Study of Mutation-Targeted Therapy With Sunitinib or Everolimus in People With Advanced Low- or Intermediate-Grade Neuroendocrine Tumors of the Gastrointestinal Tract and Pancreas With or Without Cytoreductive Surgery

Summary

Background: \- Neuroendocrine tumors (NETs) come from cells of the hormonal and nervous systems. Some people have surgery to shrink the tumor. Sometimes the tumors come back. Researchers think that treatment with drugs based on knowing the defective gene might give better results. Objective: \- To see if drugs selected based on the defective gene result in better tumor response. The drugs are Sunitinib and Everolimus. Eligibility: \- People age 18 and older with an advanced low- or intermediate-grade gastrointestinal or pancreatic neuroendocrine tumor. Design: * Participants will be screened with: * Medical history * Physical exam * Scans * Blood, urine, and lab tests * The study team will see if participants should have surgery. * If yes, participants will: * Sign a separate consent * Have computed tomography (CT) scan before and after surgery * Have as much of the tumor removed as possible. A small piece will be tested for mutation type. * If no, participants will have a small piece of tumor removed for the testing. * If the surgery might cure them, the participant will leave the study. The other participants will be assigned to take either Sunitinib or Everolimus. * Participants will take their drug by mouth once a day. They will keep a medicine diary. Some will keep track of their blood pressure at least weekly. * Screening tests may be repeated at study visits. Participants also may have their heart evaluated. * About 30 days after the last day of their study drug, participants will have a follow-up visit that repeats the screening tests. * Participants will be contacted every 3 months after this visit.

Timeline

Start

2015-04-08

Primary completion

2019-05-22

Completion

2019-05-22

Outcome

Outcome not reported

Stopped (Enrollment): “Study closed due to poor accrual.”

Publications

• Background Gan HK, Seruga B, Knox JJ. Sunitinib in solid tumors. Expert Opin Investig Drugs. 2009 Jun;18(6):821-34. doi: 10.1517/13543780902980171.
• Background Tanaka C, O'Reilly T, Kovarik JM, Shand N, Hazell K, Judson I, Raymond E, Zumstein-Mecker S, Stephan C, Boulay A, Hattenberger M, Thomas G, Lane HA. Identifying optimal biologic doses of everolimus (RAD001) in patients with cancer based on the modeling of preclinical and clinical pharmacokinetic and pharmacodynamic data. J Clin Oncol. 2008 Apr 1;26(10):1596-602. doi: 10.1200/JCO.2007.14.1127. Epub 2008 Mar 10.
• Background Khagi S, Saif MW. Neuroendocrine tumors: treatment updates. JOP. 2013 Jul 10;14(4):367-71. doi: 10.6092/1590-8577/1657.
• Results Neychev V, Steinberg SM, Cottle-Delisle C, Merkel R, Nilubol N, Yao J, Meltzer P, Pacak K, Marx S, Kebebew E. Mutation-targeted therapy with sunitinib or everolimus in patients with advanced low-grade or intermediate-grade neuroendocrine tumours of the gastrointestinal tract and pancreas with or without cytoreductive surgery: protocol for a phase II clinical trial. BMJ Open. 2015 May 19;5(5):e008248. doi: 10.1136/bmjopen-2015-008248.
• Results Tirosh A, Killian JK, Zhu YJ, Petersen D, Walling J, Mor-Cohen R, Neychev V, Stevenson H, Keutgen XM, Patel D, Nilubol N, Meltzer P, Kebebew E. ONCOGENE PANEL SEQUENCING ANALYSIS IDENTIFIES CANDIDATE ACTIONABLE GENES IN ADVANCED WELL-DIFFERENTIATED GASTROENTEROPANCREATIC NEUROENDOCRINE TUMORS. Endocr Pract. 2019 Jun;25(6):580-588. doi: 10.4158/EP-2018-0603. Epub 2019 Mar 13.
• Neychev V, Sadowski SM, Zhu J, Allgaeuer M, Kilian K, Meltzer P, Kebebew E. Neuroendocrine Tumor of the Pancreas as a Manifestation of Cowden Syndrome: A Case Report. J Clin Endocrinol Metab. 2016 Feb;101(2):353-8. doi: 10.1210/jc.2015-3684. Epub 2015 Dec 17.

Drugs

Indications