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RAD001 and Erlotinib in Patients With Neuroendocrine Tumors

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00843531
Recruitment Status : Completed
First Posted : February 13, 2009
Last Update Posted : June 19, 2017
Genentech, Inc.
Novartis Pharmaceuticals
The V Foundation for Cancer Research
Information provided by (Responsible Party):
Emily Bergsland, University of California, San Francisco

Brief Summary:
The purpose of this study is to test how safe and effective the combination of RAD001 and erlotinib is in patients with neuroendocrine tumors.

Condition or disease Intervention/treatment Phase
Neuroendocrine Tumors Drug: RAD001 Drug: erlotinib Phase 2

Detailed Description:

Preclinical data suggest that concomitant inhibition of two non-redundant amplified pathways (mTOR and EGFR) can reverse drug resistance and more profoundly affect tumor growth than targeting either pathway alone. EGFR inhibitors may abrogate feedback loops that stimulate upstream signaling events such as PI3K and Akt in the face of mTOR inhibition. Although ErbB receptors signal through mTOR-dependent mechanisms, mTOR-independent ErbB receptor signaling also occurs in cancer. Furthermore, deregulation of apoptotic pathways like the PI3K/Akt/PTEN axis (e.g. via PTEN loss of function or AKT gene amplification) may lead to resistance to EGFR inhibitors. Treatment with an inhibitor of mTOR may reverse this resistance. Targeting the mTOR and EGFR pathways concurrently may more effectively inhibit tumor growth than inhibiting either pathway alone.

The compelling preclinical data, coupled with modest single agent activity seen with EGFR inhibition and mTOR inhibition in NETs, provides a strong rationale for studying the activity of concomitant pathway inhibition in patients with advanced NETs. Support for this strategy also stems from the fact that EGFR inhibitors can be safety combined with mTOR inhibitors in humans. Emerging data from a phase I study of RAD001 plus erlotinib in patients with previously treated advanced non-small cell lung cancer (NSCLC) suggests that the two agents can be safely combined at the following doses: RAD001 5 mg PO q D and erlotinib 150 mg PO qD.

Of note, the original dose selections for RAD001 and erlotinib for this study stem directly from phase I studies with this combination (RAD001 5 mg PO qD plus erlotinib 150 mg PO qD). The modified dose selections (RAD001 5 mg PO qD plus erlotinib 100 mg PO qD) are the result of integrating discussions with the study sponsor, preliminary safety data from the first few patients enrolled in this study (suggesting that some patients tolerate full-dose therapy and others do not) and additional phase I data suggesting that the MTD in some patient populations is lower than in others, e.g. the MTD in breast cancer patients is RAD001 2.5 mg PO qD and erlotinib 100 mg PO QD (Mayer et al. ASCO 2009 Breast Cancer Symposium, Abstract #254).

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 17 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II Study to Evaluate the Safety and Efficacy of RAD001 Plus Erlotinib in Patients With Well- to Moderately-Differentiated Neuroendocrine Tumors
Study Start Date : June 2009
Actual Primary Completion Date : July 2013
Actual Study Completion Date : August 2016

Arm Intervention/treatment
Experimental: RAD001 and erlotinib

Each 28 day cycle:

RAD001: 5 mg per day by mouth (self-administered) Erlotinib: 100 mg per day by mouth (self-administered)

Drug: RAD001
5 mg/day PO (oral)
Other Name: everolimus

Drug: erlotinib
100 mg/day (oral)
Other Name: Tarceva

Primary Outcome Measures :
  1. To determine the efficacy of RAD001 plus erlotinib in patients with progressive moderately- to well-differentiated NETs as measured by radiographic response rate. [ Time Frame: 3 years ]

Secondary Outcome Measures :
  1. To determine the safety of RAD001 plus erlotinib in patients with progressive moderately- to well-differentiated NETs. [ Time Frame: 3 years ]
  2. To determine overall survival. [ Time Frame: 3 years ]
  3. To determine 6-month progression free survival (PFS). [ Time Frame: 3 years ]
  4. To determine time to treatment failure. [ Time Frame: 3 years ]
  5. To determine time to progression. [ Time Frame: 3 years ]
  6. To determine biochemical marker response rate by measuring chromogranin A levels (and other markers as indicated). [ Time Frame: 3 years ]
  7. To analyze the baseline expression of potential biomarkers of mTOR pathway activity: PTEN, pAKT, p70S6K1, pEGFR, p-IRS, p-mTOR, and p-4E-BP. [ Time Frame: 3 years ]
  8. To assess ras mutational status. [ Time Frame: 3 years ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • ≥1 measurable disease site per RECIST, not previously irradiated (if previous radiation to marker lesion(s), need evidence of PD)
  • Histologic dx of well- to moderately-differentiated NET: low- or intermediate-grade, islet cell carcinoma, pancreatic NET, carcinoid, atypical carcinoid, paraganglioma, pheochromocytoma. No longer enrolling carcinoid patients as of 4/25/2011.
  • ≥4 wks since completion of prior investigational drug tx or other tx(radiation, chemotherapy, immunotherapy, antibody-based tx); recovery from acute toxicities of prior tx
  • ECOG ≤2
  • ANC ≥1500/μL
  • Plts ≥100,000/μL
  • Hgb >9 gm/dL
  • Total bilirubin ≤2.0 mg/dL or 1.5XULN
  • Serum transaminases ≤2.5xULN (≤5xULN if liver mets)
  • Serum Cr ≤2.0 mg/dL or 1.5XULN
  • Fasting serum glucose <150 mg/dL or <1.5xULN
  • Fasting serum cholesterol ≤300 mg/dL OR ≤7.75 mmol/L AND fasting triglycerides ≤2.5xULN
  • INR ≤1.5
  • Written informed consent, compliance w/study requirements
  • Archived tissue if available
  • Negative urine/serum pregnancy test w/in 7 days prior to Day 1

