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Sirolimus in Treating Patients With HIV-Related Kaposi's Sarcoma

This study has been completed.
Sponsor:
Collaborators:
The EMMES Corporation
Information provided by (Responsible Party):
AIDS Malignancy Clinical Trials Consortium
ClinicalTrials.gov Identifier:
NCT00450320
First received: March 20, 2007
Last updated: August 27, 2014
Last verified: August 2014
  Purpose

RATIONALE: Drugs used in chemotherapy, such as sirolimus, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Sirolimus also may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor.

PURPOSE: This pilot study is studying sirolimus in treating patients with HIV-related Kaposi's sarcoma.


Condition Intervention Phase
Sarcoma
Drug: sirolimus
Phase 1

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Pilot Study of Rapamycin in Patients With HIV-Related Kaposi's Sarcoma

Resource links provided by NLM:


Further study details as provided by AIDS Malignancy Clinical Trials Consortium:

Primary Outcome Measures:
  • Safety and toxicity [ Time Frame: All study visits ] [ Designated as safety issue: Yes ]
  • Dose of sirolimus required to achieve target trough sirolimus plasma concentration [ Time Frame: Days 8, 15, 21, 29, 43, 57, 85, 113, and every 28 days thereafter ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Clinical response [ Time Frame: Days 1, 29, 57, 85, every 28 days thereafter, at treatment discontinuation, and at study discontinuation. ] [ Designated as safety issue: No ]
  • Effect of sirolimus on mTOR-dependent signaling in peripheral blood mononuclear cells (PBMC) and Kaposi's sarcoma (KS) tumor biopsies [ Time Frame: baseline, days 1, 15, 29, 57, 113, every 28 days thereafter, study discontinuation ] [ Designated as safety issue: No ]
  • Serum cytokine profile [ Time Frame: baseline, days 1, 15, 29, 57, 113, every 28 days thereafter, study discontinuation ] [ Designated as safety issue: No ]
  • Effect of sirolimus on HIV and KS-associated herpesvirus viral loads [ Time Frame: Days 1, 15, 29, 57, 113, every 28 days thereafter, study discontinuation ] [ Designated as safety issue: No ]
  • Effect of sirolimus on T-lymphocyte subsets [ Time Frame: Baseline, Days 29, 113, and at treatment discontinuation ] [ Designated as safety issue: No ]

Enrollment: 7
Study Start Date: October 2007
Study Completion Date: September 2009
Primary Completion Date: September 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Rapamycin
The target rapamycin trough level will be 5-10 ng/mL. The initial dose will be dependent upon the type of HAART regimen.
Drug: sirolimus
The target rapamycin trough level will be 5-10 ng/mL. The initial dose will be dependent upon the type of HAART regimen. Subjects will continue on study protocol for six cycles as long as their KS is stable or continuing to respond to study medication. Treatment will be extended for up to six additional cycles if the subject has met criteria for a response. Subjects with no more than stable disease will have treatment discontinued after six cycles. Protocol treatment will be discontinued if the subject develops tumor progression, unacceptable toxicity or develops one of the protocol-defined reasons for treatment discontinuation at any time during the study.
Other Name: rapamycin

Detailed Description:

OBJECTIVES:

Primary

  • Determine the safety and toxicity of sirolimus in patients with HIV-related Kaposi's sarcoma (KS) receiving protease inhibitor (PI)-based or nonnucleoside reverse transcriptase inhibitor (NNRTI)-based highly active antiretroviral treatment (HAART) regimens.
  • Estimate the dose(s) of this drug required to achieve target trough sirolimus plasma concentrations of 5-10 ng/mL in patients receiving PI-based or NNRTI-based HAART regimens.

Secondary

  • Evaluate the clinical response of KS in patients treated with this sirolimus.
  • Determine the effects of this drug on mTOR-dependent signaling in peripheral blood mononuclear cells (PBMC) and KS tumor biopsies.
  • Determine the serum cytokine profiles pre- and post-treatment with this drug.
  • Determine the effects of this drug on HIV and KS-associated herpesvirus (KSHV) viral loads.
  • Determine the effects of this drug on T-lymphocyte subsets.

OUTLINE: This is a multicenter study. Patients are assigned to 1 of 3 treatment groups.

  • Group 1 (patients receiving PI-based HAART regimen with ritonavir): Patients receive oral sirolimus 0.0015 mg/kg/day once daily on days 1-28 for 6 courses as long as KS is stable or the disease is continuing to respond to treatment. Patients may receive 6 additional courses provided they meet criteria for response in the absence of disease progression or unacceptable toxicity. Patients with no more than stable disease after 6 courses are discontinued from treatment.
  • Group 2 (patients receiving PI-based HAART regimen without ritonavir): Patients receive oral sirolimus 0.003 mg/kg/day as in group 1.
  • Group 3 (patients receiving NNRTI-based HAART regimen): Patients receive oral sirolimus 0.05 mg/kg/day as in group 1.

Blood samples are collected periodically and analyzed for sirolimus levels via LCMSMS.

