Ganetespib With Platinum, in Patients With Malignant Pleural Mesothelioma

Study Overview
=================
Brief Summary
-----------------
Malignant pleural mesothelioma (MPM) is a rapidly lethal cancer arising from the parietal pleural mesothelium, and is associated with exposure to asbestos. Once a rare disease, it is increasing in incidence in the UK and is presently more common than cervical cancer. MPM is characterized by local invasion of adjacent structures including the chest wall, mediastinum, diaphragm and pericardium resulting in progressive shortness of breath. Median survival with best supportive care alone is approximately 6-9 months and most cases of mesothelioma present in the advanced setting. Therefore this trial will be looking at whether a new drug, Ganetespib has any improvement on survival for these types of patients.

Official Title
-----------------
A Phase I/II Study of First Line Ganetespib With Platinum, in Patients With Malignant Pleural Mesothelioma

Conditions
-----------------
Lung Cancer - Malignant Pleural Mesothelioma

Intervention / Treatment
-----------------
* Drug: Ganetespib


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Histopathological confirmation of malignant pleural mesothelioma Measurable disease using meso-modified RECIST criteria (CT scan must be within 28 days of registration/randomisation) Performance status ECOG 0-1 Age at least 18 years Adequate haematological status: Haemoglobin 100g/L or greater Neutrophil count ≥2.0 x 10^9/L Platelets ≥100 x 10^9 /L Adequate organ function: Bilirubin ≤1.5x ULN, ALP ≤2.5x ULN, ALT or AST ≤1.5x ULN Serum creatinine ≤1.5 x ULN or calculated creatinine clearance ≥ 60ml/min (C&G or EDTA) Chemotherapy naïve Negative serum pregnancy test for female patients of child bearing potential. Male subjects and women of child bearing potential must agree to use an acceptable method of birth control for the duration of the trial and for 6 months after the last trial treatment cycle has finished. Ability to understand and willing to sign the written informed consent to participate (including donation of diagnostic biopsy tissue for research) Ability to comply with the requirements of the protocol Exclusion Criteria: Prior exposure to other investigational or commercial agents or therapies administered with the intent of treating the patient's malignancy. This includes crizotinib, other ALK-targeted agents, and any Hsp90 inhibitor (e.g. ganetespib). Prior valproic acid is acceptable but only if there has been at least 30 days wash-out period Evidence of CNS metastases that in the opinion of the investigator should receive local treatment prior to systemic cytotoxic chemotherapy Uncontrolled intercurrent illness including but not limited to: Symptomatic neurological illness Active uncontrolled systemic infection considered opportunistic, life threatening or clinically significant at the time of treatment Significant pulmonary disease or hypoxia Psychiatric illness/social situations that would limit compliance with trial requirements Human immunodeficiency virus (HIV)-positive patients Known hepatitis B or C infection Uncontrolled diabetes mellitus Serum potassium, magnesium, and calcium levels no more than 10% outside the Sites normal reference ranges Known serious cardiac illness including but not confined to: Clinically unstable cardiac disease, including unstable atrial fibrillation, symptomatic bradycardia, unstable congestive heart failure, active myocardial ischemia, or indwelling temporary pacemaker Ventricular tachycardia or a supraventricular tachycardia that requires treatment with a Class Ia anti-arrhythmic drug (e.g., quinidine, procainamide, disopyramide) or Class III anti-arrhythmic drug (e.g., sotalol, amiodarone, dofetilide). Use of other anti-arrhythmic drugs is permitted. Use of medications that have been linked to the occurrence of torsades de pointes Second- or third-degree atrioventricular (AV) block unless treated with a permanent pacemaker Complete left bundle branch block (LBBB) History of long QT Syndrome or a family member with this condition QTc >470ms (average of triplicate ECG recordings); a consistent method of QTc calculation must be used for each patient's QTc measurements. QTcF (Fridericia's formula) is preferred The patient has a history of prior malignant tumour, unless the patient has been without evidence of disease for at least three years, or the tumour was a non-melanoma skin tumour or in situ cervix carcinoma Pregnant women or those who are lactating Pre-planned surgery or procedures that would interfere with the conduct of the trial Patients who have had surgery (does not include pleurodesis or pleurectomy) within 28 days of randomisation should not be included Previous treatment of mesothelioma with systemic chemotherapy Receipt of extensive radiation therapy, systemic chemotherapy, or other anti-neoplastic therapy within 4 weeks before enrolment is not allowed. However, drain site radiotherapy is allowed Significant weight loss (≥10% body weight) within the 4 weeks prior to Cycle 1 Day 1. Patients who have had a yellow fever vaccination in the previous 30 days. Other medications, severe acute/chronic medical or psychiatric condition, or laboratory abnormality that may increase the risk associated with 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 subject inappropriate for entry into this study.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cisplatin/Pemetrexed<br>Cisplatin 75mg/m2, Day 1 every 21 days Pemetrexed 500mg/m2, Day 1 every 21 days | Drug: Ganetespib<br>* IV, Using dose from Phase I<br>|
| Experimental: Carboplatin/Pemetrexed<br>Carboplatin AUC5, Day 1 every 21 days Pemetrexed 500mg/m2, Day 1 every 21 days | Drug: Ganetespib<br>* IV, Using dose from Phase I<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum Tolerated Dose of Ganetespib | Primary endpoint (phase I): Dose-limiting toxicities during Cycles 1 & 2; and number of cycles of pemetrexed-cisplatin given. The Phase I trial will consist of three ganetespib dose cohorts, each with 3 or 6 patients: Cohort 1: 100mg/m2 IV on day 1 and day 15 of each cycle Cohort 2: 150mg/m2 IV on day 1 and day 15 of each cycle Cohort 3: 200mg/m2 IV on day 1 and day 15 of each cycle There will be additional patients to be treated with carboplatin (AUC5) instead of cisplatin. If treatment with carboplatin is confirmed to be safe and tolerable, the option of treating patients with either cisplatin or carboplatin during phase II will be taken. The evaluation will be done using an accelerated titrated phase I design. Primary endpoint (phase II): Progression free survival | 6 Months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression Free Survival | Secondary endpoints (phase I): To examine the number of cycles of pemetrexed/platinum chemotherapy administered. To examine the objective tumour response according to meso-modified RECIST, and the overall response rate. Secondary endpoints (phase II): To examine the frequency of all Adverse Events graded by NCI-CTCAE version 4, in particular those with grade 3 or 4 events. To examine the objective tumour response according to meso-modified RECIST, and the overall response rate. To examine overall survival. | 24 Months |