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LDE225 + Everolimus in Advanced Gastroesophageal Adenocarcinoma

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02138929
Recruitment Status : Active, not recruiting
First Posted : May 15, 2014
Last Update Posted : May 22, 2019
Sponsor:
Collaborators:
Novartis
National Cancer Institute (NCI)
Information provided by (Responsible Party):
M.D. Anderson Cancer Center

Brief Summary:
The goal of this clinical research study is to find the highest tolerable dose of LDE225 that can be given in combination with everolimus to patients with esophageal or GEJ cancer. The safety of the drug combination will also be studied.

Condition or disease Intervention/treatment Phase
Esophageal Cancer Drug: Everolimus Drug: LDE 225 Phase 1

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 25 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase I Study of LDE225 in Combination With Everolimus in Patients With Advanced Gastroesophageal Adenocarcinoma
Actual Study Start Date : November 10, 2014
Estimated Primary Completion Date : November 2020
Estimated Study Completion Date : November 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Everolimus + LDE 225

Dose Escalation: Everolimus at a dose of 10 mg by mouth daily with dose escalation of LDE 225 from 200 mg - 800mg by mouth daily. Study cycle is 28 days.

Dose Expansion: Everolimus at a dose of 10 mg by mouth daily. LDE 225 at MTD from Dose Escalation. Study cycle is 28 days.

Drug: Everolimus
Induction and Dose Expansion Phase: 10 mg by mouth daily in a 28 day cycle.
Other Names:
  • Afinitor
  • Zortress
  • RAD001

Drug: LDE 225

Induction Phase Starting Dose: 400 mg by mouth daily in a 28 day cycle.

Expansion Phase Starting Dose: Maximum tolerated dose from Induction Phase.





Primary Outcome Measures :
  1. Maximum Tolerated Dose (MTD) of LDE225 in Combination with Everolimus in Participants with Advanced Adenocarcinoma of the Esophagus, Gastroesophageal Junction (GEJ) or Stomach in the Second or Third Line Setting [ Time Frame: 10 weeks ]
    Maximum tolerated dose (MTD) defined as highest dose level for the combination therapy with no more than 1 out of 6 patients experiencing dose limiting toxicity (DLT). DLT defined as an adverse event (AE) or abnormal laboratory value assessed as at least possibly related to the study medication, occurs ≤56 days following the first dose of LDE225 (DLT assessment period).


Secondary Outcome Measures :
  1. Safety of LDE225 in Combination with Everolimus in a Cohort of Participants with Metastatic Nuclear Gli-1 Expressing Adenocarcinoma of the Esophagus, Gastroesophageal Junction or Stomach per CTCAE. [ Time Frame: 30 days after last dose of study drug given. ]
    A Bayesian method by Thall, Simon, and Estey [37] used for safety monitoring, starting from the 5th patient. The monitoring rule for toxicity is Pr (P(Tox) > 0.25 | data) > 0.80, where P(Tox) is the proportion of patients that experience DLT and it has a prior distribution of beta (0.5, 1.5).



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

Inclusion Criteria:

  1. Patients must have histologically or cytologically confirmed adenocarcinoma of esophagus,gastroesophageal junction, or stomach which is Gli-1 positive (labeling index [LI] greater than or equal to 5%). Testing is to be performed in a CLIA certified laboratory. The patients must have an archival tumor sample to facilitate this testing.
  2. Patients must have an unresectable locally advanced or metastatic adenocarcinoma.
  3. Patients agreeing to the optional biomarker study in the expansion phase only need to have an accessible primary tumor. (Optional biomarker studies will be done in up to 18 patients in the expansion phase only.)
  4. Patient must have received at least one, and no more than two prior systemic therapies for metastatic cancer.
  5. Patients whose esophageal or GEJ cancer has become metastatic or unresectable locally advanced within 6 months of completing definitive therapy for localized or locally advanced cancer can be considered as having received one line of therapy for advanced cancer.
  6. Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as greater than 20 mm with conventional techniques or as greater than 10 mm with spiral CT scan.
  7. Male or female patients greater than or equal to 18 years old.
  8. ECOG performance status less than 2.
  9. Patients must have normal organ and marrow function as defined below: leukocytes greater than 3,000/mcL; absolute neutrophil count greater than1,500/mcL; platelets greater than 100,000/mcL; Hemoglobin (Hgb) greater than or equal to 9 g/dL (transfusions are allowed); total bilirubin within normal institutional limits; AST(SGOT)/ALT(SGPT) less than 2.5 x institutional upper limit of normal (ULN) or less than or equal to 5 x institutional ULN if liver metastasis are present; Serum creatinine less than or equal to 1.5 x ULN or 24-hour clearance greater than or equal to 50ml/min; Plasma creatine phosphokinase (CK) less than 1.5 x ULN; INR less than or equal to 2; Fasting serum cholesterol less than or equal to 300 mg/dL OR less than or equal to 7.75 mmol/L AND fasting triglycerides less than or equal to 2.5 x ULN.
  10. Patient should be able to swallow and retain oral medications.
  11. Women of childbearing potential and men must use two forms of contraception (non-hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation and for 6 months after the final dose of study treatment.
  12. Ability to understand and the willingness to sign a written informed consent document. Signed informed consent will be obtained prior to any screening procedures.

