Malignant Mesothelioma
Conditions
Keywords
recurrent malignant mesothelioma, stage II malignant mesothelioma, stage III malignant mesothelioma, stage IV malignant mesothelioma
Brief summary
RATIONALE: Everolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. PURPOSE: This phase II trial is studying how well everolimus works in treating patients with pleural malignant mesothelioma that cannot be removed by surgery.
Detailed description
OBJECTIVES: Primary * To determine the 4-month progression-free survival in patients with unresectable malignant pleural mesothelioma treated with everolimus. Secondary * To determine the response rate (confirmed and unconfirmed, complete and partial responses) and disease control rate (response or stable disease) in patients with measurable disease by RECIST and modified RECIST criteria. * To determine overall survival of these patients. * To evaluate the frequency and severity of toxicities associated with this treatment regimen. OUTLINE: This is a multicenter study. Patients receive oral everolimus once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed for 3 years.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed malignant pleural mesothelioma * Unresectable disease * Must have measurable or nonmeasurable disease by RECIST or modified RECIST criteria * Must have received prior systemically administered\* platinum-based chemotherapy and meets the following criteria: * No more than 2 prior systemic therapeutic regimens allowed (including biologics, targeted, and immunotherapies) * At least 1 regimen must have been platinum-based * Neoadjuvant and/or adjuvant systemic therapy is not counted as a prior regimen, assuming ≥ 12 weeks have elapsed between the end of neoadjuvant/adjuvant therapy and development of progressive disease NOTE: \*Pleural space washing with cisplatin does not constitute systemic administration * No known CNS metastases PATIENT CHARACTERISTICS: * Zubrod performance status 0-1 * ANC ≥ 1,500/mm³ * Platelet count ≥ 100,000/mm³ * Serum bilirubin normal * AST or ALT ≤ 1.5 times upper limit of normal (ULN) * Serum creatinine ≤ 1.5 times ULN OR creatinine clearance ≥ 50 mL/min * Not pregnant or nursing * Fertile patients must use effective contraception * No evidence of bleeding diathesis or coagulopathy * Previous pulmonary embolism allowed provided the patient is on therapeutic low molecular weight heparin injections or warfarin AND no evidence of bleeding * Patients on therapeutic warfarin must have an INR of \< 5 within 28 days prior to registration * No pathologic condition other than mesothelioma that carries a high risk of bleeding * No known HIV positivity * No gastrointestinal tract disease resulting in an inability to take oral or enteral medication via a feeding tube or a requirement for IV alimentation, or active peptic ulcer disease * No other prior malignancy allowed except for any of the following: * Adequately treated basal cell or squamous cell skin cancer * In situ cervical cancer * Adequately treated stage I or II cancer from which the patient is currently in complete remission * Any other cancer from which patient has been disease-free for 5 years PRIOR CONCURRENT THERAPY: * See Disease Characteristics * Recovered from all prior therapy * At least 28 days since prior systemic therapy (42 days for nitrosoureas or mitomycin C) * At least 28 days since prior thoracic or other major surgery (e.g., pleurectomy or pleurodesis) and no anticipated need for major surgical procedures during study * At least 14 days since prior radiotherapy * No prior surgical procedure affecting absorption * No prior chronic, systemic corticosteroids or other immunosuppressive agent, except corticosteroids equivalent to prednisone ≤ 20 mg daily * Must have been on a stable dosage regimen for ≥ 4 weeks * Topical and inhaled corticosteroids allowed * No prior mTOR inhibitor therapy (i.e., rapamycin, everolimus, or temsirolimus) * No concurrent immunization with attenuated live vaccines * No concurrent antiretroviral therapy for HIV-positive patients * No other concurrent investigational therapy * No other concurrent anticancer agents
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival | Every 8 weeks until disease progression, up to 3 years. | Progression-Free Survival was defined as the duration from the date of registration until the date of disease progression per RECIST or death due to any cause. Patients known to be alive without evidence of disease progression were censored at the date of last contact. Disease progression was defined as a \>= 20% increase over nadir in the sum of longest diameters of target lesions, unequivocal progression of non-target lesions in the opinion of the treating investigator, appearance of new lesions, symptomatic deterioration, or death due to disease |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Response | Every 8 weeks until disease progression, up to 3 years. | A response was defined as either a confirmed or unconfirmed complete or partial responses as defined by RECIST. A complete response (CR) was defined as the disappearance of all disease. A partial response (PR) was defined as a \>= 30% decrease in the sum of longest diameters of target lesions. A CR or PR was considered confirmed if two consecutive determinations were made at least 4 weeks apart. |
| Overall Survival | Every 8 weeks until disease progression, up to 3 years. | Overall survival was defined as the duration between the date of enrollment and the date of death due to any cause. Patients last known to be alive were censored at the date of last contact. |
| Frequency and Severity of Toxicities | Weekly during the first 8 weeks of treatment, then every 4 weeks while on treatment, then every 8 weeks until disease progression, then every 6 months thereafter. | — |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Everolimus Daily oral Everolimus 10 mg/day
