A Phase II Study of Single Agent Depsipeptide (FK228) in Metastatic or Unresectable Soft Tissue Sarcomas
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
- 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