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.
Similar content being viewed by others
References
Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63(1):11–30
Warshaw AL, Lillemoe KD, Castillo CF (2012) Pancreatic surgery for adenocarcinoma. Curr Opin Gastroenterol 28(5):488–493
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):4548–4554
Conroy T et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364(19):1817–1825
Campen CJ, Dragovich T, Baker AF (2011) Management strategies in pancreatic cancer. Am J Health Syst Pharm 68(7):573–584
Abdelrahim M et al (2010) Angiogenesis: an update and potential drug approaches (review). Int J Oncol 36(1):5–18
Kleeff J et al (2007) Pancreatic cancer microenvironment. Int J Cancer 121(4):699–705
Whipple C, Korc M (2008) Targeting angiogenesis in pancreatic cancer: rationale and pitfalls. Langenbecks Arch Surg 393(6):901–910
Garcea G et al (2006) Hypoxia and angiogenesis in pancreatic cancer. ANZ J Surg 76(9):830–842
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):2310–2323
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):1996–2003
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):359–370
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):4162–4171
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):558–565
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):2335–2339
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
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):3955–3964
Schwartz LH et al (2009) Evaluation of lymph nodes with RECIST 1.1. Eur J Cancer 45(2):261–267
Tofts PS (1997) Modeling tracer kinetics in dynamic Gd-DTPA MR imaging. J Magn Reson Imaging 7(1):91–101
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):668–682
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):1960–1966
Rahma OE et al (2013) Second-line treatment in advanced pancreatic cancer: a comprehensive analysis of published clinical trials. Ann Oncol 24(8):1972–1979
Hoos WA et al (2013) Pancreatic cancer clinical trials and accrual in the United States. J Clin Oncol 31(27):3432–3438
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):1676–1681
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):391–397
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:e813
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):753–764
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):3402–3407
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):422–428
Ebrahimi B et al (2004) Cytokines in pancreatic carcinoma: correlation with phenotypic characteristics and prognosis. Cancer 101(12):2727–2736
Jain RK et al (2009) Biomarkers of response and resistance to antiangiogenic therapy. Nat Rev Clin Oncol 6(6):327–338
Jones S et al (2008) Core signaling pathways in human pancreatic cancers revealed by global genomic analyses. Science 321(5897):1801–1806
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):3617–3622
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):2231–2237
Iyer G et al (2012) Genome sequencing identifies a basis for everolimus sensitivity. Science 338(6104):221
Reni M et al (2013) Maintenance sunitinib or observation in metastatic pancreatic adenocarcinoma: a phase II randomised trial. Eur J Cancer 49(17):3609–3615
Acknowledgments
The authors are thankful to Ms. Amy Stoll from TGEN/PCRT, Drs. Denise Roe and Haiyan Cui from Biometry Core at the University of Arizona Cancer Center, and Ms. Tamara Burkhead for the help with trial coordination and manuscript preparation. This work was supported in part by P50 CA95060 (E. Gerner), CA017094, and P30 CA023074 from the National Cancer Institute to University of Arizona Cancer Center (TD and AFB), for correlative science. Additional support for imaging studies was provided by GE Healthcare. Supported by Investigator Initiated Grant (from Novartis) to T.D.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dragovich, T., Laheru, D., Dayyani, F. et al. Phase II trial of vatalanib in patients with advanced or metastatic pancreatic adenocarcinoma after first-line gemcitabine therapy (PCRT O4-001). Cancer Chemother Pharmacol 74, 379–387 (2014). https://doi.org/10.1007/s00280-014-2499-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00280-014-2499-4