A Phase 1, Pharmacokinetic and Pharmacodynamic Study of the Combination of RO4929097 and Cediranib in Patients With Advanced Solid Tumors
Inclusion Criteria:
- Histologically and/or cytologically confirmed solid malignancy
- Metastatic or unresectable disease
- Disease for which standard curative or palliative measures do not exist or are
no longer effective
- Patients in the expansion cohort must have one of the following malignancies:
- Breast cancer
- Malignant melanoma
- Colorectal cancer
- Pancreatic cancer
- Kidney cancer
- High-grade glioma
- Non-small cell lung cancer
- Ovarian cancer
- Measurable or non-measurable disease
- Measurable disease is defined as ≥ 1 lesion that can be accurately measured in ≥
1 dimension (longest diameter to be recorded) as ≥ 20 mm with conventional
techniques or as ≥ 10 mm with spiral CT scan
- No meningeal metastases or untreated known brain metastases
- Patients with treated brain metastasis with radiological and clinical evidence
of stability and with no evidence of cavitation or hemorrhage in the brain
lesions are eligible provided that they are asymptomatic and do not require
corticosteroids (must have discontinued steroids ≥ 1 week before randomization)
- Hormone receptor status not specified
- Menopausal status not specified
- ECOG performance status 0-1 (Karnofsky 70-100%)
- Life expectancy > 12 weeks
- Leukocytes >= 3.0 x 10^9/L
- Absolute neutrophil count >= 1.5 x 10^9/L
- Platelets >= 100 x 10^9/L
- Hemoglobin >= 90 g/L (or >= 9 g/dL)
- INR ≤ 1.3
- Total bilirubin normal =< institutional upper limit of normal
- AST/ALT ≤ 2.5 times upper limit of normal
- Serum creatinine normal within normal institutional limits
- LVEF ≥ 50% by ECHO/MUGA
- Urine dipstick for protein < +1 OR < 1 g on 24-hour urine collection
- Patients with uncontrolled hypocalcemia, hypomagnesemia, hyponatremia,
hypophosphatemia or hypokalemia defined as less than the lower limit of normal for
the institution, despite adequate electrolyte supplementation are excluded from this
study
- Note: it is acceptable to use corrected calcium when interpreting calcium levels
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use two forms of contraception (i.e., barrier contraception and
one other method of contraception) or abstain from sexual activity for ≥ 4 weeks
before study entry, during study, and for ≥ 12 months after completion of study
treatment
- Able to swallow medication
- No condition (e.g., gastrointestinal [GI] tract disease resulting in an inability to
take oral medication or a requirement for IV alimentation, active peptic ulcer
disease, short gut syndrome, malabsorption syndrome of any type, total or partial
bowel obstruction, or inability to tolerate oral medications) that potentially
impairs the patients' ability to swallow or absorb oral medication
- No QTc prolongation (defined as QTc interval ≥ 450 msec in males and 470 msec in
females, by Bazett correction) or other significant ECG abnormalities (e.g.,
clinically significant arrhythmias requiring medication or conduction delays such as
2nd or 3rd degree atrioventricular blocks), including the following:
- No history of risk factors for QT interval prolongation, including, but not
limited to family or personal history of long QT syndrome, history of torsades
de pointes, recurrent syncope without known etiology or
sudden unexpected death
- No need of antiarrhythmics or other concomitant medications with known potential
to prolong QT interval
- None of the following:
- Resting BP consistently systolic > 150 mm Hg and/or diastolic > 100 mm Hg (in
the presence or absence of a stable dose of antihypertensive medication)
- BP must be optimally controlled and < 150/100 mm Hg for ≥ 2 weeks before
study enrollment
- Poorly controlled hypertension
- History of labile hypertension
- Poor compliance with antihypertensive medication
- No uncontrolled concurrent illness including, but not limited to, any of the
following:
- Ongoing or active infection
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Cardiac arrhythmia other than chronic, stable atrial fibrillation
- Psychiatric illness or social situations that would limit compliance with study
requirements
- None of the following conditions:
- Serious or non-healing wound, ulcer, or bone fracture
- Abdominal fistula, GI perforation, or intraabdominal abscess within the past 28
days
- Cerebrovascular accident within the past 6 months
- Symptomatic cardiac dysfunction within the past 12 months including any of the
following:
- Unstable angina
- NYHA class III or IV congestive heart failure
- Myocardial infarction
- Cardiac angioplasty or stenting or bypass
- No serologic positivity for hepatitis A, B, or C or history of liver disease or other
forms of hepatitis or cirrhosis
- No HIV-positive patients on combination antiretroviral therapy
- No diarrhea ≥ grade 2 not under control with standard anti-diarrhea medications
- No history of allergic reactions attributed to compounds of similar chemical or
biologic composition to gamma-secretase inhibitor RO4929097 and/or cediranib maleate
- Female patients may not donate ova during or after study treatment
- Male patients may not donate sperm during and for ≥ 12 months after completion of
study treatment
- Patients may not donate blood during and for ≥ 12 months after completion of study
treatment
- No concurrent treatment with known potential to prolong QT interval
- Any number of prior treatment regimens allowed
- Prior angiogenesis inhibitors (e.g., sorafenib, bevacizumab) allowed
- Prior anthracyclines allowed
- Recovered from the adverse events due to previous treatment to < CTCAE grade 2
(except alopecia)
- No prior gamma-secretase inhibitor and/or cediranib maleate
- At least 4 weeks since prior radiotherapy or systemic therapy (6 weeks for
carmustine, nitrosoureas, or mitomycin C)
- Exceptions may be made for low-dose, non-myelosuppressive radiotherapy for
systemic palliation
- More than 30 days since prior and no other concurrent investigational agents
- At least 14 days since prior and no concurrent medications with narrow therapeutic
indices that are metabolized by cytochrome P450 (CYP450), including warfarin sodium
(Coumadin®)
- Low-dose warfarin for prophylaxis for central catheters is allowed
- No concurrent medications that are strong inducers/inhibitors or substrates of CYP3A4
- No concurrent medications or food (including ketoconazole, grapefruit, or grapefruit
juice) that may interfere with the metabolism of study drugs
- No other concurrent investigational or commercial agents or therapies administered
with the intent to treat the patient's malignancy
- Patients with castration-resistant prostate cancer may continue luteinizing
hormone-releasing hormone-agonist therapy