PROJECTED ACCRUAL: A total of 10 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Biopsy-proven Kaposi's sarcoma (KS) involving 1 or more of the following tissues:

    • Skin
    • Lymph nodes
    • Oral cavity
    • Gastrointestinal tract and/or lungs, if the disease meets the following criteria:

      • Asymptomatic or minimally symptomatic
      • Require systemic cytotoxic therapy
  • At least five measurable, previously non-irradiated, cutaneous lesions (indicator lesions)

    • Three non-indicator cutaneous lesions ≥ 4 x 4 mm accessible for 3-mm punch biopsy
  • Serologic documentation of HIV infection (i.e., positive enzyme-linked immunosorbent assay, positive western blot, or other federally approved licensed HIV test, or a detectable blood level of HIV RNA)

    • CD4 count > 50 cells/µL
    • Serum HIV RNA level < 400 copies/mL
  • KS that is either stable or progressing in the 4 weeks prior to study entry after being on stable antiretroviral therapy for ≥ 12 weeks with a PI-based or NNRTI-based regimen of ≥ 3 drugs, with no intention to change the regimen within 8 weeks of starting study drug

PATIENT CHARACTERISTICS:

  • Karnofsky performance status 70-100%
  • Life expectancy ≥ 3 months
  • Hemoglobin ≥ 8.0 g/dL
  • Absolute neutrophil count ≥ 1,000/mm³
  • Platelet count ≥ 75,000/mm³
  • Glomerular filtration rate > 40 mL/min
  • Total bilirubin ≤ 1.5 times upper limit of normal (ULN) (≤ 3.5 mg/dL if due to indinavir therapy and direct bilirubin normal; no limit if due to atazanavir therapy and direct bilirubin is normal)
  • AST and ALT ≤ 2.5 times ULN
  • Fasting triglyceride ≤ 400 mg/dL (4.5 mmol/L)
  • Total cholesterol ≤ 300 mg/dL (7.8 mmol/L)
  • Spot urine protein:creatinine ratio ≤ 0.5 and/or proteinuria ≤ 500 mg
  • No other prior or concurrent malignancy except for treated basal cell skin cancer or carcinoma in situ of the cervix
  • No evidence of infiltrate, cavitation, or consolidation (i.e., due to infection or other serious medical illness) on chest x-ray within the past 3 months
  • No known hypersensitivity to sirolimus or its derivatives or macrolide antibiotics
  • No New York Heart Association class III-IV cardiac disease (e.g., myocardial infarction within the past 6 months)
  • No other concurrent severe and/or life-threatening medical disease
  • No acute or known chronic liver disease (e.g., chronic active hepatitis or cirrhosis)

    • Hepatitis C with documentation of no or minimal fibrosis on liver biopsy allowed
  • No concurrent active opportunistic infection
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective barrier-method contraception during and for 3 months after completion of study therapy

PRIOR CONCURRENT THERAPY:

  • No prior sirolimus
  • No acute treatment for infection or other serious medical illness within the past 14 days
  • No anticancer therapy for KS, including chemotherapy, radiotherapy, or biological therapy within the past 4 weeks (6 weeks for nitrosoureas or mitomycin C)
  • No local therapy for any KS indicator lesion within the past 60 days, unless the lesion has progressed since treatment
  • No investigational therapies within the past 4 weeks
  • No major surgery within the past 2 weeks
  • No prior or concurrent treatment with agents or medications, other than antiretroviral drugs used to treat HIV infection, that would interfere with the metabolism or excretion of sirolimus, including, but not limited to, the following:

    • Antifungals (e.g., voriconazole, itraconazole, or ketoconazole)
    • Antibiotics (e.g., erythromycin, telithromycin, clarithromycin, rifampin, or rifabutin)
    • Cidofovir
    • Cisapride
    • Diltiazem
    • Cyclosporine
    • Grapefruit juice
    • Hypericum perforatum (St. John's wort)
  • No other concurrent anticancer therapies, including chemotherapy, biological therapy, or radiotherapy
  • No concurrent systemic corticosteroid treatment, other than replacement doses
  • No other concurrent investigational therapies
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00450320

Locations
United States, California
Rebecca and John Moores UCSD Cancer Center
La Jolla, California, United States, 92093-0658
United States, Massachusetts
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States, 02215
United States, New York
Memorial Sloan-Kettering Cancer Center
New York, New York, United States, 10065
Sponsors and Collaborators
AIDS Malignancy Clinical Trials Consortium
The EMMES Corporation
Investigators
Study Chair: Susan E. Krown, MD Memorial Sloan-Kettering Cancer Center
Principal Investigator: Dirk Dittmer, PhD UNC Lineberger Comprehensive Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: AIDS Malignancy Clinical Trials Consortium
ClinicalTrials.gov Identifier: NCT00450320     History of Changes
Other Study ID Numbers: AMC-051, U01CA070019, CDR0000536481, WYETH-0468X-4420
Study First Received: March 20, 2007
Last Updated: August 27, 2014
Health Authority: United States: Federal Government
United States: Institutional Review Board

Keywords provided by AIDS Malignancy Clinical Trials Consortium:
AIDS-related Kaposi sarcoma
recurrent Kaposi sarcoma

Additional relevant MeSH terms:
Sarcoma
Sarcoma, Kaposi
DNA Virus Infections
Herpesviridae Infections
Neoplasms
Neoplasms by Histologic Type
Neoplasms, Connective and Soft Tissue
Neoplasms, Vascular Tissue
Virus Diseases
Everolimus
Sirolimus
Anti-Bacterial Agents
Anti-Infective Agents
Antibiotics, Antineoplastic
Antifungal Agents
Antineoplastic Agents
Immunologic Factors
Immunosuppressive Agents
Pharmacologic Actions
Physiological Effects of Drugs
Therapeutic Uses

ClinicalTrials.gov processed this record on November 24, 2014