LDE225 + Everolimus in Advanced Gastroesophageal Adenocarcinoma

NCT02138929 | Completed Phase 1 FDA Drug

• 2 other identifiers: 2013-0838NCI-2014-01455
• Study Type: interventional
• Target: 25
• Locations: 1 country
• Sites: 1

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.

Conditions

Esophageal Cancer

Keywords

Esophageal Cancer; Advanced adenocarcinoma of the esophagus; Advanced adenocarcinoma of the gastroesophageal junction; GEJ; Metastatic; Everolimus; Afinitor; Zortress; RAD001; LDE 225

Outcome Measures

Primary Outcomes (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

  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).

  10 weeks

Secondary Outcomes (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.

  30 days after last dose of study drug given.

Study Arms (1)

Everolimus + LDE 225

EXPERIMENTAL

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; Drug: LDE 225

Interventions

Everolimus DRUG

Induction and Dose Expansion Phase: 10 mg by mouth daily in a 28 day cycle.

Also known as: Afinitor, Zortress, RAD001

Everolimus + LDE 225

LDE 225 DRUG

Induction Phase Starting Dose: 400 mg by mouth daily in a 28 day cycle. Expansion Phase Starting Dose: Maximum tolerated dose from Induction Phase.

Everolimus + LDE 225

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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.
• Patients must have an unresectable locally advanced or metastatic adenocarcinoma.
• 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.)
• Patient must have received at least one, and no more than two prior systemic therapies for metastatic cancer.
• 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.
• 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.
• Male or female patients greater than or equal to 18 years old.
• ECOG performance status less than 2.
• 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.
• Patient should be able to swallow and retain oral medications.
• 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.
• Ability to understand and the willingness to sign a written informed consent document. Signed informed consent will be obtained prior to any screening procedures.

You may not qualify if:

• 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.).
• 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.
• 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.
• 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.
• 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.
• Pregnant or nursing (lactating) women.
• 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.);
• (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). \[For female study patients, the vasectomized male partner should be the sole partner for that patient.\]).
• (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.
• 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.).
• 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.
• 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).
• 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.
• Patients receiving any medications or substances that are inhibitors or inducers of CYP 450 3A4 are ineligible.
• 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.

Sponsors & Collaborators

• M.D. Anderson Cancer Center: lead
• Novartis: collaborator
• National Cancer Institute (NCI): collaborator

Study Sites (1)

University of Texas MD Anderson Cancer Center

Houston, Texas, 77030, United States

Location

Related Links

• University of Texas MD Anderson Cancer Center Website

MeSH Terms

Conditions

Esophageal Neoplasms; Neoplasm Metastasis

Interventions

Everolimus

Condition Hierarchy (Ancestors)

Gastrointestinal Neoplasms; Digestive System Neoplasms; Neoplasms by Site; Neoplasms; Head and Neck Neoplasms; Digestive System Diseases; Esophageal Diseases; Gastrointestinal Diseases; Neoplastic Processes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Sirolimus; Macrolides; Lactones; Organic Chemicals

Study Officials

• Jaffer Ajani, MD

  M.D. Anderson Cancer Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 13, 2014
• First Posted: May 15, 2014
• Study Start: November 10, 2014
• Primary Completion: June 8, 2020
• Study Completion: June 8, 2020
• Last Updated: June 11, 2020

Record last verified: 2020-06

Locations

US (1)