Skip to main content
Top
Published in: Cancer Chemotherapy and Pharmacology 2/2014

01-08-2014 | Original Article

Phase II trial of vatalanib in patients with advanced or metastatic pancreatic adenocarcinoma after first-line gemcitabine therapy (PCRT O4-001)

Authors: T. Dragovich, D. Laheru, F. Dayyani, V. Bolejack, L. Smith, J. Seng, H. Burris, P. Rosen, M. Hidalgo, P. Ritch, A. F. Baker, N. Raghunand, J. Crowley, D. D. Von Hoff

Published in: Cancer Chemotherapy and Pharmacology | Issue 2/2014

Login to get access

Abstract

Purpose

Vatalanib (PTK 787/ZK22584) is an oral poly-tyrosine kinase inhibitor with strong affinity for platelet-derived growth factor and vascular endothelial growth factor (VEGF) receptors. We conducted an open-label, phase II multicenter therapeutic trial investigating the efficacy and tolerability of vatalanib in patients with metastatic or advanced pancreatic cancer who failed first-line gemcitabine-based therapy.

Methods

Vatalanib treatment consisted of a twice daily oral dosing using a “ramp-up schedule,” beginning with 250 mg bid during week 1,500 mg bid during week 2, and 750 mg bid on week three and thereafter. The primary objective of this study was to evaluate the 6-month survival rate.

Results

Sixty-seven patients were enrolled. The median age was 64, and 66 % (N = 43) had only one prior regimen. Common grade 3/4 adverse events included hypertension (20 %; N = 13), fatigue (17 %; N = 11), abdominal pain (17 %; N = 11), and elevated alkaline phosphatase (15 %; N = 10). Among the 65 evaluable patients, the 6-month survival rate was 29 % (95 % CI 18–41 %) and the median progression-free survival was 2 months. Fifteen patients survived 6 months or more. Two patients had objective partial responses, and 28 % of patients had stable disease. Changes in biomarkers including soluble VEGF and vascular endothelial growth factor receptor did not correlate with response to drug.

