STA-9090(Ganetespib) in Patients With Unresectable Stage III or Stage IV Melanoma

Study Overview
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Brief Summary
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STA9090 is a drug which inactivates or blocks the work of a protein called Heat Shock Protein 90 or HSP90. HSP90 is a protein that helps some molecules inside your cells to have the right shape. By stopping HSP90's activity, those molecules never get to have the right structure of be functional and they are destroyed. The investigators believe that if they stop the activity of HSP90, the rapidly dividing cells that are in your tumor(s) may slow down. In this research study the investigators are looking to see how well STA9090 works in stopping the spread of your melanoma.

Detailed Description
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OBJECTIVES: Primary To determine the proportion of patients alive, free of disease progression, and still taking STA-9090 at 6 months by BRAF mutant or wild type (WT) status. Secondary To assess best overall response rate and six month response rate by BRAF status To evaluate the rates of one-year overall survival and progression-free survival by BRAF status To determine safety and tolerability of STA-9090 by BRAF status Exploratory To compare the rates of response and of six-month PFS between BRAF status cohorts To explore, using peripheral blood mononuclear cells, the relationship between change in expression of hsp90 client proteins (e.g., BRAF, CRAF, AKT, CDK4, KIT) with response to therapy and progression free survival by BRAF status To explore the relationship in biopsied melanoma metastases between changes in expression of hsp90 client proteins (e.g., BRAF, CRAF, AKT, CDK4, KIT) with response to therapy and progression-free survival To explore response rate and 6 month progression free survival, in subset of patients with melanoma expressing a mutation in KIT

Official Title
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This Trial is an Open Label, Parallel Cohort, Phase II Study Evaluating the Efficacy of the Heat Shock Protein 90 (Hsp90) Inhibitor STA-9090 in Patients With Unresectable Stage III or Stage IV Melanoma Who Were Intolerant of, or Progressed on, Prior Tyrosine Kinase Inhibitor Treatment. Two Cohorts Will Enroll Concurrently. One Cohort Will be Composed of Patients With Melanoma Expressing a Mutation in the Protein BRAF and the Other Cohort Will be Composed of Patients With Melanoma Expressing Wild-type BRAF.

Conditions
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Melanoma

Intervention / Treatment
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* Drug: STA-9090


Participation Criteria
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Eligibility Criteria
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Histologically confirmed unresectable stage III or stage IV melanoma Treatment of unresectable stage III or stage IV melanoma with a tyrosine kinase inhibitor within prior 4 months. Sorafenib for purposes of eligibility will not be considered acceptable prior therapy Sufficient tumor available to determine if expresses wild-type or mutated BRAF if result not already known. The presence or absence of BRAF mutation needs to be determined at BWH, MGH, BIDMC, by Drs. Christopher Corless and Michael Heinrich at Cancer Pathology Shared Resource Oregon Health & Science University, or in context of eligibility assessment after signing consent to a previous clinical trial Sufficient tumor available to determine if expresses a mutation KIT Agreement to allow tumor to be evaluated for mutations in KIT and BRAF ECOG performance status ≤ 1 Life expectancy of ≥ 6 months Age ≥ 18 years WBC ≥ 3 x 103/ul ANC ≥ 1,500/ul Platelets ≥ 100 x 103/ul Hemoglobin ≥ 9 gm/dl Serum creatinine ≤ 1.5 x ULN Calculated creatinine clearance ≥ 60 mL/min AST ≤ 2.5 x ULN; -OR- AST ≤ 5 x ULN in the presence of known liver metastases ALT ≤ 2.5 x ULN; -OR- ALT ≤ 5 x ULN in the presence of known liver metastases Total bilirubin ≤ 1.5 x ULN Potassium within normal range or correctable with supplements Magnesium within normal range or correctable with supplements Corrected serum calcium within normal range, or correctable with supplements Not pregnant or breastfeeding. Female subjects of childbearing age must have a negative serumpregnancy test at study entry Women of childbearing potential and men must agree to use adequate contraception prior to study entry and for the duration of study participation and for 6 months following last study drug administration Agreement to provide blood samples for pharmacodynamic studies utilizing Peripheral Blood Mononuclear Cells (PMBCs) as outlined in protocol At least one site of measurable disease as defined by at least 1 cm 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 measureable disease Able to understand and willing to sign a written informed consent document Willing and able to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures No chemotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to study entry No radiotherapy within 4 weeks prior to study entry Subject has recovered from adverse events due to agents administered more than 4 weeks earlier No tyrosine kinase inhibitor within 14 days prior to study entry No major surgery within 4 weeks prior to first dose of STA-9090 No minor surgery within 7 days of first dose of STA-9090 No history of or current coronary artery disease, myocardial infarction, angina pectoris, angioplasty or coronary bypass surgery No current treatment with the following antiarrythmic drugs: flecainide, moricizine or propafenone No NYHA class II/III/IV congestive heart failure with a history of dyspnea, orthopnea, or edema that requires current treatment with angiotensin convering enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, or diuretics No current or prior radiation to the left hemithorax No embolization procedure or ablation procedure to treat tumor within 4 weeks of first dose of STA- 9090 Not receiving any other investigational agents No poor venous access for study drug administration unless subject can use silicone based catheters No history of brain metastases or of leptomeningeal involvement No history of severe allergic reactions or hypersensitivity reactions attributed to compounds of similar chemical or biologic composition to STA-9090 (e.g. olyethylene glycol [PEG] 300 or Polysorbate 80) Baseline QTc ≤ 470 msec No previous history of QT prolongation while taking other medications Ventricular ejection fraction (EF) > 55% No treatment with chronic immunosuppressants No melanoma of ocular primary No prior treatment with hsp90 inhibitor No uncontrolled intercurrent illness including, but not limited to ongoing or active infection, ventricular arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements No other medications, or severe acute/chronic medical of 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 subject inappropriate for entry into the study No history of a different malignancy except for the following circumstances. Individuals with a history of other malignancies are eligible if they have been disease-free for at least 5 years and are deemed by the investigator to be at low risk for recurrence of that malignancy. Individuals with the following cancers are eligible if diagnosed and treated within the past 5 years: cervical cancer in situ, and basal cell or squamous cell carcinoma of the skin No HIV-positive subject on combination antiretroviral therapy No more than 3 prior systemic therapies for unresectable stage III or stage IV melanoma No concomitant use of medications associated with a high incidence of QT prolongation as outlined

