MK2206 and Paclitaxel in Treating Patients With Locally Advanced or Metastatic Solid Tumors or Metastatic Breast Cancer

• MTD of the combination of MK-2206 and weekly paclitaxel determined by dose-limiting toxicities (Phase I) [ Time Frame: 21 days ] [ Designated as safety issue: Yes ]
• Determination of the antitumor activity of the combination in metastatic breast cancer (Expansion phase) [ Time Frame: Up to 3 weeks ] [ Designated as safety issue: No ]

• Determination of the maximum-tolerated dose of the combination of Akt inhibitor MK2206 and weekly paclitaxel (Phase I) [ Designated as safety issue: Yes ]
• Determination of the antitumor activity of the combination in metastatic breast cancer (Expansion phase) [ Designated as safety issue: No ]
• Determination of the safety of the combination in metastatic breast cancer (Expansion phase) [ Designated as safety issue: Yes ]

• Cell proliferation and apoptosis at baseline and 2 weeks [ Designated as safety issue: No ]
• Additional IHC markers at baseline and 2 weeks [ Designated as safety issue: No ]
• RPPA at baseline and during treatment [ Designated as safety issue: No ]
• Multiplex proteomics at baseline and during treatment [ Designated as safety issue: No ]
• Circulating tumor cells at baseline, 2 weeks, and during treatment [ Designated as safety issue: No ]
• Plasma markers at baseline and periodically during treatment [ Designated as safety issue: No ]

This phase I clinical trial is studying the side effects and best dose of MK2206 when given with paclitaxel and to see how well they work in treating patients with locally advanced or metastatic solid tumors or metastatic breast cancer. MK2206 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving MK2206 with chemotherapy may kill more cancer cells.

PRIMARY OBJECTIVES:

I. To determine the MTD of the combination of MK-2206 and weekly paclitaxel. (Dose-escalation phase) II. To determine the safety and anti-tumor activity of the combination in metastatic breast cancer. (Expansion phase)

SECONDARY OBJECTIVES:

I. To determine the pharmacokinetics of MK-2206 and weekly paclitaxel used in combination.

II. To determine the safety of MK-2206 and weekly paclitaxel used in combination.

III. To evaluate the toxicities and tolerability of the combination. IV. To document anti-tumor activity. V. To determine baseline molecular markers that may predict clinical activity. VI. To determine pharmacodynamic markers in blood and tumor tissue that may predict an increase in apoptosis (by cleaved caspase 3) and clinical activity.

VII. To determine concordance of PIK3CA and PTEN status between primary tumor and distant metastasis.

VIII. To determine concordance of PIK3CA status of circulating tumor cells and distant metastasis.

OUTLINE: This is a multicenter, dose-escalation study of Akt inhibitor MK2206.

Patients receive paclitaxel intravenously (IV) over 1 hour on days 1, 8, and 15 and Akt inhibitor MK2206 orally (PO) once daily (QD) on days 2, 9, and 16. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Tumor tissue and blood samples are collected periodically for pharmacodynamic and pharmacokinetic studies.

After completion of study treatment, patients are followed up for 3 weeks.

• Recurrent Breast Cancer
• Stage IV Breast Cancer
• Unspecified Adult Solid Tumor, Protocol Specific

• Drug: Akt inhibitor MK2206
  Given PO
  Other Name: MK2206
• Drug: paclitaxel
  Given IV
  Other Names:

  • Anzatax
  • Asotax
  • TAX
  • Taxol
• Other: circulating tumor cell analysis
  Correlative studies
  Other Name: CTC analysis
• Other: diagnostic laboratory biomarker analysis
  Correlative studies
• Other: pharmacological study
  Correlative studies
  Other Name: pharmacological studies

Inclusion Criteria:

• Patients with histologically or cytologically confirmed locally advanced or metastatic solid tumors who have received at least two lines of therapy; for the expansion phase: Female patients with metastatic breast cancer who have received a maximum of three lines of therapy
• Absolute neutrophil count (ANC) >= 1,000/μL
• Platelets >= 100,000/μL
• Hemoglobin (Hgb) >= 9 g/dL
• Creatinine =< 1.5 x upper limit of normal (ULN)
• Prothrombin time (PT) within institutional guideline for biopsy procedure
• Total bilirubin =< 1.5 x ULN
• Alanine aminotransferase (ALT) =< 2.5 x ULN (=<3 x ULN for subjects with liver involvement with cancer)
• A known diabetic patient who is taking insulin or oral anti-diabetic therapy must have a hemoglobin (HBA)_1C =< 8% or a fasting serum glucose =< 110% ULN
• Patient will have a tumor suitable for fine-needle aspirates (FNA) and core biopsy for research purposes (determined by the treating physician)
• Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
• Measurable disease by Response Evaluation Criteria In Solid Tumors (RECIST) or evaluable disease (e.g., bone metastasis or lesions which do not fulfill RECIST criteria for metastatic disease)

• Patients with central nervous system (CNS) metastasis who have completed a course of therapy (for treatment of CNS metastasis) would be eligible for the study provided they are clinically stable for 1 month prior to entry as defined as:

  • No evidence of new or enlarging CNS metastasis
  • Off steroids and anticonvulsants
• QTc interval =< 450 msec (Bazett's formula)
• Negative serum pregnancy test beta-human chorionic gonadotropin (hCG) for patients of childbearing age
• For the dose escalation cohorts, patients must have received front-line, cytotoxic, systemic therapy (combination or single agent, with or without the addition of targeted agents) for advanced cancer
• For the expansion cohort, patients must have received no more than three lines of cytotoxic systemic therapy (combination or single agent, with or without the addition of targeted agents) for metastatic breast cancer; patients could have received paclitaxel in the adjuvant setting, but not in the metastatic setting
• The last line of therapy must have been administered > 21 days prior to initiation of treatment on this study
• Women of childbearing potential and men must use two forms of 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 she or her partner is participating in this study, the patient should inform the treating physician immediately
• Ability to understand and the willingness to sign a written informed consent document
• Both men and women and members of all races and ethnic groups are eligible for this trial

Exclusion Criteria:

• Patients may not be receiving any other investigational agents
• Patients taking a potent CYP3A4 inhibitor or inducer will be excluded; patients who have discontinued any of these medications must have a wash-out period of at least 5 days or at least 5 half-lives of the drug (whichever is longer) prior to the first dose MK-2206
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to MK-2206 or other agents used in the study
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, bradycardia, related to cardiac disease, bundle branch block, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Pregnant women are excluded from this study because the effects of MK-2206 on the developing human fetus are unknown; also, because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with MK-2206 and paclitaxel, breastfeeding should be discontinued