A Phase 1 and Pharmacokinetic Single Agent Study of Romidepsin in Patients With, Lymphomas, Chronic Lymphocytic Leukemia and Select Solid Tumors and Varying Degrees of Liver Dysfunction
Inclusion Criteria:
- Patients must have histologically or cytologically confirmed (at original diagnosis
or subsequent recurrence or progression) lymphoma, chronic lymphocytic lymphoma (CLL)
or solid tumor*; patients with lymphoma or CLL must have radiologically or clinically
evaluable disease, and be refractory to standard therapy as defined by relapse within
6 months of last treatment (see note below); patients with solid tumors must have
radiologically or clinically evaluable disease that is metastatic, unresectable,
progressive, or recurrent, and for which standard curative measures do not exist or
are no longer effective
- Patients with a liver mass, raised alpha-fetoprotein level (>= 500 ng/mL) and
positive serology for hepatitis, consistent with a diagnosis of hepatocellular
carcinoma will be eligible without the need for pathologic confirmation of the
diagnosis
- excluding prostate cancer, renal cell cancer, neuroendocrine tumors, lung
cancer, colorectal cancers, soft tissue sarcomas, glioma and thyroid cancer due
to a lack of efficacy in these tumor types in phase 2 studies; patients with
breast, pancreatic, bladder, head and neck cancers, as well as melanoma and
other malignancies are eligible
- Note: As romidepsin is approved for patients with relapsed or refractory PTCL or
CTCL, these patients would be eligible WITHOUT the requirement of having
'relapsed within 6 months of last treatment'
- Life expectancy of > 3 months
- Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
- Hemoglobin >= 9 g/dL (transfusions and/or erythropoietin are permitted)
- Absolute Neutrophil Count (ANC) >= 1.5 x 10^9/L
- Platelets >= 100 x 10^9/L (or platelet count >= 75 × 10^9 cells/L in patients with
lymphoma or CLL if bone marrow disease involvement is documented)
- Creatinine =< twice upper limit institutional normal
- Patients with abnormal liver function will be eligible and will be grouped according
to the criteria below
- Group A (normal hepatic function)
- Bilirubin =< upper limit of normal (ULN) and aspartate aminotransferase
(AST) =< ULN
- Group B (mild hepatic dysfunction)
- B1: bilirubin =< ULN and AST > ULN
- B2: bilirubin > ULN but =< 1.5 x ULN and any AST
- Group C (moderate hepatic dysfunction)
- Bilirubin > 1.5 x ULN to =< 3 x ULN and any AST
- Group D (severe hepatic dysfunction)
- Bilirubin > 3 x ULN but =< 10 x ULN and any AST
- Patients with active hemolysis should be excluded; no distinction will be made
between liver dysfunction due to metastases and liver dysfunction due to other
causes; registration laboratory investigations will be used to assign a patient
to a hepatic function group; liver function tests should be repeated within 24
hours prior to starting initial therapy and may result in the patients' group
assignment being altered if different to registration test results
- Patients with brain metastases who require corticosteroids or non-enzyme
anticonvulsants must be on a stable dose of corticosteroids and seizure free for 1
month prior to enrollment; patients with known brain metastases should have completed
brain irradiation (whole brain or gamma knife) more than 4 weeks before starting the
protocol; patients on enzyme inducing anticonvulsants are not eligible; note that
patients should have had their steroids tapered to low dose (i.e. < 1.5 mg of
dexamethasone/day) due to the potential for higher dexamethasone doses to induce
cytochrome P450 3A4 (CYP3A4)
- Patients with biliary obstruction for which a stent has been placed are eligible,
provided the shunt has been in place for at least 10 days prior to the first dose of
romidepsin and the liver function has stabilized; two measurements at least 2 days
apart that put the patient in the same hepatic dysfunction stratum will be accepted
as evidence of stable hepatic function; there should be no evidence of biliary sepsis
- Eligibility of patients receiving any medications or substances known to affect or
with the potential to affect the activity or PK of romidepsin will be determined
following review of their case by the site principal investigator
- Patients treated with any of the medications prohibited must discontinue their
use at least 7 days prior to the first dose of romidepsin; certain other agents
that interact with the CYP3A4 system may be used with caution
- The effects of romidepsin on the developing human fetus are unknown; for this reason
and because histone deacetylase (HDAC) inhibitors are known to be teratogenic, women
of childbearing potential and men must agree to use adequate contraception (hormonal
or barrier method of birth control; abstinence) prior to study entry and for the
duration of study participation; should a woman become pregnant or suspect she is
pregnant while participating in this study, she should inform her treating physician
immediately; Note: Since romidepsin binds to the estrogen receptor, the effectiveness
of estrogen containing contraceptives may be reduced
- Human immunodeficiency virus (HIV)-positive patients who are not receiving: agents
with the potential for PK interactions with romidepsin or hepatotoxic antiretrovirals
(nucleoside reverse-transcriptase inhibitors [NRTIs]: abacavir, didanosine,
emtricitabine, lamivudine, stavudine, and zidovudine), dual protease inhibitor
(PI)-based regimens except low-dose boosting with ritonavir, atazanavir, indinavir,
maraviroc, and nevirapine may be eligible; additionally, the HIV-positive patients
should have a cluster of differentiation (CD)4 count > 250/mm^3; if the specific
cause of hepatic dysfunction is unknown, the patient should be worked up for other
viral causes of hepatitis and their eligibility determined after consultation with
the principal investigator
- Patients who have received prior romidepsin use are eligible
- Ability to understand and the willingness to sign a written informed consent document
Exclusion Criteria:
- Patients who have had radiation, major surgery, chemotherapy, or biological therapy
within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study;
>= 2 weeks since any prior administration of study drug in an exploratory IND/Phase 0
study; patients must have recovered to at least eligibility levels due to adverse
events and/or toxicity of prior chemotherapy or biologic therapy, with the exception
of alopecia, unless approved by the principal investigator
- Patients with prostate cancer, renal cell cancer, neuroendocrine tumors, lung cancer,
colorectal cancers, soft tissue sarcomas, glioma, and thyroid cancer are excluded due
to a lack of efficacy in these tumor types in phase 2 studies
- Patients may not be receiving any other investigational agents
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to romidepsin, including cyclic tetrapeptide compounds
- Concurrent medications associated with a risk of QTc prolongation and/or Torsades de
Pointes are not allowed within 2 weeks of initiation of study treatment; those
medications as reported but lacking substantial evidence for causing QTc prolongation
and Torsades de Pointes will be allowed, although if an alternative medication can be
substituted, that would be preferable
- Thiazolidinedione agents such as rosiglitazone and pioglitazone are not permitted due
to the cardiac risks associated with this class of agents
- Uncontrolled intercurrent illness including, but not limited to ongoing or active
infection, or psychiatric illness/social situations that would limit compliance with
study requirements
- Patients with current evidence of significant cardiovascular disease (New York Heart
Association Class III or IV cardiac disease), symptomatic congestive heart failure,
dilated/hypertrophic or restrictive cardiomyopathy, myocardial infarction (within the
past 6 months), unstable angina, unstable arrhythmia or a need for anti-arrhythmic
therapy (use of medications for rate control for atrial fibrillation is allowed such
as calcium channel blockers and beta-blockers, if stable medication for at least last
month prior to initiation of romidepsin treatment and medication not listed as
causing Torsades de Points), or evidence of acute ischemia on ECG; marked baseline
prolongation of QT/QTc interval, e.g., repeated demonstration of a QTc interval > 450
msec*; long QT Syndrome; the required use of concomitant medication that may cause
Torsades de Pointes or may cause a significant prolongation of the QTc
- Note: due to difficulties assessing QTc in patients with heart block, they may
be eligible if deemed safe by a cardiologist
- Pregnant women are excluded from this study because romidepsin is an histone
deacetylase (HDAC) 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 romidepsin, breastfeeding should be
discontinued if the mother is treated with this drug
- Warfarin is not permitted due to the potential to increase international normalized
ratio (INR)