Sutent and Radiation as Treatment for Limited Extent Metastatic Cancer
| Status: | Completed |
|---|---|
| Conditions: | Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 7/20/2018 |
| Start Date: | January 2007 |
| End Date: | July 2014 |
Phase I/II Study of Stereotactic Radiation Therapy and Concurrent and Adjuvant Sutent (SU11248) as Treatment for Oligometastatic Disease
Cancer is the second leading cause of death in the United States, with approximately 90% of
deaths resulting from patients with metastatic spread. Save for notable exceptions such as
testicular cancer, chemotherapy alone cannot cure patients with metastases. Some patients
with limited metastatic deposits (most commonly colon cancer spread to the liver) can be
cured with surgery followed by chemotherapy. Therefore, some patients with metastases should
be considered for aggressive local therapy (surgery and/or radiation).
Even though chemotherapy has improved significantly, patients treated with conventional
chemotherapy and/or biologically targeted therapy are not cured of their disease. For the
most common types of cancer, chemotherapy alone can shrink or stabilize tumors for an average
of 6 months before the tumors regrow. Both chemotherapy and biologically targeted therapy
have major limitations preventing cure of these patients.
Radiation therapy is an effective modality of treating cancer. Until recently, radiation for
metastases was used only to relieve symptoms resulting from local tumor growth. Technological
advances, including stereotactic radiotherapy, allow for radiation to be more precisely
delivered to the tumor while sparing nearby normal organs. Stereotactic radiotherapy can
completely eradicate local tumors with minimal side effects. Stereotactic radiotherapy has
never been combined with drug therapy. Sutent is a new F.D.A. approved cancer therapy that
targets tumor blood vessels. It is effective against two types of cancer that rarely respond
to chemotherapy (GI stromal tumors and kidney cancer). We propose combining biologically
targeted drug therapy with physically targeted stereotactic radiotherapy. Our goal is to
determine if this is a safe regimen and the best method of combining these treatments.
Ultimately, our goal is to cure some patients with previously incurable metastatic cancer
with this combination.
deaths resulting from patients with metastatic spread. Save for notable exceptions such as
testicular cancer, chemotherapy alone cannot cure patients with metastases. Some patients
with limited metastatic deposits (most commonly colon cancer spread to the liver) can be
cured with surgery followed by chemotherapy. Therefore, some patients with metastases should
be considered for aggressive local therapy (surgery and/or radiation).
Even though chemotherapy has improved significantly, patients treated with conventional
chemotherapy and/or biologically targeted therapy are not cured of their disease. For the
most common types of cancer, chemotherapy alone can shrink or stabilize tumors for an average
of 6 months before the tumors regrow. Both chemotherapy and biologically targeted therapy
have major limitations preventing cure of these patients.
Radiation therapy is an effective modality of treating cancer. Until recently, radiation for
metastases was used only to relieve symptoms resulting from local tumor growth. Technological
advances, including stereotactic radiotherapy, allow for radiation to be more precisely
delivered to the tumor while sparing nearby normal organs. Stereotactic radiotherapy can
completely eradicate local tumors with minimal side effects. Stereotactic radiotherapy has
never been combined with drug therapy. Sutent is a new F.D.A. approved cancer therapy that
targets tumor blood vessels. It is effective against two types of cancer that rarely respond
to chemotherapy (GI stromal tumors and kidney cancer). We propose combining biologically
targeted drug therapy with physically targeted stereotactic radiotherapy. Our goal is to
determine if this is a safe regimen and the best method of combining these treatments.
Ultimately, our goal is to cure some patients with previously incurable metastatic cancer
with this combination.
Inclusion Criteria:
- Zubrod Performance Scale 0-1
- Metastatic disease confirmed by biopsy or imaging
- 5 or fewer sites of metastatic disease on tumor staging (either CT
chest/abdomen/pelvis plus bone scan or whole body FDG-PET)
- All tumors measure < 6 cm
- Age > 18
- Chemotherapy must be completed at least 2 weeks prior to radiation
- Signed informed consent
- Adequate bone marrow function, defined as follows;
1. Platelets > 100,000 cells/mm3 based upon CBC/differential obtained within 2 weeks
prior to registration on study
2. Absolute neutrophil count (ANC) > 1,800 cells/mm3 based on CBC/differential
obtained within 2 weeks prior to registration on study
3. Hemoglobin > 8.0 g/dl based upon CBC/differential obtained within 2 weeks prior
to registration on study (Note: The use of transfusion or other intervention to
achieve Hgb > 8.0 g/dt is acceptable.)
Exclusion Criteria:
- Other coexisting malignancies or malignancies diagnosed within the previous 3 years
with the exception of basal cell carcinoma, cervical carcinoma in situ, and other
treated malignancies with no evidence of disease for at least 3 years
- Uncontrolled intercurrent illness including, but not limited to, ongoing active
infection, symptomatic congestive heart failure (CHF), unstable angina pectoris,
cardiac arrhythmia, or psychiatric illness/social situations that would limit
compliance with the study requirements
- Patients with clinically significant pulmonary dysfunction, cardiomyopathy, or any
history of clinically significant CHF are excluded. The exclusion of patients with
active coronary heart disease will be at the discretion of the attending physician.
- Patients with exudative, bloody, or cytologically malignant effusions are not
eligible.
- Pregnancy or breast feeding (Women of child-bearing potential are eligible, but must
consent to using effective contraception during therapy and for at least 3 months
after completing therapy)
- Patients must have no uncontrolled active infection other than that not curable
without treatment of their cancer.
- Prior radiation to target area
- Patient may not be receiving any other investigational agents during radiotherapy.
- Prior history of non-inducible bleeding (12/16/09).
- Requirement for continuation of anticoagulation (defined as Coumadin, lovenox,
heparin, plavix, aspirin, NSAIDs or similar drugs) during treatment (12/16/09)
- Under 18 years of age
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