Patient case: 73-year-old female with Pancreatic ductal adenocarcinoma. Genetic variant: ERBB3. Other conditions: Whipple, FNA.

Clinical trial: A Phase 2 Exploratory Study of Erlotinib and SNDX-275 in Patients With Non-small Cell Lung Carcinoma Who Are Progressing on Erlotinib

Summary: Preclinical studies have shown that SNDX-275 is able to reactivate the expression of EGFR, E-cadherin and ErbB3 expression. The combination of SNDX-275 with erlotinib (an EGFRi) in patients who are progressing on erlotinib will show measurable activity as evidenced by the disease control rate and with an acceptable safety profile.


Eligibility: INCLUSION:
  1. Cytologically or histologically confirmed NSCLC of stage IIIb (pleural effusion) or IV
  2. Disease is progressing (either no response to treatment or subsequent relapse after an objective response) on erlotinib treatment, based on at least 2 scans (the last being within 4 weeks of study enrollment and can serve as the baseline scan for the patient's screening into the study )
  3. Recovered from any toxicity associated with the most recent cancer treatment (no greater than grade 1 toxicity on CTCAE scale or to prior baseline condition)
  4. At least 1 measurable lesion ≥ 20mm by conventional CT scan or ≥ 10mm by spiral CT scan
  5. ECOG performance score of 0, 1, or 2 and life expectancy of at least 3 months
  6. Paraffin-embedded tumor specimen available for correlative studies
  7. Male or female over 18 years of age
  8. Hemoglobin ≥ 9.0 g/dL; platelets ≥ 75 x 10⁹/L; ANC ≥ 1.0 x 10⁹/L without the use of hematopoietic growth factors
  9. Coagulation tests within the normal range
  10. Bilirubin and creatinine less than 2 times the upper limit of normal for the institution
  11. AST and ALT less than 3 times the upper limit of normal for the institution
  12. Potassium, magnesium and phosphorus within the normal range for the institution (supplementation is permissible)
  13. Willing to use accepted and effective methods of contraception during the study (both men and women as appropriate) and for 3 months after the last dose of SNDX-275
  14. Patient or legally acceptable representative has granted written informed consent before any study-specific procedure (including special screening tests) is performed
  EXCLUSION:
  1. Prior stem cell transplant
  2. Symptomatic CNS involvement
  3. Prior treatment with an HDAC inhibitor
  4. Concurrent anticancer therapy, with the exception of radiotherapy for a non-target study lesion
  5. Currently taking medication(s) on the prohibited medication list
  6. Systemic chemotherapy or treatment with an investigational agent within 28 days before enrollment
  7. Current use of valproic acid
  8. Untreated or unstable brain metastases, or taken steroids for this condition within 4 weeks of study drug administration
  9. Currently active second malignancy, or any malignancy within the last 5 years other than cured basal or squamous cell skin carcinoma, cervical carcinoma in situ, or superficial bladder cancer
  10. Inability to swallow oral medications or a gastrointestinal malabsorption condition
  11. Uncontrolled infection requiring IV antibiotics, antivirals, or antifungals, known HIV infection, or active hepatitis B or C infection
  12. Abnormal cardiac function as defined as clinically significant findings on ECG (multifocal PVCs, ST-T wave changes consistent with myocardial infarction or acute ischemia, QTc greater than 500 milliseconds), tachycardia, or left ventricular ejection fraction less than 40% on MUGA scan
  13. Another serious or uncontrolled medical condition within 3 months of enrollment such as hypertension, diabetes mellitus, or suppressed immune system
  14. Known hypersensitivity to benzamides
  15. Morbid obesity
  16. Women who are currently pregnant or breast-feeding
  17. Patient is currently enrolled in (or completed within 28 days) another investigational drug study
  18. Patient unavailable for on-study or follow-up assessments
  19. Patient has any kind of medical, psychiatric, or behavioral disorder that places the patient at increased risk for study participation or compromises the ability of the patient to give written informed consent and/or to comply with study procedures and requirements

Relevance to patient case: not relevant