Clinical trial NCT01200238: STA-9090(Ganetespib) in Metastatic Ocular Melanoma
Official title: A Phase II Study of the HSP Inhibitor STA-9090 in Metastatic Ocular Melanoma
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Ocular Melanoma
Keywords: STA9090
STA-9090
HSP90
Lead sponsor: Dana-Farber Cancer Institute
Sponsor class: OTHER
Collaborators: name: Beth Israel Deaconess Medical Center
name: Massachusetts General Hospital
name: Brigham and Women's Hospital
name: Synta Pharmaceuticals Corp.
First posted: 2010-09-13
Enrollment: 17
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
Intervention model description: The original dose (Cohort A) was amended based on phase 1 data for safety. Therefore there are 2 separate arms reported.
Primary purpose: TREATMENT

Brief 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 criteria: 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

Primary outcomes:
measure: 4-month Progression Free Survival (PFS) Rate
timeFrame: Disease was evaluated radiologically at baseline and every 8 weeks on treatment; Relevant for this endpoint was status at 4 months.
measure: Expression of cMET
timeFrame: Estimated up to 24 hours after administration of STA-9090
Secondary outcomes:
measure: Objective Response Rate (ORR)
timeFrame: Disease was evaluated radiologically at baseline and every 8 weeks on treatment; Median treatment duration was 1.8 months for each cohort [range: cohort A (0.9-12.5), cohort B (0.8-31.7)]. Thus, response on treatment was evaluated up to 31.7 months.
measure: Disease Control Rate (DCR)
timeFrame: Disease was evaluated radiologically at baseline and every 8 weeks on treatment; Median treatment duration was 1.8 months for each cohort [range: cohort A (0.9-12.5), cohort B (0.8-31.7)].Thus, response on treatment was evaluated up to 31.7 months.
measure: Progression-Free Survival (PFS)
timeFrame: Dz was evaluated every 8 weeks on treatment; Imaging was obtained as clinically indicated until off-study; Median (range) on-study duration (months) was cohort A: 8.7 (3.7 to 28.7) and cohort B: 4.5 (1.2 to 36.4 months). Thus, follow-up was up to 36.4m.
measure: Overall Survival (OS)
timeFrame: Survival follow-up occurred every 4 weeks long-term; Median (range) on-study duration (months) was cohort A: 8.7 (3.7 to 28.7) and cohort B: 4.5 (1.2 to 36.4 months).Thus, follow-up was up to 36.4m.
measure: Grade 3-4 Treatment-Related Toxicity Rate
timeFrame: AE assessment was ongoing from the start of study drug and up to day 30 post-treatment. Mean treatment duration was 1.8 months for each cohort [range: cohort A (0.9-12.5), cohort B (0.8-31.7)). Thus, AEs on treatment were followed up to 31.7 months.
Other outcomes:
Locations:
city: Boston
country: United States
facility: Massachusetts General Hospital
state: Massachusetts
city: Boston
country: United States
facility: Beth Israel Deaconess Medical Center
state: Massachusetts
city: Boston
country: United States
facility: Dana-Farber Cancer Institute
state: Massachusetts
Study officials:
affiliation: Dana-Farber Cancer Institute
name: F. Stephen Hodi, MD
role: PRINCIPAL_INVESTIGATOR
References: