This is a open-label non-randomized, dose escalation and expansion Phase Ia/Ib study to determine the safety, tolerability and maximum tolerated dose (MTD) of pazopanib in combination with PCI-24781 in patients with advanced solid tumors.
Study rationale/purpose Pazopanib is a potent, multi-targeted tyrosine kinase inhibitor44 of VEGFR-1, -2, -3, PDGFR-α and -β and c-kit approved for metastatic renal cell carcinoma based on phase III data showing a significant prolongation of progression-free survival (PFS) (5 mos in pretreated patients and 8.3 mos in treatment-naïve patients). In addition recent data was presented this year, but is not yet published, with treatment-refractory sarcoma patients that showed a PFS was significantly prolonged from a median of 20 vs. 7 weeks. As can occur with all antiangiogenic agents, resistance to pazopanib may develop. Epigenetic modification with HDAC inhibitors may overcome drug resistance by causing an increase in accessibility of DNA to chemotherapeutic agents and may therefore significantly potentiate their cytotoxicity. Combination trials with chemotherapy agents are ongoing (ClinicalTrials.gov) To our knowledge, a combination trial of HDACi with anti-angiogenesis agents has not yet been performed and represents an unmet medical need. PCI-24781 is a pan HDAC inhibitor. In cell lines tested, up-regulation and down-regulation of genes known to result in changes with signal transduction, oxidation, metabolic changes, apoptosis, proliferation, differentiation and angiogenesis were seen. In addition, ongoing single agent and combination trials have shown the drug to be effective and well-tolerated. Hypothesis: Combining an antiangiogenic agent, such as pazopanib, with an epigenetic modifier, such as histone deacetylase inhibitor (HDACi) PCI-24781, can increase the efficacy of pazopanib as well as overcome development of resistance to pazopanib.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
90
PCI-24781: oral, 30 to 75 mg/m2 b.i.d. Cycle 1, Days -7 to -4 and Cycle 1 and ongoing - Days 1-5, 8-12, 15-19 PZP115891: oral, 400 - 800 mg qd 28 days per cycle
University of California, San Francisco
San Francisco, California, United States
Dose limiting toxicity (DLT)
A dose limiting toxicity (DLT) will be defined as any predetermined adverse events occurring during Cycle 1 when association to therapy that is part of this study is related or possibly related
Time frame: up to 4 weeks
Maximum Tolerated Dose (MTD)
The maximum tolerated dose (MTD) will be defined as the highest tested dose level at which less than 33% of patients experience DLT in Cycle 1
Time frame: up to 4 weeks
Establish the volume of distribution of PCI-24781, pazopanib and the combination of the two drugs.
Noncompartmental pharmacokinetic profile of PCI-24781, pazopanib and the combination will be assessed by measuring and calculating the volume of distribution (Vd)
Time frame: up to 2 months
Establish the bioavailability of PCI-24781, pazopanib and the combination of the two drugs.
Noncompartmental pharmacokinetic profile of PCI-24781, pazopanib and the combination will be assessed by measuring and calculating the bioavailability (F).
Time frame: up to 2 months
Establish the clearance of PCI-24781, pazopanib and the combination of the two drugs.
Noncompartmental pharmacokinetic profile of PCI-24781, pazopanib and the combination will be assessed by measuring and calculating clearance (CL)
Time frame: up to 2 months
Establish the half-life of PCI-24781, pazopanib and the combination of the two drugs.
Noncompartmental pharmacokinetic profile of PCI-24781, pazopanib and the combination will be assessed by measuring and calculating the half-life (t1/2)
Time frame: up to 2 months
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Establish the area under the curve (AUC) of PCI-24781, pazopanib and the combination of the two drugs.
Noncompartmental pharmacokinetic profile of PCI-24781, pazopanib and the combination will be assessed by measuring and calculating the AUC
Time frame: up to 2 months
Clinical Benefit Rate (CBR)
Clinical Benefit Rate=Complete Response (CR)+Partial Response (PR)+Stable Disease (SD) is defined as the best response at any time or maintaining stable disease for at least 12 weeks and will be evaluated by imaging criteria RECIST 1.1. A patient with unknown or missing response will be treated as a non-responder. Patients are expected to receive treatment for at least 2 Cycles, at which time the first evaluation for efficacy will occur. Exact methods for calculated confidence intervals will be utilized.
Time frame: approximately 4 months
Objective response rate (ORR)
Objective response rate is defined as the percentage or proportion of patients with a confirmed complete or partial response (CR+PR) as defined by RECIST 1.1 divided by the total number of patients on study. Patients are expected to receive treatment for at least 2 Cycles, at which time the first evaluation for efficacy will occur. A patient with unknown or missing response will be treated as a non-responder. Exact methods for calculated confidence intervals will be utilized.
Time frame: approximately 4 months
Progression-free Survival (PFS)
Time to progression will be calculated as the time from first dose of the combination until the earliest date of documented disease relapse, progression, or death from any cause. If the patient does not have a documented date of progression or death, then PFS will be censored at the date of last adequate assessment. PFS will be summarized using Kaplan-Meier method and lifetables, including the 1-year point estimates with standard errors.
Time frame: Up to 1 year
Overall survival (OS)
Overall survival will be calculated as the time from first dose of the combination until the earliest date of documented study discontinuation or death from any cause. If the patient does not have a documented date of death, then OS will be censored at the date of last adequate assessment. OS will be summarized using Kaplan-Meier method and lifetables, including the 1-year point estimates with standard errors.
Time frame: Up to 1 year
Duration of Response (DoR)
Duration of Response is defined, for the subset of patients with a confirmed complete or partial response, as the time from first documented evidence of CR or PR until first documented disease progression or death due to any cause. Only the subset of patients who show a confirmed complete or partial tumor response will be included. Censoring rules for duration of response will follow the rules for PFS
Time frame: Up to 1 year