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A Phase I Study of ABT-888 in Combination With Cyclophosphamide in Solid Tumors or Non-Hodgkins Lymphoma


Phase 1
18 Years
N/A
Open (Enrolling)
Both
Adult Grade III Lymphomatoid Granulomatosis, Adult Nasal Type Extranodal NK/T-cell Lymphoma, AIDS-related Diffuse Large Cell Lymphoma, AIDS-related Diffuse Mixed Cell Lymphoma, AIDS-related Diffuse Small Cleaved Cell Lymphoma, AIDS-related Immunoblastic Large Cell Lymphoma, AIDS-related Lymphoblastic Lymphoma, AIDS-related Peripheral/Systemic Lymphoma, AIDS-related Small Noncleaved Cell Lymphoma, Anaplastic Large Cell Lymphoma, Angioimmunoblastic T-cell Lymphoma, Cutaneous B-cell Non-Hodgkin Lymphoma, Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue, Malignant Neoplasm, Nodal Marginal Zone B-cell Lymphoma, Post-transplant Lymphoproliferative Disorder, Recurrent Adult Burkitt Lymphoma, Recurrent Adult Diffuse Large Cell Lymphoma, Recurrent Adult Diffuse Mixed Cell Lymphoma, Recurrent Adult Diffuse Small Cleaved Cell Lymphoma, Recurrent Adult Grade III Lymphomatoid Granulomatosis, Recurrent Adult Immunoblastic Large Cell Lymphoma, Recurrent Adult Lymphoblastic Lymphoma, Recurrent Adult T-cell Leukemia/Lymphoma, Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma, Recurrent Grade 1 Follicular Lymphoma, Recurrent Grade 2 Follicular Lymphoma, Recurrent Grade 3 Follicular Lymphoma, Recurrent Mantle Cell Lymphoma, Recurrent Marginal Zone Lymphoma, Recurrent Mycosis Fungoides/Sezary Syndrome, Recurrent Small Lymphocytic Lymphoma, Splenic Marginal Zone Lymphoma, Stage III Adult Burkitt Lymphoma, Stage III Adult Diffuse Large Cell Lymphoma, Stage III Adult Diffuse Mixed Cell Lymphoma, Stage III Adult Diffuse Small Cleaved Cell Lymphoma, Stage III Adult Immunoblastic Large Cell Lymphoma, Stage III Adult Lymphoblastic Lymphoma, Stage III Adult T-cell Leukemia/Lymphoma, Stage III Cutaneous T-cell Non-Hodgkin Lymphoma, Stage III Grade 1 Follicular Lymphoma, Stage III Grade 2 Follicular Lymphoma, Stage III Grade 3 Follicular Lymphoma, Stage III Mantle Cell Lymphoma, Stage III Mycosis Fungoides/Sezary Syndrome, Stage III Small Lymphocytic Lymphoma, Stage IV Adult Burkitt Lymphoma, Stage IV Adult Diffuse Large Cell Lymphoma, Stage IV Adult Diffuse Mixed Cell Lymphoma, Stage IV Adult Diffuse Small Cleaved Cell Lymphoma, Stage IV Adult Immunoblastic Large Cell Lymphoma, Stage IV Adult Lymphoblastic Lymphoma, Stage IV Adult T-cell Leukemia/Lymphoma, Stage IV Cutaneous T-cell Non-Hodgkin Lymphoma, Stage IV Grade 1 Follicular Lymphoma, Stage IV Grade 2 Follicular Lymphoma, Stage IV Grade 3 Follicular Lymphoma, Stage IV Mantle Cell Lymphoma, Stage IV Marginal Zone Lymphoma, Stage IV Mycosis Fungoides/Sezary Syndrome, Stage IV Small Lymphocytic Lymphoma, Unspecified Adult Solid Tumor, Protocol Specific, Waldenström Macroglobulinemia

Thank you

Trial Information

A Phase I Study of ABT-888 in Combination With Cyclophosphamide in Solid Tumors or Non-Hodgkins Lymphoma


PRIMARY OBJECTIVES:

I. Identify the maximally tolerated dose (MTD) and dose limiting toxicity (DLT) of
cyclophosphamide and doxorubicin when combined with escalating doses of ABT-888.

