NCT00318513

Brief Summary

The purpose of this study is to determine the safety and side effects of bevacizumab in subjects with lymphedema who will initially receive bevacizumab alone and then in combination with standard manual lymphatic drainage (MLD) and combined decongestive therapy (CDT). This study will help to determine the dose of bevacizumab to be used in future studies of subjects with lymphedema.

Trial Health

55
Monitor

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
35

participants targeted

Target at P50-P75 for phase_1

Geographic Reach
1 country

1 active site

Status
unknown

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

First Submitted

Initial submission to the registry

April 24, 2006

Completed
2 days until next milestone

First Posted

Study publicly available on registry

April 26, 2006

Completed
Last Updated

May 10, 2006

Status Verified

April 1, 2006

First QC Date

April 24, 2006

Last Update Submit

May 9, 2006

Conditions

Keywords

breast cancerlymphedemaextremitywomen

Interventions

Eligibility Criteria

Age0 Years+
Sexfemale
Healthy VolunteersNo
Age GroupsChild (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

  • Women with a history of breast cancer status post (s/p) prior surgical resection (i.e., either lumpectomy and radiation, modified radical mastectomy or radical mastectomy) with lymphedema defined as a difference in limb volume of at least 500 ml by perometric assessment
  • Lymphedema may be newly diagnosed or previously treated as long as it is Stage I (pitting) or II (fibrosis) at the time of study entry.
  • No known evidence of recurrent or active metastatic breast cancer
  • No prior chemotherapy within 6 months of study entry and has recovered to grade 1 or less from the toxicity of all prior chemotherapy or radiation therapy (with the exception of alopecia); ongoing anti-estrogen therapy for post-menopausal survivors is permissible.
  • Normal end organ function defined as: serum creatinine \< 1.5 mg/dl or a calculated creatinine clearance \> 50 ml/min; SGOT and SGPT \< 2.5 X upper limit of normal (ULN); total bilirubin \< 1.5 X ULN; absolute neutrophil count (ANC) \> 1,500 cells/µl; hemoglobin \> 10 g/dl (without transfusions); platelet count \> 100,000/µl; serum albumin within normal limits (WNL).

You may not qualify if:

  • Stage III (lymphostatic elephantiasis) lymphedema
  • Clinical evidence of bilateral lymphedema. Those patients who have undergone bilateral breast cancer surgery or prophylactic mastectomy on the non-cancerous breast will be excluded.
  • Any prior history of deep venous thrombosis (DVT) or pulmonary embolus (with the exception of prior line-related thrombotic events) or myocardial infarction (MI), cerebrovascular accident (CVA) or any other arterial thromboembolic event (i.e., transient ischemic attack \[TIA\], reversible ischemic neurologic deficit \[RIND\], history of angina pectoris, clinically significant peripheral vascular disease with claudication, etc.)
  • Patients with problems with wound healing (e.g., diabetic ulcers), gastrointestinal fistula
  • Patients receiving therapeutic anti-coagulation including full dose aspirin or non-steroidal anti-inflammatory agents known to inhibit platelet function (low dose coumadin for port prophylaxis and low dose aspirin are allowed)
  • Untreated hypertension with a baseline systolic blood pressure (SBP) of \> 150 mmHg or a diastolic blood pressure (DBP) \>100 mmHg will be excluded (stable treated hypertension with values less than those noted will be eligible).
  • A history of infectious complications of the involved arm or those with any contraindication to MLD + CB \[e.g., congestive heart failure (CHF), DVT, acute or chronic renal failure\] will be excluded.
  • Women with a history of CHF \[New York Heart Association (NYHA) Class II or greater\] will be excluded.
  • Pregnant or breast-feeding
  • Unwilling to use an appropriate form of barrier contraception for the duration of the study and for three months following the last dose of bevacizumab
  • Those patients who are actively undergoing MLD and/or CB at the time of study entry and for up to 4 weeks prior to entry
  • Unable to provide written informed consent or to comply with study procedures
  • Baseline urine protein : creatinine ratio \> 1.0
  • Known evidence of a bleeding diathesis or coagulopathy

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (1)

Premiere Oncology of Arizona

Scottsdale, Arizona, 85260, United States

Location

Related Publications (45)

  • Velanovich V, Szymanski W. Quality of life of breast cancer patients with lymphedema. Am J Surg. 1999 Mar;177(3):184-7; discussion 188. doi: 10.1016/s0002-9610(99)00008-2.

