5-Fluoro-2'-Deoxcyctidine and Tetrahydrouridine to Treat Patients With Advanced Cancer

Study Overview
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Brief Summary
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This phase I trial studies the side effects and best dose of 5-fluoro-2-deoxycytidine when given together with tetrahydrouridine in treating patients with solid tumors that have spread to other places in the body and usually cannot be cured or controlled with treatment (advanced). Drugs used in chemotherapy, such as 5-fluoro-2-deoxycytidine and tetrahydrouridine, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading.

Detailed Description
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PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) of 5-fluoro-2'-deoxycytidine (5-fluoro-2-deoxycytidine) (FdCyd) administered by intravenous (IV) infusion over three hours with concomitant infusion of 350 mg/m2 of tetrahydrouridine (THU). II. To describe the toxicities of FdCyd co-infused with THU. III. To obtain preliminary evidence of anti-tumor activity in patients treated with this combination. IV. To evaluate the pharmacokinetics of FdCyd and THU when co-infused. V. To evaluate the oral bioavailability of FdCyd when co-administered with THU. VI. When feasible, to measure the relative levels of the messenger ribonucleic acid (mRNA)'s for thymidylate synthase, deoxycytidine kinase, deoxycytidylate (dCMP) deaminase and other relevant enzymes; and the methylation status of p16 and other genes relevant to neoplasia. OUTLINE: This is a dose-escalation study of 5-fluoro-2-deoxycytidine. Patients receive tetrahydrouridine orally (PO) on day 1; 5-fluoro-2-deoxycytidine PO on days 1 and 8; tetrahydrouridine IV over 3 hours on days 2-5, 8, and 9-12; and 5-fluoro-2-deoxycytidine IV over 3 hours on days 2-5 and 9-12 of course 1. For all subsequent courses, patients receive tetrahydrouridine IV over 3 hours and 5-fluoro-2-deoxycytidine IV over 3 hours on days 1-5. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up periodically.

Official Title
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Phase I Trial of 5-Fluoro-2'-Deoxycytidine With Tetrahydrouridine

Conditions
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Neoplasms

Intervention / Treatment
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* Drug: 5-Fluoro-2-Deoxycytidine (FdCyd)
* Other: Laboratory Biomarker Analysis
* Other: Pharmacological Study
* Drug: Tetrahydrouridine (THU)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Advanced, histologically-confirmed neoplastic disease refractory to standard therapy or for which no standard therapy exists Karnofsky performance status of at least 60% and estimated survival of at least two months Serum creatinine =< 2.0 mg/dl or creatinine clearance >= 50 ml/min Absolute neutrophil count (ANC) >= 1,500/ul Platelets >= 125,000/ul Bilirubin =< 1.5 mg/dl Serum glutamic oxaloacetic transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT) =< 3 times the upper limits of normal Prior antineoplastic therapy must have been completed at least four weeks prior to the patient's entry on this study, or patients must have recovered from any expected side effects of the prior therapy; there is no limit on the number of cycles of prior chemotherapy Patients must be ineligible for or have refused participation in higher priority institutional protocols Written, voluntary, informed consent of the patient must be obtained in compliance with institutional, state and federal guidelines Pregnant patients are INELIGIBLE; all patients of child-bearing potential, both male and female, must be advised to practice adequate contraception; premenopausal women must have a negative pregnancy test prior to entry on this study Patients with any non-malignant intercurrent illness (e.g. cardiovascular, pulmonary, or central nervous system disease) which is either poorly controlled with currently available treatment, or which is of such severity that the investigators deem it inappropriate to treat the patient on this protocol are INELIGIBLE Patients currently being treated for a severe infection or who are recovering from major surgery are INELIGIBLE until recovery is deemed complete by the investigators The presence of measurable disease is NOT required for this phase I study; if bidimensionally measurable disease is present, baseline measurements of up to 3 indicator lesions should be made no earlier than four weeks prior to the first cycle of chemotherapy; pleural effusions, ascites and bone metastases are not considered measurable Complete blood count (CBC), differential count, platelet count, and blood chemistries should be done no earlier than 72 hours prior to each cycle of chemotherapy Pretreatment tests should be done no earlier than two weeks prior to the first cycle of chemotherapy Priority for accrual will be given to patients with breast cancer due to the in vitro data suggesting potential activity for this disease

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment (5-fluoro-2-deoxycytidine, tetrahydrouridine)<br>Patients receive tetrahydrouridine PO on day 1; 5-fluoro-2-deoxycytidine PO on days 1 and 8; tetrahydrouridine IV over 3 hours on days 2-5, 8, and 9-12; and 5-fluoro-2-deoxycytidine IV over 3 hours on days 2-5 and 9-12 of course 1. For all subsequent courses, patients receive tetrahydrouridine IV over 3 hours and 5-fluoro-2-deoxycytidine IV over 3 hours on days 1-5. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. | Drug: 5-Fluoro-2-Deoxycytidine (FdCyd)<br>* Given PO and IV<br>* Other names: Ro 5-1090;Other: Laboratory Biomarker Analysis<br>* Correlative Studies<br>Other: Pharmacological Study<br>* Correlative Studies<br>Drug: Tetrahydrouridine (THU)<br>* Given PO and IV<br>* Other names: THU;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum tolerated dose (MTD) of 5-fluoro-2-deoxycytidine (FdCyd) when given with tetrahydrouridine (THU) determined by dose-limiting toxicities | MTD is defined as the highest dose tested in which < 33% of patients experienced dose limiting toxicity. The toxicities observed at each dose level will be summarized in terms of type (organ affected or laboratory determination such as absolute neutrophil count), severity (by National Cancer Institute Common Toxicity Criteria version 2.0 and nadir or maximum values for the laboratory measures), time of onset (i.e., cycle number), duration, and reversibility or outcome. Tables will be created to summarize these toxicities and side effects by dose and by cycle. | 28 days | 
| Survival | Survival and time to failure will be summarized with Kaplan-Meier plots to describe the outcome of patients treated on this protocol. | Time from registration to time of death due to any cause, assessed up to 13 years | 
| Time to treatment failure | Survival and time to failure will be summarized with Kaplan-Meier plots to describe the outcome of patients treated on this protocol. | Time from registration to the first observation of disease progression, death due to any cause, or early discontinuation of treatment, assessed up to 13 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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DNA Methylation, Advanced Cancer, Methyltransferase Inhibitor, Epigenetics, Gene Re-Expression