Clinical Trials

MainTitle

Paclitaxel and Carboplatin in Treating Patients With Metastatic or Recurrent Solid Tumors and HIV Infection

This study has been terminated
( Inadequate accrual rate )

Sponsor
AIDS Malignancy Consortium

Collaborator
National Cancer Institute (NCI)
The EMMES Corporation
University of Arkansas

Information provided by (Responsible Party)
AIDS Malignancy Consortium
ClinicalTrials.gov Identifier
NCT01249443

First received: November 25, 2010
Last updated: August 23, 2017
Last Verified: August 2017
History of Changes
Purpose

Purpose

This phase I clinical trial is studying the side effects and the best dose of vorinostat when given together with paclitaxel and carboplatin in treating patients with metastatic or recurrent solid tumors and human immunodeficiency virus (HIV) infection. Vorinostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as paclitaxel and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving vorinostat together with paclitaxel and carboplatin may kill more tumor cells.

NOTE: An administrative decision was made by NCI to halt further study of vorinostat in this specific patient population as of February 1, 2013. No patients remain on vorinostat. Going forward this study will determine the safety and tolerability of the paclitaxel and carboplatin combination in this patient population.

Condition Intervention Phase
HIV Infection
Recurrent Anal Cancer
Recurrent Breast Cancer
Recurrent Esophageal Cancer
Recurrent Gastric Cancer
Recurrent Metastatic Squamous Neck Cancer With Occult Primary
Recurrent Non-small Cell Lung Cancer
Recurrent Ovarian Epithelial Cancer
Recurrent Salivary Gland Cancer
Recurrent Squamous Cell Carcinoma of the Hypopharynx
Recurrent Squamous Cell Carcinoma of the Larynx
Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity
Recurrent Squamous Cell Carcinoma of the Nasopharynx
Recurrent Squamous Cell Carcinoma of the Oropharynx
Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity
Recurrent Verrucous Carcinoma of the Larynx
Recurrent Verrucous Carcinoma of the Oral Cavity
Salivary Gland Squamous Cell Carcinoma
Stage IV Anal Cancer
Stage IV Breast Cancer
Stage IV Esophageal Cancer
Stage IV Gastric Cancer
Stage IV Non-small Cell Lung Cancer
Stage IV Ovarian Epithelial Cancer
Stage IV Salivary Gland Cancer
Stage IV Squamous Cell Carcinoma of the Hypopharynx
Stage IV Squamous Cell Carcinoma of the Larynx
Stage IV Squamous Cell Carcinoma of the Lip and Oral Cavity
Stage IV Squamous Cell Carcinoma of the Nasopharynx
Stage IV Squamous Cell Carcinoma of the Oropharynx
Stage IV Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity
Stage IV Verrucous Carcinoma of the Larynx
Stage IV Verrucous Carcinoma of the Oral Cavity
Unspecified Adult Solid Tumor, Protocol Specific

Drug : vorinostat
Other : diagnostic laboratory biomarker analysis
Other : pharmacological study
Drug : carboplatin
Drug : paclitaxel
Phase 1

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 1 Study of Paclitaxel and Carboplatin in Solid Tumors (With Focus on Upper Aerodigestive Cancers) in Persons With HIV Infection

Further study details as provided by AIDS Malignancy Consortium:

Primary Outcome Measures

  • Incidence of adverse events during paclitaxel and carboplatin treatment according to dose-limiting toxicities (DLTs), graded using Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4.0) [ Time Frame: 21 days ]
Secondary Outcome Measures:
  • Response rates in patients with lung, head and neck, and esophageal cancers assessed by Response Evaluation Criteria for Solid Tumors (RECIST) 1.1 [ Time Frame: Up to 3 years ]
    For each stratum, binomial proportions and their 95% confidence intervals will be used to preliminarily assess response rates of the therapeutic combination in lung, head and neck, and esophageal cancers.
  • Effects of therapy on HIV viral load and CD4 cell count [ Time Frame: Baseline and at 6, 12, and 18 weeks ]

Enrollment: 17
Study Start Date: November 2013
Estimated Study Completion Date: January 2020
Estimated Primary Completion Date: May 2016 (Final data collection date for primary outcome measure)

