A Phase I Study of CCI-779 in Combination With Imatinib Mesylate in Chronic Myelogenous Leukemia
Inclusion Criteria:
- Histologically confirmed chronic myelogenous leukemia (CML)
- Philadelphia chromosome-positive OR Bcr-Abl-positive disease, meeting 1 of the
following criteria:
- Accelerated phase, defined by at least 1 of the following:
- 10-19% blasts in the peripheral blood or bone marrow
- At least 20% basophils in peripheral blood or bone marrow
- Platelet count < 100,000/mm^3 (unrelated to therapy)
- Platelet count > 1,000,000/mm^3 (unresponsive to therapy)
- Increasing splenomegaly AND increasing WBC count (unresponsive to
therapy)
- Clonal evolution
- Blast phase, defined by 1 of the following:
- At least 20% blasts in peripheral blood or bone marrow
- Extramedullary disease
- Chronic phase, defined by all of the following:
- Less than 10% blasts in peripheral blood or bone marrow
- Less than 20% basophils in peripheral blood or bone marrow
- Platelet count > 100,000/mm^3
- Absence of clonal evolution
- May have received and/or failed prior imatinib mesylate therapy
- Patients not previously treated with imatinib mesylate receive oral imatinib
mesylate once daily 14 days before beginning study drug
- Must be able to tolerate 600 mg per day of imatinib mesylate before
starting CCI-779
- Patients with chronic phase disease must have failed prior imatinib mesylate at
a dose ≥ 600 mg/day, as defined by 1 of the following:
- Must not have achieved or must have lost hematologic response within 3
months after the start of imatinib mesylate
- Must not have achieved or must have lost cytogenetic response after 6
months of treatment with imatinib mesylate
- Must not have achieved or must have lost major cytogenetic response after
12 months of treatment with imatinib mesylate
- Must have lost complete cytogenetic response
- Bone marrow aspirate and biopsy with cytogenetics and fluorescent in situ
hybridization confirming t(9;22) completed within the past 28 days
- Performance status - SWOG 0-2
- More than 3 months
- See Disease Characteristics
- Bilirubin normal
- AST and ALT < 2.5 times upper limit of normal (ULN) (5 times ULN if suspected liver
involvement with leukemia)
- Creatinine normal
- Creatinine clearance > 60 mL/min
- No symptomatic congestive heart failure
- No unstable angina pectoris
- No cardiac arrhythmia
- Ejection fraction ≥ 50% by echocardiogram or MUGA scan for patients with known
positive cardiac history (e.g., heart failure, coronary artery disease, cardiomegaly
on prior chest x-ray, or valvular heart disease)
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Fasting cholesterol ≤ 350 mg/dL
- Fasting triglycerides ≤ 400 mg/dL
- No history of allergic reaction attributed to compounds of similar chemical or
biologic composition to temsirolimus or imatinib mesylate
- No active or ongoing infection
- No psychiatric illness or social situation that would preclude study compliance
- No other active malignancy except nonmelanoma skin cancer
- No other uncontrolled illness
- At least 48 hours since prior interferon alfa for CML
- At least 6 weeks since prior stem cell transplantation
- No concurrent biologic agents
- No concurrent prophylactic colony-stimulating factors
- At least 24 hours since prior hydroxyurea for CML
- At least 7 days since prior mercaptopurine or vinca alkaloids for CML
- At least 7 days since prior low-dose cytarabine (< 30 mg/m^2 every 12-24 hours) for
CML
- At least 14 days since prior homoharringtonine for CML
- At least 14 days since prior moderate-dose cytarabine (100-200 mg/m^2 for 5-7 days)
for CML
- At least 21 days since prior anthracyclines, mitoxantrone, cyclophosphamide,
etoposide, or methotrexate for CML
- At least 28 days since prior high-dose cytarabine (1-3 g/m^2 every 12-24 hours for
6-12 doses) for CML
- At least 6 weeks since prior busulfan for CML
- No concurrent hydroxyurea
- No other concurrent chemotherapy
- At least 7 days since prior steroids for CML
- No prior organ transplantation
- More than 2 weeks since prior major surgery (e.g., thoracotomy or intra-abdominal
surgery)
- Recovered from all prior therapy
- Prior experimental therapy allowed provided completion of treatment corresponds to a
duration > 5 half-lives of the experimental drug or any known active metabolite
before study
- No concurrent cyclosporine
- No concurrent anagrelide
- No concurrent oral anticoagulants, including warfarin
- No concurrent CYP3A4 inducers or inhibitors
- No concurrent tacrolimus
- No concurrent plasmapheresis
- No concurrent combination antiretroviral therapy for HIV-positive patients
- No other concurrent investigational agents
- No other concurrent anticancer therapies