Effect of Vorinostat on Nervous System Hemangioblastomas in Von Hippel-Lindau Disease (Missense Mutation Only)

• ClinicalTrials.gov Identifier: NCT02108002
• Recruitment Status: Completed
• First Posted: April 9, 2014
• Last Update Posted: September 14, 2018
• Sponsor: National Institute of Neurological Disorders and Stroke (NINDS)
• Information provided by (Responsible Party): National Institutes of Health Clinical Center (CC) ( National Institute of Neurological Disorders and Stroke (NINDS) )

Study Description

Brief Summary:

Background:

- Von Hippel-Lindau (VHL) disease is a rare gene disease. People with VHL often have a brain tumor called hemangioblastoma. Standard treatment for these tumors is risky surgery. Researchers want to find new ways to treat people who have the tumors. They want to see if a drug that fights other cancers might slow the growth of hemangioblastomas in some people with VHL. Some people with VHL have mutations that make abnormal proteins. Tumors form in such people because the abnormal protein is broken down quickly. The cancer drug may work in these tumors by preventing breakdown of protein.

Objective:

- To study how the drug vorinostat affects hemangioblastomas in people with VHL.

Eligibility:

- Adults at least 18 old with hemangioblastomas from VHL.

Design:

• Participants must already be in study 03-N-0164. They must have tumor surgery scheduled.
• Participants must stop taking most medications 14 days before surgery.
• One week before surgery, participants will enter the hospital. They will be screened with medical history and physical and neurological exams. They will give blood and urine samples. Participants will have an electrocardiogram. For this test, small sticky patches are put on the arms, legs, and chest. Participants will lie still for a few minutes while a machine records heart rate and rhythm.
• Participants will take one vorinostat by mouth each day for 7 days.
• Participants will have blood drawn during the week to check for any side effects.
• Participants will have their tumor removed in surgery. Researchers will study the tumor tissue for the effects of the study drug.
• A nurse will call participants 1 month after surgery to check for side effects.

Condition or disease	Intervention/treatment	Phase
Von Hippel-Lindau Disease	Drug: Vorinostat	Phase 1

Detailed Description:

Background

Central Nervous System (CNS) hemangioblastomas are the most common tumor found in the familial neoplasia syndrome, Von Hippel-Lindau (VHL).

Hemangioblastomas cause significant morbidity and mortality. While surgical resection is the treatment of choice for CNS hemangioblastomas, it is associated with morbidity and death. There is a critical need for new non-invasive treatments of VHL-associated CNS hemangioblastomas.

Vorinostat is a histone deacetylase inhibitor (HDACi) that is FDA-approved for the treatment of refractory cutaneous T-cell lymphoma (CTCL). Vorinostat has been tested in other hematologic malignancies and solid tumors. Recent data suggests that vorinostat may have a potent therapeutic effect in the treatment of VHL-associated hemangioblastomas in patients with missense germline mutations of the VHL gene. In most VHL mutation types, the abnormal VHL protein content is not active, which leads to tumor formation and growth. In missense mutation VHL disease, tumor cells contain a malformed VHL protein that is partially active. However, the protein is degraded quickly by normal cellular mechanisms. Vorinostat prevents degradation of a malformed protein within the tumors. Increased protein leads to slower growth in these tumors.

Objective

To determine whether vorinostat reduces degradation of mutant VHL protein in VHL patients with germline missense mutations.

Eligibility

Adult patients (age greater than or equal to 18 years) with a known germline missense VHL gene mutation that require surgical resection of a hemangioblastoma.

Design

We intend to conduct a pilot study with vorinostat in six patients with hemangioblastomas causing significant symptoms from tumor growth. Vorinostat will be administered if the patients are deemed surgical candidates. Patients will receive one (1) dose of 400 mg of vorinostat daily for seven (7) days prior to surgery. On the day of surgery, the patients will not receive vorinostat. Patients will undergo surgery as usual, with no change in planning or technique of the procedure. The tumor specimens from surgery will be examined for presence and quantity of mutant VHL protein. Comparisons for levels of mutant VHL protein will be made with tissue banked from previous surgical resections under 03-N-0164. Measurements of genetic expression of vascular endothelial growth factor (VEGF) and erythropoietin (EPO) will also be performed on these specimens.