Arms Assigned Interventions
Experimental: Treatment (carboplatin, paclitaxel)
Patients receive paclitaxel IV over 3 hours and carboplatin IV over 30 minutes on day 3. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Before February 1, 2013, patients also received vorinostat PO once daily on days 1-5 with paclitaxel and carboplatin.
Drug: vorinostat

Given PO

Other Name:
  • L-001079038
  • SAHA
  • suberoylanilide hydroxamic acid
  • Zolinza

Other: diagnostic laboratory biomarker analysis

Correlative studies

Other: pharmacological study

Correlative studies

Other Name: pharmacological studies
Drug: carboplatin

Given IV

Other Name:
  • Carboplat
  • CBDCA
  • JM-8
  • Paraplat
  • Paraplatin

Drug: paclitaxel

Given IV

Other Name:
  • Anzatax
  • Asotax
  • TAX
  • Taxol

Detailed Description:

PRIMARY OBJECTIVES:
I. To determine the safety and tolerability of vorinostat in combination with paclitaxel and carboplatin in solid tumor patients with HIV infection.
II. To determine the maximal tolerated dose (MTD) of the combination in this patient population.
*NOTE: An administrative decision was made by Cancer Therapy Evaluation Program (CTEP) to halt further study of vorinostat in this specific patient population as of February 1, 2013, and no patients remain on vorinostat. The primary objective going forward will determine the safety and tolerability of the paclitaxel and carboplatin combination in this patient population.
SECONDARY OBJECTIVES:
I. To preliminarily assess response rates of the therapeutic combination in lung, head and neck, and esophageal cancers.
II. To evaluate the pathological characteristics of non-acquired immunodeficiency syndrome (AIDS) defining cancers of the upper aerodigestive tract.
III. To determine the presence and oncogenic activity of human papillomavirus (HPV) infection in tumor tissues and to correlate HPV infection with clinical outcomes.
IV. To investigate possible pharmacokinetic interactions between paclitaxel and antiretroviral therapy in persons with HIV infection.
OUTLINE: This is a multicenter, dose-escalation study of vorinostat followed by an expansion cohort study.
Patients receive vorinostat orally (PO) once daily on days 1-5 and paclitaxel intravenously (IV) over 3 hours and carboplatin IV over 30 minutes on day 3. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
Some patients undergo blood sample collection at baseline and periodically during course 1 for pharmacokinetic studies and HIV viral load analysis.
Note: An administrative decision was made by CTEP to halt further study of vorinostat in this specific patient population as of February 1, 2013. No patients remain on vorinostat. The primary objective going forward will determine the safety and tolerability of the paclitaxel and carboplatin combination in this patient population, without vorinostat. The information pertaining to vorinostat is for historical purposes.
After completion of study therapy, patients are followed up every 6 months for up to 3 years.

Eligibility

Eligibility

Ages Eligible for Study: 18 Years and older  
Sexes Eligible for Study: All  
Accepts Healthy Volunteers: No  

Criteria

Inclusion Criteria:

