Clinical trial NCT00045006: Suberoylanilide Hydroxamic Acid in Treating Patients With Advanced Cancer
Official title: Phase I Clinical Trial of Oral Suberoylanilide Hydroxamic Acid - SAHA (MSK390) in Patients With Advanced Solid Tumors and Hematologic Malignancies
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: Cancer
Keywords: acute undifferentiated leukemia
de novo myelodysplastic syndromes
borderline ovarian surface epithelial-stromal tumor
ovarian sarcoma
ovarian stromal cancer
previously treated myelodysplastic syndromes
prolymphocytic leukemia
recurrent adult Hodgkin lymphoma
recurrent adult T-cell leukemia/lymphoma
recurrent adult acute lymphoblastic leukemia
recurrent adult acute myeloid leukemia
recurrent adult diffuse large cell lymphoma
recurrent adult diffuse small cleaved cell lymphoma
recurrent adult diffuse mixed cell lymphoma
recurrent bladder cancer
recurrent breast cancer
recurrent cutaneous T-cell non-Hodgkin lymphoma
recurrent grade 1 follicular lymphoma
recurrent grade 2 follicular lymphoma
recurrent grade 3 follicular lymphoma
recurrent metastatic squamous neck cancer with occult primary
recurrent mycosis fungoides/Sezary syndrome
recurrent non-small cell lung cancer
recurrent ovarian epithelial cancer
recurrent ovarian germ cell tumor
recurrent prostate cancer
recurrent renal cell cancer
refractory chronic lymphocytic leukemia
refractory hairy cell leukemia
refractory multiple myeloma
relapsing chronic myelogenous leukemia
secondary acute myeloid leukemia
secondary myelodysplastic syndromes
stage III multiple myeloma
stage III mycosis fungoides/Sezary syndrome
stage III ovarian germ cell tumor
stage IV mycosis fungoides/Sezary syndrome
stage IV ovarian germ cell tumor
unspecified adult solid tumor, protocol specific
stage III adult Hodgkin lymphoma
stage IV adult Hodgkin lymphoma
stage III adult T-cell leukemia/lymphoma
stage IV adult T-cell leukemia/lymphoma
stage III adult diffuse large cell lymphoma
stage III adult diffuse mixed cell lymphoma
stage III adult diffuse small cleaved cell lymphoma
stage IV adult diffuse large cell lymphoma
stage IV adult diffuse mixed cell lymphoma
stage IV adult diffuse small cleaved cell lymphoma
stage III bladder cancer
stage IV bladder cancer
stage IIIA breast cancer
stage IIIB breast cancer
stage IIIC breast cancer
stage IV breast cancer
stage III cutaneous T-cell non-Hodgkin lymphoma
stage IV cutaneous T-cell non-Hodgkin lymphoma
stage III grade 1 follicular lymphoma
stage III grade 2 follicular lymphoma
stage III grade 3 follicular lymphoma
stage IV grade 1 follicular lymphoma
stage IV grade 2 follicular lymphoma
stage IV grade 3 follicular lymphoma
stage IIIA non-small cell lung cancer
stage IIIB non-small cell lung cancer
stage IV non-small cell lung cancer
stage III oropharyngeal cancer
stage IV oropharyngeal cancer
stage III ovarian epithelial cancer
stage IV ovarian epithelial cancer
stage III prostate cancer
stage IV prostate cancer
stage III renal cell cancer
stage IV renal cell cancer
stage III chronic lymphocytic leukemia
stage IV chronic lymphocytic leukemia
recurrent salivary gland cancer
stage IV salivary gland cancer
stage III salivary gland cancer
recurrent squamous cell carcinoma of the hypopharynx
stage III squamous cell carcinoma of the hypopharynx
stage IV squamous cell carcinoma of the hypopharynx
recurrent squamous cell carcinoma of the larynx
recurrent verrucous carcinoma of the larynx
stage III squamous cell carcinoma of the larynx
stage III verrucous carcinoma of the larynx
stage IV squamous cell carcinoma of the larynx
stage IV verrucous carcinoma of the larynx
recurrent squamous cell carcinoma of the lip and oral cavity
stage III squamous cell carcinoma of the lip and oral cavity
stage IV squamous cell carcinoma of the lip and oral cavity
recurrent lymphoepithelioma of the nasopharynx
recurrent squamous cell carcinoma of the nasopharynx
stage III lymphoepithelioma of the nasopharynx
stage III squamous cell carcinoma of the nasopharynx
stage IV lymphoepithelioma of the nasopharynx
stage IV squamous cell carcinoma of the nasopharynx
recurrent lymphoepithelioma of the oropharynx
recurrent squamous cell carcinoma of the oropharynx
stage III lymphoepithelioma of the oropharynx
stage III squamous cell carcinoma of the oropharynx
stage IV lymphoepithelioma of the oropharynx
stage IV squamous cell carcinoma of the oropharynx
recurrent esthesioneuroblastoma of the paranasal sinus and nasal cavity
recurrent inverted papilloma of the paranasal sinus and nasal cavity
recurrent midline lethal granuloma of the paranasal sinus and nasal cavity
recurrent squamous cell carcinoma of the paranasal sinus and nasal cavity
stage III esthesioneuroblastoma of the paranasal sinus and nasal cavity
stage III inverted papilloma of the paranasal sinus and nasal cavity
stage III midline lethal granuloma of the paranasal sinus and nasal cavity
stage III squamous cell carcinoma of the paranasal sinus and nasal cavity
stage IV esthesioneuroblastoma of the paranasal sinus and nasal cavity
stage IV inverted papilloma of the paranasal sinus and nasal cavity
stage IV midline lethal granuloma of the paranasal sinus and nasal cavity
stage IV squamous cell carcinoma of the paranasal sinus and nasal cavity
recurrent basal cell carcinoma of the lip
stage III basal cell carcinoma of the lip
stage IV basal cell carcinoma of the lip
recurrent mucoepidermoid carcinoma of the oral cavity
stage III mucoepidermoid carcinoma of the oral cavity
stage IV mucoepidermoid carcinoma of the oral cavity
recurrent adenoid cystic carcinoma of the oral cavity
stage III adenoid cystic carcinoma of the oral cavity
stage IV adenoid cystic carcinoma of the oral cavity
recurrent verrucous carcinoma of the oral cavity
stage III verrucous carcinoma of the oral cavity
stage IV verrucous carcinoma of the oral cavity
atypical chronic myeloid leukemia, BCR-ABL1 negative
myelodysplastic/myeloproliferative neoplasm, unclassifiable
male breast cancer
Lead sponsor: National Cancer Institute (NCI)
Sponsor class: NIH
Collaborators: name: National Cancer Institute (NCI)
First posted: 2003-01-27
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Primary purpose: TREATMENT

