Addition of the Gamma-Secretase Inhibitor RO4929097 (IND 109291) to Erlotinib in Patients With Advanced Non-Small Cell Lung Cancer (NSCLC)
PRIMARY OBJECTIVES:
I. To define the maximum-tolerated dose (MTD) and toxicity of RO4929097 (gamma-secretase
inhibitor RO4929097) combined with erlotinib (erlotinib hydrochloride) in patients with
advanced non-small cell lung cancer (NSCLC). (Dose escalation portion) II. To assess whether
the probability of detectable tumor shrinkage or response by Response Evaluation Criteria in
Solid Tumors (RECIST) criteria correlates with pre-therapy immunohistochemistry (IHC) and
reverse phase protein array (RPPA) expression of Notch 1, 2, 3, and 4. (Dose escalation
portion) III. A preliminary, exploratory assessment will be performed with respect to
percent tumor shrinkage and the probability of response over the first 2 cycles of therapy.
(Expansion cohort) IV. A preliminary, exploratory assessment will be performed with respect
to change in tumor immunohistochemistry (IHC) scores and reverse phase protein array (RPPA)
expression for Notch 1, 2, 3, and 4 over the first 2 cycles of erlotinib. (Expansion cohort)
SECONDARY OBJECTIVES:
I. To perform a preliminary exploratory assessment of whether probability of detectable
tumor shrinkage/response correlates with pre RO4929097 presence in tumor of an activating
epidermal growth factor receptor (EGFR) mutation, the T790M EGFR mutation, met
proto-oncogene (c-MET) gene amplification or insulin-like growth factor 1 receptor (IGF-1R)
expression or activation or various Notch pathway markers. (Dose escalation portion) II. To
perform a preliminary exploratory assessment of whether addition of RO4929097 to erlotinib
leads to tumor shrinkage/response in any tumor deposits that had previously exhibited growth
on erlotinib alone. (Dose escalation portion) III. Conduct a preliminary exploratory
assessment on the expansion cohort with respect to tumor shrinkage/response of the following
over the first 2 cycles of erlotinib and RO4929097 treatment with and without the presence
of mutation, amplification, and activation of markers: tumor IHC scores and RPPA expression
of the Notch ligand jagged 1 (Jag1), and the Notch targets hairy and enhancer of split 1
(HES1), hairy/enhancer-of-split related with YRPW motif protein 1 (HEY1); tumor IHC scores
and RPPA expression of putative stem cell markers cluster of differentiation (CD)24
(decreased in stem cells), CD44, CD133, aldehyde dehydrogenase and of the epithelial to
mesenchymal transition (EMT) markers E-cadherin and vimentin; detectability in tumor of EGFR
T790M mutations, MET amplification, and IGF-1R expression and activation; and soluble
markers of angiogenesis, including stromal cell-derived factor 1 alpha (SDF-1alpha), basic
fibroblastic growth factor (bFGF), cryptic epitope of collagen IV, interleukin (IL)-6, IL-8,
vascular endothelial growth factor (VEGF). (Expansion cohort) IV. We will conduct a
preliminary exploratory assessment of whether percent tumor shrinkage/response or time to
progression correlates with pre-therapy IHC and RPPA expression of Notch 1, 2, 3 and 4, the
above Notch pathway and stem cell markers, with baseline detectability of T790M mutations
and MET amplification, and with baseline IGF-1R expression and activation, and with change
in these markers from the initial biopsy to the subsequent biopsy. (Expansion cohort) V. In
tumor samples collected both during the dose escalation phase and in the expansion cohort,
we will assess if IHC and RPPA expression of Notch, Notch ligand and Notch targets
correlates with expression of stem cell markers.
VI. We will assess if percent tumor shrinkage/response, time to progression and baseline and
change in IHC and RPPA expression of Notch, Notch ligand, Notch targets and stem cell
markers varies with: tumor Notch gene amplification as assessed by fluorescent in situ
hybridization (FISH); tumor IHC and RPPA expression of selected members of the Wnt and
Hedgehog pathways (since these could lead to stem cell properties in cells that do not
express Notch); host (peripheral blood mononuclear cell) polymorphisms for relevant genes in
the Notch pathway; tumor micro ribonucleic acid (RNA) levels.
VII. Trough levels of erlotinib and RO4929097 will be measured in plasma samples of all
patients on the dose-escalation portion of the study approximately 24 hours after the Cycle
1, Day 1 dose and again approximately 24 hours after the Cycle 2, Day 1 dose. These
measurements are being done to permit a preliminary exploratory assessment of whether there
is induction of metabolism of one or both drugs that will lead to decreased drug plasma
concentrations.
VIII. In the Expansion Cohort, plasma levels of erlotinib and RO4929097 will be measured
approximately 24 hours after the Cycle 2, Day 21 erlotinib dose (just prior to initiation of
Cycle 3), and plasma levels of both agents will be measured in plasma approximately 24 hours
after the Cycle 3, Day 1 doses of both agents. These measurements are done to permit a
preliminary exploratory assessment of whether: plasma drug levels correlate with % tumor
shrinkage/response or with change in tumor biomarkers over the first 6 weeks of therapy;
erlotinib plasma concentrations are affected by RO4929097 administration.
OUTLINE: This is a dose-escalation study.
Patients receive erlotinib hydrochloride orally (PO) once daily (QD) on days 1-21 and
gamma-secretase inhibitor RO4929097 QD on days 1-3, 8-10, and 15-17. Courses repeat every 21
days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up for 12 weeks.
Interventional
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Maximum-tolerated dose of gamma-secretase inhibitor RO4929097 and erlotinib hydrochloride (Dose escalation phase)
At least 3 weeks after day 1 of course 1
Yes
Don Gibbons
Principal Investigator
M.D. Anderson Cancer Center
United States: Food and Drug Administration
NCI-2010-01975
NCT01193881
August 2010
Name | Location |
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M D Anderson Cancer Center | Houston, Texas 77030 |