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SARC023: Ganetespib and Sirolimus in Patients With MPNST (Malignant Peripheral Nerve Sheath Tumors)

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ClinicalTrials.gov Identifier: NCT02008877
Recruitment Status : Completed
First Posted : December 11, 2013
Results First Posted : May 2, 2019
Last Update Posted : May 15, 2019
Sponsor:
Collaborators:
Synta Pharmaceuticals Corp.
United States Department of Defense
Information provided by (Responsible Party):
Sarcoma Alliance for Research through Collaboration

Brief Summary:

Phase 1: To assess the safety, tolerability, and maximum tolerated dose (MTD)/ recommended dose of ganetespib when administered in combination with sirolimus in patients with refractory or relapsed sarcomas including unresectable or metastatic sporadic or neurofibromatosis type 1 (NF1) associated MPNST. Phase I enrollment has been closed.

Phase 2: To determine the clinical benefit of ganetespib in combination with sirolimus for patients with unresectable or metastatic sporadic or NF1 associated MPNST.


Condition or disease Intervention/treatment Phase
Malignant Peripheral Nerve Sheath Tumors (MPNST) Sarcoma Drug: ganetespib Drug: Sirolimus Phase 1 Phase 2

Detailed Description:

Previously, no targeted agents have been able to cause tumor regression in a genetically engineered MPNST mouse model or human MPNST. Recently published data from Dr. Cichowski's laboratory demonstrated using Hsp90 inhibitors to enhance endoplasmic reticulum stress coupled with the mammalian target of rapamycin (mTOR) inhibitor sirolimus led to dramatic tumor shrinkage in a transgenic MPNST mouse model, which correlated with profound damage to the endoplasmic reticulum and cell death. Ganetespib is a novel, injectable, small molecule inhibitor of Hsp90 and is currently being investigated in adults with a broad range of tumor types with a favorable safety profile and promising early results. Ganetespib has been studied in preclinical in vivo models with a variety of targeted agents with no marked apparent pharmacological interactions. Sirolimus is a commercially available orally administered mTOR inhibitor and is the active metabolite of temsirolimus, which is FDA approved agent for advanced metastatic renal cell carcinoma. Sirolimus has been studied and tolerated in combination with multiple cytotoxic and targeted agents in a variety of tumor types. Based on strong preclinical rationale, the investigators hypothesize that ganetespib in combination with sirolimus will cause tumor regression in patients with refractory MPNSTs.

The investigators propose a multi-institutional open label phase I/II trial of ganetespib in combination with sirolimus in patients with refractory sarcoma including MPNST. Hsp90 inhibitors and mTOR inhibitors have also both demonstrated benefit in a variety of preclinical bone and soft tissue sarcoma models. The investigators hypothesize that these agents that work on separate and potentially synergistic pathways will also be beneficial for other refractory bone and soft tissue sarcomas. Thus, the phase I component will be open to patients with refractory sarcomas, which will also expedite enrollment. Upon determination of the recommended dosing, a phase II study will be conducted. The phase II study population will be limited to patients with a diagnosis of MPNST.


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 20 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I/II Trial of Ganetespib in Combination With the mTOR Inhibitor Sirolimus for Patients With Recurrent or Refractory Sarcomas Including Unresectable or Metastatic Malignant Peripheral Nerve Sheath Tumors
Study Start Date : December 2013
Actual Primary Completion Date : April 2018
Actual Study Completion Date : July 2018


Arm Intervention/treatment
Experimental: ganetespib / sirolimus
28-day cycles of ganetespib + sirolimus
Drug: ganetespib
Phase 1 Dose 1: 150 mg/m² IV on days 1, 8, and 15 intravenously over 1 hour; Phase 1 Dose 2: 200 mg/m² IV on days 1, 8, and 15 intravenously over 1 hour; Phase 2: 200 mg/m² IV on days 1, 8, and 15 intravenously over 1 hour
Other Name: STA-9090

Drug: Sirolimus
4mg taken orally once daily on a continuous dosing schedule; Loading dose 12 mg on cycle 1 day 1 only.
Other Name: Rapamycin




Primary Outcome Measures :
  1. Number of Dose Limiting Toxicities of Ganetespib When Administered in Combination With Sirolimus. [ Time Frame: Toxicities will be evaluated over the first treatment cycle (each cycle=28 days) ]
    To assess the safety, tolerability, and maximum tolerated/ recommended dose of ganetespib when administered in combination with sirolimus in patients with refractory sarcomas or unresectable or metastatic sporadic or neurofibromatosis type 1 (NF1) associated MPNST. Toxicities observed during the first cycle will be used to define the MTD/Recommended dose. Toxicity will be graded using the NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. DLT will be defined as any of the following events that are possibly, probably, or definitely attributable to ganetespib or sirolimus. The DLT observation period for the purposes of dose escalation will be the first cycle of therapy.

  2. Clinical Benefit of Ganetespib in Combination With Sirolimus [ Time Frame: Response evaluations will be performed after every 2 treatment cycles (each cycle=28 days) ]
    Assessed using the World Health Organization (WHO) criteria. Tumor assessments will be obtained every 2 cycles. Clinical benefit is defined as stable disease, Partial Response (PR), Complete Response (CR). For patients who experience progression by WHO but in the opinion of the treating investigator are deriving benefit from therapy and have not otherwise met off treatment or off study criteria, may continue on treatment as long as patient has not met progression by RECIST 1.1.


Secondary Outcome Measures :
  1. Change in Plasma Pharmacokinetic Profile of Ganetespib and Sirolimus When Administered in Combination-Observed Maximum Plasma Concentration (Cmax) [ Time Frame: Pre-therapy levels drawn at baseline and pharmacokinetic analysis occurs on Cycle 1 Day 15 ]
    To describe the plasma pharmacokinetic profile of ganetespib and sirolimus when administered in combination therapy.

  2. Changes in Pharmacodynamic Parameters in Peripheral Blood Mononuclear Cells [ Time Frame: Baseline and Cycle 1 Day 15 ]
    To explore changes in pharmacodynamic parameters in peripheral blood mononuclear cells performed on day 1 prior to ganetespib and sirolimus administration, and on day 15, 6 hours post drug administration. Hsp inhibition (Hsp70), mTOR inhibition (phospho-S6 and Akt Phosphorylation), UPR activation (EIF2alpha phosphorylation) will be explored. Western blot analyses were performed for phospho (p)-Akt, p-eIF2α, p-S6, and Hsp70. The absorbance of each phosphoprotein lane was recorded and protein levels were determined after normalizing for levels of corresponding total protein.

  3. Patient-reported Pain Severity and the Impact of Pain on Daily Activities [ Time Frame: Baseline and prior to Cycle 3 ]
    To assess patient-reported pain severity and the impact of pain on daily activities before and during treatment with ganetespib and sirolimus. The Numerical Rating Scale-11 (NRS-11) will be used to assess pain severity. The NRS-11 is a self-report segmented 11-point numeric scale that assesses pain severity. It consists of a horizontal line with 0 representing "no pain" at the right end of the line and 10 representing "worst pain you can imagine" at the left end.The Brief Pain Inventory is a 7-item self-report questionnaire that measures the extent to which pain interferes with daily functioning. Patients are asked to indicate how much pain interfered with various activities in the past week, with scores ranging from 0 (does not interfere) to 10 (completely interferes). A total score is obtained by taking the mean of the scores for all 7 items; thus, the total pain interference score can range from 0 to 10.

  4. Utility of Three-dimensional MRI (3D-MRI) Analysis in Comparison to 1-dimensional and 2-dimensional Measurements [ Time Frame: 4 months ]
    To evaluate the utility of three-dimensional MRI (3D-MRI) analysis in comparison to 1-dimensional and 2-dimensional measurements as a method to more sensitively monitor response.

  5. Plasma Pharmacokinetic Profile of Ganetespib When Administered in Combination With Sirolimus [ Time Frame: Cycle 1 Day 15 ]
    To describe the plasma pharmacokinetic profile of ganetespib in terms of half life.

