Everolimus and Capecitabine in Patients With Advanced Malignancy (m-TOR)

• Time to treatment failure [ Time Frame: Every 3 months during the first 2 years, and every 6 months thereafter. ] [ Designated as safety issue: No ]
• Toxicity profile. [ Time Frame: During treatment: assessments on day 1 every cycle (3 weeks). After treatment: every 3 months during the first 2 years, and every 6 months thereafter. ] [ Designated as safety issue: Yes ]

In the investigators study the investigators combine everolimus, administrated twice daily at a fixed total dose of 10 mg continuously with capecitabine administered bid for 14 days followed by 7 days rest. In this study, capecitabine will be dose escalated.

The results form preclinical studies suggest that mTOR inhibitors are promising drugs for the treatment of various types of cancer. Everolimus seems the most attractive mTOR inhibitor because of the favourable pharmacokinetic profile and possibility of oral administration. Based on preclinical findings, mTOR inhibitors may be more efficacious when used in a rational combination with other cancer regiments like cytostatic drugs. Indeed, several multiagent combinations are being investigated in clinical trials at the moment, and the results are promising.

In our study we combine everolimus, administrated twice daily at a fixed total dose of 10 mg continuously with capecitabine administered bid for 14 days followed by 7 days rest. In this study, capecitabine will be dose escalated. The first dose level of capecitabine is 500 mg/m2 twice daily. Three patients will be enrolled per dose level, starting at dose level 1. If one of the 3 patients develops dose-limiting toxicity at any dose level, 3 other patients will start at the same dose level. If 2 or more out of these 6 patients develop DLT, no further dose escalations will be performed. The MTD will be considered to be the dose given at the previous lower level. No intrapatient dose escalation will be applied.

Once the MTD of capecitabine is established, the phase II part of the study will start in which 25 patients with various malignancies will be enrolled to evaluate the efficacy and feasibility of the combination of everolimus and capecitabine.

• Drug: Everolimus
  Everolimus, administrated twice daily at a fixed total dose of 10 mg continuously.
  Other Name: Certican
• Drug: Capecitabine
  Capecitabine administered bid for 14 days followed by 7 days rest. In this study, capecitabine will be dose escalated. The first dose level of capecitabine is 500 mg/m2 twice daily.
  Other Name: Xeloda

Inclusion Criteria:

• Patients with histological or cytological confirmed malignancies
• Measurable lesion according to RECIST criteria (only for the phase II part of the study)
• ECOG / WHO performance status of 0-2
• Age ≥ 18 years
• Life expectancy of at least 3 months
• Minimal acceptable safety laboratory values defined as:
• WBC ≥ 3.0 x 109 /L
• Platelet count ≥ 100 x 109 /L
• Hepatic function as defined by serum bilirubin ≤ 1.5 x ULN, ALT or AST ≤ 2.5 x ULN, in case of liver metastases ≤ 5 x ULN
• Renal function as defined by creatinine < 150μmol/L
• Able and willing to give written informed consent
• Able to swallow and retain oral medication
• Able and willing to undergo blood sampling for pharmacokinetic and pharmacogenetic analysis
• Mentally, physically and geographically able to undergo treatment and follow up.

Exclusion Criteria:

• Patients with known alcoholism, drug addiction and/or psychotic disorders in the history that are not suitable for adequate follow up
• Women who are pregnant or breast feeding
• Women of childbearing potential who refuse to use a reliable contraceptive method throughout the study
• Serious concomitant systemic disorder that would compromise the safety of the patient, at the discretion of the investigator
• Any other medical condition that would interfere with study procedures and/or decrease safety of the protocol treatment