Brief summary: RATIONALE: Suberoylanilide hydroxamic acid may stop the growth of cancer cells by blocking the enzymes necessary for cancer cell growth.

PURPOSE: Phase I trial to study the effectiveness of suberoylanilide hydroxamic acid in treating patients who have advanced cancer.

Detailed description: OBJECTIVES:

* Determine the maximum tolerated dose of suberoylanilide hydroxamic acid in patients with advanced solid tumors or hematologic malignancies.
* Evaluate the pharmacokinetic profile of this drug in these patients.
* Determine the effects of this drug on absorption in the fasting and non-fasting states in these patients.
* Determine any anti-tumor effects of this drug in these patients.
* Correlate clinical outcomes with histone acetylation in circulating mononuclear cells and tumor biopsy samples in patients treated with this drug.

OUTLINE: This is a dose-escalation study. Patients are stratified according to disease (solid tumor vs multiple myeloma or lymphoma vs leukemia or myelodysplastic syndromes).

The initial 15-20 patients (in the solid tumor or multiple myeloma or lymphoma stratum) receive suberoylanilide hydroxamic acid (SAHA) IV over 2 hours on day 1 of week 0 and then orally once or twice daily beginning on day 1 of week 1. All remaining patients receive oral SAHA once or twice daily beginning on day 1 of week 1. Courses repeat every 4 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity.

In each stratum, cohorts of 3-6 patients receive escalating doses of SAHA until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which at least 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

Patients are followed monthly for resolution of adverse events.

PROJECTED ACCRUAL: A maximum of 114 patients (42 with solid tumors, 36 with lymphoma or multiple myeloma, and 36 with leukemia or myelodysplastic syndromes) will be accrued for this study within 1 year.

