A Phase I Study of Rapamycin (Sirolimus) With Bevacizumab in Patients With Advanced Malignancies
Inclusion Criteria:
- Metastatic or unresectable solid tumor for which standard treatments do not exist or
are no longer effective
- Performance status of 0-1
- Measurable or non-measurable disease
- Life expectancy of at least 12 weeks
- No anticipated need of other cancer treatments within the next 4 weeks
- 18 years or older
- Negative pregnancy test for women able to have children, agreement to use a medically
accepted birth control method while receiving the study drugs and for at least 2
weeks after stopping, not breast feeding
- Ability to understand and willingness to sign a written informed consent document
- No evidence of bleeding diathesis
- Patients without lung cancer receiving anti-coagulation treatment can participate
- Adequate organ and marrow function:
- ALT and AST less than or equal to 2.5 times the institutional ULN (less than 5
times for patients with liver involvement)
- hemoglobin at least 9g/dL
- absolute neutrophil count at least 1,500/µL
- platelets at least 100,000/µL
- total bilirubin less than or equal to 1.5 times the institutional ULN
- creatinine less than or equal to 1.5 times the institutional ULN
Exclusion Criteria:
- Prior treatment with both bevacizumab and an mTOR inhibitor is not allowed. Prior
treatment with both bevacizumab OR mTOR inhibitor (including rapamycin) is allowed.
Patients who had a grade 3 or greater side effect with either bevacizumab or an mTOR
inhibitor cannot take part in this study.
- Chemotherapy or Immunotherapy within the 4 weeks of study start
- Radiotherapy within 14 days of study start
- Cannot be receiving any other investigational drugs or any other cancer treatments
while on study (with the exception of androgen ablating agents for patients with
prostate cancer).
- Patients with squamous non-small cell lung cancer (NSCLC)
- Patients with lung cancer or lung metastases:
- on full dose anticoagulation
- taking 325mg aspirin per day
- on non-steroidal anti-inflammatory agents
- HIV positive patients receiving combination anti-retroviral therapy are excluded due
to potential for serious infections while taking marrow suppressing agents
- Ongoing illness or medical exclusions, including but not limited to:
- active or ongoing infection
- symptomatic congestive heart failure
- uncontrolled hypertension despite optimal medical management
- cardiac arrhythmia except paroxysmal atrial fibrillation
- psychiatric illness/social situations that would limit compliance with study
requirements
- history of organ allograft, bone marrow or peripheral blood stem cell transplant
- known or suspect allergy to bevacizumab or rapamycin
- seizure disorder treated with steroid or anticonvulsant therapy
- thrombotic or embolic events within 6 months of starting study
- pulmonary hemorrhage/bleeding within 12 weeks of starting study (grade 3 event
within 4 weeks of first dose of drug). Patients with a history of pulmonary
hemorrhage/bleeding cannot be on full dose anticoagulation.
- pulmonary fibrosis or interstitial lung disease
- serious non-healing wound, ulcer or bone fracture
- Major surgery, open biopsy or a traumatic injury within 4 weeks of starting
study drug
- anticipated need for major surgery while on-study
- current use of any herbal supplements or rifampin (rifampicin)
- prior history of hypertensive crisis or hypertensive encephalopathy
- history of myocardial infarction or unstable angina within 6 months of starting
study
- known CNS disease
- significant vascular disease
- symptomatic peripheral vascular disease
- evidence of bleeding diathesis or coagulopathy
- core biopsy or other minor surgical procedure (except placement of vascular
access device) within 7 days of starting study
- history of abdominal fistula, gastrointestinal perforation, or intra-abdominal
abscess within 6 months of study start
- proteinuria at screening