PURO Panitumumab in Combination With Gemcitabine/Cisplatin in Advanced Urothelial Cancer

WiSP Wissenschaftlicher Service Pharma

Status and phase

Terminated

Phase 2

Conditions

Urinary Bladder Cancer

Treatments

Drug: GemCis + Panitumumab

Drug: GemCis

Study type

Interventional

Funder types

Other

Identifiers

NCT01374789

WiSP_AG48

GMIHO-007/2008 (Other Identifier)

2009-015119-42 (EudraCT Number)

Details and patient eligibility

About

The primary objective of the study is to assess the efficacy of the combination consisting of gemcitabine/cisplatin and panitumumab in patients with urothelial carcinoma and wild-type HRAS (non-mutated status). The progression-free survival rate at 12 months will be compared to expectations derived from historical data, which are verified by a randomised control group without the antibody.

Full description

Mutation of ras oncogenes is frequently observed in human tumours and occurs in approximately 30% of all cancer types. Frequent mutation "hot spots" occur in codon 12 (glycine to valine), codon 13 (glycine to cysteine) and codon 61 (glutamine to arginine, lysine and leucine) (Bonner et al. 1993, Levesque et al. 1993). Point mutations in ras genes result in blockade of intrinsic GTPase activity, the physiological mechanism that switches off ras GTPases. The consequence is persistent up-regulation of the signal pathway and increased cell proliferation. The first HRAS mutation in association with bladder cancer was described during establishment of the human urinary bladder carcinoma cell line T24. In further studies, a research group led by Fitzgerald was able to demonstrate that HRAS gene mutations were present in the urine sediment of up to 44% of patients with urinary bladder cancer (Fitzgerald et al. 1995).

Viola et al. subsequently investigated whether an increased mutation rate is accompanied by increased expression of ras proteins in bladder cancer. It was shown that there is indeed increased expression of ras proteins in dedifferentiated tumours and carcinomas in situ, whereas highly differentiated tumours do not exhibit this rate of expression (Viola et al. 1985).

At present, there is no clinical evidence, that the findings of an obvious lack of activity of EGFR antibodies in colorectal cancer with RAS-related mutations, is likewise valid in urothelial carcinoma. However, as it is the aim of this study to detect a first signal of activity in this type of cancer, and the chance of missing such evidence in a phase II trial with limited patient numbers is high anyway, it seems sensible, not to miss this opportunity of "enrichment". In case of a clearly positive signal of efficacy in the present trial, a subsequent phase II study may focus on HRAS mutated tumors.

Overexpression of the EGF receptor in bladder cancer has been described by many research groups (Colquhuon & Mellon, 2002) and is associated with an advanced stage of the tumour, progression of the tumour and a poor clinical prognosis. The EGFR antibody cetuximab (Erbitux®) has been investigated in a human urothelial carcinoma cell line and in a mouse model with human bladder carcinoma. Cetuximab was found to inhibit tumorigenesis and metastatic progression in vivo and in vitro by means of suppression of angiogenesis and simultaneous induction of apoptosis (Perotte et al., 1999; Inoue et al., 2000). Similar results have also been reported in urothelial carcinoma for the tyrosine kinase inhibitor gefitinib (Villares et al., 2007, Shrader et al., 2007).

There are currently two on-going studies of cetuximab in metastatic bladder cancer: a randomised phase II study of first-line treatment with Gemcitabine and Cisplatin +/- Erbitux (NCT00645593) and a randomised phase II study of second-line treatment with Erbitux +/- Paclitaxel (NCT00350025).

The HRAS mutation rate in urothelial carcinoma is approximately 40%. The primary objective of the study is to assess the efficacy of the combination consisting of gemcitabine/cisplatin and panitumumab in patients with wild-type HRAS (non-mutated status). The progression-free survival rate at 12 months will be compared to expectations derived from historical data, which are verified by a randomised control group without the antibody.

Enrollment

2 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Histologically or cytologically confirmed, unresectable urothelial carcinoma of the bladder or the upper urinary tract
Wild-type HRAS
Male and female subjects > 18 years of age
General condition ECOG 0-1
Life expectancy at least 12 weeks
Women of child-bearing potential: negative pregnancy test and use of effective contraception(oral contraceptive, coil); men: use of adequate male contraception (condom) for up to 3 months after discontinuation of panitumumab therapy
Locally advanced or metastatic disease (T3b,T4 and/or N+ and/or M+)
At least one unidimensionally measurable lesion detectable in CT or MRI corresponding to the RECIST criteria
Adequate haematological, hepatic, renal and metabolic function parameters:

Leukocytes > 3000/mm³, ANC ≥ 1500/mm³, platelets ≥ 100,000/mm³, hemoglobin > 9 g/dl Creatinine clearance ≥ 50 ml/min and serum creatinine ≤ 1.5 x upper limit of normal Bilirubin ≤ 1.5 x upper limit of normal, GOT-GPT ≤ 2.5 x upper limit of normal in absence of liver metastases, or ≤ 5 x upper limit of normal in presence of liver metastases, AP ≤ 5 x upper limit of normal Magnesium ≥ lower limit of normal; calcium ≥ lower limit of normal INR and PTT < 1.5 x the upper limit of the normal reference range

Exclusion criteria

HRAS mutation
Absence of any of the above-listed inclusion criteria
Dialysis-dependence following nephrectomy
Patients with cerebral tumours and/or cerebral metastases
Clinically significant cardiovascular disease in (incl. myocardial infarction, unstable angina, symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia) ≤ 1 year before enrolment.
Patients with uncontrolled hypertension; systolic blood pressure > 150 mmHg or diastolic blood pressure > 90 mmHg despite optimal medical treatment
History of interstitial lung disease, e.g. pneumonitis or pulmonary fibrosis or evidence of interstitial lung disease on baseline chest CT scan.
Patients with thrombotic or embolic events, such as stroke or pulmonary embolism
Patients with recent or known history of haemorrhagic diathesis
Known significant neurological or psychiatric disorders, including dementia and epileptic seizures
Serious inflammatory eye conditions, hearing impairment
Pulmonary (pO2 < 60 mmHg), haemopoietic (e.g. serious bone marrow aplasia), hepatic or renal disorders
Patients with poorly controlled diabetes mellitus
Serious bacterial or fungal infections (>grade 2 NCI CTC Version 3)
Chronic hepatitis B or C; HIV infection
Autoimmune disease
Allergic reaction to one of the medications to be used
Status post organ transplantation
Status post autologous bone marrow transplantation or stem cell transplantation in the 4 months prior to study commencement
Manifest secondary malignancy or other form of cancer in the previous 5 years (excluding basalioma, in situ cervical cancer, incidental prostatic cancer)
Subject pregnant or breast feeding, or planning to become pregnant within 6 months after the end of treatment
Subject (male or female) is not willing to use highly effective methods of contraception (per institutional standard) during treatment and for 3 months (male or female) after the end of treatment (adequate: oral contraceptives, intrauterine device or barrier method in conjunction with spermicidal jelly).
Active participation in other clinical studies in the previous 4 weeks
Prior systemic therapy with cytostatics or immunotherapeutic agents
Concurrent use of other anticancer treatments after study commencement
Intravesical chemotherapy in the previous 4 weeks
Radiotherapy in the previous 4 weeks
Previous radiotherapy in which all lesions to be used for the evaluation of tumour response were irradiated
Patients in a closed institution according to an authority or court decision