Ixabepilone and Temsirolimus in Treating Patients With Solid Tumors That Are Metastatic or Cannot Be Removed by Surgery

• Toxicity profile of combination ixabepilone and temsirolimus [ Designated as safety issue: Yes ]
• MTD of ixabepilone and temsirolimus in patients with advanced solid tumors [ Designated as safety issue: No ]
• Time to progression and time to treatment failure [ Designated as safety issue: No ]

• 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 overall toxicity, as well as toxicity profiles by dose level, patient and tumor site [ Time Frame: Up to 3 months ] [ Designated as safety issue: Yes ]
• Best response, defined to be the best objective status recorded from the start of the treatment until disease progression/recurrence [ 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).
• Time until any treatment related toxicity [ Time Frame: Up to 3 months ] [ Designated as safety issue: Yes ]
• Time until treatment related grade 3+ toxicity [ Time Frame: Up to 3 months ] [ Designated as safety issue: Yes ]
• Time until hematologic nadirs (WBC, ANC, platelets) [ Time Frame: Up to 3 months ] [ Designated as safety issue: No ]
• Time to progression [ Time Frame: Up to 3 months ] [ Designated as safety issue: No ]
• Time to treatment failure [ Time Frame: From registration to documentation of progression, unacceptable toxicity, or refusal to continue participation by the patient, assessed up to 3 months ] [ Designated as safety issue: No ]

This phase I trial studies the side effects and best dose of ixabepilone and temsirolimus in treating patients with solid tumors that are metastatic or cannot be removed by surgery. Drugs used in chemotherapy, such as ixabepilone, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Temsirolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving ixabepilone together with temsirolimus may kill more tumor cells

PRIMARY OBJECTIVES:

I. To determine the maximally tolerated dose (MTD) of the combination of ixabepilone and temsirolimus in patients with advanced solid tumors.

II. To describe toxicity profiles associated with the combination of ixabepilone and temsirolimus.

III. To assess preliminary efficacy of the combination of ixabepilone and temsirolimus.

OUTLINE: This is a dose-escalation study.

Patients receive ixabepilone IV over 3 hours on day 1 and temsirolimus IV over 30-60 minutes on days 2 and 9. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

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

• Drug: ixabepilone
  Given IV
  Other Names:

  • BMS-247550
  • epothilone B lactam
  • Ixempra
• Drug: temsirolimus
  Given IV
  Other Names:

  • CCI-779
  • cell cycle inhibitor 779
  • Torisel

Inclusion Criteria:

• Adult patients with histologically confirmed solid tumor malignancy that is metastatic or unresectable and for which standard curative measures or other therapy that provide survival benefit do not exist or are no longer effective; there are no limitations on the number of prior therapeutic regimens
• Patients with non-measurable, but assessable, disease will be allowed
• Absolute neutrophil count >= 1500/mcL
• Hemoglobin >= 9.0 g/dL
• Platelets >= 100,000/mcL
• Total bilirubin < 1.5 mg/dL
• SGPT (ALT) or SGOT (AST) =< 2.5 x ULN in the absence of hepatic metastasis; SGPT (ALT) =< 3 x ULN or SGOT (AST) =< 5 x ULN in the presences of hepatic metastasis
• Creatinine =< 1.5 x ULN
• INR =< 1.4 for patients not on warfarin (Coumadin®)
• INR range of 2.0-3.0 for patients on therapeutic doses of warfarin (Coumadin®)
• ECOG Performance Status (PS) 0, 1, or 2
• Ability to provide informed consent
• Willingness to return to a Mayo Clinic institution for follow up
• Life expectancy >= 84 days (12 weeks)
• Women of childbearing potential only: Negative serum pregnancy test done =< 7 days prior to registration

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, uncontrolled diabetes or with HbA1C > 8, 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
• New York Heart Association classification III or IV
• Known CNS metastases or seizure disorder; patients with known brain metastases that have been successfully treated and stable for > 6 months without requirement for corticosteroids and without seizure activity will be eligible

• Any of the following because this study involves an agent that has known genotoxic, mutagenic and teratogenic effects:

  • 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) including patients known to be HIV positive
• Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm
• History of myocardial infarction =< 168 days (6 months), or congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias
• >= Grade 2 sensory neuropathy
• >= Grade 2 hypertriglyceridemia
• >= Grade 2 hypercholesterolemia
• Patients on medication considered strong CYP3A4 inducers (efavirenz, nevirapine, carbamazepine, phenobarbital, phenytoin, pioglitazone, rifabutin, rifampin, St. John's wort) or CYP3A4 inhibitors (indinavir, nelfinavir, ritonavir, clarithromycin, itraconazole, ketoconazole, nefazodone, saquinavir, telithromycin) unless the medication can be substituted with another agent