A Phase I Study of R04929097 in Combination With Gemcitabine in Patients With Advanced Solid Tumors
Inclusion Criteria:
- Meets one of the following sets of 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
- Histologically and/or cytologically confirmed adenocarcinoma of the pancreas
(for patients in the expansion cohort)
- Locally advanced or metastatic disease
- No prior chemotherapy for advanced disease
- Measurable disease, 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 known brain metastases
- ECOG performance status (PS) 0-1 (Karnofsky PS 60-100%)
- Life expectancy > 12 weeks
- Hemoglobin ≥ 90 g/L (or ≥ 9 g/dL)
- Leukocytes ≥ 3,000/mm^3
- ANC ≥ 1,500/mm^3
- Platelet count ≥ 100,000/mm^3
- Total bilirubin ≤ 1.25 times upper limit of normal (ULN)
- AST/ALT ≤ 1.5 times ULN
- Serum creatinine =< ULN OR creatinine clearance ≥ 60 mL/min
- No uncontrolled hypocalcemia, hypomagnesemia, hyponatremia, hypophosphatemia, or
hypokalemia, defined as less than the lower limit of normal despite adequate
electrolyte supplementation
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use two forms of adequate contraception (i.e., barrier
contraception and one other method of contraception) for ≥ 4 weeks before, during,
and for ≥ 12 months after completion of study treatment
- Able to swallow medication
- No malabsorption syndrome or other condition that would interfere with intestinal
absorption
- 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
- No baseline QTc > 450 msec (for male patients) or > 470 msec (for female patients)
- No history of risk factors for QT interval prolongation including, but not limited
to, a family or personal history of any of the following:
- Long QT syndrome
- Recurrent syncope without known etiology
- Sudden unexpected death
- No history of torsade de pointes or other significant cardiac arrhythmias or the need
for concomitant meds with known potential to prolong QT interval or antiarrhythmics
- No diarrhea ≥ grade 2 not under control with standard anti-diarrhea medications
- No serologic positivity for hepatitis A, B, or C
- No history of liver disease or other forms of hepatitis or cirrhosis
- No history of allergic reactions attributed to compounds of similar chemical or
biologic composition to gamma-secretase inhibitor RO4929097 or to gemcitabine
hydrochloride
- Female patients may not donate ova during or after completion of 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 other concurrent investigational or commercial agents or therapies administered
with the intent to treat the patient's malignancy
- Any number of prior therapies allowed
- No prior therapy with a Notch inhibitor
- At least 4 weeks since prior radiotherapy, chemotherapy, or systemic therapy (6 weeks
if the last regimen included nitrosourea or mitomycin C) and recovered
- Exceptions may be made for low-dose, non-myelosuppressive radiotherapy for
symptomatic palliation
- Patients in the expansion cohort must meet the following criteria:
- No prior chemotherapy for advanced disease except for fluorouracil (with or
without folinic acid) or gemcitabine hydrochloride given concurrently with
radiotherapy as a "radiosensitizer"
- At least 6 months since prior adjuvant gemcitabine hydrochloride
- Prior radiotherapy for the management of local disease allowed provided > 4
weeks have elapsed since the last radiation treatment and all toxicities have
resolved
- Patients who have had radiotherapy to their sole site of disease are eligible
provided they have documented progression of that lesion before study
registration
- Recovered from side effects of previous systemic anticancer therapy to ≤ CTCAE grade
2
- No concurrent combination antiretroviral therapy for HIV-positive patients
- No concurrent medications with narrow therapeutic indices that are metabolized by
cytochrome P450 (CYP450), including warfarin sodium (Coumadin®)
- No concurrent medications with known potential to prolong QT interval
- No concurrent medications that are strong inducers/inhibitors or substrates of CYP3A4
- No concurrent medications or food that may interfere with the metabolism of
gamma-secretase inhibitor RO4929097, including ketoconazole and grapefruit or
grapefruit juice
- No other concurrent investigational agents