Inclusion Criteria:
- COHORT I (DOSE ESCALATION): histologic proof of cancer that is now unresectable, not
amenable to any other standard therapies, or patient refuses standard therapy
- COHORT II (MTD): metastatic adenocarcinoma of the pancreas and tumor amenable to
biopsies; prior systemic treatment for metastatic disease is allowed
- Absolute neutrophil count (ANC) => 1500/uL
- Platelet >= 100,000/uL
- Total bilirubin =< upper limit of normal (ULN) Aspartate aminotransferase (AST)
(serum glutamic oxaloacetic transaminase [SGOT]) =< 3 x ULN
- Creatinine =< 1.5 x ULN
- Hemoglobin >= 9.0 g/dL
- Prothrombin time (PT)/international normalized ratio (INR) < 1.25 x ULN (Cohort II
[MTD] only)
- Cholesterol < Common Terminology Criteria for Adverse Events (CTCAE) grade 3
- Triglycerides < CTCAE grade 2
- Magnesium >= lower limit of normal (LLN) and =< ULN
- Ability to provide informed consent
- Willing to return to Mayo Clinic for follow up
- Life expectancy >= 12 weeks
- Cohort II (MTD) only - Translational Research: Willing to provide the biologic
specimens as required by the protocol; Note: this is part of the mandatory
translational research component
- Women of childbearing potential only: Negative serum pregnancy test done =< 7 days
prior to registration; NOTE: female subjects who are pregnant or nursing are excluded
from this study; there is no specific mitigation strategy for vismodegib toxicity;
however, male patients should be made aware of it during the consent process;
although this effect is expected to be reversible with discontinuation of dosing,
long-term effects on male fertility cannot be excluded at this time
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0, 1 or 2
- Able to swallow or have medication administered through a G-tube and absorb the
medication
- Participant agrees to use acceptable form of contraception during the study and for
up to 7 months after last study drug dose
- Acceptable forms of contraception:
- Latex condom (always used with spermicide)
- Diaphragm (always used with spermicide)
- Cervical cap (always used with spermicide)
- Acceptable forms of secondary contraception, when used along with a barrier method:
- Hormonal contraception methods, including pills, patches, rings, or injections
except progestin-only containing pills (i.e. "Mini-pill")
- Tubal ligation
- Partner's vasectomy
- Intrauterine device (non-progesterone T)
- Vaginal sponge (containing spermicide)
- Other acceptable forms:
- 100% commitment to abstinence
- Unacceptable forms of contraception for women of childbearing potential:
- Oral contraception containing progestins only
- Intrauterine device (IUD) progesterone T
- Female condom
- Natural family planning (rhythm method) or breastfeeding
- Fertility awareness
- Withdrawal
- Cervical shield
- Willing not to smoke
- Willing to complete a pill diary each day
Exclusion Criteria:
- COHORT I (DOSE ESCALATION): Known standard therapy for the patient's disease that is
potentially curative or definitely capable of extending life expectancy
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, diabetes mellitus or psychiatric illness/social situations that would
limit compliance with study requirements
- Any of the following prior therapies:
- Chemotherapy =< 4 weeks prior to registration
- Mitomycin C/nitrosoureas =< 6 weeks prior to registration
- Immunotherapy =< 4 weeks prior to registration
- Biologic therapy =< 4 weeks prior to registration
- Radiation therapy =< 4 weeks prior to registration
- Radiation to > 25% of bone marrow
- Failure to fully recover from acute, reversible effects of prior chemotherapy
regardless of interval since last treatment
- New York Heart Association classification III or IV
- Uncontrolled Seizure Disorder
- Central nervous system (CNS) metastases if not stable for at least 2-3 months based
on imaging, clinical assessment, use of steroids, or seizure disorder
- Any of the following:
- Pregnant women
- Nursing women
- This study involves an investigational agent whose genotoxic, mutagenic and
teratogenic effects on the developing fetus and newborn are unknown
- Other concurrent chemotherapy, immunotherapy, radiotherapy, any ancillary therapy
considered investigational (utilized for a non-Food and Drug Administration
[FDA]-approved indication and in the context of a research investigation) or
receiving any other investigational agent which would be considered as a treatment
for the primary neoplasm
- Receiving any medications or substances that are strong or moderate inhibitors of
cytochrome P450 3A4 (CPY450 3A4); use of the following strong or moderate inhibitors
are prohibited:
- Strong Inhibitors of CYP3A4: Indinavir, Nelfinavir, Ritonavir, Clarithromycin,
Itraconazole, Ketoconazole, Nefazodone, Saquinavir, Telithromycin
- Moderate Inhibitors of CYP3A4: Aprepitant, Erythromycin, Fluconazole, Grapefruit
juice, Verapamil, Diltiazem
- Receiving any medications or substances that are inducers of CYP450 3A4
- Inducers of CYP3A4: Efavirenz, Nevirapine, Carbamazepine, Modafinil,
Phenobarbital, Phenytoin, Pioglitazone, Rifabutin, Rifampin, St. John's wort
- Receiving any medications or substances that are strong or moderate inhibitors of
CYP450 CYP2C8
- Strong or Moderate Inhibitors of CYP2C8: Gemfibrozil, Trimethoprim
- Receiving any medications or substances that are inducers of CYP450 2C8
- Inducer of CYP2C8: Rifampin
- Receiving any medications or substances that are strong or moderate inhibitors of
CYP450 CYP2C9
- Strong or Moderate Inhibitors of CYP2C9: Fluconazole, Amiodarone
- Receiving any medications or substances that are inducers of CYP450 2C9
- Inducers of CYP2C9: Rifampin, Secobarbital
- Immunocompromised patients (other than that related to the use of corticosteroids)
including patients receiving highly active antiretroviral therapy (HAART) treatment
- Active other malignancy, excepting non-melanotic skin cancer or carcinoma-in situ
(e.g. of cervix, breast prostate); if there is a history of prior malignancy, they
must not be receiving other specific treatment (other than hormonal therapy) for
their cancer
- History of myocardial infarction =< 6 months, or congestive heart failure requiring
use of ongoing maintenance therapy for life-threatening ventricular arrhythmias
- Abnormalities of the cornea based on history (e.g., dry eye syndrome, Sjogren's
syndrome), congenital abnormality (e.g., Fuch's dystrophy), abnormal slit-lamp
examination using a vital dye (e.g., fluorescein, Bengal Rose), and/or an abnormal
corneal sensitivity test (Schirmer test or similar tear production test)
- Prior therapy with a hedgehog inhibitor