everolimus | 59 |
| Total | 59 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 11 |
| Overall Study | Death | 3 |
| Overall Study | Ineligible | 1 |
| Overall Study | Never Received Treatment/Not Analyzable | 1 |
| Overall Study | Not Protocol Specified | 11 |
| Overall Study | Progression | 31 |
| Overall Study | Reason under Review | 1 |
| Overall Study | Withdrawal by Subject | 2 |
Baseline characteristics
| Characteristic | Everolimus |
|---|---|
| Age, Continuous | 67 years |
| Ethnicity (NIH/OMB) Hispanic or Latino | 9 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 47 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 3 Participants |
| Histology Biphasic | 4 participants |
| Histology Epithelial | 36 participants |
| Histology Mesothelioma, NOS | 17 participants |
| Histology Not Reported | 2 participants |
| Number of Metastatic Sites Multiple | 31 participants |
| Number of Metastatic Sites None | 5 participants |
| Number of Metastatic Sites Single | 23 participants |
| Performance Status 0 | 13 participants |
| Performance Status 1 | 46 participants |
| Prior Systemic Regimens 1 Regimen | 34 participants |
| Prior Systemic Regimens 2 Regimens | 25 participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 1 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 | 3 Participants |
| Race (NIH/OMB) White | 55 Participants |
| Sex: Female, Male Female | 14 Participants |
| Sex: Female, Male Male | 45 Participants |
| Weight Loss Last 6 Months 10% - 20% | 6 participants |
| Weight Loss Last 6 Months < 5% | 47 participants |
| Weight Loss Last 6 Months 5% - < 10% | 6 participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 58 / 59 |
| serious Total, serious adverse events | 25 / 59 |
Outcome results
Progression-Free Survival
Progression-Free Survival was defined as the duration from the date of registration until the date of disease progression per RECIST or death due to any cause. Patients known to be alive without evidence of disease progression were censored at the date of last contact. Disease progression was defined as a \>= 20% increase over nadir in the sum of longest diameters of target lesions, unequivocal progression of non-target lesions in the opinion of the treating investigator, appearance of new lesions, symptomatic deterioration, or death due to disease
Time frame: Every 8 weeks until disease progression, up to 3 years.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Everolimus | Progression-Free Survival | 3.0 months |
Frequency and Severity of Toxicities
Time frame: Weekly during the first 8 weeks of treatment, then every 4 weeks while on treatment, then every 8 weeks until disease progression, then every 6 months thereafter.
Population: Number of Subjects With Greater Than Grade 2 Toxicity
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Everolimus | Frequency and Severity of Toxicities | Anorexia | 1 participants |
| Everolimus | Frequency and Severity of Toxicities | Confusion | 1 participants |
| Everolimus | Frequency and Severity of Toxicities | Dehydration | 2 participants |
| Everolimus | Frequency and Severity of Toxicities | Diarrhea | 1 participants |
| Everolimus | Frequency and Severity of Toxicities | Dyspnea (shortness of breath) | 3 participants |
| Everolimus | Frequency and Severity of Toxicities | Fatigue (asthenia, lethargy, malaise) | 6 participants |
| Everolimus | Frequency and Severity of Toxicities | Glucose, serum-high (hyperglycemia) | 3 participants |
| Everolimus | Frequency and Severity of Toxicities | Hemoglobin | 4 participants |
| Everolimus | Frequency and Severity of Toxicities | INR (of prothrombin time) | 1 participants |
| Everolimus | Frequency and Severity of Toxicities | Inf (clin/microbio) w/Gr 3-4 neuts - Lung | 1 participants |
| Everolimus | Frequency and Severity of Toxicities | Infection with unknown ANC - Lung (pneumonia) | 3 participants |
| Everolimus | Frequency and Severity of Toxicities | Left ventricular systolic dysfunction | 1 participants |
| Everolimus | Frequency and Severity of Toxicities | Lymphopenia | 2 participants |
| Everolimus | Frequency and Severity of Toxicities | Mucositis/stomatitis (clinical exam) - Oral cavity | 1 participants |
| Everolimus | Frequency and Severity of Toxicities | Mucositis/stomatitis (functional/symp) - Oral cav | 1 participants |
| Everolimus | Frequency and Severity of Toxicities | Muscle weakness, not d/t neuropathy - body/general | 2 participants |
| Everolimus | Frequency and Severity of Toxicities | Pneumonitis/pulmonary infiltrates | 2 participants |
| Everolimus | Frequency and Severity of Toxicities | Rash/desquamation | 1 participants |
| Everolimus | Frequency and Severity of Toxicities | Triglyceride, serum-high (hypertriglyceridemia) | 2 participants |
Overall Survival
Overall survival was defined as the duration between the date of enrollment and the date of death due to any cause. Patients last known to be alive were censored at the date of last contact.
Time frame: Every 8 weeks until disease progression, up to 3 years.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Everolimus | Overall Survival | 6.3 months |
Response
A response was defined as either a confirmed or unconfirmed complete or partial responses as defined by RECIST. A complete response (CR) was defined as the disappearance of all disease. A partial response (PR) was defined as a \>= 30% decrease in the sum of longest diameters of target lesions. A CR or PR was considered confirmed if two consecutive determinations were made at least 4 weeks apart.
Time frame: Every 8 weeks until disease progression, up to 3 years.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Everolimus | Response | 2 percentage of overall response rate |