Recurrent Prostate Cancer, Stage IV Prostate Cancer, Unspecified Adult Solid Tumor, Protocol Specific
Conditions
Brief summary
This phase I trial is studying the side effects and best dose of combination chemotherapy in treating patients with metastatic or unresectable solid tumors. Drugs used in chemotherapy, such as docetaxel and 17-N-allylamino-17-demethoxygeldanamycin, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells.
Detailed description
OBJECTIVES: I. Determine the maximum tolerated dose of 17-N-allylamino-17-demethoxygeldanamycin (17-AAG) administered with docetaxel in patients with progressive metastatic prostate cancer or other progressive metastatic or unresectable solid tumors. II. Determine the pharmacokinetics of this regimen in these patients. OUTLINE: This is a dose-escalation study of 17-N-allylamino-17-demethoxygeldanamycin (17-AAG). Patients are assigned to 1 of 2 treatment groups. Group 1: Patients receive docetaxel IV over 1 hour and 17-AAG IV over 1-2 hours on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Group 2: Patients receive docetaxel IV over 30 minutes and 17-AAG as in group 1. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients per group receive escalating doses of 17-AAG until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Up to 20 additional patients (10 per group) are treated at the MTD. Patients are followed every 2-3 months.
Interventions
Given IV
Given IV
Sponsors
Study design
Eligibility
Inclusion criteria
* Histologically confirmed metastatic or unresectable malignancy for which standard curative or palliative therapy does not exist or is no longer effective * Progressive disease manifested by the following parameters * For prostate cancer: * Must have castrate, metastatic disease defined by disease progression after surgical castration or treatment with a gonadotropin-releasing hormone (GnRH) analog (testosterone level less than 50 ng/mL) * Patients who have not undergone surgical orchiectomy should continue on medical therapies to maintain castrate levels of testosterone * Progressive metastatic disease on imaging studies (bone scan, CT scan, or MRI) OR metastatic disease and a rising prostate-specific antigen (PSA) * Biochemical progression indicated by at least 3 rising PSA values (obtained at least 1 week apart) from a baseline OR 2 rising PSA values (more than 1 month apart), where the percentage increase over the range of values is at least 25% * Patients who have received an antiandrogen as part of first-line hormonal therapy must have shown progression of disease off of the antiandrogen prior to study enrollment * For other solid tumors: * Development of new lesions or an increase in pre-existing lesions by bone scintigraphy, CT scan, MRI, positron emission tomography, or physical examination * Patients whose sole criterion for progression is an increase in a biochemical marker (e.g., carcinoembryonic antigen or CA 15-3) or an increase in symptoms are not eligible * Patients with metastatic disease must not be progressing to the extent as to require palliative treatment within 4 weeks of study entry * No active brain metastases * Performance status - Karnofsky 70-100% * More than 6 months * WBC at least 3,000/mm\^3 * Absolute neutrophil count at least 1,500/mm\^3 * Platelet count at least 100,000/mm\^3 * Bilirubin ≤ 1.5 times upper limit of normal (ULN) * AST and ALT \< 1.5 times ULN * PT ≤ 1.1 times ULN * Creatinine no greater than 1.4 mg/dL or within ULN * Creatinine clearance greater than 55 mL/min * No prior history of pulmonary toxicity after receiving anthracyclines (e.g., doxorubicin hydrochloride, daunorubicin hydrochloride, mitoxantrone hydrochloride, bleomycin, or carmustine) * No dyspnea ≥ grade 2 at rest on room air * No requirement for supplementary oxygen therapy or oxygen saturations ≤ 88% * No clinically significant pulmonary comorbidities that require medication (e.g., severe chronic obstructive pulmonary disease that could predispose patient to pulmonary toxicity) * QTc ≤ 450 msec for male patients (470 for female patients) * LVEF \> 40% by echocardiogram or MUGA * Echocardiogram or MUGA required for patients with any of the following: * Myocardial infarction \> 1 year ago * NYHA class I or II CHF * Atrial fibrillation * Right or left bundle branch block by EKG * No history of serious ventricular arrhythmia (i.e., ventricular tachycardia or ventricular fibrillation ≥ 3 beats in a row) * No myocardial infarction within the past year * No active ischemic heart disease within the past year * No New York Heart Association (NYHA) class III or IV congestive heart failure (CHF) * No poorly controlled angina * No uncontrolled dysrhythmia * No congenital long QT syndrome * No left bundle branch block * No other significant cardiac disease * No prior history of cardiac toxicity after receiving anthracyclines such as doxorubicin hydrochloride, daunorubicin hydrochloride, mitoxantrone hydrochloride, bleomycin, or carmustine * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * No history of severe hypersensitivity reaction to paclitaxel, docetaxel, or polysorbate 80 * No ongoing or active infection * No psychiatric illness or social situation that would preclude study compliance * No grade 2 or greater symptomatic peripheral neuropathy * No allergy to eggs or egg products * No other concurrent uncontrolled illness * At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) * See Disease Characteristics * At least 4 weeks since prior radiotherapy and recovered * No concurrent radiotherapy to sole measurable lesion * No prior mantle-field radiotherapy * See Disease Characteristics * No concurrent surgery for sole measurable lesion * Recovered from prior therapy * At least 1 week since prior ketoconazole and recovered * At least 4 weeks since prior investigational anticancer therapeutic drugs * No concurrent combination antiretroviral therapy for HIV-positive patients * No concurrent medications that prolong QTc interval * No concurrent medication used to control arrhythmias * Calcium blockers and beta blockers allowed * No other concurrent investigational agents * No other concurrent anticancer agents or therapies (investigational or commercial) * No concurrent CYP3A4 inhibitors, including any of the following: * Fluconazole * Itraconazole * Ketoconazole * Macrolide antibiotics (azithromycin, clarithromycin, erythromycin, or troleandomycin) * Nifedipine * Verapamil * Diltiazem * Cyclosporine * Grapefruit juice * No concurrent CYP3A4 inducers, including any of the following: * Carbamazepine * Phenobarbital * Phenytoin * Rifampin * No concurrent herbal extracts or tinctures with CYP3A4 inhibitory activity, including any of the following: * Hydrastis canadensis (goldenseal) * Hypericum perforatum (St. John's wort) * Uncaria tomentosa (cat's claw) * Echinacea angustifolia roots * Trifolium pratense (wild cherry) * Matricaria chamomilla (chamomile) * Glycyrrhiza glabra (licorice) * Dillapiol * Hypericin * Naringenin * Concurrent CYP3A4 substrates allowed
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Maximum tolerated dose determined by dose-limiting toxicities assessed using the NCI Common Toxicity Criteria (CTC) version 2.0 | 28 days |
Countries
United States