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Sorafenib and Temsirolimus in Treating Patients With Metastatic, Recurrent, or Unresectable Melanoma
This study is ongoing, but not recruiting participants.

First Received on July 5, 2006.   Last Updated on May 31, 2011   History of Changes
Sponsor: M.D. Anderson Cancer Center
Collaborator: National Cancer Institute (NCI)
Information provided by: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT00349206
  Purpose

RATIONALE: Sorafenib and temsirolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Sorafenib may also stop the growth of tumor cells by blocking blood flow to the tumor. Giving sorafenib together with temsirolimus may kill more tumor cells.

PURPOSE: This phase I/II trial is studying the side effects and best dose of temsirolimus when given together with sorafenib and to see how well they work in treating patients with metastatic, recurrent, or unresectable melanoma.


Condition Intervention Phase
Melanoma
Skin Cancer
Drug: Sorafenib Tosylate
Drug: Temsirolimus
Phase I
Phase II

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase I/II Study of the Combination of BAY43-9006 (Sorafenib) and CCI-779 (Temsirolimus) in Patients With Metastatic Melanoma

Resource links provided by NLM:


Further study details as provided by M.D. Anderson Cancer Center:

Primary Outcome Measures:
  • Maximum Tolerated Dose (Phase I) [ Time Frame: Every 2 weeks during first 2 cycles (8 weeks) ] [ Designated as safety issue: Yes ]
    The MTD is defined as the highest dose studied in which incidence of Dose Limiting Toxicity (DLT) is < 33%.

  • Objective Response Rate (complete and partial) (Phase II) [ Time Frame: Every 2 cycles (8 weeks) ] [ Designated as safety issue: No ]
    Clinical responses evaluated using RECIST criteria after every two cycles.


Estimated Enrollment: 69
Study Start Date: April 2006
Estimated Primary Completion Date: December 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Sorafenib + Temsirolimus
Phase I: Temsirolimus by vein (IV) on days 1, 8,15, and 22 and oral Sorafenib daily on days 1-28.
Drug: Sorafenib Tosylate
Starting dose 400 mg by mouth (PO) every day.
Other Name: Bay 43-9006
Drug: Temsirolimus
Starting dose 15 mg IV weekly
Other Names:
  • Torisel
  • CCI-779

Detailed Description:

OBJECTIVES:

Primary

  • Determine the maximum tolerated dose of temsirolimus when administered with sorafenib in patients with metastatic, recurrent, or unresectable melanoma. (Phase I)
  • Determine the safety and toxicity of this regimen in these patients. (Phase I)
  • Evaluate the clinical activity, in terms of overall response rate (complete and partial response), of this regimen in these patients. (Phase II)
  • Evaluate the in vivo biological activity of this regimen in these patients. (Phase II)

Secondary

  • Determine the progression-free survival and overall survival of patients treated with this regimen. (Phase II)
  • Determine the safety and toxicity of this regimen in these patients. (Phase II)
  • Determine the population pharmacokinetics of this regimen in these patients. (Phase I and II)
  • Correlate tumor and blood biomarkers with clinical outcome in patients treated with this regimen. (Phase I and II)

OUTLINE: This is a multicenter, phase I, dose-escalation study of temsirolimus followed by a phase II, open-label study.

  • Phase I: Patients receive temsirolimus IV over 30 minutes on days 1, 8,15, and 22 and oral sorafenib once or twice daily on days 1-28. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients with responding or stable disease may continue treatment beyond 6 courses.

Cohorts of 3-6 patients receive escalating doses of temsirolimus until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which at least 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Ten additional patients are treated at the MTD.

  • Phase II: Patients receive temsirolimus (at the MTD determined in phase I) and sorafenib as in phase I.

Patients undergo a mandatory blood draw and tumor biopsy (punch biopsy, core-needle biopsy with or without ultrasound guidance, or excisional biopsy) at baseline (unless tissue is available from a prior biopsy or resection). Reverse phase protein array analysis is conducted on these pre-treatment specimens along with biomarker studies.

After completion of study treatment, patients are followed every 3-6 months.