Conclusion

Vatalanib was well tolerated as a second-line therapy and resulted in favorable 6-month survival rate in patients with metastatic pancreatic cancer, compared with historic controls.
Literature
1.
2.
go back to reference Warshaw AL, Lillemoe KD, Castillo CF (2012) Pancreatic surgery for adenocarcinoma. Curr Opin Gastroenterol 28(5):488–493PubMedCrossRef Warshaw AL, Lillemoe KD, Castillo CF (2012) Pancreatic surgery for adenocarcinoma. Curr Opin Gastroenterol 28(5):488–493PubMedCrossRef
3.
go back to reference Von Hoff DD et al (2011) Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial. J Clin Oncol 29(34):4548–4554CrossRef Von Hoff DD et al (2011) Gemcitabine plus nab-paclitaxel is an active regimen in patients with advanced pancreatic cancer: a phase I/II trial. J Clin Oncol 29(34):4548–4554CrossRef
4.
go back to reference Conroy T et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364(19):1817–1825PubMedCrossRef Conroy T et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364(19):1817–1825PubMedCrossRef
5.
go back to reference Campen CJ, Dragovich T, Baker AF (2011) Management strategies in pancreatic cancer. Am J Health Syst Pharm 68(7):573–584PubMedCrossRef Campen CJ, Dragovich T, Baker AF (2011) Management strategies in pancreatic cancer. Am J Health Syst Pharm 68(7):573–584PubMedCrossRef
6.
go back to reference Abdelrahim M et al (2010) Angiogenesis: an update and potential drug approaches (review). Int J Oncol 36(1):5–18PubMed Abdelrahim M et al (2010) Angiogenesis: an update and potential drug approaches (review). Int J Oncol 36(1):5–18PubMed
8.
go back to reference Whipple C, Korc M (2008) Targeting angiogenesis in pancreatic cancer: rationale and pitfalls. Langenbecks Arch Surg 393(6):901–910PubMedCrossRef Whipple C, Korc M (2008) Targeting angiogenesis in pancreatic cancer: rationale and pitfalls. Langenbecks Arch Surg 393(6):901–910PubMedCrossRef
9.
10.
go back to reference Bold G et al (2000) New anilinophthalazines as potent and orally well absorbed inhibitors of the VEGF receptor tyrosine kinases useful as antagonists of tumor-driven angiogenesis. J Med Chem 43(12):2310–2323PubMedCrossRef Bold G et al (2000) New anilinophthalazines as potent and orally well absorbed inhibitors of the VEGF receptor tyrosine kinases useful as antagonists of tumor-driven angiogenesis. J Med Chem 43(12):2310–2323PubMedCrossRef
11.
go back to reference Baker CH, Solorzano CC, Fidler IJ (2002) Blockade of vascular endothelial growth factor receptor and epidermal growth factor receptor signaling for therapy of metastatic human pancreatic cancer. Cancer Res 62(7):1996–2003PubMed Baker CH, Solorzano CC, Fidler IJ (2002) Blockade of vascular endothelial growth factor receptor and epidermal growth factor receptor signaling for therapy of metastatic human pancreatic cancer. Cancer Res 62(7):1996–2003PubMed
12.
go back to reference Solorzano CC et al (2001) Inhibition of growth and metastasis of human pancreatic cancer growing in nude mice by PTK 787/ZK222584, an inhibitor of the vascular endothelial growth factor receptor tyrosine kinases. Cancer Biother Radiopharm 16(5):359–370PubMedCrossRef Solorzano CC et al (2001) Inhibition of growth and metastasis of human pancreatic cancer growing in nude mice by PTK 787/ZK222584, an inhibitor of the vascular endothelial growth factor receptor tyrosine kinases. Cancer Biother Radiopharm 16(5):359–370PubMedCrossRef
13.
go back to reference Thomas AL et al (2005) Phase I study of the safety, tolerability, pharmacokinetics, and pharmacodynamics of PTK787/ZK 222584 administered twice daily in patients with advanced cancer. J Clin Oncol 23(18):4162–4171PubMedCrossRef Thomas AL et al (2005) Phase I study of the safety, tolerability, pharmacokinetics, and pharmacodynamics of PTK787/ZK 222584 administered twice daily in patients with advanced cancer. J Clin Oncol 23(18):4162–4171PubMedCrossRef
14.
go back to reference Drevs J et al (2005) Soluble markers for the assessment of biological activity with PTK787/ZK 222584 (PTK/ZK), a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor in patients with advanced colorectal cancer from two phase I trials. Ann Oncol 16(4):558–565PubMedCrossRef Drevs J et al (2005) Soluble markers for the assessment of biological activity with PTK787/ZK 222584 (PTK/ZK), a vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitor in patients with advanced colorectal cancer from two phase I trials. Ann Oncol 16(4):558–565PubMedCrossRef