  • Patients must have known HIV infection and histologically confirmed solid malignancy that is metastatic or unresectable and is therefore incurable; although the focus of this trial will be on upper aerodigestive cancers (non-small cell lung cancer, head and neck squamous cell carcinoma, and non-gastroesophageal junction esophageal cancer), patients with other incurable solid tumor with disease potentially sensitive to carboplatin and/or taxanes (including but not limited to salivary gland cancer, gastric cancer, breast cancer, ovarian cancer, or anal cancer, BUT excluding Kaposi sarcoma), will be eligible
  • Up to 1 prior systemic therapy regimen will be permitted for palliative treatment of metastatic or unresectable relapsed disease; however, previous chemotherapy delivered with curative-intent (i.e., chemoradiotherapy or adjuvant [postoperative] chemotherapy at a time disease was considered potentially curable) will be permitted; prior taxane (including paclitaxel or docetaxel) and/or platinum exposure will be permitted; however, patients must not experience disease progression within 3 months of platinum-based therapy; at least 4 weeks must have elapsed since prior chemotherapy or radiation therapy, 6 weeks if the last regimen included carmustine (BCNU) or mitomycin C; toxicities from prior anticancer therapy must have recovered to =< Grade 1
  • Serologic documentation of HIV infection at any time prior to study entry, as evidenced by positive enzyme-linked immunosorbent assay (ELISA), positive Western Blot, or any other federally approved licensed HIV test; a positive HIV viral load prior to study entry will also be permitted
  • Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 50%)
  • Documented life expectancy of greater than 12 weeks
  • Leukocytes >= 3,000/mcL
  • Absolute neutrophil count >= 1,500/mcL
  • Platelets >= 100,000/mcL
  • Total bilirubin within normal institutional limits
  • Aspartate aminotransferase (AST)(serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT)(serum glutamic-pyruvic transaminase [SGPT]) =< ~#o1~5 X institutional upper limit of normal
    • Creatinine within normal institutional limits OR creatinine clearance >= 50 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal
    • Additionally, serum magnesium and potassium must be within institutional normal limits, and a CD4 count > 100/mcL will be required within 2 weeks of study participation
    • Presence of at least one measureable tumor lesion is required
    • Participating patients must receive medically appropriate care and treatment for HIV infection, including antiretroviral medications, when clinically indicated, and should be under the care of a physician experienced in HIV management; with the exception of treatment with zidovudine and stavudine, patients will be eligible regardless of antiretroviral regimen (no antiretroviral therapy, nonnucleoside reverse transcriptase inhibitors [NNRTI]-based therapy, or protease inhibitor based therapy), provided there is no intention to initiate therapy or the regimen has been stable for at least 4 weeks with no intention to change the regimen within 8 weeks following study entry; the exact regimen used for HIV therapy will be captured on Case Report Forms; as study-specific (antiretroviral therapy-based) strata fill, however, only patients fitting the remaining open strata will be accrued
    • Because histone deacetylase inhibitors as well as other therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, during the duration of study participation, and for at least 3 months following study completion; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately; women of child-bearing potential must have a negative pregnancy test within 7 days before initiation of study drug dosing; post menopausal women must be amenorrheic for at least 12 months to be considered of non-childbearing potential; (Note: A woman of childbearing potential is one who is biologically capable of becoming pregnant; this includes women who are using contraceptives or whose sexual partners are either sterile or using contraceptives)
    • Ability to understand and the willingness to sign a written informed consent document; as the correlative studies are critical to the clinical and scientific value of the trial, CD4 count/HIV viral load determinations will be required, and participation in the tumor-based correlative studies will be strongly recommended; additionally, investigators MUST request sample donation to the AIDS Cancer Specimen Resource (ACSR); however, the patient may refuse sample donation; patients accrued to the expansion phase of the study will be required to undergo pharmacokinetic sampling
    • Subjects must in the opinion of the Investigator be capable of complying with this protocol

    • Exclusion Criteria:
    • Patients who have had 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 (toxicities not improved to =< Grade 1) due to agents administered more than 4 weeks earlier; additionally, patients experiencing disease progression within 3 months of platinum-based therapy will be excluded from trial participation
    • Due to availability of effective first- and second-line therapies (as well as disease-specific clinical trials), patients with diagnosis of active Kaposi sarcoma will be excluded from study participation; however, persons with other active malignancy with prior history of Kaposi sarcoma can be considered for participation at the discretion of the Study Chair
    • Patients may not be receiving any other investigational agents
    • Patients with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events
    • History of allergic reactions attributed to compounds of similar chemical or biologic composition to the study agents used in study (including hypersensitivity to paclitaxel, Cremophor, or platins)
    • For subjects assigned to take vorinostat, inability to take oral medications; vorinostat capsules must be administered whole; note: this criterion does NOT apply to subjects treated on the Expansion Cohort (accruals post February 1, 2013)
    • As ketoconazole may inhibit paclitaxel metabolism, patients receiving ketoconazole for any treatment indication are ineligible; patients receiving any other medications or substances that are inhibitors or inducers of CYP450 enzymes will be eligible; however, use all such medications or substances must be documented in the Case Report Forms
    • For subjects assigned to take vorinostat, prior exposure to vorinostat or other known histone deacetylase (HDAC) inhibitors for cancer therapy; patients should not have taken valproic acid, another histone deacetylase inhibitor, for at least 2 weeks prior to study enrollment; note: this criterion does NOT apply to subjects treated on the Expansion Cohort (accruals post February 1, 2013)
    • Since zidovudine and stavudine have potential for severe hematological toxicity potentially overlapping with toxicities of the study therapy, treatment with these agents will be disallowed
    • Due to potential toxicity associated with study therapy (particularly with paclitaxel), patients with peripheral neuropathy > Grade 1 will be excluded from study participation
    • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, opportunistic infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements; patients with HIV infection will be eligible provided they meet the criteria specified; patients with known Hepatitis B infection should be screened for active disease prior to study participation; patients with chronic Hepatitis C infection will be eligible at the discretion of the treating investigator
    • Pregnant women are excluded from this study and women who become pregnant while on
    study must be immediately discontinued; women who are breastfeeding will not be eligible for study participation

