Patient case: 58-year-old female with adenoid cystic carcinoma; genetic feature: KIT

Clinical trial: Imatinib Mesylate in Treating Patients With Salivary Gland Cancer

Summary: RATIONALE: Imatinib mesylate may stop the growth of tumor cells by blocking the enzymes necessary for tumor cell growth.
  PURPOSE: Phase II trial to study the effectiveness of imatinib mesylate in treating patients who have unresectable and/or metastatic salivary gland cancer.

Detailed description: OBJECTIVES:
  -  Determine the antitumor activity of imatinib mesylate, in terms of objective response rates (partial and complete responses) and duration of overall response, in patients with unresectable and/or metastatic adenoid cystic, lymphoepithelioma-like, or myoepithelial salivary gland cancer.
  -  Determine the safety and tolerability of this drug in these patients.
  -  Correlate the activity of c-kit and downstream kinases in pre- and post-treatment tumoral biopsies with clinical course in patients treated with this drug.
  -  Determine the effect of treatment with this drug on tumor samples from these patients in terms of proliferation, apoptosis, and angiogenesis.
  -  Correlate the steady state levels of this drug achieved with clinical and laboratory correlative endpoints in these patients.
  -  Determine whether early changes in metabolic activity correlate with molecular changes and predict outcome to therapy in these patients.
  OUTLINE: This is a multicenter study.
  Patients receive oral imatinib mesylate twice daily. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients with stable disease receive treatment for up to 6 months.
  Patients are followed within 3 weeks and then every 3 months thereafter.
  PROJECTED ACCRUAL: A total of 12-37 patients will be accrued for this study within 6-19 months.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically or cytologically confirmed adenoid cystic, lymphoepithelioma-like, or myoepithelial salivary gland cancer
  -  Unresectable AND/OR
  -  Radiologically documented metastatic disease
  -  c-kit positive tumor (1+, 2+, or 3+)
  -  At least 1 unidimensionally measurable lesion
  -  More than 20 mm by conventional techniques OR
  -  More than 10 mm by spiral CT scan
  -  No known brain metastases
  PATIENT CHARACTERISTICS:
  Age
  -  18 and over
  Performance status
  -  ECOG 0-2
  Life expectancy
  -  More than 12 weeks
  Hematopoietic
  -  Absolute neutrophil count greater than 1,500/mm3
  -  Platelet count greater than 100,000/mm3
  Hepatic
  -  Bilirubin less than 1.25 times upper limit of normal (ULN)
  -  AST/ALT less than 2.5 times ULN
  Renal
  -  Creatinine less than 1.25 times ULN OR
  -  Creatinine clearance greater than 50 mL/min
  Cardiovascular
  -  No myocardial infarction within the past 6 months
  -  No congestive heart failure
  -  No unstable angina
  -  No active cardiomyopathy
  -  No unstable ventricular arrhythmias
  -  No uncontrolled hypertension
  Other
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective barrier contraception during and for 3 months after study
  -  No other active malignancy within the past 5 years except adequately treated carcinoma in situ of the cervix or non-melanomatous skin cancer
  -  No uncontrolled psychotic disorders
  -  No serious infections
  -  No active peptic ulcer disease
  -  No other serious medical condition that would preclude study
  -  No prior allergy to compounds of similar chemical or biologic composition as imatinib mesylate
  PRIOR CONCURRENT THERAPY:
  Biologic therapy
  -  No concurrent filgrastim (G-CSF)
  Chemotherapy
  -  At least 4 weeks since prior chemotherapy and recovered
  -  No concurrent chemotherapy
  Endocrine therapy
  -  Not specified
  Radiotherapy
  -  At least 4 weeks since prior radiotherapy and recovered
  -  No concurrent radiotherapy to sites of measurable disease
  Surgery
  -  At least 4 weeks since prior surgery and recovered
  Other
  -  No other concurrent investigational agents
  -  No concurrent therapeutic warfarin
  -  Mini-dose warfarin for prophylaxis or low-molecular weight heparin allowed
  -  No concurrent erythromycin
  -  No concurrent acetaminophen doses exceeding 3 g/day

Relevance to patient case: definitely relevant