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