Patient case: 32-year-old female with inflammatory myofibroblastic tumor; genetic feature: RANBP2-ALK fusion

Clinical trial: A Study of AUY922 in Non-small-cell Lung Cancer Patients Who Have Received Previous Two Lines of Chemotherapy.

Summary: This study will assess the efficacy of AUY922, when administered weekly at 70 mg/m2, in adult patients with advanced Non-small-cell Lung Cancer (NSCLC), who have received at least two prior lines of chemotherapy. Patients will be retrospectively, and prospectively, stratified based on their molecular tumor etiology. The following strata was assigned: Patients with Epidermal growth factor receptor (EGFR) activating mutations, Patients with Kirstin Raus sarcoma virus (KRAS) activating mutations, Patients with EML4-ALK (anaplastic lymphoma kinase) translocations and patients that were both EGFR and Kras wild type.


Eligibility: Inclusion Criteria:
  -  Patients with histologically or cytologically confirmed advanced (stage IIIB or stage IV) NSCLC who have received at least two prior lines of treatment. Patients who, in the investigators opinion, are deemed unsuitable for the standard 2nd line chemotherapy will be eligible for protocol participation. One of the prior lines must have included a platinum agent. Prior treatment with a platinum agent is not a requirement for EGFR mutant patients and patients with EML4-ALK translocations
  -  Patients enrolled to the fifth stratum, modified EGFR mutant, must have documented prior response to EGFR TKI as defined by CR, PR or SD for 6 months or greater unless patient has de novo resistance to EGFR TKI (e.g. exon 20 insertions.)
  -  All patients must have at least one measurable lesion as defined by RECIST criteria. Previously irradiated lesions are not measurable unless the lesion is new or has demonstrated clear progression after radiation
  -  World Health Organization (WHO) performance status ≤ 2. For patients enrolled to the fifth stratum, modified EGFR mutant, World Health Organization (WHO) performance status ≤ 1
  -  Patients enrolled to the fifth stratum, modified EGFR mutant, must be willing and suitable to undergo fresh baseline biopsy prior to study treatment (unless patient had recent biopsy after EGFR TKI progression that concluded resistance to EGFR TKI.)
  -  Hematologic:
  -  Absolute Neutrophil Count (ANC) ≥ 1.5 x 109/L.
  -  Hemoglobin (Hgb) ≥ 9 g/dl.
  -  Platelets (plt) ≥ 100 x 109/L.
  Biochemistry:
  -  Total calcium (corrected for serum albumin) within normal limits or correctable with supplements.
  -  Magnesium within lower normal limits or correctable with supplements.
  Adequate liver function defined as:
  -  AST/SGOT and ALT/SGPT ≤ 3.0 x Upper limit of Normal (ULN) or ≤ 5.0 x ULN if liver metastasis are present.
  -  Serum bilirubin ≤ 1.5 x ULN.
  -  Serum albumin > 2.5 g/dL.
  -  Serum creatinine ≤ 1.5 x ULN or 24 hour clearance ≥ 50 mL/min.
  Exclusion Criteria:
  -  Patients who have received more than four lines of prior treatment. Exception: Patients enrolled to the fifth stratum, modified EGFR mutant, must not have received more than two prior lines of therapy. Chemotherapy administered as adjuvant treatment more than six months prior to study enrollment is not considered a prior line of therapy for purposes of this study.
  -  Patients with a history of CNS metastasis. Note: Patients without clinical signs and symptoms of CNS involvement are not required to have MRI of the brain. Exception: Patients with treated brain metastases who are asymptomatic, who has discontinued corticosteroids, and who have been clinically stable for one month will be eligible for protocol participation. This exception is not valid for patients enrolled to the fifth stratum, modified EGFR mutant. These patients must not have CNS involvement.
  -  Prior anti-neoplastic treatment with any HSP90 or HDAC inhibitor compound.
  -  Patients must not have received:
  -  any systemic anti-cancer treatment or radiotherapy within 4 weeks prior to first dose of study treatment and should have recovered to baseline or less than Grade 1 from toxicities of such therapy prior to the first dose of study treatment
  -  2 weeks for palliative radiotherapy to bones, 6 weeks for nitrosoureas and mitomycin
  -  4 weeks for monoclonal antibodies
  -  and ≤5 half-life of the agent or active metabolites [if any] for continuous systemic anti-cancer treatment or investigational
  -  Patients who do not have either an archival tumor sample available or are unwilling to have a fresh tumor sample collected at baseline.
  Other protocol-defined inclusion/exclusion criteria may apply

Relevance to patient case: not relevant