SECONDARY OBJECTIVES:

I. Evaluate any effect of ABT-888 on the systemic clearance of parent cyclophosphamide and
the dose normalized AUC of 4-OH cyclophosphamide when used in combination, using historical
single-agent cyclophosphamide and 4-OH data.

II. Evaluate any effect of cyclophosphamide administration on the systemic pharmacokinetics
of ABT-888 and its primary metabolite A-925088 (M8), by comparing pharmacokinetic (PK)
parameters of ABT-888 on Day 1 (before cyclophosphamide) and Day 3 (with cyclophosphamide
administration). PK parameters of ABT-888 will also be assessed on Cycle 2, Day 1, to
assess for altered PK due to the potential of CYP450 enzyme induction by cyclophosphamide or
ABT-888. PK samples for analysis will not be collected from patients enrolled after
2/15/2012.

III. Evaluate inhibition of poly (ADP ribose) polymerase (PARP) using an immunoassay
designed to measure PAR levels in baseline and on-study peripheral blood mononuclear cells
(PBMC) samples. PBMC samples for PAR analysis will not be collected from patients enrolled
after 2/15/2012.

IV. Evaluate gammaH2AX at baseline and on-study circulating tumor cell samples to evaluate
the point of maximal deoxyribonucleic acid (DNA) damage from the combination of
cyclophosphamide and doxorubicin with ABT-888.

OUTLINE: Patients receive ABT-888 orally (PO) twice daily on days 1-4 (days 1-7 as of
2/15/2012). Patients also receive cyclophosphamide IV over 60 minutes on day 3 (day 1 in
combination with doxorubicin IV as of 2/15/2012).

Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Blood samples are collected periodically for pharmacokinetic analysis by liquid and gas
chromatography and mass spectrometry assays and for analysis of poly-ADP-ribosylated (PAR)
levels by immunoassay.

After completion of study treatment, patients are followed up for 4 weeks.


Inclusion Criteria:



- Patients must have histologically confirmed malignancy that is metastatic or
unresectable and for which standard curative or palliative measures do not exist or
are no longer effective; Patients with either solid tumors or non-Hodgkins lymphoma
are eligible.

- At the recommended Phase II dose level, an additional 6 to 12 patients in each
group with the following criteria will be enrolled: documented breast cancer
(BRCA)1/BRC2 mutation, triple-negative breast cancer defined as estrogen
receptor (ER)-negative, progesterone receptor (PR)-negative, and Human Epidermal
Growth Factor Receptor (HER)2-negative, or patients who would benefit from a
cyclophosphamide-based regimen.

- On the schedule of ABT-888 given for 7 or 14 days, only patients with metastatic
breast cancer will be enrolled

- Patients must be >= 4 weeks since prior chemotherapy or radiation therapy (>= 6 weeks
if the last regimen included BCNU or mitomycin C); Patients previously treated with
cyclophosphamide should not be necessarily excluded

- Patients with non-Hodgkins lymphoma that is amenable to hematopoietic stem cell
transplantation with curative intent may participate only if stem cell transplant is
refused or is not indicated

- Eastern Cooperative Oncology Group (ECOG) performance status 0-2

- Life expectancy > 2 months

- Hemoglobin >= 9.0 g/dL

- Absolute neutrophil count (ANC) >= 1,500/mm^3

- Platelet count >= 100,00/mm^3

- Total bilirubin normal

- Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) =< 2.5 times upper
limit of normal (ULN) (=< 5 times ULN if hepatic metastases are present)

- Creatinine normal OR creatinine clearance >= 60 mL/min

- Prothrombin time (PT)/International normalized ratio (INR) or partial thromboplastin
time (PTT) =< 1.2 times ULN

- The effects of ABT-888 on the developing human fetus are unknown; For this reason and
because other therapeutic agents or modalities used in this trial are known to be
teratogenic, women of child-bearing potential and men must agree to use adequate
contraception (hormonal or barrier method of birth control; abstinence) prior to
study entry and for the duration of study participation; Should a woman become
pregnant or suspect she is pregnant while participating in this study, she should
inform her treating physician immediately

- Patients enrolled in a group where the treatment is AC: Ejection fraction ≥ 50% by
MUGA or echocardiogram

- Patients must sign informed consent

Exclusion Criteria:

- Concurrent administration of any other investigational agent(s)

- Prior high-dose therapy requiring hematopoietic stem cell transplantation

- Prior anti-cancer treatments involving radioactive pharmaceuticals

- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to ABT-888 and/or cyclophosphamide

