A Phase I Study Evaluating the Combination of the Deacetylase Inhibitor, LBH589 Plus the mTOR Inhibitor RAD001, in Relapsed and Refractory Adult Patients With Lymphoma
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed diagnosis of one of the following:
- Hodgkin or non-Hodgkin lymphoma (including small lymphocytic lymphoma [SLL])
- Any histology, including B, T, or NK/T cell allowed
- Multiple myeloma (MM)
- Relapsed or refractory disease
- Patients with lymphoma must have relapsed after or be refractory to an upfront
regimen (e.g., CHOP or ABVD) and a salvage regimen (e.g., ICE or ESHAP)
- Patients with SLL should have relapsed after a fludarabine-containing
regimen
- Patients with MM must have progressed within 100 days after receiving a regimen
containing bortezomib and either thalidomide or lenalidomide AND have a 25%
increase in serum paraproteins, urinary light chains, or plasma cell number in
the bone marrow
- No active CNS disease
PATIENT CHARACTERISTICS:
- ECOG performance status 0-2
- ANC ≥ 1,500/mm³
- Platelet count ≥ 75,000/mm³ (transfusion allowed in patients with biopsy-proven bone
marrow involvement)
- AST and ALT ≤ 2.5 times upper limit of normal (ULN) (≤ 5.0 times ULN if elevation due
to leukemic involvement)
- Serum bilirubin ≤ 1.5 times ULN
- Serum creatinine ≤ 1.5 times ULN OR creatinine clearance ≥ 50 mL/min
- Serum potassium normal
- Serum phosphorous normal
- Serum total calcium (corrected for serum albumin) or serum ionized calcium normal
- Serum magnesium normal
- TSH and free T4 normal (thyroid hormone replacement allowed)
- Fasting serum cholesterol ≤ 300 mg/dL (or ≤ 7.75 mmol/L) AND fasting triglycerides ≤
2.5 times ULN (elevated levels allowed provided an appropriate lipid-lowering
medication has been initiated)
- LVEF normal by MUGA or ECHO
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective double-method (including barrier method)
contraception during and for 3 months after completion of study treatment
- No impaired cardiac function, including any of the following:
- QTc > 450 msec by screening ECG
- Congenital long QT syndrome
- History of sustained ventricular tachycardia
- History of ventricular fibrillation or torsades de pointes
- Bradycardia, defined as heart rate (HR) < 50 beats/min (pacemaker allowed
provided HR ≥ 50 beats/min)
- Myocardial infarction or unstable angina within the past 6 months
- NYHA class III-IV congestive heart failure
- Right bundle branch block and left anterior hemiblock (bifascicular block)
- No uncontrolled hypertension
- No unresolved diarrhea > CTCAE grade 1
- No impairment of gastrointestinal (GI) function or GI disease that may significantly
alter the absorption of oral agents (e.g., ulcerative disease, uncontrolled nausea,
vomiting, diarrhea, malabsorption syndrome, or small bowel resection)
- No other concurrent severe or uncontrolled medical condition
- No other primary malignancy within the past 5 years other than curatively treated
carcinoma in situ of the cervix or basal cell or squamous cell carcinoma of the skin
- No known HIV or hepatitis C positivity
- No significant history of non-compliance to medical regimens
- No known hypersensitivity to everolimus, other rapamycins (e.g., sirolimus or
temsirolimus), or their excipients
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- Prior autologous or allogeneic stem cell transplantation allowed
- More than 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C)
or radiotherapy and recovered
- More than 1 week since prior and no concurrent immunization with live attenuated
vaccines
- More than 4 weeks since prior valproic acid
- No other prior histone deacetylase inhibitors
- No concurrent chronic systemic corticosteroids or another immunosuppressive agent,
other than for control of itching (as in cutaneous T-cell lymphoma)
- Concurrent corticosteroids allowed provided patient has been on a stable dosage
regimen for ≥ 2 weeks before study entry
- Topical or inhaled corticosteroids allowed
- No concurrent drugs that may induce torsades de pointes
- No concurrent CYP3A4 inhibitors
- No concurrent radiotherapy or other anticancer therapy
- No concurrent grapefruit, grapefruit juice, or seville (sour) oranges
- No concurrent medications that may cause QTc prolongation
- No other concurrent investigational therapy