Exclusion Criteria:

  1. Patients currently receiving anticancer therapies or who have received anticancer therapies within 4 weeks of the start of Everolimus and LDE225 (including chemotherapy, radiation therapy, antibody based therapy, etc.).
  2. Uncontrolled diabetes mellitus as defined by HbA1c greater than 8% despite adequate therapy. Patients with a known history of impaired fasting glucose or diabetes mellitus (DM) may be included, however blood glucose and antidiabetic treatment must be monitored closely throughout the trial and adjusted as necessary.
  3. Patients who have any severe and/or uncontrolled medical conditions such as: a) unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction less than or equal to 6 months prior to start of Everolimus, serious uncontrolled cardiac arrhythmia, or any other clinically significant cardiac disease; b) symptomatic congestive heart failure of New York Heart Association Class III or IV; c) active (acute or chronic) or uncontrolled severe infection, liver disease such as cirrhosis, decompensated liver disease, and chronic hepatitis (i.e. quantifiable HBV-DNA and/or positive HbsAg, quantifiable HCV-RNA); d) known severely impaired lung function (spirometry and DLCO 50% or less of normal and O2 saturation 88% or less at rest on room air); e) active, bleeding diathesis.
  4. Patients who have a history of another primary malignancy, with the exceptions of: non-melanoma skin cancer, and carcinoma in situ of the cervix, uteri, or breast from which the patient has been disease free for greater than or equal to 3 years.
  5. Patients with a history of non-compliance to medical regimens or who are considered potentially unreliable or will not be able to complete the entire study.
  6. Pregnant or nursing (lactating) women.
  7. Women of child-bearing potential (WOCBP), defined as all women physiologically capable of becoming pregnant, must use highly effective methods of contraception during the study and 6 months after. Hormonal contraception methods (e.g. oral, injected, implanted) are not allowed as it cannot be ruled out that the study drug decreases the effectiveness of hormonal contraception. Highly effective contraception methods include combination of any two of the following: a) Placement of a non-hormonal intrauterine device (IUD) or non-hormonal intrauterine system (IUS); b) Barrier methods of contraception: condom or occlusive cap (diaphragm or cervical/vault caps) with spermicidal foam/gel/film/cream/ vaginal suppository; c. Total abstinence (When this is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception.);
  8. (Continued from # 7): or d) Male/female sterilization. (Sterilization: Patient has had surgical bilateral oophorectomy (with or without hysterectomy) or tubal ligation at least six weeks before taking study treatment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment. Male partner sterilization (with the appropriate post-vasectomy documentation of the absence of sperm in the ejaculate). [For female study patients, the vasectomized male partner should be the sole partner for that patient.]).
  9. (Continued from # 8): Women are considered post-menopausal and not of child-bearing potential if they have had 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g. age appropriate, history of vasomotor symptoms) or have had surgical bilateral oophorectomy (with or without hysterectomy) or tubal ligation at least six weeks prior to randomization. In the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment is she considered not of child-bearing potential.
  10. Male patients whose sexual partner(s) are WOCBP who are not willing to use adequate contraception, during the study and for 6 months after the end of treatment (Male patients must use highly effective (double barrier) methods of contraception (e.g., spermicidal gel plus condom) for the entire duration of the study, and continuing using contraception and refrain from fathering a child for 6 months following the study drug. A condom is required to be used also by vasectomized men as well as during intercourse with a male partner in order to prevent delivery of the study treatment via seminal fluid.).
  11. Patients with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
