Gamma-Secretase Inhibitor RO4929097 and Gemcitabine Hydrochloride in Treating Patients With Advanced Solid Tumors

Inclusion Criteria:

• Meets one of the following sets of criteria:

  • Histologically and/or cytologically confirmed solid malignancy

    • Metastatic or unresectable disease
    • Disease for which standard curative or palliative measures do not exist or are no longer effective

  • Histologically and/or cytologically confirmed adenocarcinoma of the pancreas (for patients in the expansion cohort)

    • Locally advanced or metastatic disease
    • No prior chemotherapy for advanced disease
• Measurable disease, defined as ≥ 1 lesion that can be accurately measured in ≥ 1 dimension (longest diameter to be recorded) as ≥ 20 mm with conventional techniques or as ≥ 10 mm with spiral CT scan
• No known brain metastases
• ECOG performance status (PS) 0-1 (Karnofsky PS 60-100%)
• Life expectancy > 12 weeks
• Hemoglobin ≥ 90 g/L (or ≥ 9 g/dL)
• Leukocytes ≥ 3,000/mm^3
• ANC ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3
• Total bilirubin ≤ 1.25 times upper limit of normal (ULN)
• AST/ALT ≤ 1.5 times ULN
• Serum creatinine =< ULN OR creatinine clearance ≥ 60 mL/min
• No uncontrolled hypocalcemia, hypomagnesemia, hyponatremia, hypophosphatemia, or hypokalemia, defined as less than the lower limit of normal despite adequate electrolyte supplementation
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use two forms of adequate contraception (i.e., barrier contraception and one other method of contraception) for ≥ 4 weeks before, during, and for ≥ 12 months after completion of study treatment
• Able to swallow medication
• No malabsorption syndrome or other condition that would interfere with intestinal absorption

• No uncontrolled concurrent illness including, but not limited to, any of the following:

  • Ongoing or active infection
  • Symptomatic congestive heart failure
  • Unstable angina pectoris
  • Cardiac arrhythmia other than chronic, stable atrial fibrillation
  • Psychiatric illness or social situations that would limit compliance with study requirements
• No baseline QTc > 450 msec (for male patients) or > 470 msec (for female patients)

• No history of risk factors for QT interval prolongation including, but not limited to, a family or personal history of any of the following:

  • Long QT syndrome
  • Recurrent syncope without known etiology
  • Sudden unexpected death
• No history of torsade de pointes or other significant cardiac arrhythmias or the need for concomitant meds with known potential to prolong QT interval or antiarrhythmics
• No diarrhea ≥ grade 2 not under control with standard anti-diarrhea medications
• No serologic positivity for hepatitis A, B, or C
• No history of liver disease or other forms of hepatitis or cirrhosis
• No history of allergic reactions attributed to compounds of similar chemical or biologic composition to gamma-secretase inhibitor RO4929097 or to gemcitabine hydrochloride
• Female patients may not donate ova during or after completion of study treatment
• Male patients may not donate sperm during and for ≥ 12 months after completion of study treatment
• Patients may not donate blood during and for ≥ 12 months after completion of study treatment
• No other concurrent investigational or commercial agents or therapies administered with the intent to treat the patient's malignancy
• Any number of prior therapies allowed
• No prior therapy with a Notch inhibitor

• At least 4 weeks since prior radiotherapy, chemotherapy, or systemic therapy (6 weeks if the last regimen included nitrosourea or mitomycin C) and recovered

  • Exceptions may be made for low-dose, non-myelosuppressive radiotherapy for symptomatic palliation

• Patients in the expansion cohort must meet the following criteria:

  • No prior chemotherapy for advanced disease except for fluorouracil (with or without folinic acid) or gemcitabine hydrochloride given concurrently with radiotherapy as a "radiosensitizer"
  • At least 6 months since prior adjuvant gemcitabine hydrochloride
  • Prior radiotherapy for the management of local disease allowed provided > 4 weeks have elapsed since the last radiation treatment and all toxicities have resolved
  • Patients who have had radiotherapy to their sole site of disease are eligible provided they have documented progression of that lesion before study registration
• Recovered from side effects of previous systemic anticancer therapy to ≤ CTCAE grade 2
• No concurrent combination antiretroviral therapy for HIV-positive patients
• No concurrent medications with narrow therapeutic indices that are metabolized by cytochrome P450 (CYP450), including warfarin sodium (Coumadin®)
• No concurrent medications with known potential to prolong QT interval
• No concurrent medications that are strong inducers/inhibitors or substrates of CYP3A4
• No concurrent medications or food that may interfere with the metabolism of gamma-secretase inhibitor RO4929097, including ketoconazole and grapefruit or grapefruit juice
• No other concurrent investigational agents