Linsitinib To Treat Patients With Gastrointestinal Stromal Tumors

Status: Recruiting
Phase: Phase 2
Diagnosis: Sarcoma
NCT ID: NCT01560260 (View complete trial on ClinicalTrials.gov)
DFCI Protocol ID: 12-387

 

RATIONALE: Linsitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. PURPOSE: This phase II trial studies how well linsitinib works in treating younger and adult patients with gastrointestinal stromal tumors.

 

Conducting Institutions:
Dana-Farber Cancer Institute, Brigham and Women's Hospital

Overall PI:
Suzanne George, MD, Dana-Farber Cancer Institute

Site-responsible Investigators:

Contacts:
Dana-Farber Cancer Institute: Melissa Hohos, mhohos@partners.org
Dana-Farber Cancer Institute: Mark Morley, mmorley@partners.org

Eligibility Criteria

DISEASE CHARACTERISTICS: - Patients must have histologically confirmed gastrointestinal stromal tumor (GIST) with confirmed genotype of wild-type in a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory - At a minimum, mutation analysis should include exons 9, 11, 13, and 17 of KIT and exons 12 and 18 of PDGFRA - Patients will be stratified into Pediatric and Adult cohorts - Pediatric cohort: age at diagnosis ≤ 18 years OR diagnosis of Carney Triad or Carney-Stratakis Diad (paraganglioma, pulmonary chondroma) - Must have received at least sunitinib malate (sunitinib) and have had progression on or intolerance to therapy - Adult cohort: age at diagnosis > 18 years AND no diagnosis of Carney Triad or Carney-Stratakis Diad - Must have had progression on or intolerance to imatinib mesylate (imatinib) therapy as documented by treating physician - Patients must have measurable disease defined as lesions that can be measured in 2 dimensions by medical-imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI); ascites, pleural fluid, and lesions seen on positron emission tomography (PET) scan only are not considered measurable - Patients with known brain metastases should be excluded from this clinical trial PATIENT CHARACTERISTICS: - Eastern Cooperative Oncology Group (ECOG) performance status 0-2 - Patients must weigh 40 kilograms or more - White blood cell count ≥ 2.0 x 10^9/L - Absolute neutrophil count (ANC) ≥ 1.5 x 10^9/L (≥ 14 days off growth factors) - Platelet count ≥ 75 x 10^9/L - Total bilirubin ≤ 1.5 times the upper limit of normal (ULN) for age - Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) (serum glutamic pyruvate transaminase [SGPT]/serum glutamic oxaloacetic transaminase [SGOT]) ≤ 3 times the ULN for the reference lab (≤ 5 times the ULN for the reference lab in the presence of known hepatic metastasis, adjusted for age) - Creatinine clearance < 70 ml/min OR serum creatinine > 1.5 times ULN per age and gender - QTc interval < 450 msec at baseline - No significant cardiac disease - Fasting blood glucose < 150 mg/dL at baseline - Glycosylated hemoglobin (HbA1c) < 7% at screening - Patients with diabetes mellitus should have controlled disease on oral medications, defined as no diabetic ketoacidosis (hyperglycemia, ketonuria, pH < 7.3, and bicarbonate < 15 mEq/L) at the time of enrollment or within 30 days prior to enrollment - No change in oral medications greater than 10% within 30 days prior to enrollment - No patients with diabetes mellitus requiring insulin for control of their diabetes - Patient must be able to swallow to participate in the study - No history of allergic reactions attributed to compounds of similar chemical or biologic composition to OSI-906 - No 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 - Pregnant women are excluded from this study and breastfeeding should be discontinued - No fertile men and women of childbearing potential not employing an effective method of birth control throughout the trial and for 3 months after last study drug administration in both sexes; women of childbearing potential must have a negative pregnancy test (serum β-HCG) within the 7 days prior to study drug administration - Women of childbearing potential includes both pre-menopausal women and women within the first 2 years of the onset of menopause - Effective methods of birth control include: surgically sterile, barrier device (condom, diaphragm), contraceptive coil, abstinence; oral contraceptives (OCPs) alone are not considered an effective method - Known human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy are ineligible PRIOR CONCURRENT THERAPY: - See Disease Characteristics - No concomitant drugs that prolong the QTc interval - Time elapsed from previous therapy must be ≥ 3 weeks except for prior tyrosine kinase inhibitor therapy, which can be ≥ 7 days; patients must be recovered from the effects of any prior surgery, radiotherapy, or systemic therapy - No patients who are receiving any other investigational agents or other anti-cancer therapies other than those administered in this study during protocol treatment - Use of the potent CYP1A2 inhibitors ciprofloxacin and fluvoxamine are prohibited; other less potent CYP1A2 inhibitors/inducers are not excluded - No prior treatment with another kinase inhibitor targeting IGF-1R pathway - Use of drugs that have a known risk of causing Torsades de Pointes (TdP) are prohibited within 14 days prior to initiation of OSI-906 - Patients with a history of solid organ transplant are ineligible - Patients requiring palliative radiotherapy will be discontinued from study drug - Surgery done for progressive symptom management will be considered evidence of progressive disease and patients will be removed from study - Patients that are deemed appropriate for surgical debulking because of response or prolonged stable disease will be allowed to undergo resection without being removed from study as long as: - They do not undergo complete resection - They have had stable or responding disease for > 9 months - Patients who undergo surgical resection prior to 9 months who do not have evidence of progressive disease will be removed from study
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