Clinical Trials /

Trial of the Combination of Bortezomib and Clofarabine in Adults With Relapsed Solid Tumors

NCT02211755

Description:

Background: - Researchers want to develop better ways to treat cancer. In this study, they will give people with cancer two drugs. These drugs have been used on their own to treat some blood cell cancers. Objectives: - To test the safety and efficacy of the drug combination of bortezomib and clofarabine. Eligibility: - Adults age 18 and over with advanced cancer that has progressed after receiving standard treatment or that has no effective therapy. Design: - Participants will be screened with medical history, physical exam, and scans to measure their tumors. They will also have heart, blood, and urine tests. All of these may be done by their regular doctors. - Participants will get the study drugs in 21-day cyles. They will stay at the clinic for week 1 of every cycle, then have 2 weeks off. <TAB>- Bortezomib will be injected under the skin on days 1 and 4. <TAB>- Clofarabine will be injected in a vein for days 1-5. - During cycle 1 only, participants will go to the clinic or their doctor to have a physical exam and blood tests at the start of the second and third week. - Participants will have clinical evaluations throughout the study, including before receiving treatment and then before the start of each cycle. - Participants may stay in the study as long as they are tolerating the drugs and their tumor is not getting worse. - Participants will have follow-up for 30 days after the last dose of study drugs. - The first part of this study tests the safety of different doses of clofarabine and bortezomib. - The second part of this study involves a separate group of participants who will undergo mandatory research biopsies to learn more about the effects of clofarabine and bortezomib on cancer cells.

Related Conditions:
  • Lymphoma
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Trial of the Combination of Bortezomib and Clofarabine in Adults With Relapsed Solid Tumors
  • Official Title: Phase I Trial of the Combination of Bortezomib and Clofarabine in Adults With Refractory Solid Tumors, Lymphomas, or Myelodysplastic Syndromes

Clinical Trial IDs

  • ORG STUDY ID: 140161
  • SECONDARY ID: 14-C-0161
  • NCT ID: NCT02211755

Conditions

  • Neoplasms
  • Myelodysplastic Syndromes
  • Lymphomas

Interventions

DrugSynonymsArms
Bortezomib plus Clofarabine1

Purpose

Background: - Researchers want to develop better ways to treat cancer. In this study, they will give people with cancer two drugs. These drugs have been used on their own to treat some blood cell cancers. Objectives: - To test the safety and efficacy of the drug combination of bortezomib and clofarabine. Eligibility: - Adults age 18 and over with advanced cancer that has progressed after receiving standard treatment or that has no effective therapy. Design: - Participants will be screened with medical history, physical exam, and scans to measure their tumors. They will also have heart, blood, and urine tests. All of these may be done by their regular doctors. - Participants will get the study drugs in 21-day cyles. They will stay at the clinic for week 1 of every cycle, then have 2 weeks off. <TAB>- Bortezomib will be injected under the skin on days 1 and 4. <TAB>- Clofarabine will be injected in a vein for days 1-5. - During cycle 1 only, participants will go to the clinic or their doctor to have a physical exam and blood tests at the start of the second and third week. - Participants will have clinical evaluations throughout the study, including before receiving treatment and then before the start of each cycle. - Participants may stay in the study as long as they are tolerating the drugs and their tumor is not getting worse. - Participants will have follow-up for 30 days after the last dose of study drugs. - The first part of this study tests the safety of different doses of clofarabine and bortezomib. - The second part of this study involves a separate group of participants who will undergo mandatory research biopsies to learn more about the effects of clofarabine and bortezomib on cancer cells.

Detailed Description

      BACKGROUND:

      The proteasome inhibitor bortezomib and purine nucleoside metabolic inhibitor clofarabine
      demonstrated greater than additive activity in combination in preclinical xenograft models,
      justifying the clinical evaluation of this combination for its antitumor activity

      OBJECTIVES:

        -  To establish the safety, tolerability, and maximum tolerated dose (MTD) of bortezomib
           and clofarabine in patients with refractory solid tumors, lymphomas, or myelodysplastic
           syndromes (MDS)

        -  To determine the molecular effects of the clofarabine-bortezomib combination on
           biomarkers of cell death and DNA damage in tumor biopsy tissue

        -  To explore the mechanism of action of the bortezomib and clofarabine combination by

      examining markers of DNA damage and apoptosis in tumor cells before and after treatment

      -To characterize the changes in MDS residual disease burden that occur with bortezomib

      and clofarabine treatment

      ELIGIBILITY:

        -  Study participants must have histologically confirmed solid tumors or lymphomas or
           myelodysplastic syndromes that have progressed on standard therapy known to prolong
           survival or for which no standard treatment options exist

        -  Age greater than or equal to 18

        -  No major surgery, radiation, or chemotherapy within 3 weeks prior to entering the study

        -  Adequate organ function

      STUDY DESIGN:

        -  This is an open-label Phase I trial

        -  The starting dose of clofarabine will be 1 mg/m2 administered intravenously on days 1
           through 5 of a 21-day cycle; bortezomib will be administered at 0.8 mg/m2 subcutaneously
           on days 1 and 4 of a 21-day cycle.

        -  Dose escalation will follow a 3+3 design, with dose limiting toxicities defined during
           cycle 1.

        -  Dose escalation will proceed in cohorts comprised of two separate groups of patients
           (one group of patients with solid tumor/lymphoma and one group of patients with MDS),
           with at least 1 from each group, until hematologic DLT or the second grade 2 hematologic
           toxicity is observed, at which point, dose escalation will proceed separately for two
           cohorts: (1) patients with solid tumors/lymphoma and (2) patients with MDS.

        -  Up to 33 patients will be accrued to a PD expansi n cohort at the MTD to further assess
           pharmacodynamic endpoints in tumor and blood.
    

Trial Arms

NameTypeDescriptionInterventions
1ExperimentalStarting doses are clofarabine at 1 mg/m(2) IV on days 1 through 5 of a 21-day cycle, and bortezomib at 0.8 mg/m2 subcutaneously on days 1 and 4 of a 21-day cycle.
  • Bortezomib plus Clofarabine

Eligibility Criteria

        -  INCLUSION CRITERIA

        Patients must have:

        3.1.1 Histologically confirmed solid tumors that have progressed on standard therapy known
        to prolong survival or for which no standard treatment options exist, or

        3.1.1.2 histologically confirmed myelodysplastic syndrome that has progressed on standard
        therapy or for which no standard treatment options exist. (As of Amendment L, January 2021,
        the MDS cohort has been closed due to low accrual.)

        3.1.2 Age greater than or equal to18 years.

        3.1.3 ECOG performance status less than or equal to 2.

        3.1.4 Life expectancy of greater than 3 months

        3.1.5 Patients must have normal organ and marrow function as defined below:

          -  Absolute neutrophil count: greater than or equal to 1,500/mcL for solid tumors and
             lymphomas only

          -  Platelets: greater than or equal to 100,000/mcL for solid tumors and lymphomas only

          -  Total bilirubin: less than or equal to 1.5 X institutional ULN

          -  AST(SGOT)/ALT(SGPT): less than or equal to 3 X institutional upper limit of normal

        OR

        less than 5 X institutional upper limit of normal for

        -creatinine: ess than or equal to 1.5 X institutional ULN

        OR

        creatinine clearance greater than or equal to 60 mL/min/1.73 m2 for patients with
        creatinine levels >1.5 mg/dL

        3.1.6 Bortezomib and clofarabine have both been assigned to pregnancy category D by the
        FDA. For this reason, 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 and for the duration of study participation and for at least 3 months after dosing
        with study drugs ceases. Should a woman become pregnant or suspect she is pregnant while
        she or her partner is participating in this study, she should inform her treating physician
        immediately. Men treated or enrolled on this protocol must also agree to use adequate
        contraception prior to the study, for the duration of study participation, and 3 months
        after completion of study drug administration.

