A Phase II Study of MK-2206 in the Treatment of Recurrent High-grade Serous Platinum-Resistant Ovarian, Fallopian Tube, or Primary Peritoneal Cancer
Inclusion Criteria:
- Participants must have histologically or cytologically confirmed high grade (grade 2
or 3) serous ovarian, fallopian tube, or primary peritoneal cancer; participants with
mixed histology are eligible if the serous component is the dominant histological
subtype
- Participants must have measurable disease as defined by RECIST 1.1 criteria
- Participants must have evidence of a defect in the PI3K/AKT pathway, defined by A)
evidence of loss of PTEN by immunohistochemistry in a CLIA-certified assay or B)
documentation of PIK3CA or AKT mutation in a CLIA-certified assay; for patients
without prior CLIA-certified evidence of a PI3K/AKT pathway defect, PTEN testing will
be performed by immunohistochemistry in a CLIA-certified assay; availability of a
formalin fixed paraffin embedded (FFPE) block of cancer tissue from the original or
most recent biopsy must be available for mutational and immunohistochemical analysis
- Prior therapy:
- Prior chemotherapy must have included a first-line platinum-based regimen with
or without consolidation chemotherapy
- Patients may have received up to 2 lines of therapy (including cytotoxic or
biological and/or targeted therapies) in the recurrent setting
- Prior hormonal therapy is acceptable and will not count as an additional line of
therapy
- Patients may not have previously received prior AKT or PI3 kinase pathway
inhibitors (including mTOR inhibitors)
- Patients should have platinum-resistant disease, where platinum resistance is
defined as having progressive disease within 6 months of receipt of prior
platinum therapy
- Life expectancy of greater than 6 months
- Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 (Karnofsky > 60%)
- Absolute neutrophil count >= 1,500/mcL
- Platelets >= 100,000/mcL
- Hemoglobin >= 8.0 g/dL
- Total bilirubin within normal institutional limits
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
[SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvate transaminase [SGPT])
< 2.5 X institutional upper limit of normal
- Creatinine within normal institutional limits or creatinine clearance > 60
mL/min/1.73 m^2 for subjects with creatinine levels about institutional normal
- Toxicities of prior therapy (excepting alopecia) should be resolved to less than or
equal to grade 1 as per NCI-CTCAE v4.0
- Patients must be able to tolerate oral medications and not have gastrointestinal
illnesses that would preclude absorption of MK-2206
- The effects of MK-2206 on the developing human fetus are unknown; for this reason,
women of child-bearing potential 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
- Ability to understand and the willingness to sign a written informed consent document
Exclusion Criteria:
- Participants who exhibit any of the following conditions at screening will not be
eligible for admission into the study
- Participants who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for
nitrosoureas or mitomycin C) prior to entering the study or those who have not
recovered to grade 1 or less (excepting alopecia) due to agents administered more
than 4 weeks earlier
- Participants may not be receiving any other study agents
- Participants with known brain metastases should be excluded from this clinical trial
because of their poor prognosis and because they often develop progressive neurologic
dysfunction that would confound the evaluation of neurologic and other adverse events
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to MK-2206
- Participants receiving any medications or substances that are strong inhibitors or
inducers of CYP450 3A4 are ineligible; lists including medications and substances
known or with the potential to interact with the CYP450 3A4 isoenzymes are provided
in Appendix C; if the participant is taking any agent known to affect or with the
potential to affect CYP450 3A4 isoenzymes, this should be discussed with the overall
PI
- Preclinical studies demonstrated the potential of MK-2206 for induction of
hyperglycemia in all preclinical species tested; patients with diabetes or at risk
for hyperglycemia are eligible for this study, but the hyperglycemia should be well
controlled on oral agents before the patient enters the trial; a fasting serum
glucose of > 130 mg/dL or a HgbA1c > 7.5 mg/dL will exclude patients from entry on
study; patients requiring insulin for control of their hyperglycemia are excluded
from entry on this study
- Preclinical studies indicated transient changes in QTc interval during MK-2206
treatment; prolongation of QTc interval is potentially a safety concern while on
MK-2206 therapy; cardiovascular: baseline QTcF > 450 msec (male) or QTcF > 470 msec
(female) will exclude patients from entry on study; a list of medications that may
cause QTc interval prolongation are listed in Appendix D, and should be avoided by
patients entering on trial
- Due to a high incidence of bradycardia by Holter monitor, preexisting significant
heart block or baseline bradycardia due to cardiac disease will exclude patients from
treatment with MK-2206
- Uncontrolled intercurrent illness including, but not limited to ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements
- Current signs and/or symptoms of bowel obstruction
- Current dependency on IV hydration or TPN
- Pregnant women are excluded from this study because MK-2206 is an agent with the
potential for teratogenic or abortifacient effects; because there is an unknown but
potential risk of adverse events in nursing infants secondary to treatment of the
mother with MK-2206, breastfeeding should be discontinued if the mother is treated
with MK-2206; these potential risks may also apply to other agents used in this study
- Individuals with a history of a different malignancy are ineligible except for the
following circumstances; individuals with a history of other malignancies are
eligible if they have been disease-free for at least 5 years and are deemed by the
investigator to be at low risk for recurrence of that malignancy; individuals with
the following cancers are eligible if diagnosed and treated within the past 5 years:
breast cancer in situ, cervical cancer in situ, and basal cell or squamous cell
carcinoma of the skin
- Human immunodeficiency virus (HIV)-positive individuals on combination antiretroviral
therapy are ineligible because of the potential for pharmacokinetic interactions with
MK-2206; iIn addition, these individuals are at increased risk of lethal infections
when treated with marrow-suppressive therapy; appropriate studies will be undertaken
in participants receiving combination antiretroviral therapy when indicated
- Patients may not use natural herbal products or other "folk remedies" while
participating in this study