High-Dose or Low-Dose Vorinostat in Combination With Carboplatin or Paclitaxel in Treating Patients With Advanced Solid Tumors

• Adverse events of two different escalated intermittent dosing schedules of vorinostat combined with carboplatin as assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v. 4.0 [ Time Frame: Up to 4 weeks ] [ Designated as safety issue: Yes ]
  The percentage of patients with any grade and with grade 3 or higher toxicity will be reported along with 95% confidence intervals.
• Pharmacodynamic markers of vorinostat activity, including AUC and changes in platelet counts [ Time Frame: 0 (pre-treatment), 60, 120, 180, 240, 360 and 480 minutes and 24 hours after vorinostat administration on days 3 and 10 of course 0 and on day 3 of course 1 ] [ Designated as safety issue: No ]
  The correlation between changes in AUC and changes in platelet counts will be analyzed by a non-parametric Spearman's correlation coefficient with 95% confidence intervals. Similar analyses will be performed for Cmax and other pharmacodynamic markers. Additionally, the effects of including a variable for vorinostat exposure to the effect equation developed by Egorin, et al. relating carboplatin exposure to the change in platelet count from pre-treatment to nadir measured weekly will be examined. The association between genetic polymorphisms and vorinostat pharmacokinetics analyzed using ANOVA.

• Adverse events of two different escalated intermittent dosing schedules of vorinostat combined with carboplatin as assessed by NCI CTCAE v. 4.0 [ Designated as safety issue: Yes ]
• Pharmacodynamic markers of vorinostat activity [ Designated as safety issue: No ]

This randomized clinical trial is studying high-dose or low-dose vorinostat in combination with carboplatin or paclitaxel to see how well it works in treating patients with advanced solid tumors. Vorinostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving different doses of vorinostat together with carboplatin or paclitaxel may kill more tumor cells.

PRIMARY OBJECTIVES:

I. To determine whether high dose, short course vorinostat achieves higher peak serum concentrations than standard dosing.

SECONDARY OBJECTIVES:

I. To determine the toxicity profiles of two different escalated intermittent dosing schedules of vorinostat combined with carboplatin at an area under curve (AUC) of 5.

II. To describe the response rate in patients with advanced solid tumors treated with these regimens.

III. To develop pharmacodynamic markers for vorinostat. IV. To determine the toxicity profiles of escalated intermittent dosing schedule of vorinostat at 1200 mg combined with paclitaxel at 175 mg/m^2 and to describe the response rate in patients with advanced solid tumors treated with this regimen.

OUTLINE: Patients are randomized to 1 of 4 treatment arms.

ARM I: Patients receive high-dose vorinostat orally (PO) once daily (QD) on days 1-3 and low-dose vorinostat PO QD on days 8-10 (course 1). After 5 days, patients receive high-dose vorinostat PO QD on days 1-3 and carboplatin IV over 30 minutes on day 3 of all subsequent courses.

ARM II: Patients receive high-dose vorinostat and low-dose vorinostat as in arm I. After 5 days, patients receive lower-dose vorinostat PO QD on days 1-3 and carboplatin IV over 30 minutes on day 3 of all subsequent courses.

ARM III: Patients receive low-dose vorinostat PO QD on days 1-3 and high-dose vorinostat PO QD on days 8-10 (course 0). After 5 days, patients receive vorinostat and carboplatin as in arm I.

ARM IV: Patients receive low-dose vorinostat and high-dose vorinostat as in arm III. After 5 days, patients receive vorinostat and carboplatin as in arm II.

ARM V: Patients receive low-dose vorinostat PO QD on days 1-3 and mid-dose vorinostat PO QD on days 8-10 (course 0). After 5 days, patients receive mid-dose vorinostat PO QD on days 1-3 and paclitaxel IV over 3 hours on day 3.

ARM VI: Patients receive mid-dose vorinostat PO QD on days 1-3 and low-dose vorinostat PO QD on days 8-10 (course 0). After 5 days, patients receive vorinostat and paclitaxel as in arm V.

In all arms, courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

After completion of study therapy, patients are followed up for 4 weeks.

