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Nelfinavir for the Treatment of Gammaherpesvirus-Related Tumors

This study has been terminated.
(Very slow accrual; terminated to allow resources to be utilized more effectively on other studies. No data analysis completed, nor any conclusions reached.)
Information provided by (Responsible Party):
Sidney Kimmel Comprehensive Cancer Center Identifier:
First received: March 4, 2014
Last updated: June 8, 2016
Last verified: June 2016
The goals of this study is to determine if nelfinavir can target Epstein-Barr virus (EBV) and Kaposi sarcoma-associated herpesvirus (KSHV) in patients with certain cancers.

Condition Intervention Phase
Non-Hodgkin Lymphoma
Hodgkin Lymphoma
Kaposi Sarcoma
Gastric Cancer
Nasopharyngeal Cancer
Castleman Disease
Drug: Nelfinavir
Early Phase 1

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Pilot Trial of Nelfinavir for the Lytic Activation and Treatment of Gammaherpesvirus-Related Tumors

Resource links provided by NLM:

Further study details as provided by Sidney Kimmel Comprehensive Cancer Center:

Primary Outcome Measures:
  • Lytic activation of viral gene expression by NFV [ Time Frame: Day 4 and day 5 of Cycle 1 ]
    To determine if NFV activates lytic gene expression in the tumors of patients with EBV(+) or KSHV(+) cancers, as evidenced by the ability to image the tumor with [124I]fialuridine-PET-CT.

Secondary Outcome Measures:
  • Serial assessment of methylation of viral DNA [ Time Frame: Day 4 of Cycle 1, at the end of cycles 1-4, 2 weeks post-treatment, and 4 weeks post-treatment ]
    The methylation of viral DNA in plasma at baseline and during the course of NFV therapy and follow-up will be determined for each patient.

  • Serial assessment of viral copy number in plasma [ Time Frame: Day 4 of Cycle 1, at the end of cycles 1-4, 2 weeks post-treatment, and 4 weeks post-treatment ]
    Viral DNA copy number in plasma at baseline and during the course of NFV therapy and follow-up will be determined for each patient by quantitative polymerase chain reaction assay (qPCR).

  • Tolerability of high-dose nelfinavir [ Time Frame: Every week up to 2 weeks post-treatment ]
    The tolerability of high-dose NFV in patients with relapsed/refractory EBV(+) or KSHV(+) tumors will be determined by evaluation of dose limiting toxicities (DLT).

  • Tumor regression and response [ Time Frame: Within 2 weeks of ending treatment ]
    The responses of EBV(+) and KSHV(+) tumors after 4 cycles of NFV therapy will be assessed by CT for solid tumors, CT or PET-CT for lymphomas and lymphoproliferative disorders, and skin exam with lesion measurements for KS.

Enrollment: 1
Study Start Date: July 2014
Study Completion Date: February 2016
Primary Completion Date: February 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Nelfinavir
Nelfinavir twice daily on days 1-14 of a 14-day cycle for 4 cycles
Drug: Nelfinavir
Nelfinavir will be given 3000 mg orally twice daily on days 1-14 of a 14-day cycle. NFV will be continued in patients tolerating therapy for 4 cycles (8 weeks).
Other Name: Viracept®

Detailed Description:

Epstein-Barr virus (EBV) and Kaposi sarcoma-associated herpesvirus (KSHV) are gammaherpesviruses that are associated with a variety of human cancers, including a subset of lymphomas, carcinomas, and sarcomas. In tumors the virus typically exists in a latent state. In latently infected cells, the vast majority of viral genes are not expressed and there is little to no production of infectious virions. The virus replicates in tandem with cell division using cellular machinery. This highly restricted pattern of gene expression allows the virus to evade immune recognition and clearance.

Currently, the treatment approach to virally-associated malignancies is no different than the treatment approach to the same tumors where there is no viral association. Yet, the presence of virus within these tumors offers an opportunity to develop virus-specific, targeted therapies in these diseases. Such therapies might not only be more effective but also less toxic. EBV- and KSHV-associated cancers are more common in patients with HIV, congenital immunodeficiencies, or other immunosuppression, such as transplant recipients. These patients in particular would benefit from more targeted treatment approaches to their malignancies, potentially sparing the toxicities of cytotoxic chemotherapy in an already immunocompromised patient population.

