RAD001 and Temozolomide in Patients With Advanced Pancreatic Neuroendocrine Tumors

• To determine the duration of response to the combination of RAD001 and temozolomide in this patient population. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
• To determine the safety and tolerability of this drug combination. [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
• To determine the progression free survival and overall survival of patients receiving this combination. [ Time Frame: 2 years ] [ Designated as safety issue: No ]

This research study will test the safety of RAD001 in combination with temozolomide.

• Participants will take RAD001 by mouth daily. They will also take temozolomide by mouth daily for one week, followed by a one-week break period. This one-week on/one week off schedule for temozolomide will continue for the duration of the treatment.
• After the first month of treatment, there will be a 7-day observation period during which no study medication will be taken to observe for any side effects.
• During all treatment cycles (1 cycle is 28 days in length) participants will have a physical exam and will be asked questions about their general health and specific questions about any problems they may be experiencing. Initially, participants will come in every other week. At each of these visits, blood work will be taken to monitor the participants health.
• After every 2 months of treatment, participants will have a CT scan or MRI done to see how the medication is working.

• Drug: RAD001
  Given orally once a day
• Drug: Temozolomide
  Taken orally once a day for one week followed by a one-week break period
  Other Name: Temodar

Inclusion Criteria:

• Locally unresectable or metastatic pancreatic neuroendocrine tumor
• Radiologic, operative, or pathology reports should document a pancreatic location of tumor
• Patients must have confirmed low-grade or intermediate-grade neuroendocrine carcinoma
• Patients must have at least one measurable site of disease according to RECIST criteria that has not been preciously irradiated
• 18 years of age or older
• Minimum of two weeks since any major surgery, completion of radiation, or completion of all prior systemic anticancer therapy
• Prior treatment with chemotherapy is allowed, with the exception of prior treatment with temozolomide or dacarbazine
• No Prior therapy with RAD001 or any other mTOR inhibitor
• ECOG Performance status 0,1 or 2
• Life expectancy 12 weeks or more
• Adequate bone marrow, liver and renal function as outlined in the protocol
• Negative serum pregnancy test
• Fasting serum cholesterol as outlined in protocol

Exclusion Criteria:

• Prior treatment with any investigational drug within the preceding 4 weeks
• Chronic treatment with systemic steroids or another immunosuppressive agent
• Patients should not receive immunization with attenuated live vaccines during study period or within 1 week of study entry
• Uncontrolled brain or leptomeningeal metastases, including patients who continue to require glucocorticoids for brain or leptomeningeal metastases
• Other malignancies within the past 3 years except for adequately treated carcinoma of the cervix or basal or squamous cell carcinoma of the skin
• Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study
• Women who are pregnant or breast feeding
• Patients who have received prior treatment with an mTOR inhibitor or temozolomide
• Patients with known hypersensitivity to RAD001 or other rapamycins or to its excipients
• History of noncompliance to medical regimens

• Beth Israel Deaconess Medical Center
• Brigham and Women's Hospital
• Massachusetts General Hospital
• Novartis
• Schering-Plough