• Drug: vorinostat
  Given PO
  Other Names:

  • L-001079038
  • SAHA
  • suberoylanilide hydroxamic acid
  • Zolinza
• Drug: carboplatin
  Given IV
  Other Names:

  • Carboplat
  • CBDCA
  • JM-8
  • Paraplat
  • Paraplatin
• Drug: paclitaxel
  Given IV
  Other Names:

  • Anzatax
  • Asotax
  • TAX
  • Taxol
• Other: laboratory biomarker analysis
  Correlative studies
• Other: pharmacological study
  Correlative studies
  Other Name: pharmacological studies

• Experimental: Arm I (high- and low-dose vorinostat and carboplatin)
  Patients receive high-dose vorinostat PO QD on days 1-3 and low-dose vorinostat PO QD on days 8-10 (course 0). After 5 days, patients receive high-dose vorinostat PO QD on days 1-3 and carboplatin IV over 30 minutes on day 3 of all subsequent courses.
  Interventions:

  • Drug: vorinostat
  • Drug: carboplatin
  • Other: laboratory biomarker analysis
  • Other: pharmacological study
• Experimental: Arm II (high- and low-dose vorinostat and carboplatin)
  Patients receive high-dose vorinostat and low-dose vorinostat as in arm I. After 5 days, patients receive lower-dose vorinostat PO QD on days 1-3 and carboplatin IV over 30 minutes on day 3.
  Interventions:

  • Drug: vorinostat
  • Drug: carboplatin
  • Other: laboratory biomarker analysis
  • Other: pharmacological study
• Experimental: Arm III (low- and high-dose vorinostat and carboplatin)
  Patients receive low-dose vorinostat PO QD on days 1-3 and high-dose vorinostat PO QD on days 8-10 (course 0). After 5 days, patients receive vorinostat and carboplatin as in arm I.
  Interventions:

  • Drug: vorinostat
  • Drug: carboplatin
  • Other: laboratory biomarker analysis
  • Other: pharmacological study
• Experimental: Arm IV (low- and high-dose vorinostat and carboplatin)
  Patients receive low-dose vorinostat and high-dose vorinostat as in arm III. After 5 days, patients receive vorinostat and carboplatin as in arm II.
  Interventions:

  • Drug: vorinostat
  • Drug: carboplatin
  • Other: laboratory biomarker analysis
  • Other: pharmacological study
• Experimental: Arm V (low- and mid-dose vorinostat and paclitaxel)
  Patients receive low-dose vorinostat PO QD on days 1-3 and mid-dose vorinostat PO QD on days 8-10 (course 0). After 5 days, patients receive mid-dose vorinostat PO QD on days 1-3 and paclitaxel IV over 3 hours on day 3.
  Interventions:

  • Drug: vorinostat
  • Drug: paclitaxel
  • Other: laboratory biomarker analysis
  • Other: pharmacological study
• Experimental: Arm VI (mid- and low-dose vorinostat and paclitaxel)
  Patients receive mid-dose vorinostat PO QD on days 1-3 and low-dose vorinostat PO QD on days 8-10. After 5 days, patients receive vorinostat and paclitaxel as in arm V.
  Interventions:

  • Drug: vorinostat
  • Drug: paclitaxel
  • Other: laboratory biomarker analysis
  • Other: pharmacological study

Inclusion Criteria:

• Histologically confirmed malignancy that is metastatic or unresectable and for which no superior curative or palliative measures are known

• No known brain metastases that are untreated or have progressed after definitive therapy

  • Patients with treated brain metastases who are no longer receiving steroids (for at least 14 days) or enzyme-inducing anti-epileptic drugs and who have no unstable neurologic symptoms may be enrolled at the discretion and joint decision of the principal investigator and treating physician
• Eastern Cooperative Oncology Group (ECOG) performance status 0-1
• Life expectancy > 3 months
• Leukocytes > 3,000/mm³
• Absolute neutrophil count > 1,500/mm^3
• Platelet count > 100,000/mm^3
• Total bilirubin normal
• Potassium normal
• Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) < 2.5 times upper limit of normal (ULN) (< 5 times ULN for patients with liver metastases)
• Creatinine normal OR creatinine clearance > 60 mL/min
• Not pregnant or nursing
• Negative pregnancy test
• Women of child-bearing potential and men must agree to use adequate contraception for the duration of the study
• Able to swallow oral medications
• No history of allergic reactions attributed to compounds of similar chemical or biologic composition to vorinostat or carboplatin
• No 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
• At least 4 weeks since prior chemotherapy or radiotherapy (6 weeks for carmustine [BCNU], nitrosoureas, or mitomycin C) and recovered to grade ≤ 1 toxicity
• No prior or concurrent valproic acid
• No other concurrent investigational agents
• No concurrent combination antiretroviral therapy for human immunodeficiency virus (HIV)-positive patients