Study to the Optimal Duration of Therapy With Oral Angiogenesis Inhibitors

Study to the Optimal Duration of Therapy With Oral Angiogenesis Inhibitors

Gastrointestinal Stromal Tumor

Unknown

4

Start Date 10/08/2008

Age of Trial (yrs) 15.9

Gleevec-resistant

VEGFR inhibitor (TKI)

Block tumor blood vessel growth

Specifically GIST plus other cancers

UMCNONCO200801

Radboud University

See site contact info below

Randomized

Oral

Patient must have been treated with angiogenesis inhibitors for at least 12 weeks.

Until now, in trials it is common to stop therapy when progressive disease occurs; RECIST criteria are used, in which progressive disease is defined as >20% increase of the sum of the longest diameter of the lesions, or occurence of new lesions. However, angiogenesis inhibitors have a rather cytostatic than cytotoxic effect compared to chemotherapeutics, as a result of which less frequently reduction of tumor volume is being seen.

Often in the centre of the lesion necrosis is shown. Sometimes accompanied with edema; so even tumorvolume increase can be the result without real progression being the case. Recently, in our clinic, we found a number of patients, treated with oral angiogenesis inhibitors, a remarkable quickening of progressive disease and complaints after stopping this treatment. Reintroduction of the same or another type of angiogenesis inhibitor subsequently lead to a new stabilization. The causuality of this phenomenom is unknown. Perhaps that the inhibitory effect of the angiogenesis is not fully exhausted at the moment that progressive disease on CT is observed. An alternative explanation is contrareaction of longterm angiogenetic inhibition through upregulation of proangiogenic factors with subsequent vascular expansion and edema. This study means to gain more insight information about the optimal treatment policy when progressive disease is found in patients treated with oral angiogenesis inhibitors. Because of the increase of patients that is being treated with these products, both in trials as in daily clinical practice, this is important to investigate.