Patient case: 64-year-old male with cholangiocarcinoma; genetic feature: BRAF (V600E)

Clinical trial: STA-9090(Ganetespib) in Metastatic Ocular Melanoma

Summary: STA-9090, a synthetic small molecule, demonstrates significant activity for down-regulating Heat Shock Protein 90 or Hsp90 levels. Hsp90 belongs to a class of molecular chaperone proteins known to be critical regulators of cancer cell proliferation and survival. Preclinical laboratory experiments have shown STA-9090, an Hsp90 inhibitor, could inhibit ocular melanoma cell lines. The primary objective of this trial is to obtain evaluations of STA-9090 efficacy to metastatic ocular melanoma.

Detailed description: Patients with metastatic ocular melanoma have a poor prognosis and very limited standard therapeutic options. The recent discoveries of GNAQ and GNA11 mutations leading to MAPK pathway activation and the over-expression of c-Met generate the hypothesis that inhibition of hsp90 client proteins will provide clinical benefit. This study tests the feasibility and efficacy of hsp90 inhibition in patients with metastatic ocular melanoma. Multiple components of the MAPK pathway (B-Raf, C-Raf, cdk4) in addition to c-Met are client proteins of hsp90 and dependent of active hsp90 for stability. Inhibition of hsp90 should lead to decreased expression of these client proteins.

Eligibility: Inclusion Criteria:
  -  Histologically confirmed stage IV ocular melanoma
  -  ECOG Performance status 0, 1, or 2
  -  18 years of age or older
  -  Laboratory values as indicated in the protocol
  -  Women of child-bearing potential and men must agree to use adequate contraception prior to study entry and for the duration of study participation
  -  Presence of metastatic disease that would be amenable to the required biopsies
  -  At least one site of measurable disease as defined by at least 1cm in greatest dimension. This site must be different from the sites to be used for biopsy. No prior radiation therapy or directed ablation to the site of measurable disease
  Exclusion Criteria:
  -  Chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
  -  Major surgery within 4 weeks prior to first dose of STA-9090
  -  Minor surgery within 7 days of first dose of STA-9090
  -  Embolization procedure or ablation procedure to treat tumor within 4 weeks of first dose
  -  Participants may not be receiving any other investigational agents
  -  Poor venous access for study drug administration unless patient can use silicone based catheters
  -  History of brain metastases or of leptomeningeal involvement
  -  History of allergic reactions or hypersensitivity reactions attributed to compounds of similar chemical or biologic composition to STA-9090
  -  Baseline QTc > 450 msec or previous history of QT prolongation while taking other medications
  -  Ventricular ejection fraction (EF) of 55% or less at baseline
  -  Treatment with chronic immunosuppressants
  -  Melanoma of cutaneous, mucosal or acral-lentiginous origin or of unknown primary
  -  Prior treatment with HSP90 inhibitor
  -  Not willing to undergo biopsy before and after treatment
  -  Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  -  Other medications, or severe acute/chronic medical or psychiatric conditions or laboratory abnormality that may increase the risk associated with the study participation or study drug administration, or may interfere with the interpretation of study results, and in the judgment of the investigator would make the participant inappropriate for entry into the study
  -  Pregnant or breastfeeding women
  -  Individual with a history of a different malignancy are ineligible except for circumstances outlined in the protocol
  -  HIV-positive individuals on combination antiretroviral therapy
  -  History of or current coronary artery disease, myocardial infarction, angina pectoris, angioplasty or coronary bypass surgery
  -  History of or current uncontrolled dysrhythmias, or requirement for antiarrhythmic medication, or Grade 2 or greater left bundle branch block
  -  NYHA class II/III/IV congestive heart failure with a history of dyspnea, orthopnea or edema that requires current treatment with angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers or diuretics
  -  Current or prior radiation therapy to the left hemithorax

Relevance to patient case: not relevant