15.
go back to reference Drevs J et al (2010) A phase IA, open-label, dose-escalating study of PTK787/ZK 222584 administered orally on a continuous dosing schedule in patients with advanced cancer. Anticancer Res 30(6):2335–2339PubMed Drevs J et al (2010) A phase IA, open-label, dose-escalating study of PTK787/ZK 222584 administered orally on a continuous dosing schedule in patients with advanced cancer. Anticancer Res 30(6):2335–2339PubMed
16.
go back to reference Hecht JR et al (2011) Randomized, placebo-controlled, phase III study of first-line oxaliplatin-based chemotherapy plus PTK787/ZK 222584, an oral vascular endothelial growth factor receptor inhibitor, in patients with metastatic colorectal adenocarcinoma. J Clin Oncol 29(15):1997–2003. doi:10.1200/JCO.2010.29.4496 PubMedCrossRef Hecht JR et al (2011) Randomized, placebo-controlled, phase III study of first-line oxaliplatin-based chemotherapy plus PTK787/ZK 222584, an oral vascular endothelial growth factor receptor inhibitor, in patients with metastatic colorectal adenocarcinoma. J Clin Oncol 29(15):1997–2003. doi:10.​1200/​JCO.​2010.​29.​4496 PubMedCrossRef
17.
go back to reference Morgan B et al (2003) Dynamic contrast-enhanced magnetic resonance imaging as a biomarker for the pharmacological response of PTK787/ZK 222584, an inhibitor of the vascular endothelial growth factor receptor tyrosine kinases, in patients with advanced colorectal cancer and liver metastases: results from two phase I studies. J Clin Oncol 21(21):3955–3964PubMedCrossRef Morgan B et al (2003) Dynamic contrast-enhanced magnetic resonance imaging as a biomarker for the pharmacological response of PTK787/ZK 222584, an inhibitor of the vascular endothelial growth factor receptor tyrosine kinases, in patients with advanced colorectal cancer and liver metastases: results from two phase I studies. J Clin Oncol 21(21):3955–3964PubMedCrossRef
18.
19.
go back to reference Tofts PS (1997) Modeling tracer kinetics in dynamic Gd-DTPA MR imaging. J Magn Reson Imaging 7(1):91–101PubMedCrossRef Tofts PS (1997) Modeling tracer kinetics in dynamic Gd-DTPA MR imaging. J Magn Reson Imaging 7(1):91–101PubMedCrossRef
20.
go back to reference Rajaraman S et al (2011) Automated registration of sequential breath-hold dynamic contrast-enhanced MR images: a comparison of three techniques. Magn Reson Imaging 29(5):668–682PubMedCentralPubMedCrossRef Rajaraman S et al (2011) Automated registration of sequential breath-hold dynamic contrast-enhanced MR images: a comparison of three techniques. Magn Reson Imaging 29(5):668–682PubMedCentralPubMedCrossRef
21.
go back to reference Moore MJ et al (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 25(15):1960–1966PubMedCrossRef Moore MJ et al (2007) Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 25(15):1960–1966PubMedCrossRef
22.
go back to reference Rahma OE et al (2013) Second-line treatment in advanced pancreatic cancer: a comprehensive analysis of published clinical trials. Ann Oncol 24(8):1972–1979PubMedCrossRef Rahma OE et al (2013) Second-line treatment in advanced pancreatic cancer: a comprehensive analysis of published clinical trials. Ann Oncol 24(8):1972–1979PubMedCrossRef
23.
go back to reference Hoos WA et al (2013) Pancreatic cancer clinical trials and accrual in the United States. J Clin Oncol 31(27):3432–3438PubMedCrossRef Hoos WA et al (2013) Pancreatic cancer clinical trials and accrual in the United States. J Clin Oncol 31(27):3432–3438PubMedCrossRef
24.
go back to reference Pelzer U et al (2011) Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: a phase III-study from the German CONKO-study group. Eur J Cancer 47(11):1676–1681PubMedCrossRef Pelzer U et al (2011) Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: a phase III-study from the German CONKO-study group. Eur J Cancer 47(11):1676–1681PubMedCrossRef
25.
go back to reference Saif MW (2008) New developments in the treatment of pancreatic cancer. Highlights from the “44th ASCO Annual Meeting”. Chicago, IL, USA. May 30–June 3, 2008. JOP 9(4):391–397PubMed Saif MW (2008) New developments in the treatment of pancreatic cancer. Highlights from the “44th ASCO Annual Meeting”. Chicago, IL, USA. May 30–June 3, 2008. JOP 9(4):391–397PubMed
