Adult Alveolar Soft-part Sarcoma, Adult Angiosarcoma, Adult Epithelioid Sarcoma, Adult Extraskeletal Chondrosarcoma, Adult Extraskeletal Osteosarcoma, Adult Fibrosarcoma, Adult Leiomyosarcoma, Adult Liposarcoma, Adult Malignant Fibrous Histiocytoma, Adult Malignant Hemangiopericytoma, Adult Malignant Mesenchymoma, Adult Neurofibrosarcoma, Adult Rhabdomyosarcoma, Adult Synovial Sarcoma, Gastrointestinal Stromal Tumor, Metastatic Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor, Recurrent Adult Soft Tissue Sarcoma, Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor, Stage III Adult Soft Tissue Sarcoma, Stage IV Adult Soft Tissue Sarcoma
Conditions
Brief summary
This phase II trial studies how well depsipeptide (romidepsin) works in treating patients with metastatic or unresectable soft tissue sarcoma. Drugs used in chemotherapy, such as depsipeptide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing.
Detailed description
PRIMARY OBJECTIVES: I. To estimate the response rates of metastatic or unresectable soft tissue sarcomas to single-agent depsipeptide. II. To estimate the time to progression of metastatic or unresectable soft tissue sarcomas to single-agent depsipeptide. III. To evaluate the scope and extent of acute toxicities associated with single-agent depsipeptide when given to patients with soft tissue sarcomas. OUTLINE: This is a multicenter study. Patients receive depsipeptide (romidepsin) intravenously (IV) over 4 hours on days 1, 8, and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients achieving a complete response (CR) receive 6 additional courses beyond documentation of CR. After completion of study treatment, patients are followed up every 2 months.
Interventions
DRUGromidepsin
DEP is administered at a dose of 13 mg/m2 as a 4-hour intravenous infusion in the outpatient setting.
Sponsors
National Cancer Institute (NCI)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically or cytologically confirmed soft tissue sarcoma (STS), including, but not limited to, the following histologies: * Gastrointestinal stromal tumors (GIST) * Refractory to imatinib mesylate * Desmoplastic small round cell tumors * Clear cell sarcoma * Extraskeletal osteosarcoma\* * Extraskeletal Ewing's sarcoma\* * Extraskeletal (myxoid) chondrosarcoma\* * Secondary STS (e.g., radiation-induced STS or neurofibrosarcoma due to neurofibromatosis) allowed * Metastatic or unresectable disease * No standard curative therapy exists * Patients with GIST must have received and progressed on imatinib mesylate * Measurable disease, defined as ≥ 1 unidimensionally measurable lesion ≥ 20 mm by conventional techniques OR ≥ 10 mm by spiral CT scan * No known brain metastases * Performance status - Eastern Cooperative Oncology Group (ECOG) 0-2 * Performance status - Karnofsky 50-100% * More than 3 months * White blood cells (WBC) ⥠3,000/mm\^3 * Absolute neutrophil count ≥ 1,500/mm\^3 * Platelet count ≥ 100,000/mm\^3 * Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ⤠2.5 times upper limit of normal (ULN) * Bilirubin normal * Creatinine \< 1.5 times ULN * Creatinine clearance ≥ 60 mL/min * QTc ≤ 480 msec
Exclusion criteria
* No cardiac abnormalities (e.g., congenital long QT syndrome) * No myocardial infarction within the past year * No history of coronary artery disease (e.g., angina Canadian Class II-IV or positive stress imaging study) * No cardiac ischemia (ST depression \>2 mm) by electrocardiogram (ECG) * No New York Heart Association Class II-IV congestive heart failure * Ejection fraction \> 50% by multi gated acquisition scan (MUGA) scan or echocardiogram * No history of sustained ventricular tachycardia, ventricular fibrillation, Torsades de Pointes, or cardiac arrest unless controlled by an automatic implantable cardioverter defibrillator * No hypertrophic or restrictive cardiomyopathy from prior treatment or other causes * No significant left ventricular hypertrophy * No uncontrolled hypertension (i.e., blood pressure ≥ 160/95 mm Hg) * No cardiac arrhythmia requiring anti-arrhythmic medication * Beta blocker or calcium channel blocker allowed * Patients on digitalis that cannot be discontinued not allowed * No Mobitz II second degree block without a pacemaker (first degree or Mobitz I second degree block, bradyarrhythmias, or sick sinus syndrome require Holter monitoring and evaluation by cardiology) * No uncontrolled dysrhythmia * No poorly controlled angina * No other cardiac disease * No history of allergic reaction attributed to compounds of similar chemical or biological composition to FR901228 * No ongoing or active infection * No iatrogenic immune deficiency or immune deficiency secondary to an underlying disorder * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * Potassium ≥ 4.0 mmol/L * Magnesium ≥ 2.0 mg/dL * No other uncontrolled illness * No psychiatric illness or social situation that would preclude study compliance * No concurrent anticancer biologic agents * No more than 1 prior chemotherapy regimen for sarcoma * Adjuvant chemotherapy preceding disease relapse is considered 1 prior chemotherapy regimen * Patients with GIST may have received up to 3 prior chemotherapy regimens comprising imatinib mesylate and/or sunitinib malate provided no other chemotherapy agents were used * No prior FR901228 (depsipeptide) * At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) * No prior cumulative doxorubicin dose \> 500 mg/m\^2 * No other concurrent anticancer chemotherapy * At least 4 weeks since prior radiotherapy * No concurrent anticancer radiotherapy * At least 4 weeks since prior surgery * No prior organ transplantation * Recovered from all prior therapy * No concurrent medications that cause QTc prolongation * No concurrent combination highly active anti-retroviral therapy for HIV-positive patients * No other concurrent drugs known to have histone deacetylase inhibitor activity (e.g., sodium valproate) * No other concurrent investigational agents * No other concurrent anticancer agents