Outcome Measures

1. The presence and quantity of mutant VHL protein in resected hemangioblastoma specimens, including comparison of specimens without vorinostat treatment and those with presurgical vorinostat treatment.
2. Measurement of VEGF and EPO results from resected hemangioblastoma specimens, including comparison of specimens without vorinostat treatment and those with presurgical vorinostat treatment.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 7 participants
• Allocation: Non-Randomized
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Diagnostic
• Official Title: Pilot Study of the Effect of Vorinostat on Nervous System Hemangioblastomas In Von Hippel-Lindau Disease
• Study Start Date: April 5, 2014
• Actual Primary Completion Date: September 12, 2018
• Actual Study Completion Date: September 12, 2018

Arms and Interventions

Outcome Measures

Primary Outcome Measures :

1. The presence and quantity of mutant VHL protein in resected hemangioblastoma specimens, including comparison of specimens without vorinostat treatment and those with presurgical vorinostat treatment. [ Time Frame: ongoing ]

Eligibility Criteria

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

Criteria

• INCLUSION CRITERIA

  1. Adult patients (age greater than or equal to 18 years)
  2. Known VHL disease arising from a missense mutation.
  3. Demonstrated clinical progression of CNS hemangioblastoma.
  4. Enrolled in 03-N-0164, Evaluation of Neurosurgical Disorders.
  5. Able to provide written informed consent.

EXCLUSION CRITERIA

1. Patients who have been previously treated with vorinostat.
2. Significant medical illnesses that in the investigator s opinion cannot be adequately controlled with appropriate therapy or would compromise the patient s ability to tolerate this therapy.
3. History of a second cancer (except non-melanoma skin cancer or carcinoma in-situ of the cervix), unless in complete remission and off of all therapy for that disease for a minimum of 3 years.
4. Active infection or serious concurrent medical illness.
5. Pregnancy and breast-feeding.
6. Presence of any disease that will obscure toxicity or dangerously alter drug metabolism (such as uncontrolled diabetes, liver disease, bleeding disorder)
7. Currently receiving other investigational agents.
8. History of allergic reactions attributed to compounds of similar chemical or biologic composition to vorinostat, such as valproate.
9. Currently taking another HDACi, such as valproate.

Contacts and Locations

Locations

United States, Maryland

National Institutes of Health Clinical Center, 9000 Rockville Pike

Bethesda, Maryland, United States, 20892

Sponsors and Collaborators

National Institute of Neurological Disorders and Stroke (NINDS)

Investigators

• Principal Investigator: Prashant Chittiboina, M.D.; National Institute of Neurological Disorders and Stroke (NINDS)

More Information

Publications:

Harries RW. A rational approach to radiological screening in von Hippel-Lindau disease. J Med Screen. 1994 Apr;1(2):88-95. doi: 10.1177/096914139400100205.

Friedrich CA. Von Hippel-Lindau syndrome. A pleomorphic condition. Cancer. 1999 Dec 1;86(11 Suppl):2478-82.

Maher ER, Willatt L, Cuthbert G, Chapman C, Hodgson SV. Three cases of 16q duplication. J Med Genet. 1991 Nov;28(11):801-2. doi: 10.1136/jmg.28.11.801. No abstract available. Erratum In: J Med Genet 1992 Feb;29(2):133.

• Responsible Party: National Institute of Neurological Disorders and Stroke (NINDS)
• ClinicalTrials.gov Identifier: NCT02108002
• Other Study ID Numbers: 140067; 14-N-0067
• First Posted: April 9, 2014
• Last Update Posted: September 14, 2018
• Last Verified: September 12, 2018

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Neurological Disorders and Stroke (NINDS) ):

Missense Mutations; Hemangioblastoma; Histone Deacytelase Inhibitors; Von Hippel-Lindau Disease

Additional relevant MeSH terms:

Hemangioblastoma; Von Hippel-Lindau Disease; Neurocutaneous Syndromes; Nervous System Diseases; Angiomatosis; Vascular Diseases; Cardiovascular Diseases; Ciliopathies; Abnormalities, Multiple; Congenital Abnormalities; Genetic Diseases, Inborn; Hemangioma, Capillary; Hemangioma; Neoplasms, Vascular Tissue; Neoplasms by Histologic Type; Neoplasms; Vorinostat; Antineoplastic Agents; Histone Deacetylase Inhibitors; Enzyme Inhibitors; Molecular Mechanisms of Pharmacological Action