Phase II trial of pazopanib in advanced/progressive malignant pheochromocytoma and paraganglioma

Sina Jasim, Vera J. Suman, Camilo Jimenez, Pamela Harris, Kostandinos Sideras, Jill K. Burton, Francis Paul Worden, Richard J. Auchus, Keith C. Bible

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Introduction: Pheochromocytomas and paragangliomas (Pheo/PGL) are rare, vascular, sometimes malignant endocrine tumors. Case reports indicate the activity of vascular endothelium growth factor receptor-targeted kinase inhibitors in these cancers. Objectives: To assess the antitumor activity and tolerability of pazopanib in progressive malignant Pheo/PGL. Patients and methods: This multicenter Phase II trial (MC107C) enrolled individuals ≥18 years old with disease progression ≤ 6 months prior to registration, Eastern Cooperative Oncology Group PS 0–2, and measurable disease (response evaluation criteria in solid tumors 1.0). Pazopanib was administered in 28-day cycles, with the regimen ultimately being as follows: cycle 1: 400 mg daily on days 1–14, cycle 2: 800 mg daily on days 1–14, and then cycle 2 + : 800 mg daily on all days. Results: The study was halted due to poor accrual. Seven patients were enrolled (05/2011–11/2014). One patient withdrew consent prior to treatment, leaving six evaluable patients. Treatment was discontinued, due to the following reasons: disease progression (4); withdrawal (1); and grade 4 (Takotsubo) cardiomyopathy (1). The median number of cycles administered was 4 (range: 2–29, total: 49). Four patients had >1 dose reduction due to the following reasons: fatigue (1), abnormal liver tests (2), hypertension and (Takotsubo) cardiomyopathy (1), and headaches (1). Common severe (Common Terminology Criteria for Adverse Events v3.0 grades 3–5) toxicities were as follows: hypertension (3/6), (Takotsubo) cardiomyopathy (2/6), diarrhea (1/6), fatigue (1/6), headache (1/6), and hematuria (1/6). One confirmed partial response was observed in PGL (17%, duration 2.4 years); median progression-free survival and overall survival were 6.5 and 14.8 months, respectively. Conclusion: Pazopanib has activity in Pheo/PGL requiring more study; optimal alpha- and beta-blockade are imperative pre-therapy in patients with secretory tumors, as risk of hypertension and cardiomyopathy are potentially life threatening.

Original languageEnglish (US)
Pages (from-to)220-225
Number of pages6
JournalEndocrine
Volume57
Issue number2
DOIs
StatePublished - Aug 1 2017

Keywords

  • Metastatic
  • Paraganglioma
  • Pazopanib
  • Takotsubo cardiomyopathy

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Jasim, S., Suman, V. J., Jimenez, C., Harris, P., Sideras, K., Burton, J. K., Worden, F. P., Auchus, R. J., & Bible, K. C. (2017). Phase II trial of pazopanib in advanced/progressive malignant pheochromocytoma and paraganglioma. Endocrine, 57(2), 220-225. https://doi.org/10.1007/s12020-017-1359-5