Activation of lytic gene expression in virally-infected tumors may enhance tumor-specific cell killing through multiple mechanisms. Importantly, the cytotoxic effects of antiviral nucleoside analogues, such as acyclovir and its cogeners, depend on the activity of viral kinases which are only expressed during lytic replication. Because EBV(+) or KSHV(+) tumors are characterized by latent viral infection, these antiviral drugs as a single agent are not active in these tumors. However, if lytic gene expression could be activated in virally-associated tumors, this could render EBV(+) and KSHV(+) tumor cells susceptible to killing by antiviral nucleoside analogues.

Nelfinavir (NFV), an FDA-approved protease inhibitor for the treatment of HIV, has been shown to be a potent activator of lytic gene expression of EBV(+) and KSHV(+) cancer cell lines. Furthermore, NFV is able to activate lytic gene expression of EBV and KSHV at drug levels that are achievable in humans. There is also growing evidence that NFV has antitumor activity.

The goals of this study is to determine if NFV activates lytic gene expression in the tumors and causes tumor regression in patients with EBV(+) or KSHV(+) cancers.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age 18 years or older
  • Biopsy proven EBV(+) or KSHV(+) malignancy
  • Relapsed/refractory disease failing > 2 prior therapies
  • Measurable, non-bony disease (at least one lesion on radiographic or physical exam assessment measuring > 2 cm in longest axis)
  • KS patients with skin-only disease must have cutaneous lesions amenable to four 3 mm punch biopsies during the course of the study
  • Eastern Cooperative Oncology Group (ECOG) performance status < 2
  • Life expectancy of greater than 12 weeks
  • Patients must be able to lie flat for at least 60 minutes and fit on a PET-CT scanner
  • Ability to comply with an oral drug regimen
  • Females of childbearing potential must have a negative pregnancy test at screening
  • Patients must have normal organ and marrow function as defined below within 14 days of study entry

Exclusion Criteria:

  • Patients with HIV-associated primary central nervous system lymphoma
  • Radiotherapy or chemotherapy ending within 14 days of study enrollment
  • Patients currently on other protease inhibitors
  • Chronic diarrhea
  • Acute, active infection within 14 days of enrollment
  • Patients on active treatment for hypo- or hyperthyroidism
  • End-stage liver disease unrelated to tumor
  • Hepatitis B or hepatitis C infection
  • Use of any other type of investigational agent or treatment concurrently or within 28 days before the first dose of study treatment
  • History of iodine hypersensitivity
  • Females who are pregnant or breastfeeding
  • Physical or psychiatric conditions that in the estimation of the investigator place the patient at high risk of toxicity, non-compliance, or inability to complete the study requirements
  • Use of drugs to treat or prevent herpesvirus infections
  • Essential medication that is known to interact with nelfinavir
  Contacts and Locations
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Please refer to this study by its identifier: NCT02080416

United States, Maryland
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, Maryland, United States, 21287
Sponsors and Collaborators
Sidney Kimmel Comprehensive Cancer Center
Principal Investigator: Richard Ambinder, MD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
  More Information

Responsible Party: Sidney Kimmel Comprehensive Cancer Center Identifier: NCT02080416     History of Changes
Other Study ID Numbers: J13174
NA_00092477 ( Other Identifier: Johns Hopkins IRB )
Study First Received: March 4, 2014
Last Updated: June 8, 2016
Individual Participant Data  
Plan to Share IPD: No
Plan Description: Study terminated; no data analysis completed

Keywords provided by Sidney Kimmel Comprehensive Cancer Center:

Additional relevant MeSH terms:
Giant Lymph Node Hyperplasia
Lymphoma, Non-Hodgkin
Stomach Neoplasms
Hodgkin Disease
Sarcoma, Kaposi
Nasopharyngeal Neoplasms
Neoplasms by Histologic Type
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Neoplasms, Connective and Soft Tissue
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Gastrointestinal Diseases
Stomach Diseases
Herpesviridae Infections
DNA Virus Infections
Virus Diseases
Neoplasms, Vascular Tissue
Pharyngeal Neoplasms
Otorhinolaryngologic Neoplasms
Head and Neck Neoplasms
Nasopharyngeal Diseases
Pharyngeal Diseases processed this record on April 28, 2017