    PMID: 10219851BACKGROUND
  • Yeoh EK, Denham JW, Davies SA, Spittle MF. Primary breast cancer. Complications of axillary management. Acta Radiol Oncol. 1986 Mar-Apr;25(2):105-8. doi: 10.3109/02841868609136386.

    PMID: 3012953BACKGROUND
  • Brennan MJ, DePompolo RW, Garden FH. Focused review: postmastectomy lymphedema. Arch Phys Med Rehabil. 1996 Mar;77(3 Suppl):S74-80. doi: 10.1016/s0003-9993(96)90248-8.

    PMID: 8599548BACKGROUND
  • Kobayashi MR, Miller TA. Lymphedema. Clin Plast Surg. 1987 Apr;14(2):303-13.

    PMID: 3555946BACKGROUND
  • Mortimer PS. The pathophysiology of lymphedema. Cancer. 1998 Dec 15;83(12 Suppl American):2798-802. doi: 10.1002/(sici)1097-0142(19981215)83:12b+3.3.co;2-5.

    PMID: 9874400BACKGROUND
  • Bates DO, Levick JR, Mortimer PS. Starling pressures in the human arm and their alteration in postmastectomy oedema. J Physiol. 1994 Jun 1;477(Pt 2):355-63. doi: 10.1113/jphysiol.1994.sp020197.

    PMID: 7932226BACKGROUND
  • Svensson WE, Mortimer PS, Tohno E, Cosgrove DO. Increased arterial inflow demonstrated by Doppler ultrasound in arm swelling following breast cancer treatment. Eur J Cancer. 1994;30A(5):661-4. doi: 10.1016/0959-8049(94)90540-1.

    PMID: 8080683BACKGROUND
  • Stanton AW, Holroyd B, Northfield JW, Levick JR, Mortimer PS. Forearm blood flow measured by venous occlusion plethysmography in healthy subjects and in women with postmastectomy oedema. Vasc Med. 1998;3(1):3-8. doi: 10.1177/1358836X9800300102.

    PMID: 9666525BACKGROUND
  • Mellor RH, Stanton AW, Menadue L, Levick JR, Mortimer PS. Evidence for dermal angiogenesis in breast cancer related lymphedema demonstrated using dual-site fluorescence angiography. Microcirculation. 2002 Jul;9(3):207-19. doi: 10.1038/sj.mn.7800133.

    PMID: 12080418BACKGROUND
  • Roberts CC, Stanton AW, Pullen J, Bull RH, Levick JR, Mortimer PS. Skin microvascular architecture and perfusion studied in human postmastectomy oedema by intravital video-capillaroscopy. Int J Microcirc Clin Exp. 1994 Nov-Dec;14(6):327-34. doi: 10.1159/000178851.

    PMID: 7543461BACKGROUND
  • Mellor RH, Bush NL, Stanton AW, Bamber JC, Levick JR, Mortimer PS. Dual-frequency ultrasound examination of skin and subcutis thickness in breast cancer-related lymphedema. Breast J. 2004 Nov-Dec;10(6):496-503. doi: 10.1111/j.1075-122X.2004.21458.x.

    PMID: 15569205BACKGROUND
  • Brown LF, Yeo KT, Berse B, Yeo TK, Senger DR, Dvorak HF, van de Water L. Expression of vascular permeability factor (vascular endothelial growth factor) by epidermal keratinocytes during wound healing. J Exp Med. 1992 Nov 1;176(5):1375-9. doi: 10.1084/jem.176.5.1375.

    PMID: 1402682BACKGROUND
  • Dvorak HF, Brown LF, Detmar M, Dvorak AM. Vascular permeability factor/vascular endothelial growth factor, microvascular hyperpermeability, and angiogenesis. Am J Pathol. 1995 May;146(5):1029-39.

    PMID: 7538264BACKGROUND
  • Dvorak HF. Vascular permeability factor/vascular endothelial growth factor: a critical cytokine in tumor angiogenesis and a potential target for diagnosis and therapy. J Clin Oncol. 2002 Nov 1;20(21):4368-80. doi: 10.1200/JCO.2002.10.088.

