This phase I/Ib trial studies the side effects and best dose of afatinib dimaleate when given together with capecitabine in treating patients with solid tumors, pancreatic cancer, or biliary cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment and has not responded to previous treatment. Afatinib dimaleate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving afatinib dimaleate together with capecitabine may be a better treatment for solid tumors, pancreatic cancer, or biliary cancer.
PRIMARY OBJECTIVES: I. Evaluate the safety, maximum tolerated dose (MTD), and the recommended phase II dose (RP2D) of afatinib dimaleate (afatinib) in combination with capecitabine in patients with advanced solid tumors (phase I) and pancreatico-biliary cancers (phase Ib). (Phase I/Ib) SECONDARY OBJECTIVES: I. Evaluate biomarkers of response from tumor biopsies, including markers related to the epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) pathways via OncoPlex or other equivalent gene sequencing assay. (Phase I/Ib) II. Evaluate rates of response and stable disease, duration of response, time to progression, progression-free and overall survival. (Phase I/Ib) OUTLINE: This is a phase I, dose-escalation study of afatinib dimaleate followed by a phase Ib study. Patients receive afatinib dimaleate orally (PO) once daily (QD) on days 1-21 and capecitabine PO twice daily (BID) on days 1-14. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 3 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
41
Indiana University/Melvin and Bren Simon Cancer Center
Indianapolis, Indiana, United States
Fred Hutch/University of Washington Cancer Consortium
Seattle, Washington, United States
Incidence of adverse events, assessed according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0
Adverse events will be tabulated and summarized by dose levels. Summary tabulations will be presented displaying the number of observations, mean, standard deviation, median, minimum, and maximum for continuous variables, and the number and percentage per category for categorical data. Toxicity measurement will be accompanied by 90% confidence intervals.
Time frame: Up to 30 days following the last dose of study treatment
Incidence of dose limiting toxicity (DLT) graded according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 (Phase Ib)
DLTs will be tabulated and summarized by dose levels. Summary tabulations will be presented displaying the number of observations, mean, standard deviation, median, minimum, and maximum for continuous variables, and the number and percentage per category for categorical data. Toxicity measurement will be accompanied by 90% confidence intervals.
Time frame: Up to 21 days
Maximum tolerated dose (MTD) of afatinib dimaleate in combination with capecitabine (Phase Ib)
Defined as the dose at which 0/3 or =\< 1/6 patients experience a DLT graded according to NCI CTCAE version 4.0, will be assessed.
Time frame: Up to 21 days
Recommended phase 2 dose (RP2D) (Phase Ib)
Defined as the best tolerated dose overall, considering overall toxicity, including beyond course 1, will be evaluated.
Time frame: Up to 3 years
Biomarker profile (including EGFR and HER2 gene copy number and mutations, Kirsten rat sarcoma viral oncogene homolog, B-Raf proto-oncogene, serine/threonine kinase, neuroblastoma RAS viral oncogene homolog NRAS mutations, and E-cadherin expression)
Will be summarized using mean +/- standard deviation. Baseline biomarker profile will also be summarized by the categories of treatment responses. Logistic models with objective response and stable disease as outcome and the baseline tumor profile as covariate will be fitted to evaluate their association. Correlative analysis of the presence of specific biomarkers and objective response/stable disease and progression free survival (PFS) (for patients in expansion cohorts) will be performed using Chi-square test or Fisher?s exact tests, as appropriate.
Time frame: Baseline
Duration of response
Duration of response will be assessed with the Kaplan-Meier method.
Time frame: Time that measurement criteria are met for complete or partial response (whichever status is recorded first) until the first date that recurrent or progressive disease is objectively documented, assessed up to 3 years
Duration of stable disease
Duration of stable disease will be assessed with the Kaplan-Meier method.
Time frame: Time that stable disease is documented until the first date that recurrent disease is objectively documented, assessed up to 3 years
Overall survival
Overall survival will be assessed with the Kaplan-Meier method.
Time frame: From the day of first treatment to the earlier of (1) death (from any cause) and (2) the last date of subject contact, assessed up to 3 years
Progression-free survival
Assessed with the Kaplan-Meier method.
Time frame: From time from registration to disease progression or death of any cause, assessed up to 3 years
Rates of response, assessed using Response Evaluation Criteria in Solid Tumors (RECIST) criteria
Response rates will be tabulated and summarized by dose levels. Response rate measurement will be accompanied by 90% confidence intervals.
Time frame: Up to 3 years
Stable disease, defined as neither sufficient shrinkage to qualify for partial response nor sufficient increase to quality for progressive disease assessed using Response Evaluation Criteria in Solid Tumors (RECIST) criteria
Stable disease will be tabulated and summarized by dose levels.
Time frame: Up to 3 years
Time to progression
Time to progression will be assessed with the Kaplan-Meier method.
Time frame: From the study enrollment until the criteria for disease progression are met (or death occurs), assessed up to 3 years
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