        3.1.7 Patients must have completed any chemotherapy, radiation therapy, or biologic therapy
        greater than or equal to 3 weeks (or greather than or equal to 5 half-lives, whichever is
        shorter) prior to entering the study. Patients must be greater than or equal to 2 weeks
        since any prior administration of a study drug in a Phase 0 or equivalent study and be
        greater than or equal to 1 week from palliative radiation therapy (patients on study may be
        eligible for palliative radiotherapy to non-targeted lesions after 2 cycles of therapy at
        the PI s discretion). Patients must have recovered to eligibility levels from prior
        toxicity or adverse events. Treatment with bisphosphonates is permitted.

        3.1.8 For patients enrolled on the expansion cohort, patients must have tumor amenable to
        biopsy (excisional or incision biopsies of skin or H & N lesions under visualization) and
        willingness to undergo tumor biopsies.

        EXCLUSION CRITERIA

        3.2.1 Sensory/motor neuropathy greater than or equal to Grade 2

        3.2.2 QTc interval (Fridericia formula) > 450 msec for men or > 470 msec for women at study
        entry; history of congenital long QT syndrome

        3.2.3 Patients who are receiving any other investigational agents.

        3.2.4 Patients with active brain metastases, CNS disease, or carcinomatous meningitis are
        excluded from this clinical trial. Patients with treated brain metastases, whose brain
        metastatic disease has remained stable for greater than or equal to 4 weeks without
        requiring steroid and anti-seizure medication, are eligible to participate.

        3.2.5 History of allergic reactions attributed to compounds of similar chemical or biologic
        composition to study drugs. Patients who have previously received either clofarabine or
        bortezomib will be excluded as this may affect accurate determination of the MTD.

        3.2.6 Uncontrolled intercurrent illness including, but not limited to, serious untreated
        infection, symptomatic respiratory failure/congestive heart failure, unstable angina
        pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit
        compliance with study requirements.

        3.2.7 Pregnant women are excluded from this study because bortezomib and clofarabine have
        been assigned to pregnancy category D by the FDA. Because there is an unknown but potential
        risk for adverse events in nursing infants secondary to treatment of the mother with the
        study drugs, breastfeeding should be discontinued prior to the first dose of study drug and
        women should refrain from nursing throughout the treatment period and for 3 months
        following the last dose of study drug.

        3.2.8 HIV-positive patients on combination antiretroviral therapy are ineligible because of
        possible pharmacokinetic interactions with study drugs.

        3.2.9 Both men and women of all races and ethnic groups are eligible for this trial.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Safety and MTD
Time Frame:Cycle 1 (21 days)
Safety Issue:
Description:To establish the safety, tolerability, and maximum tolerated dose (MTD) of bortezomib and clofarabine in patients with refractory solid tumors or lymphomas or myelodysplastic syndromes

Secondary Outcome Measures

Measure:Biomarkers of DNA damage and apoptosis in circulating tumor cells
Time Frame:Baseline, cycle 1 day 1, and cycle 2 day 1
Safety Issue:
Description:To determine the effects of the clofarabine-bortezomib combination on biomarkers of DNA damage and apoptosis in circulating tumor cells
Measure:Biomarkers of cell death and DNA damage in tumor biopsy tissue
Time Frame:Baseline, cycle 1 day 1, and cycle 2 day 4/day 5
Safety Issue:
Description:To determine the effects of the clofarabine-bortezomib combination on biomarkers of cell death and DNA damage in tumor biopsy tissue

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:National Cancer Institute (NCI)

Trial Keywords

  • Purine Nucleoside Inhibitor
  • Proteasome Inhibitor
  • Combination Treatment
  • Solid Tumors
  • Hematologic

Last Updated

August 19, 2021