Unspecified Adult Solid Tumor, Protocol Specific Clinical Trial
Official title:
Two Phase I Studies in Patients With Brain Metastases From Any Primary Histology, Followed by a Randomized Phase 2 Study of RO4929097 Combined With CNS Radiotherapy in Patients With Brain Metastases From Breast Cancer Whose Tumors Are Estrogen Receptor Negative
This randomized phase I/II trial studies the side effects and the best dose of RO4929097 (gamma-secretase/Notch signalling pathway inhibitor RO4929097) when given together with whole-brain radiation therapy or stereotactic radiosurgery and to see how well it works compared to whole-brain radiation therapy or stereotactic radiosurgery alone in treating patients with breast cancer or other cancers (such as lung cancer or melanoma) that have spread to the brain. RO4929097 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Whole-brain radiation therapy uses high energy x-rays deliver radiation to the entire brain to treat tumors that can and cannot be seen. Stereotactic radiosurgery may be able to deliver x-rays directly to the tumor and cause less damage to normal tissue. It is not yet known whether giving RO4929097 together with whole-brain radiation therapy or stereotactic radiosurgery may kill more tumor cells.
PRIMARY OBJECTIVES:
I. Determine the maximum-tolerated dose (MTD) and phase II dose of RO4929097 when combined
with whole-brain radiation therapy (WBRT). (Phase I) II. Determine the safety profile of
RO4929097 when combined with WBRT. (Phase I) III. Determine the MTD and phase II dose of
RO4929097 when combined with stereotactic radiosurgery (SRS). (Phase I) IV. Determine the
safety profile of RO4929097 when combined with SRS. (Phase I) V. Determine whether the
addition of RO4929097 to WBRT or SRS significantly increases the percentages of estrogen
receptor-negative breast cancer patients with brain metastases who achieve response (complete
response [CR] + partial response [PR]) in the brain at the 12-week (3-month) time point after
cranial radiotherapy. (Phase II)
SECONDARY OBJECTIVES:
I. Correlate responses and time to progression to: pre- and post-therapy tumor and archived
tumor tissue expression of molecular and stem cell markers; pre- and post-therapy plasma
biomarkers; changes in pre- and post-therapy tumor and archived tumor tissue expression of
molecular and stem cell markers over the first 5 days of therapy and changes of pre- and
post-therapy plasma biomarkers over the course of therapy; in Notch positive and Notch
negative tumors, over the first 5 days of therapy with RO4929097, compare tumor tissue
expression of molecular and stem cell markers. (Phase I and II) II. Determine progression
free survival (PFS) in the brain for each treatment arm. (Phase II) III. Determine the
percentage of patients alive and disease free (in the brain) at 6 months. (Phase II) IV.
Determine local control rate (in the brain) at 24- and 48-week time point after cranial
radiotherapy for each treatment arm. (Phase II) V. Determine distant failure rate (in the
brain) at 24- and 48-week time point after cranial radiotherapy for each treatment arm.
(Phase II) VI. Determine PFS in the body for each treatment arm. (Phase II) VII. Determine
systemic response rate. (Phase II) VIII. Determine percentage of patients alive and without
progression systemically at 6 months. (Phase II) IX. Further describe the safety profile of
each treatment arm. (Phase II) X. Compare neurocognitive outcomes in each treatment arm.
(Phase II)
OUTLINE: This is a phase I, dose-escalation study of gamma-secretase/Notch signalling pathway
inhibitor RO4929097 followed by a randomized phase II study.
PHASE I: Patients with >= 4 brain lesions receive RO4929097 orally (PO) once daily (QD) on
days 1-3 weekly beginning 1 day prior to the first day of WBRT and continuing for 6 weeks (42
days) after the completion of radiation therapy. Patients with >= 4 brain lesions also
undergo whole-brain radiotherapy (WBRT) once daily, 5 days a week, for 2-4 weeks beginning on
day 2. Patients with =< 3 brain lesions receive RO4929097 PO QD on days 1-7 in weeks 1 and 2
and then days 1-3 in all subsequent weeks beginning 2 days prior to the first day of SRS and
continuing for 6 weeks (42 days) after the completion of radiation therapy. Patients with =<
3 brain lesions also undergo stereotactic radiosurgery (SRS) on day 4. Treatment continues in
the absence of disease progression or unacceptable toxicity.
PHASE II: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients with >= 4 brain lesions undergo WBRT as in phase I and patients with =< 3
brain lesions undergo SRS as in phase I.
ARM II: Patients with >= 4 brain lesions receive RO4929097 and undergo WBRT as in phase I and
patients with =< 3 brain lesions receive RO4929097 and undergo SRS as in phase I.
After completion of study treatment, patients are followed up every 12 weeks for up to 52
weeks.
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