Patient case: 32-year-old male with dilated cardiomyopathy; genetic feature: LMNA

Clinical trial: Phase I/II Trial of Everolimus in Combination With Lonafarnib in Progeria

Summary: This is a phase I/II dose-escalation trial of everolimus in combination with lonafarnib in Hutchinson-Gilford Progeria Syndrome (HGPS) and progeroid laminopathies (henceforth "progeria"). The study will be conducted at a single clinical site utilizing the Clinical and Translational Study Unit (CTSU) at Boston Children's Hospital. Lonafarnib will be administered at doses previously established in the pediatric population and in this population of progeria subjects. This study will first determine the dose-limiting toxicities (DLT) and the maximum tolerated dose (MTD) of everolimus when administered in combination with lonafarnib. It will then determine the efficacy of everolimus when administered at its MTD in combination with lonafarnib for disease in progeria.


Eligibility: Inclusion Criteria:
  -  Genetically-confirmed progeria.
  -  display clinical signs of progeria as per the clinical trial team.
  -  currently receiving lonafarnib under protocol 09-06-0298
  -  have not experienced a grade 3 or 4 toxicity within two months preceding enrollment
  -  willing and able to come to Boston for appropriate studies and examinations.
  -  no recent fractures or major surgery (within four weeks)
  -  Absolute poly count (Absolute neutrophil count + bands + monocytes) >1,000/uL
  -  platelets >75,000/uL (transfusion independent)
  -  hemoglobin >9 g/dL
  -  creatinine ≤ 1.5 times upper limit of normal (ULN) for age or Glomerular filtration rate (GFR) >70 mL/min/1.73m2
  -  bilirubin ≤ 1.5x upper limit of normal for age
  -  SGPT (ALT) < and SGOT (AST) ≤ 2.5x normal range for age
  -  serum albumin greater than or equal to 2 g/dL
  -  PT/PTT: INR <1.3 (or <3 on anticoagulants)
  -  Fasting LDL cholesterol within 1.5x ULN per institutional guidelines (ie, <195 mg/dL for 2 - 18 years of age, <240 mg/dL for subjects >18 years old)* and Fasting serum cholesterol <300 mg/dL (<7.75 mmol/L)* and Fasting triglycerides <2.5 ULN (<325 mg/dL for ages 2 - 18, <400 for ages >18)*
  *may be re-evaluated for eligibility after initiation of lipid-lowering therapy
  -  Signed informed consent according to institutional guidelines must be obtained and subject must begin therapy within twenty-eight (28) days.
  Exclusion Criteria:
  -  Other than the drugs used in this protocol, other drugs targeted to treat progeria are excluded. Drugs to treat symptoms of progeria are permitted.
  -  Subjects must not be taking medications that significantly affect the metabolism of lonafarnib
  -  Subjects receiving chronic, systemic treatment with corticosteroids or another immunosuppressive agent. Subjects with endocrine deficiencies are allowed to receive physiologic or stress doses of steroids if necessary. Topical or inhaled steroids are allowed.
  -  Subjects who have had a major surgery or significant traumatic injury within 4 weeks of start of study drug; have not recovered from the side effects of any major surgery (defined as requiring general anesthesia but excluding a procedure for insertion of central venous access); or who may require major surgery during the course of the study.
  -  13.2.5 Subjects with an active bleeding diathesis or on oral anti-vitamin K medication (except low dose coumadin).
  -  Subjects who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study such as:
  -  known severely impaired lung function
  -  active (acute or chronic) or uncontrolled severe infections.
  -  liver disease such as cirrhosis, chronic active hepatitis or chronic persistent hepatitis.
  -  History of hepatitis B or hepatitis C
  -  Other concurrent severe and/or uncontrolled medical disease that could compromise participation in the study (i.e., uncontrolled diabetes, uncontrolled hypertension, severe infection, severe malnutrition, chronic liver or renal disease, active upper GI tract ulceration).
  -  A known history of Human Immunodeficiency Virus (HIV) seropositivity or known immunodeficiency.
  -  Impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of everolimus (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome or small bowel resection). A nasogastric tube (NG tube) or gastric tube (G tube) is allowed.
  -  Subjects who have known or suspected hypersensitivity to any of the excipients included in the formulation should not be treated.
  -  Subjects must not be pregnant or breast-feeding. Female subjects of childbearing potential must have negative serum or urine pregnancy test. Sexually active male and female subjects of reproductive potential must agree to use a medically accepted form of birth control while on study and up to 10 weeks after treatment. It is permissible for female subjects to take oral contraceptives or other hormonal methods while receiving treatment with everolimus.

Relevance to patient case: not relevant