    contacts and locations

    Contacts and Locations

    Choosing to participate in a study is an important personal decision.Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.For general information, see Learn About Clinical Studies.

    Please refer to this study by its ClinicalTrials.gov identifier: NCT01249443

    Locations

    United States, California
    UC San Diego Moores Cancer Center
    La Jolla, California, United States, 92093
    UCLA Center for Clinical AIDS Research and Education
    Los Angeles, California, United States, 90035
    United States, District of Columbia
    Lombardi Comprehensive Cancer Center at Georgetown University
    Washington, D.C., District of Columbia, United States, 20057
    United States, Florida
    University of Miami Miller School of Medicine-Sylvester Cancer Center
    Miami, Florida, United States, 33136
    United States, Illinois
    John H. Stroger Jr. Hospital of Cook County
    Chicago, Illinois, United States, 60612
    United States, Massachusetts
    Boston Medical Center
    Boston, Massachusetts, United States, 02118
    United States, Missouri
    Siteman Cancer Center at Washington University
    Saint Louis, Missouri, United States, 63110
    United States, New York
    Montefiore Medical Center
    The Bronx, New York, United States, 10467-2490
    United States, Pennsylvania
    Pennsylvania Oncology Hematology Associates
    Philadelphia, Pennsylvania, United States, 19106
    United States, Washington
    Benaroya Research Institute at Virginia Mason
    Seattle, Washington, United States, 98101-2795

    Sponsors and Collaborators

    AIDS Malignancy Consortium
    National Cancer Institute (NCI)
    The EMMES Corporation
    University of Arkansas

    Investigators

    Principal Investigator: Missak Haigentz AIDS Associated Malignancies Clinical Trials Consortium
    More Information

    More Information


    Responsible Party: AIDS Malignancy Consortium  
    ClinicalTrials.gov Identifier: NCT01249443   History of Changes  
    Other Study ID Numbers: AMC-078  
      NCI-2011-02511  
      CDR0000689900  
      AMC-078  
      AMC-078  
      U01CA121947  
    Study First Received: November 25, 2010  
    Last Updated: August 23, 2017  

    Studies a U.S. FDA-regulated Drug Product: Yes  
    Studies a U.S. FDA-regulated Device Product: No  
    Product Manufactured in and Exported from the U.S.: No  

    Additional relevant MeSH terms:
    Carcinoma
    Breast Neoplasms
    Infection
    Communicable Diseases
    Lung Neoplasms
    Carcinoma, Non-Small-Cell Lung
    Carcinoma, Squamous Cell
    HIV Infections
    Acquired Immunodeficiency Syndrome
    Stomach Neoplasms
    Esophageal Neoplasms
    Laryngeal Diseases
    Neoplasms, Glandular and Epithelial
    Ovarian Neoplasms
    Laryngeal Neoplasms
    Oropharyngeal Neoplasms
    Carcinoma, Verrucous
    Nasopharyngeal Neoplasms
    Salivary Gland Neoplasms
    Paranasal Sinus Neoplasms
    Anus Neoplasms
    Head and Neck Neoplasms
    Neoplasms, Unknown Primary
    Paclitaxel
    Vorinostat
    Albumin-Bound Paclitaxel
    Carboplatin

    ClinicalTrials.gov processed this data on December 15, 2017
    This information is provided by ClinicalTrials.gov.