  6. Determine Maximum Tolerated Dose (MTD)/Recommended Dose (RD) of Ganetespib [ Time Frame: Phase 1 of study ]
    A conventional 3+3 dose escalation design was used for phase 1. All patients in phase 2 were treated with the recommended dose.



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Ages Eligible for Study:   16 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients ≥ 16 years old
  • Patients with unresectable or metastatic histologically confirmed sporadic or NF1 associated high grade MPNST
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
  • Patients must have at least 1 measurable tumor
  • Patients must have fully recovered from the acute toxic effects of all prior anti-cancer therapy (toxicity < grade 2)
  • Must be able to swallow whole pills
  • Adequate organ function
  • Normal fasting cholesterol and triglycerides
  • May be on cholesterol medications

Exclusion Criteria:

  • Patients receiving current treatment with corticosteroids or another immunosuppressive. Topical or inhaled corticosteroids are allowed.
  • Uncontrolled brain or leptomeningeal metastases, including patients who continue to require glucocorticoids for brain or leptomeningeal metastases
  • Symptomatic congestive heart failure
  • Severely impaired lung function
  • Significant vascular disease
  • Uncontrolled diabetes
  • Active (acute or chronic) or uncontrolled severe infections hepatitis
  • Impairment of gastrointestinal function
  • Patients with an active, bleeding diathesis or significant coagulopathy
  • Use of cytochrome P450 isoenzyme 3A4 (CYP3A4)/ CYP2C19 substrates

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 ClinicalTrials.gov identifier (NCT number): NCT02008877


Locations
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United States, California
Sarcoma Oncology Center
Santa Monica, California, United States, 90403
United States, District of Columbia
Children's National Medical Center
Washington, District of Columbia, United States, 20010
United States, Iowa
University of Iowa
Iowa City, Iowa, United States, 52242
United States, Maryland
National Cancer Institute
Bethesda, Maryland, United States, 20892
United States, Michigan
University of Michigan
Ann Arbor, Michigan, United States, 48109
United States, Missouri
Washington University
Saint Louis, Missouri, United States, 63130
United States, Utah
Huntsman Cancer Institute
Salt Lake City, Utah, United States, 84112
Sponsors and Collaborators
Sarcoma Alliance for Research through Collaboration
Synta Pharmaceuticals Corp.
United States Department of Defense
Investigators
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Principal Investigator: AeRang Kim, MD, PhD Children's National
Principal Investigator: Brigitte Widemann, MD National Cancer Institute (NCI)
  Study Documents (Full-Text)

Documents provided by Sarcoma Alliance for Research through Collaboration:

Additional Information:
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Responsible Party: Sarcoma Alliance for Research through Collaboration
ClinicalTrials.gov Identifier: NCT02008877     History of Changes
Other Study ID Numbers: SARC023
CDMRP-NF120087 ( Other Grant/Funding Number: Department of Defense )
First Posted: December 11, 2013    Key Record Dates
Results First Posted: May 2, 2019
Last Update Posted: May 15, 2019
Last Verified: April 2019

Keywords provided by Sarcoma Alliance for Research through Collaboration:
Malignant Peripheral Nerve Sheath Tumors
MPNST
Sarcoma
Ganetespib
Sirolimus
mTOR inhibitor
Heat shock protein
Hsp90

Additional relevant MeSH terms:
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Sarcoma
Nerve Sheath Neoplasms
Neurofibrosarcoma
Neoplasms, Connective and Soft Tissue
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Nerve Tissue
Peripheral Nervous System Neoplasms
Nervous System Neoplasms
Nervous System Diseases
Peripheral Nervous System Diseases
Neuromuscular Diseases
Fibrosarcoma
Neoplasms, Fibrous Tissue
Neoplasms, Connective Tissue
Neurofibroma
Sirolimus
Everolimus
Anti-Bacterial Agents
Anti-Infective Agents
Antibiotics, Antineoplastic
Antineoplastic Agents
Antifungal Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs