Patient case: 64-year-old male with bladder cancer; genetic feature: FGFR3 (S249C)

Clinical trial: Thalidomide and Docetaxel in Treating Patients With Advanced Cancer

Summary: RATIONALE: Thalidomide may stop the growth of cancer by stopping blood flow to the tumor. Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Combining thalidomide with docetaxel may kill more tumor cells.
  PURPOSE: Phase I trial to study the effectiveness of combining thalidomide with docetaxel in treating patients who have advanced cancer.

Detailed description: OBJECTIVES:
  -  Determine the maximum tolerated dose of docetaxel when administered with thalidomide in patients with advanced solid tumors, multiple myeloma, and non-Hodgkin's lymphoma.
  -  Determine the dose-limiting toxicity and safety profile of this regimen in these patients.
  -  Determine the plasma pharmacokinetics of this regimen in these patients.
  -  Determine the objective tumor response and prolonged freedom from progression in patients treated with this regimen.
  OUTLINE: This is a dose-escalation study.
  Patients receive oral thalidomide twice daily and docetaxel IV over 30 minutes once weekly. Courses repeat every 12 weeks in the absence of disease progression or unacceptable toxicity.
  Cohorts of 3-6 patients receive escalating doses of docetaxel and thalidomide until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 1 of 3 or 2 of 6 patients experience dose-limiting toxicity.
  PROJECTED ACCRUAL: A total of 3-30 patients will be accrued for this study.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed malignancy not amenable to curative surgery, radiotherapy, or chemotherapy
  -  Tumor types may include any of the following:
  -  Any solid tumor including, but not limited to, head and neck, breast, lung, gastrointestinal, genitourinary, melanoma, and sarcoma
  -  Primary CNS neoplasms if the following are true:
  -  Received primary radiotherapy
  -  No concurrent corticosteroids or has been on a stable corticosteroid dose for at least 30 days
  -  No concurrent enzyme-inducible anti-epileptic medications (i.e., carbamazepine or phenytoin)
  -  Multiple myeloma
  -  Non-Hodgkin's lymphoma
  -  No refractory or relapsed acute or chronic leukemia
  -  Measurable or evaluable disease
  -  No life-prolonging therapy available
  -  Hormone receptor status:
  -  Not specified
  PATIENT CHARACTERISTICS:
  Age
  -  18 and over
  Sex
  -  Male or female
  Menopausal status
  -  Not specified
  Performance status
  -  ECOG 0-1
  Life expectancy
  -  At least 4 months
  Hematopoietic
  -  WBC at least 4,000/mm^3
  -  Absolute neutrophil count at least 1,500/mm^3
  -  Platelet count at least 100,000/mm^3
  -  Hemoglobin at least 10 g/dL
  Hepatic
  -  Bilirubin no greater than upper limit of normal (ULN)
  -  AST and/or ALT no greater than 2.5 times ULN if alkaline phosphatase less than ULN OR
  -  Alkaline phosphatase no greater than 4 times ULN if AST/ALT less than ULN
  Renal
  -  Creatinine no greater than 1.5 mg/dL OR
  -  Creatinine clearance at least 60 mL/min
  Cardiovascular
  -  No New York Heart Association class III or IV heart disease
  Other
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use 2 effective methods of contraception 4 weeks before, during, and 4 weeks after study
  -  Willing and able to comply with FDA-mandated STEPS program
  -  No peripheral neuropathy grade 2 or greater
  -  No prior severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80
  PRIOR CONCURRENT THERAPY:
  Biologic therapy
  -  Not specified
  Chemotherapy
  -  At least 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered
  -  No more than 2 prior courses of mitomycin
  Endocrine therapy
  -  See Disease Characteristics
  Radiotherapy
  -  At least 4 weeks since prior large-field radiotherapy and recovered
  Surgery
  -  Not specified
  Other
  -  At least 3 weeks since other prior anticancer therapy and recovered

Relevance to patient case: not relevant