- Patients receiving any medications or substances that are strong inhibitors or strong
inducers of CYP 3A4, 2B6, 2C9 or 2C19 are prohibited; At the time of screening, if
the patient is currently receiving any of the listed prohibited medication(s), the
medication(s) must be discontinued for a period of no less than 7 days prior to
administration of the first dose of study medication in order for the patient to meet
study eligibility except for the following substance where the washout should be 6
months: amiodarone

- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, psychiatric illness/social situations that would limit compliance with
study requirements, New York Heart Association (NYHA) Grade II or greater congestive
heart failure

- Pregnant women are excluded from this study because ABT-888 is a PARP inhibitor with
the potential for teratogenic or abortifacient effects; In addition,
cyclophosphamide, an alkylating agent, also has potential for teratogenic or
abortifacient effects; Because there is an unknown but potential risk for adverse
events in nursing infants secondary to treatment of the mother with ABT-888,
breastfeeding should be discontinued if the mother is treated with ABT-888; These
potential risks may also apply to other agents used in this study

- Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral
therapy are ineligible because of the potential for pharmacokinetic interactions with
cyclophosphamide and ABT-888; In addition, these patients are at increased risk of
lethal infections when treated with marrow-suppressive therapy; Appropriate studies
will be undertaken in patients receiving combination antiretroviral therapy when
indicated; NOTE: HIV seropositive patients not receiving combination antiretroviral
therapy who have CD4 cells >= 350/mm^3, no opportunistic infections and meet all
eligibility criteria may participate in this study

- Any condition (e.g., gastrointestinal tract disease resulting in an inability to take
oral medication or a requirement for IV alimentation, prior surgical procedures
affecting absorption, or active peptic ulcer disease) that impairs their ability to
swallow and retain ABT-888 capsules

- Patients with gastrointestinal conditions that might predispose for drug
intolerability or poor drug absorption (e.g., inability to take oral medication or a
requirement for IV alimentation, prior surgical procedures affecting absorption,
malabsorption syndrome, active peptic ulcer disease) are excluded; Subjects with
ulcerative colitis, inflammatory bowel disease, or a partial or complete small bowel
obstruction are also excluded

- Patients with active central nervous system (CNS) metastases are excluded

- Patients with CNS metastases that have been treated must be off steroid
treatment for > 3 months, be asymptomatic and off steroid treatment prior to
study enrollment

- Patients that have symptoms to suggest CNS metastases should have a brain
magnetic resonance imaging (MRI) within 28 days of enrollment to confirm the
absence of CNS metastases; contrast computed tomography (CT) is acceptable for
patients who are unable to undergo a brain MRI

- Patients with active seizure or a history of active seizure

- Any other medical, social, or psychological condition that may significantly affect
safety and/or compliance

- Patients enrolled in a group where treatment is AC: Prior doxorubicin exposure of >
300 mg/m2 or equivalent anthracycline exposure (i.e., epirubicin dose > 540 mg/m^2)

Type of Study:

Interventional

Study Design:

Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Maximum tolerated dose determined by dose-limiting toxicities of ABT-888 and cyclophosphamide

Outcome Time Frame:

21 days

Safety Issue:

Yes

Principal Investigator

Antoinette Tan

Investigator Role:

Principal Investigator

Investigator Affiliation:

Cancer Institute of New Jersey

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-00262

NCT ID:

NCT00740805

Start Date:

August 2008

Completion Date:

Related Keywords:

  • Adult Grade III Lymphomatoid Granulomatosis
  • Adult Nasal Type Extranodal NK/T-cell Lymphoma
  • AIDS-related Diffuse Large Cell Lymphoma
  • AIDS-related Diffuse Mixed Cell Lymphoma
  • AIDS-related Diffuse Small Cleaved Cell Lymphoma
  • AIDS-related Immunoblastic Large Cell Lymphoma
  • AIDS-related Lymphoblastic Lymphoma
  • AIDS-related Peripheral/Systemic Lymphoma
  • AIDS-related Small Noncleaved Cell Lymphoma
  • Anaplastic Large Cell Lymphoma
  • Angioimmunoblastic T-cell Lymphoma
  • Cutaneous B-cell Non-Hodgkin Lymphoma
  • Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue
  • Malignant Neoplasm
  • Nodal Marginal Zone B-cell Lymphoma
  • Post-transplant Lymphoproliferative Disorder
  • Recurrent Adult Burkitt Lymphoma
  • Recurrent Adult Diffuse Large Cell Lymphoma
  • Recurrent Adult Diffuse Mixed Cell Lymphoma
  • Recurrent Adult Diffuse Small Cleaved Cell Lymphoma
  • Recurrent Adult Grade III Lymphomatoid Granulomatosis
  • Recurrent Adult Immunoblastic Large Cell Lymphoma
  • Recurrent Adult Lymphoblastic Lymphoma
  • Recurrent Adult T-cell Leukemia/Lymphoma
  • Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma
  • Recurrent Grade 1 Follicular Lymphoma
  • Recurrent Grade 2 Follicular Lymphoma
  • Recurrent Grade 3 Follicular Lymphoma
  • Recurrent Mantle Cell Lymphoma
  • Recurrent Marginal Zone Lymphoma
  • Recurrent Mycosis Fungoides/Sezary Syndrome
  • Recurrent Small Lymphocytic Lymphoma
  • Splenic Marginal Zone Lymphoma
  • Stage III Adult Burkitt Lymphoma
  • Stage III Adult Diffuse Large Cell Lymphoma
  • Stage III Adult Diffuse Mixed Cell Lymphoma
  • Stage III Adult Diffuse Small Cleaved Cell Lymphoma
  • Stage III Adult Immunoblastic Large Cell Lymphoma
  • Stage III Adult Lymphoblastic Lymphoma
  • Stage III Adult T-cell Leukemia/Lymphoma
  • Stage III Cutaneous T-cell Non-Hodgkin Lymphoma
  • Stage III Grade 1 Follicular Lymphoma
  • Stage III Grade 2 Follicular Lymphoma
  • Stage III Grade 3 Follicular Lymphoma
  • Stage III Mantle Cell Lymphoma
  • Stage III Mycosis Fungoides/Sezary Syndrome
  • Stage III Small Lymphocytic Lymphoma
  • Stage IV Adult Burkitt Lymphoma
  • Stage IV Adult Diffuse Large Cell Lymphoma
  • Stage IV Adult Diffuse Mixed Cell Lymphoma
  • Stage IV Adult Diffuse Small Cleaved Cell Lymphoma
  • Stage IV Adult Immunoblastic Large Cell Lymphoma
  • Stage IV Adult Lymphoblastic Lymphoma
  • Stage IV Adult T-cell Leukemia/Lymphoma
  • Stage IV Cutaneous T-cell Non-Hodgkin Lymphoma
  • Stage IV Grade 1 Follicular Lymphoma
  • Stage IV Grade 2 Follicular Lymphoma
  • Stage IV Grade 3 Follicular Lymphoma
  • Stage IV Mantle Cell Lymphoma
  • Stage IV Marginal Zone Lymphoma
  • Stage IV Mycosis Fungoides/Sezary Syndrome
  • Stage IV Small Lymphocytic Lymphoma
  • Unspecified Adult Solid Tumor, Protocol Specific
  • Waldenström Macroglobulinemia
  • Acquired Immunodeficiency Syndrome
  • HIV Infections
  • Burkitt Lymphoma
  • Neoplasms
  • Immunoblastic Lymphadenopathy
  • Leukemia
  • Leukemia, Lymphocytic, Chronic, B-Cell
  • Leukemia, T-Cell
  • Leukemia-Lymphoma, Adult T-Cell
  • Lymphoma
  • Lymphoma, Follicular
  • Lymphoma, Large B-Cell, Diffuse
  • Lymphoma, Non-Hodgkin
  • Lymphomatoid Granulomatosis
  • Lymphoproliferative Disorders
  • Waldenstrom Macroglobulinemia
  • Mycoses
  • Mycosis Fungoides
  • Sezary Syndrome
  • Lymphoma, B-Cell
  • Lymphoma, Large-Cell, Immunoblastic
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma
  • Lymphoma, T-Cell
  • Lymphoma, T-Cell, Cutaneous
  • Lymphoma, Large-Cell, Anaplastic
  • Lymphoma, B-Cell, Marginal Zone
  • Lymphoma, Extranodal NK-T-Cell
  • Lymphoma, Mantle-Cell

Name

Location

Cancer Institute of New Jersey New Brunswick, New Jersey  08901