Patient case: 50-year-old female with Lung cancer. Genetic variant: EGFR (L858R). Other conditions: Lupus.

Clinical trial: CCI-779 and EKB-569 in Treating Patients With Advanced Solid Tumors

Summary: This phase I trial is studying the side effects, best way to give, and best dose of CCI-779 and EKB-569 in treating patients with advanced solid tumors. Drugs used in chemotherapy, such as CCI-779, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. EKB-569 may stop the growth of tumor cells by blocking some of the enzymes needed for their growth. Giving CCI-779 together with EKB-569 may kill more tumor cells.

Detailed description: OBJECTIVES:
  I. Determine the maximum tolerated dose of the combination of CCI-779 and EKB-569 in patients with advanced solid tumors.
  II. Determine the toxicity of this regimen in these patients. III. Determine the response rate in patients treated with this regimen.
  OUTLINE: This is a dose-escalation study. Patients are assigned to 1 of 3 treatment groups.
  Group I: Patients receive oral EKB-569 on days 1-28 and oral CCI-779 on days 1-7 and 15-21.
  Cohorts of 3-6 patients receive escalating doses of EKB-569 and CCI-779 until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
  Group II: Patients receive oral EKB-569 at the MTD on days 4-28 of course 1 and days 1-28 of all subsequent courses and CCI-779 at the MTD on days 1-3 and 15-17.
  Group III: Patients receive EKB-569 at the MTD as in group I and oral CCI-779 at the MTD on days 7-9 and 19-21 of course 1 and days 1-3 and 15-17 of all subsequent courses.
  In all groups, courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  PROJECTED ACCRUAL: A total of 30-42 patients (18-30 for group I, 6 for group II, and 6 for group III) will be accrued for this study within 1.35-1.75 years.

Eligibility: Inclusion Criteria:
  -  Histologically confirmed unresectable solid tumor for which there is no known standard therapy that is potentially curative or capable of extending life expectancy
  -  No CNS metastases
  -  Performance status - ECOG 0-2
  -  At least 12 weeks
  -  Absolute neutrophil count ≥ 1,500/mm^3
  -  Platelet count ≥ 100,000/mm^3
  -  Hemoglobin ≥ 10 g/dL
  -  Bilirubin normal
  -  AST ≤ 3 times upper limit of normal (ULN) (5 times ULN if liver involvement)
  -  Creatinine ≤ 1.5 times ULN
  -  No New York Heart Association class III or IV heart disease
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective contraception during and for 3 months after study participation
  -  Fasting cholesterol < 350 mg/dL
  -  Fasting triglycerides < 400 mg/dL
  -  No uncontrolled infection
  -  No seizure disorder
  -  More than 4 weeks since prior immunotherapy
  -  More than 4 weeks since prior biologic therapy
  -  No concurrent immunotherapy
  -  No concurrent prophylactic colony-stimulating factor therapy
  -  More than 4 weeks since prior chemotherapy (6 weeks for mitomycin or nitrosoureas) and recovered
  -  No other concurrent chemotherapy
  -  No concurrent oral contraceptives
  -  More than 4 weeks since prior radiotherapy
  -  No prior radiotherapy to > 30% of bone marrow
  -  No concurrent radiotherapy
  -  More than 7 days since prior CYP3A4 inducers
  -  No prior mTOR-targeting agents
  -  No prior epidermal growth factor receptor-targeting agents
  -  No concurrent antiretroviral therapy that induces or inhibits CYP3A4 for HIV-positive patients
  -  No other concurrent investigational agents
  -  No concurrent warfarin

Relevance to patient case: not relevant