26.
go back to reference Bafeta A et al (2012) Impact of single centre status on estimates of intervention effects in trials with continuous outcomes: meta-epidemiological study. BMJ 344:e813PubMedCentralPubMedCrossRef Bafeta A et al (2012) Impact of single centre status on estimates of intervention effects in trials with continuous outcomes: meta-epidemiological study. BMJ 344:e813PubMedCentralPubMedCrossRef
27.
go back to reference Morabito A et al (2006) Tyrosine kinase inhibitors of vascular endothelial growth factor receptors in clinical trials: current status and future directions. Oncologist 11(7):753–764PubMedCrossRef Morabito A et al (2006) Tyrosine kinase inhibitors of vascular endothelial growth factor receptors in clinical trials: current status and future directions. Oncologist 11(7):753–764PubMedCrossRef
28.
go back to reference Armstrong AJ, George DJ, Halabi S (2012) Serum lactate dehydrogenase predicts for overall survival benefit in patients with metastatic renal cell carcinoma treated with inhibition of mammalian target of rapamycin. J Clin Oncol 30(27):3402–3407PubMedCrossRef Armstrong AJ, George DJ, Halabi S (2012) Serum lactate dehydrogenase predicts for overall survival benefit in patients with metastatic renal cell carcinoma treated with inhibition of mammalian target of rapamycin. J Clin Oncol 30(27):3402–3407PubMedCrossRef
29.
go back to reference Weide B et al (2012) Serum markers lactate dehydrogenase and S100B predict independently disease outcome in melanoma patients with distant metastasis. Br J Cancer 107(3):422–428PubMedCentralPubMedCrossRef Weide B et al (2012) Serum markers lactate dehydrogenase and S100B predict independently disease outcome in melanoma patients with distant metastasis. Br J Cancer 107(3):422–428PubMedCentralPubMedCrossRef
30.
go back to reference Ebrahimi B et al (2004) Cytokines in pancreatic carcinoma: correlation with phenotypic characteristics and prognosis. Cancer 101(12):2727–2736PubMedCrossRef Ebrahimi B et al (2004) Cytokines in pancreatic carcinoma: correlation with phenotypic characteristics and prognosis. Cancer 101(12):2727–2736PubMedCrossRef
32.
33.
go back to reference Kindler HL et al (2010) Gemcitabine plus bevacizumab compared with gemcitabine plus placebo in patients with advanced pancreatic cancer: phase III trial of the Cancer and Leukemia Group B (CALGB 80303). J Clin Oncol 28(22):3617–3622PubMedCentralPubMedCrossRef Kindler HL et al (2010) Gemcitabine plus bevacizumab compared with gemcitabine plus placebo in patients with advanced pancreatic cancer: phase III trial of the Cancer and Leukemia Group B (CALGB 80303). J Clin Oncol 28(22):3617–3622PubMedCentralPubMedCrossRef
34.
go back to reference Van Cutsem E et al (2009) Phase III trial of bevacizumab in combination with gemcitabine and erlotinib in patients with metastatic pancreatic cancer. J Clin Oncol 27(13):2231–2237PubMedCrossRef Van Cutsem E et al (2009) Phase III trial of bevacizumab in combination with gemcitabine and erlotinib in patients with metastatic pancreatic cancer. J Clin Oncol 27(13):2231–2237PubMedCrossRef
36.
go back to reference Reni M et al (2013) Maintenance sunitinib or observation in metastatic pancreatic adenocarcinoma: a phase II randomised trial. Eur J Cancer 49(17):3609–3615PubMedCrossRef Reni M et al (2013) Maintenance sunitinib or observation in metastatic pancreatic adenocarcinoma: a phase II randomised trial. Eur J Cancer 49(17):3609–3615PubMedCrossRef
Metadata
Title
Phase II trial of vatalanib in patients with advanced or metastatic pancreatic adenocarcinoma after first-line gemcitabine therapy (PCRT O4-001)
Authors
T. Dragovich
D. Laheru
F. Dayyani
V. Bolejack
L. Smith
J. Seng
H. Burris
P. Rosen
M. Hidalgo
P. Ritch
A. F. Baker
N. Raghunand
J. Crowley
D. D. Von Hoff
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
Cancer Chemotherapy and Pharmacology / Issue 2/2014
Print ISSN: 0344-5704
Electronic ISSN: 1432-0843
DOI
https://doi.org/10.1007/s00280-014-2499-4

Other articles of this Issue 2/2014

Cancer Chemotherapy and Pharmacology 2/2014 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine