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Study of Sunitinib in Young Patients with a rare type of cancer of the stomach and bowel.

ABSTRACT: Intervention1: Sutent (Sunitinib malate; sponsor code SU011248).: The sunitinib intended starting dose will be 15 mg/m2/day (not to exceed 50 mg/day. Intra-patient dose escalation of sunitinib will be allowed after completion of Cycle 1. Dose escalation will be in increments of 7.5 mg/m2, up to a maximum dose of 30 mg/m2 (not to exceed 50 mg/day). A cycle of therapy is considered to be 42 days, with the reporting period for each cycle being Day 1 to Day 42. For all patients, sunitinib will be dosed intermittently [4 weeks on study drug followed by 2 weeks off therapy. In the absence of progressive disease, patients may receive up to 18 cycles of sunitinib therapy for up to 24 months, so maximum duration of treatment according to the protocol is 2 years. Control Intervention1: Nil: Nil Primary outcome(s): Pharmacokinetic parameters of sunitinib and its main active metabolite (SU012662) including total plasma exposure (AUC24) and oral clearance (CL/F).Timepoint: Descriptive statistics for observed and dose-corrected (where appropriate) PK data will be reported for all patients with at least one PK observation by presenting the population size, arithmetic mean, standard deviation, percent coefficient of variation (CV%), median, minimum, maximum values at the end of the study.

DISEASE(S): Advanced Gastrointestinal Stromal Tumor

PROVIDER: 2576443 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Individuals with Urea Cycle Disorders (UCD) cannot remove ammonia, a waste product, from the blood. At present there is little information on the use of sodium phenylbutyrate (Buphenyl™) in children with argininosuccinic aciduria (ASA). It is hoped that this drug may help lower ammonia and argininosuccinic acid levels in patients with ASA. Through this study we hope to learn whether the use of sodium phenylbutyrate (Buphenyl™) in patients with ASA, in addition to diet and arginine therapy, will decrease liver damage and the number of periods during which ammonia levels are high. The primary study objective is to determine if the treatment of ASA patients with sodium phenylbutyrate (Buphenyl™) in conjunction with lowered doses of arginine improves liver function as measured by short-term assessment of synthetic activity and the use of stable isotope tracers to assess ureagenesis and nitric oxide production. Twelve patients with ASA will be studied using a randomized, cross-over design. Medical records will be reviewed to confirm the diagnosis prior to enrollment. Patients will be on the each arm of the study for one week each preceded by a three day washout period. Patients will come to the Baylor College of Medicine General Clinical Research Center in Texas Children's Hospital for an inpatient hospitalization. This hospitalization is for diet control, clinical evaluation, and stable isotope infusions for measurement of in vivo rates of ureagenesis and nitric oxide production. During the washout periods Buphenyl™ or other alternative route medications, e.g., benzoate, will be discontinued and arginine will be administered at the standard therapeutic dose of 500 mg/kg/day or 10 grams/m2. Following randomization, subjects will be maintained on either high-dose arginine (500 mg/kg/day or 10 grams/m2) alone, or the alternative of low-dose arginine (100 mg/kg/d or 2 grams/m2) along with sodium phenylbutyrate (500 mg/kg/day or 10 grams/m2). For the second week they will be crossed over to the other arm of the study preceded by another three day washout. Previous medications and dietary protein intake (0.6 g/kg/day or current metabolic diet) will be continued during both arms of the study. The two arms may be performed as separate ten-day admissions. The decision to design the study with two arms, high-dose arginine and low-dose arginine/Buphenyl™, was reached after weighing several considerations. First, the current accepted practice for treatment of ASA is high-dose arginine. Based on metabolic flux studies, we have quantified the effects of this dose of arginine as compared to standard doses of Buphenyl™/phenylacetate on ureagenesis. Since the study is not designed or intended to address the independent effects of Buphenyl™ as compared to arginine alone, Buphenyl™ was added for safety reasons to accommodate loss of clearance of nitrogen by decreasing the arginine dose. Moreover, based on our experience with recruiting for previous versions of this study, most ASA patients with liver dysfunction are on an alternative route ammonia scavenger medication in addition to arginine. We found that this has in fact become an accepted practice. Hence, when considering study design from both a safety and recruitment perspective, it was most reasonable to design the study to investigate specifically the hypothesis that the production and presence of argininosuccinic acid leads to liver dysfunction. Since both low-dose arginine with Buphenyl™ and high-dose arginine alone lead to a decreased production of argininosuccinic acid, and both are currently accepted therapies in ASA and UCDs in general, the need to address their effects distinctly is not being investigated at this time. Sodium phenylbutyrate dosage will be 500 mg/kg/day in patients weighing less than 20kg and 10 g/m2/day in larger patients. Daily dosage will be given in equally divided doses 4 times per day. In order to ensure that the study remains double-blind to investigators, study staff and subjects, the Investigational Pharmacy Service at Texas Children's Hospital will dispense both the Buphenyl™ and arginine in powder form which is compounded into capsules or will be mixed with syrpalta (up to 5 grams will dissolve in 10cc liquid) and administered orally or through nasogastric or gastrostomy tube. No nasogastric tube should be placed or gastrostomy performed solely for the purpose of inclusion in this study. Because the reported adverse effects of sodium phenylbutyrate include gastritis, participants will be started on a standard dose of ranitidine (Zantac™), or comparable drug, during both arms of the study.

Project description:Interventions: Step1: Confirmation of dosage of each drug (Oxaliplatin and Irinotecan) i)Induction treatment The following drugs will be administered in 3week/cycle for 6cycles (maximum 8cycle, if investigator required). With regard to determination of oxaliplatin (OX) and Irinotecan (IRI) dosage, initial 3patients (pts) will be enrolled of level0. After finishing initial enrollment, Steering committee (SC) will evaluate safety of 3pts at the time of starting of cycle2 and will decide whether the proceeding same level (add 3 pts) or other level (level+1 or level-0.5). Final decision of Recommended Dose (RD) of OX and IRI will be required 6pts of safety evaluation in same level and will be endorsed by SC and Independent Data monitoring committee (IDMC). 1) Each drug dosage of CAPOXIRI+Bevacizumab Bevacizumab (BEV: 7.5 mg/kg, i.v., 90, 60, 30 min, Day 1) Irinotecan (IRI: 130 mg/m2, i.v., 90 min, Day 1) Oxaliplatin (OX: 200 mg/m2, i.v., 120 min, Day 1) Capecitabine (CAP: 800 mg/m2 p.o., twice daily, 14 days consecutively) 2) OX and IRI dose level Level +1: IRI: 200 mg/m2, OX:130mg/m2 Level 0: IRI: 200 mg/m2, OX:100mg/m2 Level -0.5: IRI: 180 mg/m2, OX:100mg/m2 Level -1: IRI: 150 mg/m2, OX:100mg/m2 ii)Maintenance treatment After finishing the induction treatment, investigator will select 1) 5-FU/LV+BEV (2weeks cycle) or 2) CAP+BEV treatment (3weeks/cycle). 1)5-FU/LV+BEV treatment The following drugs will be administered in 2week/cycle until meeting discontinuation criteria. - Each drug dosage of 5-FU/LV+BEV - Bevacizumab (BEV: 5.0 mg/kg, i.v., 90, 60, 30 min, Day 1) Leucovorin (LV: 200 mg/m2, i.v., 120 min, Day 1) 5-FU (3200 mg/m2, c.i.v., 48 hours, Day 1-3) 2)CAP+BEV treatment The following drugs will be administered in 2week/cycle until meeting discontinuation criteria. - Each Primary outcome(s): Progression-free survival (PFS) Study Design: randomized controlled trial, open(masking not used), active control, parallel assignment, treatment purpose

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Study of Sunitinib in Young Patients with a rare type of cancer of the stomach and bowel.

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