    PMID: 12409337BACKGROUND
  • Yoshiji H, Kuriyama S, Hicklin DJ, Huber J, Yoshii J, Ikenaka Y, Noguchi R, Nakatani T, Tsujinoue H, Fukui H. The vascular endothelial growth factor receptor KDR/Flk-1 is a major regulator of malignant ascites formation in the mouse hepatocellular carcinoma model. Hepatology. 2001 Apr;33(4):841-7. doi: 10.1053/jhep.2001.23312.

    PMID: 11283848BACKGROUND
  • Yuan F, Chen Y, Dellian M, Safabakhsh N, Ferrara N, Jain RK. Time-dependent vascular regression and permeability changes in established human tumor xenografts induced by an anti-vascular endothelial growth factor/vascular permeability factor antibody. Proc Natl Acad Sci U S A. 1996 Dec 10;93(25):14765-70. doi: 10.1073/pnas.93.25.14765.

    PMID: 8962129BACKGROUND
  • Infanger M, Schmidt O, Kossmehl P, Grad S, Ertel W, Grimm D. Vascular endothelial growth factor serum level is strongly enhanced after burn injury and correlated with local and general tissue edema. Burns. 2004 Jun;30(4):305-11. doi: 10.1016/j.burns.2003.12.006.

    PMID: 15145186BACKGROUND
  • Goto T, Fujigaki Y, Sun DF, Yamamoto T, Hishida A. Plasma protein extravasation and vascular endothelial growth factor expression with endothelial nitric oxide synthase induction in gentamicin-induced acute renal failure in rats. Virchows Arch. 2004 Apr;444(4):362-74. doi: 10.1007/s00428-004-0977-5. Epub 2004 Feb 24.

    PMID: 14986132BACKGROUND
  • Nagy JA, Vasile E, Feng D, Sundberg C, Brown LF, Detmar MJ, Lawitts JA, Benjamin L, Tan X, Manseau EJ, Dvorak AM, Dvorak HF. Vascular permeability factor/vascular endothelial growth factor induces lymphangiogenesis as well as angiogenesis. J Exp Med. 2002 Dec 2;196(11):1497-506. doi: 10.1084/jem.20021244.

    PMID: 12461084BACKGROUND
  • Kasseroller RG. The Vodder School: the Vodder method. Cancer. 1998 Dec 15;83(12 Suppl American):2840-2. doi: 10.1002/(sici)1097-0142(19981215)83:12b+3.0.co;2-5.

    PMID: 9874409BACKGROUND
  • Leduc O, Leduc A, Bourgeois P, Belgrado JP. The physical treatment of upper limb edema. Cancer. 1998 Dec 15;83(12 Suppl American):2835-9. doi: 10.1002/(sici)1097-0142(19981215)83:12b+3.0.co;2-v.

    PMID: 9874408BACKGROUND
  • Casley-Smith JR, Boris M, Weindorf S, Lasinski B. Treatment for lymphedema of the arm--the Casley-Smith method: a noninvasive method produces continued reduction. Cancer. 1998 Dec 15;83(12 Suppl American):2843-60. doi: 10.1002/(sici)1097-0142(19981215)83:12b+3.3.co;2-l.

    PMID: 9874410BACKGROUND
  • Johansson K, Lie E, Ekdahl C, Lindfeldt J. A randomized study comparing manual lymph drainage with sequential pneumatic compression for treatment of postoperative arm lymphedema. Lymphology. 1998 Jun;31(2):56-64.

    PMID: 9664269BACKGROUND
  • Loprinzi CL, Kugler JW, Sloan JA, Rooke TW, Quella SK, Novotny P, Mowat RB, Michalak JC, Stella PJ, Levitt R, Tschetter LK, Windschitl H. Lack of effect of coumarin in women with lymphedema after treatment for breast cancer. N Engl J Med. 1999 Feb 4;340(5):346-50. doi: 10.1056/NEJM199902043400503.

    PMID: 9929524BACKGROUND
  • Ueda Y, Yamagishi T, Samata K, Ikeya H, Hirayama N, Okazaki T, Nishihara S, Arai K, Yamaguchi S, Shibuya M, Nakaike S, Tanaka M. A novel low molecular weight VEGF receptor-binding antagonist, VGA1102, inhibits the function of VEGF and in vivo tumor growth. Cancer Chemother Pharmacol. 2004 Jul;54(1):16-24. doi: 10.1007/s00280-004-0763-8. Epub 2004 Apr 3.