PROJECTED ACCRUAL: A total of 69 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patients must have histologically or cytologically confirmed Stage IV or recurrent or unresectable Stage III melanoma of non-choroidal origin. Patients must have easily accessible tumor for biopsy (in treating physician's or PI's opinion). A patient does not need easily accessible tumor for biopsy only if: - patient had tumor sample collection within 3 months prior to registration; - tumor sample was collected appropriately (snap frozen or OCT-embedded); and - patient agrees to provide these tumor samples for analysis planned in this trial
  2. Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >/= 20 mm with conventional techniques or as >/= 10 mm with spiral CT scan. In case of obviously visible cutaneous metastatic lesions, the margins of the lesions should be clearly defined and measured in at least one dimension as >/= 10 mm.
  3. Phase I study: There is no limitation on the number of prior therapeutic regimens.
  4. Phase II study: Patients may have received up to 1 systemic chemotherapy regimen for metastatic melanoma: No limit in number of prior biological or immunotherapy: No limit for the number of regional chemotherapy regimens unless all target lesions are located w/in the prior regional treatment field. If all target lesions are located w/in the prior regional treatment field, only up to one prior regional chemotherapy regimen is allowed. If pts received prior chemotherapy for other cancers, no limit in number of prior chemotherapy regimens as long as the last chemotherapy was at least 5 years ago.
  5. Age 18 years or older. Because no dosing or adverse event data are currently available on the use of BAY43-9006 in combination with CCI-779 in patients <18 years of age, children are excluded from this study, but will be eligible for future pediatric phase 1 combination trials.
  6. ECOG performance status less than or equal to 1.
  7. Patients must have normal organ and marrow function as defined as: leukocytes >/= 3,000/mcL; absolute neutrophil count >/= 1,500/mcL; platelets >/= 100,000/mcL; fasting serum cholesterol </= 350 mg/dL; fasting triglycerides </= 400 mg/dL; total bilirubin within normal institutional limits; ALT/AST </= 2.5 X institutional upper limits of normal; creatinine within normal institutional limits or creatinine clearance >/= 60 ml/min/1.73 meter squared for patients with creatinine levels above institutional normal.
  8. Patients on prophylactic anticoagulation therapy (e.g., low-dose warfarin) are eligible provided their coagulation parameter levels are as follows: Prothrombin time (INR; International Normalized Ratio of prothrombin time) <1.1 x institutional upper limit of normal.
  9. Eligibility of patients receiving any other medications or substances known to affect or with the potential to affect the activity or pharmacokinetics of BAY43-9006 or CCI-779 will be determined following review of individual cases by the Principal Investigator. Patients cannot be receiving enzyme-inducing antiepileptic drugs (EIAEDs) such as phenytoin, carbamazepine, phenobarbital, rifampin, or St. John's wort.
  10. The effects of BAY43-9006 and CCI-779 on the developing human fetus are unknown. For this reason and because other tyrosine kinase inhibitors and mRNA translation inhibitors are known to be teratogenic, women of child-bearing 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.
  11. Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  1. 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 to grade 1 toxicity (except for peripheral neuropathy, for which </= grade 2 toxicity is allowed to participate) from adverse events due to agents administered more than 4 weeks earlier.
  2. For phase II study portion, patients may not have previously received either BAY43-9006 or CCI-779 or any other agents targeting raf, VEGF/VEGFR, or mTOR. However, for phase I study portion, this exclusion criterion does not apply.
  3. Patients may not be receiving any investigational agents other than BAY43-9006 and CCI-779.
  4. Patients with known brain metastases are excluded because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound evaluation of neurologic and other adverse events. The following exception is allowed: patients without radiographical evidence of recurrence in the brain for >/= 3 months after complete resection of brain metastases or who have asymptomatic brain metastases stable for >/= 3 months since whole brain radiation therapy and/or stereotactic radiosurgery are eligible. Patients must not require steroid treatment for brain metastases.
  5. History of allergic reactions attributed to compounds of similar chemical or biologic composition to BAY43-9006 or CCI-779.
  6. Uncontrolled hypertension with systolic blood pressure of > 140 mmHg on 2 separate days within 1 week before enrollment or diastolic pressure > 90 mmHg on 2 separate days within 1 week before enrollment. However, patients with well-controlled hypertension are eligible.
  7. Patients must not have any evidence of bleeding diathesis or coagulopathy.
  8. Patients on full-dose anticoagulation (i.e. warfarin, IV heparin, low-molecular weight heparin).
  9. Patients with any condition (e.g., gastrointestinal tract disease resulting in an inability to take oral medication or a requirement for IV alimentation, prior surgical procedures affecting absorption, or active peptic ulcer disease) that impairs their ability to swallow pills are excluded.
  10. Uncontrolled intercurrent illness including, but not limited to, uncontrolled hypertension, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  11. Pregnant women are excluded from this study because BAY43-9006 is a serine-threonine kinase inhibitor and CCI-779 is an mRNA translation inhibitor, both of which have 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 BAY43-9006 or CCI-779, breastfeeding should be discontinued if the mother is treated with either of these agents.
  12. HIV-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with BAY43-9006 and/or CCI-779. 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.
  13. Patients undergoing major surgery or a sustaining a significant traumatic injury within 21 days prior to treatment are ineligible.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00349206

Locations
United States, Texas
M. D. Anderson Cancer Center at University of Texas
Houston, Texas, United States, 77030-4009
University of Texas M.D. Anderson CCOP Research Base
Houston, Texas, United States, 77030-4009
United States, Virginia
University of Virginia Cancer Center
Charlottesville, Virginia, United States, 22908
Sponsors and Collaborators
M.D. Anderson Cancer Center
Investigators
Study Chair: Kevin Kim, MD M.D. Anderson Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: Kevin B. Kim, MD, BA / Associate Professor, M. D. Anderson Cancer Center at University of Texas
ClinicalTrials.gov Identifier: NCT00349206     History of Changes
Other Study ID Numbers: 2005-0215, U01CA062461, P30CA016672, MDA-2005-0215, NCI-7149, CDR0000480157
Study First Received: July 5, 2006
Last Updated: May 31, 2011
Health Authority: United States: Food and Drug Administration

Keywords provided by M.D. Anderson Cancer Center:
stage III melanoma
stage IV melanoma
recurrent melanoma
Sorafenib
Bay43-9006
Temsirolimus
CCI-779

Additional relevant MeSH terms:
Skin Neoplasms
Melanoma
Neoplasms by Site
Neoplasms
Skin Diseases
Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms, Nerve Tissue
Nevi and Melanomas
Sirolimus
Everolimus
Sorafenib
Antibiotics, Antineoplastic
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Antifungal Agents
Anti-Infective Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Anti-Bacterial Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action

ClinicalTrials.gov processed this record on February 09, 2012