Kidney Cancer, Unspecified Adult Solid Tumor, Protocol Specific
Conditions
Keywords
unspecified adult solid tumor, protocol specific, recurrent renal cell cancer, stage IV renal cell cancer
Brief summary
RATIONALE: Vatalanib and everolimus may stop the growth of tumor cells by blocking blood flow to the tumor and by blocking some of the enzymes needed for cell growth. PURPOSE: This phase I trial is studying the side effects and best dose of vatalanib and everolimus and to see how well they work in treating patients with advanced solid tumors.
Detailed description
OBJECTIVES: Primary * Determine the maximum tolerated dose (MTD) of vatalanib and everolimus in patients with advanced solid tumors. * Determine the safety and tolerability of vatalanib and everolimus in patients with advanced solid tumors. * Evaluate the safety and tolerability of vatalanib and everolimus at the MTD in patients with metastatic renal cell carcinoma (RCC). Secondary * Describe the non dose-limiting toxic effects associated with vatalanib and everolimus. * Describe the pharmacokinetics of vatalanib and everolimus in patients with advanced solid tumors. * Determine the functional extent of mTOR inhibition by changes in the phosphorylation status of S6K protein in peripheral blood mononuclear cells in patients treated with vatalanib and everolimus. * Describe any clinical responses seen in patients with metastatic RCC in a dose-expansion cohort treated at the MTD. * Observe overall survival of RCC patients treated with vatalanib and everolimus. * Determine the time to progression of patients with RCC treated with vatalanib and everolimus. OUTLINE: This is a phase I dose-escalation study followed by a phase Ib study. * Phase I (solid tumors): Patients receive oral vatalanib on days 1-28 and oral everolimus on days 15-28 during course 1 and on days 1-28 during all subsequent courses. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of vatalanib and everolimus 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. * Phase Ib (renal cell carcinoma only): Patients receive oral vatalanib and oral everolimus at the MTD on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed every 6 months. PROJECTED ACCRUAL: A total of 44 patients will be accrued for this study.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed solid tumor with radiographic evidence of metastatic disease * No standard therapy exists (phase I) * Unresectable or metastatic renal cell carcinoma (phase Ib) PATIENT CHARACTERISTICS: * Karnofsky performance status 70-100% * Absolute neutrophil count ≥ 1,500/mm³ * Platelet count ≥ 100,000/mm³ * Hemoglobin ≥ 9 g/dL * AST or ALT ≤ 2.5 times upper limit of normal (ULN) * Total cholesterol \< 300 mg/dL * Triglycerides \< 350 mg/dL * Bilirubin ≤ 1.5 times ULN * Creatinine ≤ 1.5 times ULN OR creatinine clearance \> 40 mL/min * Negative proteinuria by dip stick OR total urinary protein ≤ 500 mg * No uncontrolled high blood pressure, history of labile hypertension, or history of poor compliance with antihypertensive regimen * No unstable angina pectoris * No symptomatic congestive heart failure (New York Heart Association class III or IV heart disease) * No uncontrolled serious cardiac arrhythmia (symptomatic supraventricular tachycardia or any ventricular tachycardia/fibrillation) * No myocardial infarction in the past 6 months * No uncontrolled diabetes * No interstitial pneumonia or extensive and symptomatic interstitial fibrosis of the lung * No active or uncontrolled infection * No uncontrolled hyperlipidemia * No chronic renal disease * No acute or chronic liver disease (e.g., hepatitis or cirrhosis) * No impaired gastrointestinal (GI) function OR GI disease that may significantly alter the absorption of vatalanib or everolimus, including any of the following: * Ulcerative disease * Uncontrolled nausea and vomiting with solid food * Watery diarrhea \> 5 times daily * Malabsorption syndrome * Bowel obstruction * Inability to swallow the tablets * No confirmed HIV infection * Not pregnant * Negative pregnancy test * Fertile patients must use effective contraception * No other concurrent severe and/or uncontrolled medical condition that would preclude study participation PRIOR CONCURRENT THERAPY: * Recovered from prior therapy * No prior antivascular endothelial growth factor therapy * More than 4 weeks since prior major surgery\* (laparotomy) * More than 2 weeks since prior minor surgery\* * More than 4 weeks since prior chemotherapy (6 weeks for mitomycin C or nitrosoureas) * More than 6 weeks since prior antibody therapy * More than 2 weeks since prior biologic/immunotherapy * More than 2 weeks since prior limited-field radiotherapy * More than 4 weeks since prior full-field radiotherapy * More than 4 weeks since prior investigational agents * Prior transfusions allowed provided blood counts are stable for \> 2 weeks * Concurrent epoetin alfa allowed * No concurrent warfarin or similar oral anticoagulants that are metabolized by the cytochrome P450 system * Heparin and low molecular weight heparin allowed NOTE: \*Insertion of a vascular access device is not considered major or minor surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum tolerated dose (MTD) of vatalanib and everolimus | Day 1 - 28 | Patients were evaluated on Day 1,14 and 28 for dose limiting toxicities |
| Safety and tolerability | Duration of study treatment | Adverse events were assessed every 14 days for the length of the treatment period. |
| Safety and tolerability at the MTD in patients with metastatic renal cell carcinoma (RCC) | Duration of study treatment | Patients were assessed for adverse events every 14 days while on study treatment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical response in patients with metastatic RCC | Duration of treatment | patients underwent restaging studies every 2 cycles while on treatment for evidence of disease response |
| Pharmacokinetics | Day 14 Cycle 1, Day 1 Cycle 2 | Blood was drawn for PK assessment on Day 14 of Cycle 1 and Day 1 of Cycle 2 |
| Time to progression of patients with RCC | Duration of study treatment | Patients were followed for evidence of disease progression as long as they remained on study drug. |
| Overall survival of patients with RCC | Until death | — |
| Non dose-limiting toxicity | Duration of study treatment | Patients were assessed every 14 days for non dose-limiting toxicity while on study treatment |
| Changes in the phosphorylation status of S6K protein in peripheral blood mononuclear cells | Day 1 and 28 | Samples were collected on Day 1 and at Day 28 of Cycle 1 |
Countries
United States