Phase II trial of combination bevacizumab and temsirolimus in the treatment of A recurrent or persistent endometrial carcinoma: A Gynecologic Oncology Group study
Article
Alvarez, Edwin A., Brady, William E., Walker, Joan L., Rotmensch, Jacob, Zhou, Xun C., Kendrick, James E., Yamada, S. Diane, Schilder, Jeanne M., Cohn, David E., Harrison, Charles R., Moore, Kathleen N., Aghajanian, Carol
funding text
This study was supported by National Cancer Institute grants to the Gynecologic Oncology Group Administrative Office (CA 27469) and the Gynecologic Oncology Group Statistical and Data Center (CA 37517). Dr. Alvarez was supported, in part, by K12 HD001259-12. The following Gynecologic Oncology Group member institutions participated in this study: Duke University Medical Center, University of Iowa Hospitals and Clinics, Indiana University School of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Washington University School of Medicine, Memorial Sloan-Kettering Cancer Center, Columbus Cancer Council, Fox Chase Cancer Center, University of Oklahoma, University of Chicago,. Case Western Reserve University, The Hospital of Central Connecticut, Georgia Core, Gynecologic Oncology of West Michigan and Community Clinical Oncology Program.
abstract
Objective. This two-stage phase II study was designed to assess the activity of the combination of temsirolimus and bevacizumab in patients with recurrent or persistent endometrial carcinoma (EMC). Methods. Eligible patients had persistent or recurrent EMC after receiving 1-2 prior cytotoxic regimens, measurable disease, and Gynecologic Oncology Group performance status <= 2. Treatment consisted of bevacizumab 10 mg/kg every other week and temsirolimus 25 mg IV weekly until disease progression or prohibitory toxicity. Primary end points were progression-free survival (PFS) at six months and overall response rate using RECIST criteria. Results. Fifty-three patients were enrolled. Forty-nine patients were eligible and evaluable. Median age was 63 years, and prior treatment consisted of one or two regimens in 40 (82%) and 9 (18%), respectively. Twenty (41%) received prior radiation. Adverse events were consistent with those expected with bevacizumab and temsirolimus treatment Two gastrointestinal-vaginal fistulas, one grade 3 epistaxis, two intestinal perforations and 1 grade 4 thrombosis/embolism were seen. Three patient deaths were possibly treatment related. Twelve patients (24.5%) experienced clinical responses (one complete and 11 partial responses), and 23 patients (46.9%) survived progression free for at least six months. Median progression-free survival (PFS) and overall survival (OS) were 5.6 and 16.9 months, respectively. Conclusion. Combination of temsirolimus and bevacizumab is deemed active based on both objective tumor response and PFS at six months in recurrent or persistent EMC. However, this treatment regimen was associated with significant toxicity in this pretreated group. Future study will be guided by strategies to decrease toxicity and increase response rates. (C) 2012 Elsevier Inc. All rights reserved.