Temsirolimus in Treating Patients With Recurrent or Persistent Cancer of the Uterus

Inclusion Criteria:

• Histologically or cytologically confirmed Carcinosarcoma (MMMT)
• Patients must have measurable disease; Patients having only lesions measuring ≥ 1 cm to < 2 cm must use spiral CT imaging for both pre- and post-treatment tumor assessments; patients who have had prior palliative radiotherapy to metastatic lesion(s) must have at least one measurable lesion(s) that have not been previously irradiated
• Only one prior systemic treatments after primary adjuvant treatment for persistent or metastatic disease are permitted, including targeted therapies, biologic response modifiers, chemotherapy, hormonal therapy or investigational therapy; for example, if a patient recurred after receiving radiation therapy and adjuvant ifosfamide or platinum based regimen, then was treated with Doxil and progressed, she is eligible; or, if a patient had stage 4 MMT cytoreduced followed by ifosfamide or platinum based regimen, then was treated with Doxil and progressed, she is eligible; NOTE: Hormonal therapy must be discontinued one week prior to registration; all other therapies must be discontinued at least 3 weeks prior to registration
• Radiation therapy (adjuvant or palliative) must be completed ≥ 4 weeks prior to registration
• Required laboratory values obtained =< 7 days prior to registration:
• Absolute Neutrophil Count (ANC) >= 1500/mm^3
• Platelets >= 75,000/mm^3
• Hemoglobin >= 9.0 g/dL
• Direct bilirubin =< 1.5 x upper limit of normal (ULN)
• Alkaline phosphatase =< 2.5 x ULN (≤ 5 x ULN if liver metastasis is present)
• SGOT(AST) =< 2.5 x ULN (≤ 5 x ULN if liver metastasis is present)
• Creatinine =< 1.5 x ULN
• Fasting serum cholesterol ≤ 350mg/dL (9.0 mmol/L)

• Triglycerides ≤ 1.5 x ULN

  • Patients with Triglyceride levels > 1.5 x ULN can be started on lipid lowering agents and reevaluated within 1 week; if levels go to ≤ 1.5 x ULN, they can be considered for the trial and continue the lipid lowering agents
• International Normalized Ratio (INR) ≤ 1.5 (unless the patient is on full dose warfarin)
• ECOG Performance Status (PS) 0-1
• Capable of understanding the investigational nature, potential risks and benefits of the study and able to provide valid informed consent
• Negative serum pregnancy test done ≤ 7 days prior to registration, for women of childbearing potential only; NOTE: Patients and their partners should be practicing an effective form of contraception during the study and for at least 3 months following the last dose of this combined therapy

• Full-dose anticoagulants, if a patient is receiving full-dose anticoagulants, the following criteria should be met for enrollment:

  • The subject must have an in-range INR (usually between 2 and 3) on a stable dose of warfarin or on stable dose of LMW heparin
• Patients who have had prior anthracycline must have a normal ejection fraction on LVEF assessment by MUGA or Echo ≤ 4 weeks prior to registration
• Availability of tissue samples or blocks (from the primary tumor or metastases) for tumor studies
• Willingness to donate blood for correlative marker studies

Exclusion Criteria:

• Prior therapy with Temsirolimus or another mTOR inhibitors
• Patients cannot be receiving enzyme-inducing antiepileptic drugs (EIAEDs; e.g., phenytoin, carbamazepine, phenobarbital) nor any other CYP3A4 inducer such as rifampin or St. John's wort

• Untreated central nervous system (CNS) metastases; exceptions: patients with known CNS metastases can be enrolled if the brain metastases have been adequately treated and there is no evidence of progression or hemorrhage after treatment as ascertained by clinical examination and brain imaging (MRI or CT) ≤ 12 weeks prior to registration and no ongoing requirement for steroids

  • Anticonvulsants (stable dose) are allowed
  • Patients who had surgical resection of CNS metastases or brain biopsy ≤ 3 months prior to registration will be excluded
• Currently active, second malignancy other than non-melanoma skin cancers; NOTE: Patients are not considered to have a 'currently active' malignancy if they have completed anti-cancer therapy and are considered by their physician to be at less than 30% risk of relapse

• Any of the following, as this regimen may be harmful to a developing fetus or nursing child:

  • Pregnant women
  • Breastfeeding women
  • Men or women of childbearing potential or their sexual partners who are unwilling to employ adequate contraception (diaphragm, birth control pills, injections, intrauterine device [IUD], surgical sterilization, subcutaneous implants, or abstinence, etc.)
• NOTE: The effects of the agent(s) on the developing human fetus at the recommended therapeutic dose are unknown
• Other uncontrolled serious medical or psychiatric condition (e.g. cardiac arrhythmias, diabetes, etc.)
• Active infection requiring antibiotics
• Received prior radiotherapy to any portion of the abdominal cavity or pelvis OTHER THAN for the treatment of endometrial cancer
• Radiation therapy to > 50% of marrow bearing areas