A Phase I Trial of the mTOR Inhibitor RAD001 in Combination With VEGF Receptor Tyrosine Kinase Inhibitor PTK787/ZK 222584 in Patients With Advanced Solid Tumors
OBJECTIVES:
- To determine the dose-limiting toxicity (DLT) and maximum tolerated dose (MTD) of
everolimus and vatalanib in patients with advanced solid tumors. (Cohort 1) (Closed to
enrollment as of 12/6/06)
- To describe the toxicities of this regimen in these patients. (Cohort 1) (Closed to
enrollment as of 12/6/06)
- To evaluate the therapeutic antitumor activity of this regimen in these patients.
(Cohort 1) (Closed to enrollment as of 12/6/06)
- To determine the recommended phase II dose (RPTD) of this regimen in these patients.
(Cohort 1) (Closed to enrollment as of 12/6/06)
- To investigate the biological activity of this regimen when given at the MTD/RPTD.
(Cohort 2)
- To evaluate the therapeutic antitumor activity of this regimen when given at the
MTD/RPTD. (Cohort 2)
- To evaluate pharmacogenetic, metabolic, and clinical markers that may predict
hypertension induced by anti-VEGF therapy. (Cohort 2)
- To obtain pilot data on efficacy outcomes in patients with metastatic kidney cancer,
neuroendocrine carcinoma, non-small cell lung cancer, or melanoma treated with this
regimen. (Cohort 2)
OUTLINE: Patients are assigned to 1 of 4 treatment cohorts* according to disease (cohort
1A*, 1B*, or 2A [any histopathologic diagnosis] or cohort 2B [metastatic kidney cancer,
neuroendocrine carcinoma, melanoma, or non-small cell lung cancer]). Patients are initially
enrolled into cohorts 1A* or 1B* until the maximum tolerated dose (MTD) and recommended
phase II dose (RPTD) of everolimus and vatalanib are determined. Once the MTD/RPTD of
everolimus and vatalanib are determined, subsequent patients are enrolled and treated at the
MTD/RPTD in expansion cohorts 2A or 2B.
NOTE: *Cohorts 1A and 1B are closed to enrollment as of 12/6/06.
- Cohorts 1A or 1B (dose escalation cohorts; closed to enrollment as of 12/6/06):
Patients receive oral vatalanib once (cohort 1A) or twice (cohort 1B) daily on days
1-28 and oral everolimus once daily on days 15-28 of course 1. For all subsequent
courses, patients receive oral vatalanib once (cohort 1A) or twice (cohort 1B) daily
and oral everolimus once daily on days 1-28. Courses repeat every 28 days in the
absence of disease progression or unacceptable toxicity.
- Cohorts 2A or 2B (expansion cohorts treated at the MTD/RPTD):
- Cohort 2A: Patients receive oral everolimus once daily for 14 days followed by a
7-day rest period. Patients then receive oral vatalanib twice daily on days 1-28
and oral everolimus once daily on days 15-28 of course 1. For all subsequent
courses, patients receive oral vatalanib twice daily and oral everolimus once
daily on days 1-28. Courses repeat every 28 days in the absence of disease
progression or unacceptable toxicity.
- Cohort 2B: Patients receive oral vatalanib twice daily on days 1-28 and oral
everolimus once daily on days 15-28 of course 1. For all subsequent courses,
patients receive oral vatalanib twice daily and oral everolimus once daily on days
1-28. Courses repeat every 28 days in the absence of disease progression or
unacceptable toxicity.
Patients in cohorts 2A or 2B undergo blood sample collection periodically for translational
research studies. Translational studies include pharmacokinetic studies (cohort 2A only) by
high performance liquid chromatography; pharmacogenetic studies; and analysis of plasma
levels of VEGF-A and soluble VEGFR-1 by ELISA techniques. Factors predicting the development
of hypertension induced by anti-VEGF therapy are also studied in these patients by
quantifying plasma levels of ADMA by mass spectrometry and measuring brachial artery
flow-mediated vasodilation by brachial artery ultrasound. Formalin-fixed paraffin embedded
(FFPE) and fresh tumor tissue samples* are collected and analyzed to assess total and
phosphorylated 4E-BP and p70S6 kinase expression and phosphorylated AKT, PTEN, and cyclin D
expression by immunohistochemistry. Patients in cohort 2A also undergo dynamic
contrast-enhanced MRI periodically to assess changes in tumor perfusion.
NOTE: *FFPE tumor tissue samples are collected from patients enrolled in cohorts 2A or 2B;
fresh tumor tissue samples are collected from patients enrolled in cohort 2A only.
Interventional
Primary Purpose: Treatment
Maximum tolerated dose of everolimus and vatalanib (Cohort 1) (Closed to enrollment as of 12/6/06)
Yes
Julian Molina, MD, PhD
Study Chair
Mayo Clinic
United States: Food and Drug Administration
CDR0000592921
NCT00655655
December 2004
Name | Location |
---|---|
Mayo Clinic | Rochester, Minnesota 55905 |