Exclusion Criteria:

  • Poorly differentiated NET, high-grade NET, adenocarcinoid, goblet cell carcinoid, small cell carcinoma
  • Major surgery or traumatic injury w/in 4 wks, inadequate recovery from side effects of any surgery, or likely to require major surgery during study
  • Liver-directed therapy w/in 2 mths of enrollment. Prior tx w/ radiotherapy (including radiolabeled spheres, cyberknife, hepatic arterial embolization (w/ or w/o chemotherapy), cryotherapy/ablation) allowed if areas of measurable disease being used for the study are not affected, or if PD can clearly be documented in the area
  • Prior tx w/ EGFR inhibitor or mTOR inhibitor
  • Known hypersensitivity to RAD001 or other rapamycins
  • Chronic, systemic tx w/ corticosteroids or another immunosuppressive agent (topical or inhaled corticosteroids are allowed)
  • Immunization w/ attenuated live vaccines w/in 1 wk of study entry or during study
  • Uncontrolled brain or leptomeningeal mets, including pts who continue to require glucocorticoids for brain or leptomeningeal mets
  • Other malignancies w/in the past 3 years except for adequately treated carcinoma of the cervix, basal/squamous cell skin carcinomas, or other in situ cancer
  • Severe and/or uncontrolled intercurrent medical conditions or other conditions that may affect study participation, including, but not limited to:
  • Severely impaired lung function (spirometry and DLCO that is 50% of the normal predicted value and/or O2 saturation ≤88% at rest on room air)
  • Symptomatic congestive heart failure (CHF) of NYHA Class III or IV
  • Unstable angina pectoris, symptomatic CHF, myocardial infarction w/in 6 mths of Day 1, uncontrolled cardiac arrhythmia or any other significant cardiac disease
  • Uncontrolled diabetes (fasting serum glucose ≥ 150 mg/dL or >1.5xULN)
  • Any active (acute or chronic) or severe infection, disorder, or nonmalignant medical illness that is uncontrolled or whose control may be jeopardized by study tx
  • Liver disease
  • Hx of HIV seropositivity or other immunocompromised state
  • GI function impairment or disease that may alter absorption of RAD001 or erlotinib
  • Active, bleeding diathesis or on oral anti-vitamin K medication (pts needing anticoagulation must use LMW heparin)
  • Hx of other disease, metabolic dysfunction, or physical exam or lab finding giving reasonable suspicion of disease/condition that contraindicates study tx, might affect study results or puts the pt at high risk
  • Pregnant or breast feeding females
  • Adults of reproductive potential not willing to use effective methods of birth control during tx and ≥8 wks after completing tx
  • Inability to comply w/ objectives and procedures
  • Inability to comply w/ concomitant medication restrictions

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00843531

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United States, California
UCSF Helen Diller Family Comprehensive Cancer Center
San Francisco, California, United States, 94115
Sponsors and Collaborators
University of California, San Francisco
Genentech, Inc.
Novartis Pharmaceuticals
The V Foundation for Cancer Research
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Principal Investigator: Emily K. Bergsland, MD University of California, San Francisco

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Responsible Party: Emily Bergsland, Sponsor-Investigator, University of California, San Francisco Identifier: NCT00843531    
Other Study ID Numbers: 084511
First Posted: February 13, 2009    Key Record Dates
Last Update Posted: June 19, 2017
Last Verified: June 2017
Keywords provided by Emily Bergsland, University of California, San Francisco:
islet cell
pancreatic neuroendocrine
Additional relevant MeSH terms:
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Neuroendocrine Tumors
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms, Nerve Tissue
Erlotinib Hydrochloride
Antineoplastic Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Anti-Bacterial Agents
Anti-Infective Agents
Antibiotics, Antineoplastic
Antifungal Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action