    PMID: 15064856BACKGROUND
  • Checkley D, Tessier JJ, Kendrew J, Waterton JC, Wedge SR. Use of dynamic contrast-enhanced MRI to evaluate acute treatment with ZD6474, a VEGF signalling inhibitor, in PC-3 prostate tumours. Br J Cancer. 2003 Nov 17;89(10):1889-95. doi: 10.1038/sj.bjc.6601386.

    PMID: 14612898BACKGROUND
  • Morgan B, Thomas AL, Drevs J, Hennig J, Buchert M, Jivan A, Horsfield MA, Mross K, Ball HA, Lee L, Mietlowski W, Fuxuis S, Unger C, O'Byrne K, Henry A, Cherryman GR, Laurent D, Dugan M, Marme D, Steward WP. 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. 2003 Nov 1;21(21):3955-64. doi: 10.1200/JCO.2003.08.092. Epub 2003 Sep 29.

    PMID: 14517187BACKGROUND
  • Folkman J. Seminars in Medicine of the Beth Israel Hospital, Boston. Clinical applications of research on angiogenesis. N Engl J Med. 1995 Dec 28;333(26):1757-63. doi: 10.1056/NEJM199512283332608. No abstract available.

    PMID: 7491141BACKGROUND
  • Weidner N, Semple JP, Welch WR, Folkman J. Tumor angiogenesis and metastasis--correlation in invasive breast carcinoma. N Engl J Med. 1991 Jan 3;324(1):1-8. doi: 10.1056/NEJM199101033240101.

    PMID: 1701519BACKGROUND
  • Ferrara N, Davis-Smyth T. The biology of vascular endothelial growth factor. Endocr Rev. 1997 Feb;18(1):4-25. doi: 10.1210/edrv.18.1.0287. No abstract available.

    PMID: 9034784BACKGROUND
  • Borgstrom P, Hillan KJ, Sriramarao P, Ferrara N. Complete inhibition of angiogenesis and growth of microtumors by anti-vascular endothelial growth factor neutralizing antibody: novel concepts of angiostatic therapy from intravital videomicroscopy. Cancer Res. 1996 Sep 1;56(17):4032-9.

    PMID: 8752175BACKGROUND
  • Hu L, Hofmann J, Zaloudek C, Ferrara N, Hamilton T, Jaffe RB. Vascular endothelial growth factor immunoneutralization plus Paclitaxel markedly reduces tumor burden and ascites in athymic mouse model of ovarian cancer. Am J Pathol. 2002 Nov;161(5):1917-24. doi: 10.1016/S0002-9440(10)64467-7.

    PMID: 12414537BACKGROUND
  • Presta LG, Chen H, O'Connor SJ, Chisholm V, Meng YG, Krummen L, Winkler M, Ferrara N. Humanization of an anti-vascular endothelial growth factor monoclonal antibody for the therapy of solid tumors and other disorders. Cancer Res. 1997 Oct 15;57(20):4593-9.

    PMID: 9377574BACKGROUND
  • Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, Berlin J, Baron A, Griffing S, Holmgren E, Ferrara N, Fyfe G, Rogers B, Ross R, Kabbinavar F. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004 Jun 3;350(23):2335-42. doi: 10.1056/NEJMoa032691.

    PMID: 15175435BACKGROUND
  • Yang JC, Haworth L, Sherry RM, Hwu P, Schwartzentruber DJ, Topalian SL, Steinberg SM, Chen HX, Rosenberg SA. A randomized trial of bevacizumab, an anti-vascular endothelial growth factor antibody, for metastatic renal cancer. N Engl J Med. 2003 Jul 31;349(5):427-34. doi: 10.1056/NEJMoa021491.

    PMID: 12890841BACKGROUND
  • Ostendorf T, Kunter U, Eitner F, Loos A, Regele H, Kerjaschki D, Henninger DD, Janjic N, Floege J. VEGF(165) mediates glomerular endothelial repair. J Clin Invest. 1999 Oct;104(7):913-23. doi: 10.1172/JCI6740.

    PMID: 10510332BACKGROUND
  • Shen BQ, Lee DY, Gerber HP, Keyt BA, Ferrara N, Zioncheck TF. Homologous up-regulation of KDR/Flk-1 receptor expression by vascular endothelial growth factor in vitro. J Biol Chem. 1998 Nov 6;273(45):29979-85. doi: 10.1074/jbc.273.45.29979.

