Patient case: 68-year-old male with melanoma; genetic feature: PTEN loss of function

Clinical trial: Temsirolimus/AZD 6244 for Treatment-naive With BRAF Mutant Unresectable Stage IV

Summary: The purpose of this study is to find out how often two investigational drugs that are given together will shrink the patient's tumor and how well they will prolong the time it takes their tumor to grow. The investigators also wish to find out how they affect certain substances in the patient's tumor and in their blood important for tumor growth. The combination of these drugs is experimental, and has not been proven to help treat melanoma

Detailed description: PRIMARY OBJECTIVES:
  I. To determine the clinical response rate (Response Evaluation Criteria in Solid Tumors [RECIST]) and one-year overall survival to the study drugs temsirolimus and AZD6244 (selumetinib) hydrogen sulfate in BRAF V600E mutant unresectable stage IV melanoma.
  SECONDARY OBJECTIVES:
  I. Estimate 6-month progression-free survival in patients receiving temsirolimus and AZD6244 hydrogen sulfate.
  II. Determine the pharmacodynamic effects of temsirolimus and AZD6244 on pERK, s6K, PTEN and mediators of apoptosis.
  III. Determine the toxicity profile of temsirolimus with AZD6244 hydrogen sulfate.
  OUTLINE:
  Treatment Phase: This period begins with the first intravenous (through the vein) infusion of TEMSIROLIMUS and the first AZD6244 administration by mouth (visit 2, Week 1) and will continue until Week 8 (Visit 4).
  As many as 38 patients will receive the same dosage of TEMSIROLIMUS injected in the veins once a week for 8 weeks, and the AZD6244 will be given as capsules by mouth twice a day for 8 weeks. That is one cycle. The TEMSIROLIMUS and AZD6244 will be given to participants as an outpatient, unless admission to the hospital was needed for treatment of related side effects or underlying disease. The subsequent cycles of TEMSIROLIMUS and AZD6244 will be given every 8 weeks. The TEMSIROLIMUS will be injected in a vein over 30 minutes.
  The continuation phase begins with visits at weeks 12 in patients who receive at least two cycles of treatments.

Eligibility: Inclusion Criteria:
  -  Subject must have read, understood, and provided written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization after the nature of the study has been fully explained
  -  Subjects with a histologic diagnosis of unresectable stage IV melanoma (may include mucosal melanoma)
  -  Tumor must be BRAF V600E mutation positive from a certified lab
  -  At least 4 weeks since any previous treatment (surgery, radiotherapy, or systemic treatment)
  -  Women should be either: post-menopausal for at least 1 year; surgically incapable of bearing children; or utilizing a reliable form of contraception during the study and for at least 4 months after the final study drug infusion or ingestion; women of childbearing potential must have a negative serum hCG-beta pregnancy test conducted during the screening period
  -  Men who may father a child must agree to the use of male contraception for the duration of their participation in the trial and for at least 4 months after the final temsirolimus and AZD6244 hydrogen sulfate administration
  -  Life expectancy >= 3 months
  -  ECOG performance status of 0 or 1
  -  Patients with brain metastases treated with surgery, radiation, or stereotactic radiosurgery who are without evidence of progression in their brain metastases after MRI imaging performed at least 30 days after treatment, and are not taking systemic steroids will be eligible
  -  WBC >= 3000 cells/mm^3
  -  ANC >= 1500 cells/mm^3
  -  Platelets >= 100,000/mm^3
  -  Hematocrit >= 30%
  -  Hemoglobin >= 9 g/dL
  -  Creatinine =< 2.0 mg/dL
  -  AST/ALT =< 2 x ULN
  -  Bilirubin =< 1.5 x ULN, (except subjects with Gilbert's Syndrome who must have a total bilirubin less than 3.0 mg/dL)
  -  HIV negative
  -  HBsAg negative
  -  Anti-HCV Ab nonreactive; if reactive, subject must have a negative HCV RNA qualitative PCR
  -  Patients with hyperlipidemia must have adequate control with a lipid lowering agent
  Exclusion Criteria:
  -  Any prior malignancy except for the following: adequately treated basal or squamous cell skin cancer, superficial bladder cancer, carcinoma in situ of the cervix, or any other cancer from which the subject has been disease-free for at least 5 years
  -  Active infection, requiring therapy, chronic active HBV or HCV; patients with HIV, who have adequate CD4 counts and who do not require HAART therapy, are NOT excluded
  -  Pregnancy or nursing: due to the possibility that temsirolimus and AZD6244 hydrogen sulfate could have a detrimental effect on the developing fetus or infant, exposure in utero or via breast milk will not be allowed
  -  Any underlying medical condition which, in the opinion of the principal investigator, will make the administration of study drug hazardous or obscure the interpretation of adverse events
  -  Prior treatment with temsirolimus or AZD6244 or any prior mTOR or MEK inhibitor
  -  Evidence or history of significant cardiac, pulmonary, hepatic, renal, psychiatric or gastrointestinal disease that would make the administration of temsirolimus or AZD6244 hydrogen sulfate unsafe
  -  Tumor that is BRAF V600E mutation negative

Relevance to patient case: possibly relevant