Eligibility criteria: DISEASE CHARACTERISTICS:

* One of the following diagnoses:

  * Histologically confirmed advanced primary or metastatic solid tumor, including, but not limited to, the following:

    * Androgen-independent prostate cancer
    * Breast cancer
    * Ovarian cancer
    * Head and neck cancer
    * Non-small cell lung cancer
    * Bladder cancer
    * Kidney cancer
  * Diagnosis of lymphoma, multiple myeloma, leukemia, or myelodysplastic syndromes (MDS), including, but not limited to, the following:

    * Intermediate-grade or follicular non-Hodgkin's lymphoma
    * Hodgkin's lymphoma
* Patients with lymphoma or multiple myeloma must be ineligible for peripheral blood stem cell transplantation
* For patients with solid tumors (except prostate cancer):

  * Disease progression based on development of new lesions or an increase in pre-existing lesions
  * Biochemical marker increase must not be sole criterion for disease progression
* For prostate cancer patients only:

  * Disease progression based on rising prostate-specific antigen (PSA) values, transaxial imaging, or radionuclide scans
  * Increase in disease-related symptoms must not be sole manifestation of progression
  * Patients receiving an antiandrogen as part of first-line hormonal therapy must show disease progression off of the antiandrogen prior to study
  * Biochemical progression (at least 25% increase over range of values) defined as 1 of the following:

    * Rising PSA documented by at least 3 consecutive measurements obtained at least 1 week apart
    * Rising PSA documented by at least 2 consecutive measurements obtained more than 1 month apart
  * PSA at least 4 ng/mL

    * Testosterone no greater than 50 ng/mL
    * If no prior orchiectomy, must maintain castrate levels of testosterone
* Disease must be refractory to standard therapy or for which no curative therapy exists
* No active CNS or epidural tumors
* Hormone receptor status:

  * Not specified NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. However, this protocol uses the former terminology.

PATIENT CHARACTERISTICS:

Age

* 18 and over

Sex

* Male or female

Menopausal status

* Not specified

Performance status

* Karnofsky 70-100%

Life expectancy

* Not specified

Hematopoietic

* WBC at least 3,500/mm\^3
* Platelet count at least 100,000/mm\^3 (patients with solid tumors)
* Platelet count greater than 25,000/mm\^3 (patients with hematologic malignancy)
* Absolute neutrophil count at least 500/mm\^3 (patients with hematologic malignancy)

Hepatic

* Bilirubin no greater than 1.5 times upper limit of normal (ULN)
* AST and ALT no greater than 3 times ULN
* PT no greater than 15 seconds

Renal

* Creatinine no greater than 2.0 mg/dL

Cardiovascular

* No New York Heart Association class III or IV heart disease

Pulmonary

* No severe debilitating pulmonary disease

Other

* No infection requiring IV antibiotics
* No other severe medical problems that would preclude study participation
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

* See Disease Characteristics

Chemotherapy

* At least 4 weeks since prior chemotherapy

Endocrine therapy

* See Disease Characteristics
* At least 4 weeks since prior ketoconazole
* At least 2 weeks since prior steroids for patients with lymphoma
* Concurrent gonadotropin-releasing hormone analogs or diethylstilbestrol to maintain castrate levels of testosterone allowed for prostate cancer patients
* No concurrent ketoconazole

Radiotherapy

* At least 4 weeks since prior radiotherapy
* No concurrent radiotherapy to sole measurable lesion

Surgery

* See Disease Characteristics
* No concurrent surgery

Other

* Recovered from all prior therapy
* At least 4 weeks since prior palliative therapy for solid tumor patients with progressive metastatic disease (if present)
* At least 4 weeks since prior investigational anticancer therapeutic drugs
* At least 2 weeks since prior conventional cytotoxic therapy for patients with leukemia or MDS
* At least 4 weeks since prior investigational therapy for patients with leukemia or MDS
* No other concurrent investigational drugs
* No other concurrent anticancer agents

Primary outcomes:
Secondary outcomes:
Other outcomes:
Locations:
city: New York
country: United States
facility: Memorial Sloan-Kettering Cancer Center
state: New York
Study officials:
affiliation: Memorial Sloan Kettering Cancer Center
name: William K. Kelly, DO
role: STUDY_CHAIR
References: