A Phase I/II Trial of Ganetespib in Combination With the mTOR Inhibitor Sirolimus for Patients With Recurrent or Refractory Sarcomas Including Unresectable or Metastatic Malignant Peripheral Nerve Sheath Tumors
Overview
- Phase
- Phase 1
- Intervention
- ganetespib
- Conditions
- Malignant Peripheral Nerve Sheath Tumors (MPNST)
- Sponsor
- Sarcoma Alliance for Research through Collaboration
- Enrollment
- 20
- Locations
- 7
- Primary Endpoint
- Clinical Benefit of Ganetespib in Combination With Sirolimus
- Status
- Completed
- Last Updated
- 6 years ago
Overview
Brief Summary
Phase 1: To assess the safety, tolerability, and maximum tolerated dose (MTD)/ recommended dose of ganetespib when administered in combination with sirolimus in patients with refractory or relapsed sarcomas including unresectable or metastatic sporadic or neurofibromatosis type 1 (NF1) associated MPNST. Phase I enrollment has been closed.
Phase 2: To determine the clinical benefit of ganetespib in combination with sirolimus for patients with unresectable or metastatic sporadic or NF1 associated MPNST.
Detailed Description
Previously, no targeted agents have been able to cause tumor regression in a genetically engineered MPNST mouse model or human MPNST. Recently published data from Dr. Cichowski's laboratory demonstrated using Hsp90 inhibitors to enhance endoplasmic reticulum stress coupled with the mammalian target of rapamycin (mTOR) inhibitor sirolimus led to dramatic tumor shrinkage in a transgenic MPNST mouse model, which correlated with profound damage to the endoplasmic reticulum and cell death. Ganetespib is a novel, injectable, small molecule inhibitor of Hsp90 and is currently being investigated in adults with a broad range of tumor types with a favorable safety profile and promising early results. Ganetespib has been studied in preclinical in vivo models with a variety of targeted agents with no marked apparent pharmacological interactions. Sirolimus is a commercially available orally administered mTOR inhibitor and is the active metabolite of temsirolimus, which is FDA approved agent for advanced metastatic renal cell carcinoma. Sirolimus has been studied and tolerated in combination with multiple cytotoxic and targeted agents in a variety of tumor types. Based on strong preclinical rationale, the investigators hypothesize that ganetespib in combination with sirolimus will cause tumor regression in patients with refractory MPNSTs. The investigators propose a multi-institutional open label phase I/II trial of ganetespib in combination with sirolimus in patients with refractory sarcoma including MPNST. Hsp90 inhibitors and mTOR inhibitors have also both demonstrated benefit in a variety of preclinical bone and soft tissue sarcoma models. The investigators hypothesize that these agents that work on separate and potentially synergistic pathways will also be beneficial for other refractory bone and soft tissue sarcomas. Thus, the phase I component will be open to patients with refractory sarcomas, which will also expedite enrollment. Upon determination of the recommended dosing, a phase II study will be conducted. The phase II study population will be limited to patients with a diagnosis of MPNST.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patients ≥ 16 years old
- •Patients with unresectable or metastatic histologically confirmed sporadic or NF1 associated high grade MPNST
- •Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
- •Patients must have at least 1 measurable tumor
- •Patients must have fully recovered from the acute toxic effects of all prior anti-cancer therapy (toxicity \< grade 2)
- •Must be able to swallow whole pills
- •Adequate organ function
- •Normal fasting cholesterol and triglycerides
- •May be on cholesterol medications
Exclusion Criteria
- •Patients receiving current treatment with corticosteroids or another immunosuppressive. Topical or inhaled corticosteroids are allowed.
- •Uncontrolled brain or leptomeningeal metastases, including patients who continue to require glucocorticoids for brain or leptomeningeal metastases
- •Symptomatic congestive heart failure
- •Severely impaired lung function
- •Significant vascular disease
- •Uncontrolled diabetes
- •Active (acute or chronic) or uncontrolled severe infections hepatitis
- •Impairment of gastrointestinal function
- •Patients with an active, bleeding diathesis or significant coagulopathy
- •Use of cytochrome P450 isoenzyme 3A4 (CYP3A4)/ CYP2C19 substrates
Arms & Interventions
ganetespib / sirolimus
28-day cycles of ganetespib + sirolimus
Intervention: ganetespib
ganetespib / sirolimus
28-day cycles of ganetespib + sirolimus
Intervention: Sirolimus
Outcomes
Primary Outcomes
Clinical Benefit of Ganetespib in Combination With Sirolimus
Time Frame: Response evaluations will be performed after every 2 treatment cycles (each cycle=28 days)
Assessed using the World Health Organization (WHO) criteria. Tumor assessments will be obtained every 2 cycles. Clinical benefit is defined as stable disease, Partial Response (PR), Complete Response (CR). For patients who experience progression by WHO but in the opinion of the treating investigator are deriving benefit from therapy and have not otherwise met off treatment or off study criteria, may continue on treatment as long as patient has not met progression by RECIST 1.1.
Number of Dose Limiting Toxicities of Ganetespib When Administered in Combination With Sirolimus.
Time Frame: Toxicities will be evaluated over the first treatment cycle (each cycle=28 days)
To assess the safety, tolerability, and maximum tolerated/ recommended dose of ganetespib when administered in combination with sirolimus in patients with refractory sarcomas or unresectable or metastatic sporadic or neurofibromatosis type 1 (NF1) associated MPNST. Toxicities observed during the first cycle will be used to define the MTD/Recommended dose. Toxicity will be graded using the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. DLT will be defined as any of the following events that are possibly, probably, or definitely attributable to ganetespib or sirolimus. The DLT observation period for the purposes of dose escalation will be the first cycle of therapy.
Secondary Outcomes
- Changes in Pharmacodynamic Parameters in Peripheral Blood Mononuclear Cells(Baseline and Cycle 1 Day 15)
- Change in Plasma Pharmacokinetic Profile of Ganetespib and Sirolimus When Administered in Combination-Observed Maximum Plasma Concentration (Cmax)(Pre-therapy levels drawn at baseline and pharmacokinetic analysis occurs on Cycle 1 Day 15)
- Patient-reported Pain Severity and the Impact of Pain on Daily Activities(Baseline and prior to Cycle 3)
- Utility of Three-dimensional MRI (3D-MRI) Analysis in Comparison to 1-dimensional and 2-dimensional Measurements(4 months)
- Plasma Pharmacokinetic Profile of Ganetespib When Administered in Combination With Sirolimus(Cycle 1 Day 15)
- Determine Maximum Tolerated Dose (MTD)/Recommended Dose (RD) of Ganetespib(Phase 1 of study)