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
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: STA-9090 Cohort A<br>Patients enrolled into two possible cohorts based on tumor expression of BRAF: Cohort A - BRAF mutant disease or Cohort B - BRAF wild type. Cohort A patients received STA-9090 200 mg/m2 once weekly (d1, 8, 15 of 28 day cycle). Patients were treated until evidence of disease progression, unacceptable toxicity, intercurrent illness or withdrawal. | Drug: STA-9090<br> <br> * Other names: Ganetespib;|
| Experimental: STA-9090 Cohort B<br>Patients enrolled into two possible cohorts based on tumor expression of BRAF: Cohort A - BRAF mutant disease or Cohort B - BRAF wild type. Cohort B patients received STA-9090 150 mg/m2 twice weekly (d1, 4, 8, 11, 15, 18 of 28 day cycle). Patients were treated until evidence of disease progression, unacceptable toxicity, intercurrent illness or withdrawal. | Drug: STA-9090<br> <br> * Other names: Ganetespib;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 6-month Progression-Free Survival Rate | 6-month progression-free survival rate was defined as the proportion of patients absent death or progression based on Response Evaluation Criteria In Solid Tumors Criteria (RECIST) before 6 months. Per RECIST 1.0 criteria: progressive disease (PD) is at least a 20% increase in the sum of longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. PD for the evaluation of non-target lesions is the appearance of one or more new lesions and/or unequivocal progression of non-target lesions. | Disease was evaluated radiologically at baseline and every 8 weeks on treatment; Treatment continued until evidence of disease progression or unacceptable toxicity. Relevant for this endpoint was disease status at 6 months. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Best Overall Response | Best overall response (BOR) on treatment was based on RECIST 1.0 criteria. For target lesions, complete response (CR) is complete disappearance of all target lesions and partial response (PR) is at least a 30% decrease in the sum of longest diameter (LD) of target lesions, taking as reference baseline sum LD. CR or PR confirmation required within 4 weeks. Progressive disease (PD) is at least a 20% increase in the sum LD of target lesions from smallest sum LD as reference or the appearance of one or more new lesions. Stable disease (SD) is neither meeting PR or PD. PD for the evaluation of non-target lesions is the appearance of one or more new lesions and/or unequivocal progression of non-target lesions. CR is disappearance of all non-target lesions. | Disease was evaluated radiologically at baseline and every 8 weeks on treatment. Median (range) treatment duration was 1 cycle/4 weeks (1-2 cycles; 4-8 weeks). | 
| Overall Survival | Overall survival is defined as the time from study entry to death or date last known alive and estimated using Kaplan-Meier (KM) methods. | Patients were followed every 4 weeks for survival until death, lost to follow-up or study closure (approximately 6 months after the last patient ended treatment). In this study cohort, patients were followed up to 13 weeks. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Stage III, Stage IV, Unresectable, Metastatic