  12. History of allergic reactions attributed to compounds of similar chemical or biologic composition to LDE 225 or Everolimus in the study or other rapamycin analogs (e.g. sirolimus, temsirolimus).
  13. Patients who are receiving treatment with medications known to be moderate and strong inhibitors or inducers of CYP3A4/5 or drugs metabolized by CYP2B6 or CYP2C9 that have narrow therapeutic index, and that cannot be discontinued before starting treatment with LDE225. Medications that are strong CYP3A4/5 inhibitors should be discontinued at least 7 days and strong CYP3A/5 inducers for at least 2 weeks prior to starting treatment with LDE225.
  14. Patients receiving any medications or substances that are inhibitors or inducers of CYP 450 3A4 are ineligible.
  15. Patients who have neuromuscular disorders (e.g. inflammatory myopathies, muscular dystrophy, amyotrophic lateral sclerosis and spinal muscular atrophy) or are on concomitant treatment with drugs that are recognized to cause rhabdomyolysis, such as HMG CoA inhibitors (statins), clofibrate and gemfibrozil, and that cannot be discontinued at least 2 weeks prior to starting LDE225 treatment. Patients who are planning on embarking on a new strenuous exercise regimen after initiation of study treatment, should also be excluded. Muscular activities, such as strenuous exercise, that can result in significant increases in plasma CK levels should be avoided whilst on LDE225 treatment.
  16. Concurrent medical condition requiring the use of immunosuppressive medications or immunosuppressive doses of systemic or absorbable topical corticosteroids (doses greater than 10mg/day prednisone or equivalent). Inhaled or intranasal corticosteroids (with minimal systemic absorption) may be continued. Non-absorbed intra-articular steroid injections are allowed. The exception to the use of steroids is the treatment of serious adverse events (SAEs) such as pneumonitis and the prevention of emesis.
  17. Known history of HIV seropositivity.
  18. Patients who have received live attenuated vaccines within 1 week of start of Everolimus and during the study.
  19. Impaired cardiac function or clinically significant heart disease, including any one of the following: a) Angina pectoris within 3 months; b) Acute myocardial infarction within 3 months; c) QTcF greater than 450 msec for males and greater than 470 msec for females on the screening electrocardiogram (ECG); d) A past medical history of clinically significant ECG abnormalities or a family history of prolonged QT-interval syndrome; e) Other clinically significant heart disease (e.g. congestive heart failure, uncontrolled hypertension, history of labile hypertension, or history of poor compliance with an antihypertensive regimen).
  20. All patients known to be positive for hepatitis B will be excluded from the study, and those at high risk for hepatitis B infection will be screened.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02138929


Locations
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United States, Texas
University of Texas MD Anderson Cancer Center
Houston, Texas, United States, 77030
Sponsors and Collaborators
M.D. Anderson Cancer Center
Novartis
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Jaffer Ajani, MD M.D. Anderson Cancer Center

Additional Information:
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Responsible Party: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT02138929    
Other Study ID Numbers: 2013-0838
NCI-2014-01455 ( Registry Identifier: NCI CTRP )
First Posted: May 15, 2014    Key Record Dates
Last Update Posted: May 22, 2019
Last Verified: May 2019

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by M.D. Anderson Cancer Center:
Esophageal Cancer
Advanced adenocarcinoma of the esophagus
Advanced adenocarcinoma of the gastroesophageal junction
GEJ
Metastatic
Everolimus
Afinitor
Zortress
RAD001
LDE 225
Additional relevant MeSH terms:
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Adenocarcinoma
Esophageal Neoplasms
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Head and Neck Neoplasms
Digestive System Diseases
Esophageal Diseases
Gastrointestinal Diseases
Sirolimus
Everolimus
Antineoplastic Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Anti-Bacterial Agents
Anti-Infective Agents
Antibiotics, Antineoplastic
Antifungal Agents