression-free Survival
To determine the progression-free survival of patients treated with Sorafenib plus Topotecan.
Time frame: From enrollment until treatment discontinuation. Participants may remain on study drug indefinitely
Clinical Benefit
To determine the rate of clinical benefit defined as the percentage of patients experiencing an objective response or a CA125 response.
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Indianapolis, Indiana, United States
St. Vincent Hospital Cynecologic Oncology
Indianapolis, Indiana, United States
Arnett Cancer Care
Lafayette, Indiana, United States
Medical Consultants, P.C.
Muncie, Indiana, United States
Schwartz Gynecologic Oncology, PLLC
Brightwaters, New York, United States
Time frame: From enrollment until treatment discontinuation. Participants may remain on study drug indefinitely
Duration of Stable Disease
To determine duration of stable disease, in months
Time frame: From enrollment until treatment discontinuation. Participants may remain on study drug indefinitely