Patient case: 4-year-old female with leukemia; genetic feature: ABL1

Clinical trial: Imatinib Mesylate in Treating Patients With Advanced Cancer and Liver Dysfunction

Summary: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Phase I trial to study the effectiveness of imatinib mesylate in treating patients who have advanced cancer and liver dysfunction

Detailed description: PRIMARY OBJECTIVES:
  I. Determine the maximum tolerated dose and dose-limiting toxicity of imatinib mesylate in patients with advanced malignancies and varying degrees of liver dysfunction.
  II. Determine the effects of hepatic dysfunction on the pharmacodynamics and pharmacokinetics of this drug in these patients.
  III. Determine the non-dose-limiting toxic effects of this drug in these patients.
  IV. Determine the response rate of these patients treated with this drug. V. Correlate the Childs-Pugh classification of hepatic dysfunction with observed toxic effects, pharmacodynamics, and pharmacokinetics of this drug in these patients.
  OUTLINE: This is a dose-escalation, multicenter study. Patients are stratified according to liver dysfunction (normal vs mild vs moderate vs severe).
  Patients receive oral imatinib mesylate daily. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients within each stratum (except normal stratum) receive escalating doses of imatinib mesylate 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.
  PROJECTED ACCRUAL: A total of 60 patients will be accrued for this study within 1 year.

Eligibility: Inclusion Criteria:
  -  Histologically or cytologically confirmed surgically incurable solid tumor orhematologic malignancy for which no standard or palliative therapy exists oris no longer effective
  -  All tumor types are eligible, including:
  -  Chronic myelogenous leukemia or other Philadelphia chromosome-positive leukemia OR
  -  Gastrointestinal stromal tumors
  -  Patients with gliomas that require corticosteroids or anticonvulsants must beon a stable dose and seizure-free for 1 month
  -  No unstable or untreated (non-irradiated) brain metastases
  -  Performance status - ECOG 0-2
  -  Performance status - Karnofsky 60-100%
  -  More than 3 months
  -  WBC at least 3,000/mm^3
  -  Absolute neutrophil count at least 1,500/mm^3
  -  Platelet count at least 100,000/mm^3
  -  No active hemolysis
  -  See Surgery
  -  No evidence of biliary sepsis
  -  Creatinine normal
  -  Creatinine clearance at least 60 mL/min
  -  No symptomatic congestive heart failure
  -  No unstable angina pectoris
  -  No cardiac arrhythmia
  -  Able to swallow pills
  -  No other uncontrolled concurrent illness that would preclude study participation
  -  No ongoing or active infection
  -  No uncontrolled diarrhea
  -  No psychiatric illness or social situation that would preclude study compliance
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective barrier contraception during and for 6 months after study completion
  -  At least 24 hours since prior colony-stimulating factors
  -  No concurrent colony-stimulating factors
  -  At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered
  -  See Disease Characteristics
  -  See Disease Characteristics
  -  At least 4 weeks since prior radiotherapy and recovered
  -  See Disease Characteristics
  -  At least 10 days since prior placement of shunt for treatment of biliary obstruction
  -  At least 14 days since prior major surgery
  -  No prior solid organ transplantation
  -  No other concurrent investigational agents
  -  No concurrent therapeutic doses of warfarin for anticoagulation
  -  No other concurrent investigational or commercial agents or therapies for treatment of this disease
  -  No concurrent combination antiretroviral therapy for HIV-positive patients
  -  No concurrent acetaminophen of more than 4,000 mg/day

Relevance to patient case: not relevant