    PMID: 9792718BACKGROUND
  • Dvorak HF, Nagy JA, Feng D, Brown LF, Dvorak AM. Vascular permeability factor/vascular endothelial growth factor and the significance of microvascular hyperpermeability in angiogenesis. Curr Top Microbiol Immunol. 1999;237:97-132. doi: 10.1007/978-3-642-59953-8_6.

    PMID: 9893348BACKGROUND
  • Dvorak AM, Kohn S, Morgan ES, Fox P, Nagy JA, Dvorak HF. The vesiculo-vacuolar organelle (VVO): a distinct endothelial cell structure that provides a transcellular pathway for macromolecular extravasation. J Leukoc Biol. 1996 Jan;59(1):100-15.

    PMID: 8558058BACKGROUND
  • Feng D, Nagy JA, Pyne K, Hammel I, Dvorak HF, Dvorak AM. Pathways of macromolecular extravasation across microvascular endothelium in response to VPF/VEGF and other vasoactive mediators. Microcirculation. 1999 Mar;6(1):23-44.

    PMID: 10100187BACKGROUND
  • Feng D, Nagy JA, Hipp J, Pyne K, Dvorak HF, Dvorak AM. Reinterpretation of endothelial cell gaps induced by vasoactive mediators in guinea-pig, mouse and rat: many are transcellular pores. J Physiol. 1997 Nov 1;504 ( Pt 3)(Pt 3):747-61. doi: 10.1111/j.1469-7793.1997.747bd.x.

    PMID: 9401980BACKGROUND
  • Tulpule A, Scadden DT, Espina BM, Cabriales S, Howard W, Shea K, Gill PS. Results of a randomized study of IM862 nasal solution in the treatment of AIDS-related Kaposi's sarcoma. J Clin Oncol. 2000 Feb;18(4):716-23. doi: 10.1200/JCO.2000.18.4.716.

    PMID: 10673512BACKGROUND
  • Granato AM, Nanni O, Falcini F, Folli S, Mosconi G, De Paola F, Medri L, Amadori D, Volpi A. Basic fibroblast growth factor and vascular endothelial growth factor serum levels in breast cancer patients and healthy women: useful as diagnostic tools? Breast Cancer Res. 2004;6(1):R38-45. doi: 10.1186/bcr745. Epub 2003 Nov 25.

    PMID: 14680499BACKGROUND
  • Hoar FJ, Lip GY, Belgore F, Stonelake PS. Circulating levels of VEGF-A, VEGF-D and soluble VEGF-A receptor (sFIt-1) in human breast cancer. Int J Biol Markers. 2004 Jul-Sep;19(3):229-35. doi: 10.1177/172460080401900308.

    PMID: 15503825BACKGROUND
  • Malamitsi-Puchner A, Tziotis J, Tsonou A, Protonotariou E, Sarandakou A, Creatsas G. Changes in serum levels of vascular endothelial growth factor in males and females throughout life. J Soc Gynecol Investig. 2000 Sep-Oct;7(5):309-12.

    PMID: 11035284BACKGROUND

MeSH Terms

Conditions

LymphedemaBreast Neoplasms

Interventions

Bevacizumab

Condition Hierarchy (Ancestors)

Lymphatic DiseasesHemic and Lymphatic DiseasesNeoplasms by SiteNeoplasmsBreast DiseasesSkin DiseasesSkin and Connective Tissue Diseases

Intervention Hierarchy (Ancestors)

Antibodies, Monoclonal, HumanizedAntibodies, MonoclonalAntibodiesImmunoglobulinsImmunoproteinsBlood ProteinsProteinsAmino Acids, Peptides, and ProteinsSerum GlobulinsGlobulins

Study Officials

  • Michael S Gordon, MD

    Premiere Oncology of Arizona

    PRINCIPAL INVESTIGATOR

Central Study Contacts

Michael S Gordon, MD

CONTACT

Study Design

Study Type
interventional
Phase
phase 1
Allocation
NON RANDOMIZED
Masking
NONE
Purpose
TREATMENT
Intervention Model
SINGLE GROUP
Sponsor Type
OTHER

Study Record Dates

First Submitted

April 24, 2006

First Posted

April 26, 2006

Last Updated

May 10, 2006

Record last verified: 2006-04

Locations