Inclusion Criteria:
- Patients must have histologically confirmed malignancy that is metastatic or
unresectable and for which there is no standard therapy
- Patients must not have received radiation to > 25% of bone marrow
- ECOG performance status =< 2 (Karnofsky >= 60%)
- Life expectancy of greater than 12 weeks
- Hemoglobin >= 9 g/dL
- Leukocytes >= 3,000/mcL
- Absolute neutrophil count >= 1,500/mcL
- Platelets >= 100,000/mcL
- Total bilirubin within normal institutional limits
- AST(SGOT)/ALT(SGPT) =< 2.5 X institutional upper limit of normal
- Creatinine within normal institutional limits OR creatinine clearance >= 60
mL/min/1.73 m^2 for patients with creatinine levels above institutional normal
- Preclinical studies indicate that RO4929097 is a substrate of CYP3A4 and inducer of
CYP3A4 enzyme activity; caution should be exercised when dosing RO4929097
concurrently with CYP3A4 substrates, inducers, and/or inhibitors; furthermore,
patients who are taking concurrent medications that are strong inducers/inhibitors or
substrates of CYP3A4 should be switched to alternative medications to minimize any
potential risk; if such patients cannot be switched to alternative medications, they
will be ineligible to participate in this study
- Caution should be exercised when dosing ketoconazole, rifampin, omeprazole,
midazolam, tolbutamide, and dextromethorphan concurrently with CYP3A4 substrates,
inducers, and/or inhibitors; furthermore, patients who are taking concurrent
medications that are strong inducers/inhibitors or substrates of CYP3A4 should be
switched to alternative medications to minimize any potential risk; if such patients
cannot be switched to alternative medications, they will be ineligible to participate
in this study
- The effects of RO4929097on the developing human fetus at the recommended therapeutic
dose are unknown; for this reason and because Notch signal pathway inhibitors are
known to be teratogenic, women of childbearing potential and men must use two forms
of contraception (i.e., barrier contraception and one other method of contraception)
at least 4 weeks prior to study entry, for the duration of study participation, and
for at least 12 months post-treatment; should a woman become pregnant or suspect she
is pregnant while she or her partner are participating in this study and for 12
months after study participation, the patient should inform the treating physician
immediately
- Women randomized to Regimen I (Arm B) and Regimen II (Arm B), and receiving rifampin
will need to use an additional, non-hormonal birth control during cycle 2; rifampin
induces enzymes responsible for hormone metabolism, making hormonal birth control
ineffective; should a woman become pregnant or suspect she is pregnant while
participating in this study, she should inform her treating physician immediately
- Ability to understand and the willingness to sign a written informed consent document
- Patients must have measurable disease, or radiographically evaluable metastatic
disease (e.g. osseous metastases) with evidence of disease progression (e.g. new
lesions or rising tumor markers)
- Treated, stable brain metastases are allowed; patients must be four weeks from
radiation with stable brain imaging and off any medications used to treat brain
metastases, excepting those anti-epileptics not metabolized by cytochrome P450
Exclusion Criteria:
- Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for
nitrosoureas or mitomycin C) prior to entering the study or those who have not
recovered (=< grade 1) from clinically significant adverse events due to agents
administered more than 4 weeks earlier; prior palliative radiotherapy is allowed if
greater than 2 weeks have elapsed and patient has also recovered to baseline or grade
< 1 from any treatment adverse effects
- Patients may not be receiving any other investigational agents
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to RO4929097, or other agents used in study
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, and a
history of torsades de pointes or other significant cardiac arrhythmia other than
chronic, stable atrial fibrillation, or psychiatric illness/social situations that
would limit compliance with study requirements
- Pregnant women are excluded from this study because RO4929097 is a gamma-secretase
inhibitor with the potential for teratogenic or abortifacient effects; because there
is an unknown but potential risk for adverse events in nursing infants secondary to
treatment of the mother with RO4929097, breastfeeding should be discontinued if the
mother is treated with RO4929097; these potential risks may also apply to other
agents used in this study
- HIV-positive patients receiving combination antiretroviral therapy are ineligible
because of the potential for pharmacokinetic interactions with RO4929097; in
addition, these patients are at increased risk of lethal infections when treated with
marrow-suppressive therapy; appropriate studies will be undertaken in patients
receiving combination antiretroviral therapy when indicated
- Patients with uncontrolled hypocalcemia, hypomagnesemia, hyponatremia,
hypophosphatemia or hypokalemia defined as less than the lower limit of normal for
the institution, despite adequate electrolyte supplementation are excluded from this
study; Note: it is acceptable to use corrected calcium when interpreting calcium
levels
- Patients must not be taking omeprazole or dextromethorphan, or be willing to take
only the study dose and formulation on the PK days; patients who require or are
likely to require therapeutic doses of these drugs are excluded
- Patients must not be taking rifampin, ketoconazole, tolbutamide, or midazolam;
patients who require or are likely to require therapeutic doses of these drugs are
excluded
- Patients must not be taking monoamine oxidase inhibitors, such as Clorgyline,
Iproniazid, Isocarboxazid, Moclobemide, Nialamide, Pargyline, Phenelzine,
Procarbazine, Rasagiline, Selegiline, Toloxatone, or Tranylcypromine because of drug
interactions with dextromethorphan
- Patients must not have acute narrow-angle glaucoma or untreated open-angle glaucoma,
as midazolam is contraindicated
- Baseline QTcF > 450 msec
- Patients who are serologically positive for Hepatitis A, B or C, or have a history of
liver disease, other forms of hepatitis or cirrhosis are ineligible
- Patients with malabsorption syndrome or other condition that would interfere with
intestinal absorption; patients must be able to swallow tablets
- Because opioid containing pain medications may be metabolized by the CYP3A4 pathway,
patients should be monitored carefully to avoid toxicity and doses adjusted if
necessary; subjects who would not tolerate adjustments in their opioid pain
medications are excluded
- Subjects with a history of hypoglycemia, diabetes mellitus, or abnormal glucagon
regulation are excluded; subjects with a current diagnosis of diabetes mellitus who
are receiving treatment (i.e. insulin or other medication) are not eligible; a
diagnosis of diabetes mellitus that is managed by diet is allowable
- Subjects with mild to severe skin exanthems are excluded
- A requirement for antiarrhythmics or other medications known to prolong QTc