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective Tumor Response (Complete and Partial) | While on treatment - max of 16 months | Objective tumor response was evaluated using the criteria proposed by the Response Evaluation Criteria In Solid Tumors (RECIST) Committee (JNCI 92(3):205-216,2000). Changes in only the largest diameter (unidimensional measurement) of the target lesions are used. A sum of the longest diameter (LD) for all target lesions was calculated and reported as the baseline sum LD. The baseline sum LD was used as reference by which to characterize the objective tumor response. Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions, taking as reference the baseline sum LD; Overall Response (OR) = CR + PR |
| Time to Progression | Until disease progression - max of 48 months | Progressive disease is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameters (LD) of target lesions, taking as reference the smallest sum LD recorded since treatment started, or a measurable increase in a non-target lesion, or the appearance of new lesions. Time to progression is the number of months from first treatment until the date of progression. |
| Toxicity as Assessed Using the Expanded Common Toxicity Criteria Version 3 | During treatment (max of 16 months) and for 1 month following treatment | The outcome reported here is the number (%) of participants who experienced grade 3 or greater toxicity while on study. A summary of the individual toxicities can be found in the AE/SAE results. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Survival | Max of 98 months | Months from first treatment until death or the last date of contact |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Treatment (Single-agent Depsipeptide) Patients receive depsipeptide (romidepsin) intravenously (IV) over 4 hours on days 1, 8, and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients achieving a complete response (CR) receive 6 additional courses beyond documentation of CR. | 40 |
| Total | 40 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Never started treatment | 2 |
| Overall Study | Physician Decision | 1 |
| Overall Study | Progression | 30 |
| Overall Study | Second Primary | 1 |
| Overall Study | Toxicity | 3 |
| Overall Study | Withdrawal by Subject | 2 |
Baseline characteristics
| Characteristic | Treatment (Single-agent Depsipeptide) |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 16 Participants |
| Age, Categorical Between 18 and 65 years | 24 Participants |
| Age, Continuous | 59 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 40 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 5 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants |
| Race (NIH/OMB) White | 32 Participants |
| Region of Enrollment United States | 40 participants |
| Sex: Female, Male Female | 19 Participants |
| Sex: Female, Male Male | 21 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 38 / 38 |
| serious Total, serious adverse events | 13 / 38 |
Outcome results
Primary
Objective Tumor Response (Complete and Partial)
Objective tumor response was evaluated using the criteria proposed by the Response Evaluation Criteria In Solid Tumors (RECIST) Committee (JNCI 92(3):205-216,2000). Changes in only the largest diameter (unidimensional measurement) of the target lesions are used. A sum of the longest diameter (LD) for all target lesions was calculated and reported as the baseline sum LD. The baseline sum LD was used as reference by which to characterize the objective tumor response. Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions, taking as reference the baseline sum LD; Overall Response (OR) = CR + PR
Time frame: While on treatment - max of 16 months
Population: Participants who were evaluable for response
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (Single-agent Depsipeptide) | Objective Tumor Response (Complete and Partial) | 2 Participants |
Primary
Time to Progression
Progressive disease is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameters (LD) of target lesions, taking as reference the smallest sum LD recorded since treatment started, or a measurable increase in a non-target lesion, or the appearance of new lesions. Time to progression is the number of months from first treatment until the date of progression.
Time frame: Until disease progression - max of 48 months
Population: All treated participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Treatment (Single-agent Depsipeptide) | Time to Progression | 1.9 months |
Primary
Toxicity as Assessed Using the Expanded Common Toxicity Criteria Version 3
The outcome reported here is the number (%) of participants who experienced grade 3 or greater toxicity while on study. A summary of the individual toxicities can be found in the AE/SAE results.
Time frame: During treatment (max of 16 months) and for 1 month following treatment
Population: All treated participants
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Treatment (Single-agent Depsipeptide) | Toxicity as Assessed Using the Expanded Common Toxicity Criteria Version 3 | 13 Participants |
Secondary
Survival
Months from first treatment until death or the last date of contact
Time frame: Max of 98 months
Population: All treated participants
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Treatment (Single-agent Depsipeptide) | Survival | 12.2 months |