Breast Cancer Clinical Trial
Suberoylanilide Hydroxamic Acid in Treating Patients With Advanced Cancer
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.
Full 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
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There is 1 Location for this study
New York New York, 10021, United States
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