Cediranib Maleate and Selumetinib in Treating Patients With Solid Malignancies

• MTD of AZD2171 in combination with AZD6244 hydrogen sulfate in patients with solid malignancies [ Designated as safety issue: Yes ]
• Toxicity profile associated with AZD2171 in combination with AZD6244 hydrogen sulfate in patients with solid malignancies [ Designated as safety issue: Yes ]
• Response to AZD2171 in combination with AZD6244 hydrogen sulfate in patients with solid malignancies [ Designated as safety issue: No ]
• Pharmacokinetic interaction of AZD2171 in combination with AZD6244 hydrogen sulfate [ Designated as safety issue: No ]

• Adverse events profile, in terms of number and severity of all adverse events (overall, by dose-level, and by tumor group) [ Time Frame: Up to 3 months ] [ Designated as safety issue: Yes ]
• Incidence of hematologic and non-hematologic toxicities as per NCI CTCAE [ Time Frame: Up to 3 months ] [ Designated as safety issue: Yes ]
  Overall toxicity incidence as well as toxicity profiles by dose level, patient and tumor site will be explored and summarized. Frequency distributions, graphical techniques and other descriptive measures will form the basis of these analyses.
• Best response, in terms of RECIST [ Time Frame: Up to 3 months ] [ Designated as safety issue: No ]
  Responses will be summarized by simple descriptive summary statistics delineating complete and partial responses as well as stable and progressive disease in this patient population (overall and by tumor group).

This phase I trial studies the side effects and best dose of cediranib maleate and selumetinib in treating patients with solid malignancies. Cediranib maleate and selumetinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Cediranib maleate may also stop the growth of tumor cells by blocking blood flow to the tumor

PRIMARY OBJECTIVES:

I. To determine the maximally tolerated dose of AZD2171 (cediranib) in combination with AZD6244 hydrogen sulfate.

II. To describe the toxicity profile associated with AZD2171 (cediranib) in combination with AZD6244 hydrogen sulfate.

III. To describe the tumor responses and identify any activity of this AZD2171 (cediranib) in combination with AZD6244 hydrogen sulfate.

IV. To explore, through correlative studies, the effect of AZD2171 (cediranib) with or without AZD6244 hydrogen sulfate on serum markers of apoptosis.

V. To assess the pharmacokinetic interaction of AZD2171 (cediranib) in combination with AZD6244 hydrogen sulfate.

VI. To study the association of clinical (toxicity and/or tumor response or activity) with the pharmacologic (pharmacokinetic/pharmacodynamic) parameters, and/or biologic (correlative laboratory study) results.

OUTLINE: This is a dose-escalation study followed by a dose-expansion cohort study.

Patients receive cediranib maleate orally (PO) once daily and selumetinib PO once or twice daily on days 1-28 (days 8-28 of course 1). Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Some patients undergo blood sample collection at baseline and periodically during study for correlative studies.

After completion of study therapy, patients are followed up at 3 months.

• Stage IV Melanoma
• Unspecified Adult Solid Tumor, Protocol Specific

• Drug: cediranib maleate
  Given PO
  Other Names:

  • AZD2171
  • Recentin
• Drug: selumetinib
  Given PO
  Other Names:

  • ARRY-142886
  • AZD6244
• Other: laboratory biomarker analysis
  Correlative studies
• Other: pharmacological study
  Correlative studies
  Other Name: pharmacological studies

Inclusion Criteria:

• Histologic proof of cancer that is now considered clinically unresectable and for whom there is no standard therapy; NOTE: For the MTD expansion cohort only: Metastatic melanoma histology is required
• Measurable and non-measurable disease are eligible
• Ability to provide informed consent
• ANC >= 1500/uL
• PLT >= 100,000/uL
• Total bilirubin =< 1.5 x upper limit of normal (ULN)
• AST =< 2.5 x ULN or =< 5 x ULN in presence of liver metastases
• Creatinine =< 1.5 x ULN
• HgB >= 9.0 gm/dL
• Alkaline phosphatase =< 2.5 x ULN
• Creatinine clearance > 50 ml/min, by either Cockcroft-Gault formula or 24-hour urine collection analysis
• ECOG Performance Status (PS) 0, 1
• Willing to return to Mayo for follow up
• Life expectancy >= 12 weeks
• Women of childbearing potential only: Negative serum pregnancy test done =< 7 days prior to registration, for women of childbearing potential only
• Expansion Phase only: Willing to provide blood samples and archived tumor tissue for correlative research purposes

Exclusion Criteria:

• Known standard therapy for the patient's disease that is potentially curative or definitely capable of extending life expectancy
• Uncontrolled intercurrent illness including, but not limited to, 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

• Any of the following prior therapies:

  • Chemotherapy =< 28 days prior to registration
  • Mitomycin C/nitrosoureas =< 42 days prior to registration
  • Immunotherapy =< 28 days prior to registration
  • Biologic therapy =< 28 days prior to registration
  • Radiation therapy =< 28 days prior to registration
  • Radiation to > 25% of bone marrow
• Failure to fully recover from acute, reversible effects of prior chemotherapy regardless of interval since last treatment

• Cardiac conditions as follows:

  • Uncontrolled hypertension (BP >= 150/95 despite optimal therapy)
  • Heart failure NYHA Class II or above or Left ventricular ejection fraction < 50%
  • Atrial fibrillation with heart rate >100 bpm
  • Unstable ischemic heart disease (MI within 6 months prior to starting treatment, or angina requiring use of nitrates more than once weekly)
  • Patients who require concomitant agents that prolong QTc
• Known brain or CNS metastases without definitive therapy; patients who have received definitive therapy for CNS lesions may be considered if there is no evidence of progression on CT or MRI imaging obtained 3 months apart

• Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:

  • Pregnant women
  • Nursing women
  • Men or women of childbearing potential who are unwilling to employ adequate contraception
• Other concurrent chemotherapy, immunotherapy, radiotherapy, or any ancillary therapy considered investigational (utilized for a non-FDA-approved indication and in the context of a research investigation)
• Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
• Immunocompromised patients (other than that related to the use of corticosteroids) with the exception of patients known to be HIV positive and have a CD4 count > 400 and do not require antiretroviral therapy
• Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm
• Other active malignancy =< 3 years prior to registration; EXCEPTIONS: Nonmelanotic skin cancer or carcinoma-in-situ of the cervix; NOTE: If there is a history or prior malignancy, they must not be receiving other specific treatment (i.e. hormonal therapy) for their cancer
• Greater than +1 proteinuria on two consecutive dipsticks taken no less than 1 week apart unless urinary protein < 1.5g in a 24 hr period or urine protein/creatinine ratio < 1.5
• History of exposure to AZD2171 (cediranib), AZD6244 hydrogen sulfate, or MEK, Ras or Raf inhibitors (sorafenib); Note: prior therapy with bevacizumab, sunitinib, pazopanib or aflivercept (VEGF Trap) are allowed
• Surgery within two weeks prior to registration
• Significant hemorrhage (> 30mL bleeding/episode in previous 3 months) or hemoptysis (> 5mL fresh blood in previous 4 weeks)
• Mean QTc interval with Bazetts correction > 480msec (CTC Grade 1) in screening ECG or history of familial long QT syndrome
• Patients who are unable to swallow tablets and capsules