Intermittent Selumetinib for Uveal Melanoma

  • STATUS
    Recruiting
  • End date
    Sep 27, 2022
  • participants needed
    28
  • sponsor
    Richard D. Carvajal
Updated on 27 March 2021
platelet count
cancer
measurable disease
karnofsky performance status
liver disease
neutrophil count
alopecia
mek inhibitor
spiral ct scan

Summary

The purpose of this study is to find out what effects, good and/or bad, intermittent dosing of the drug Selumetinib will have on subjects with uveal melanoma. Selumetinib is a drug that blocks (or turns off) methyl ethyl ketone (MEK), a protein activated in some uveal melanoma cells. Selumetinib is a MEK inhibitor. Blocking MEK may stop the cancer from growing.

Description

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults, and arises from melanocytes within the choroid plexus of the eye. The development of metastasis is common and occurs in approximately 50% of patients with posterior UM within 15 years of initial diagnosis and treatment. As no effective systemic therapy has yet been identified for this disease, outcomes for metastatic UM are poor with a median survival of 12 months.

There is no FDA approved therapy for patients with advanced UM. Studies have shown that inhibition of the Mitogen-activated protein kinase (MAPK) pathway with the MEK inhibitor selumetinib (hyd-sulfate AZD6244) is an effective therapy for uveal melanoma but despite this treatment, cures are not achieved. Although drugs such as selumetinib have been studied when patients take the treatment every day, research has shown that in some cases, it may be better to use the treatment on an intermittent schedule. Such a strategy may reduce the side effects, allow higher doses of the drug to be used, more completely block the MAPK pathway, and prevent the development of drug resistance mechanisms within the tumor.

Details
Condition Uveal Melanoma
Treatment Selumetinib
Clinical Study IdentifierNCT02768766
SponsorRichard D. Carvajal
Last Modified on27 March 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Histopathologically confirmed diagnosis of metastatic or unresectable uveal melanoma. Note - Documentation of mutation status for uveal melanoma will not be required prospectively given the high rate of GNAQ/11 mutations (>90%) in this population
Able to provide informed consent prior to initiation of study
Age 18 years old
Measurable indicator lesion by RECIST v1.1
Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as 20 mm with conventional techniques or as 10 mm with spiral CT scan, MRI, or calipers by clinical exam
Karnofsky Performance Status 60% or Eastern Cooperative Oncology Group (ECOG) 2
Ability to take oral medications
All clinically significant toxicities from prior therapy must be grade 1 (with the exception of alopecia)
Organ and marrow function and laboratory values as follows
Adequate marrow function
absolute neutrophil count (ANC) >1500 cells/mm3
platelet count >100,000/mm3
hemoglobin >9.0g/dL
Adequate hepatic function
Angiotensin Sensitivity Test/alternative (AST/ALT)<2.5x upper limit of normal if no documented liver disease or <5x upper limit of normal if documented liver disease
Total bilirubin <1.5X upper limit of normal unless known diagnosis of Gilbert's disease
Alkaline phosphatase <2.5x upper limit of normal if no documented liver disease or <6x upper limit of normal if documented liver or bone disease
Creatinine clearance 60 mL/min/1.73 m2 for patients with creatinine levels above institutional normal
Negative pregnancy test (serum or urine) for women of child bearing potential
The effects of selumetinib on the developing human fetus are unknown. 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 4 weeks after study discontinuation. 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 selumetinib administration

Exclusion Criteria

Patients who have had chemotherapy or immunotherapy within 4 weeks or radiation therapy within 2 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
Patients who are receiving any other investigational agents concurrently. Palliative radiation therapy will be allowed as long as the patient meets all other eligibility criteria
Have had recent major surgery within a minimum 4 weeks prior to starting study treatment, with the exception of surgical placement for vascular access
History of allergic reactions attributed to compounds of similar chemical or biologic composition to selumetinib
Every effort must be made to avoid the use of a concomitant medication that can prolong the corrected QT (QTc) interval while receiving selumetinib (hyd-sulfate AZD6244). If the patient cannot discontinue medications that prolong QTc interval while receiving selumetinib, close cardiac monitoring should be performed
Patients with QTc interval >450 msecs or other factors that increase the risk of QTc prolongation or arrhythmic events (ex. Heart failure, hypokalemia, family history of long QT syndrome) including heart failure that meets New York Heart Association (NYHA) class III and IV definitions (see Appendix A) are excluded
Prior or current cardiomyopathy including but not limited to the following: known hypertrophic cardiomyopathy, known arrhythmogenic right ventricular cardiomyopathy, previous moderate or severe impairment of left ventricular systolic function (LVEF <45% on echocardiography or equivalent on MuGA) even if full recovery has occurred
Atrial fibrillation with a ventricular rate >100 bpm on ECG at rest
Baseline Left ventricular ejection fraction (LVEF) below the LLN or <55% measured by echocardiography or institution's lower limit of normal (LLN) for MUGA
Severe valvular heart disease
Uncontrolled Angina - Canadian Cardiovascular Society grade II-IV despite medical therapy
Acute coronary syndrome within 6 months prior to starting treatment
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 because selumetinib may be teratogenic or have abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with selumetinib, breastfeeding should be discontinued if the mother is treated with selumetinib
HIV positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with selumetinib
Prior treatment with a MEK, Ras or Raf inhibitor
History of current evidence/risk of retinal vein occlusion (RVO) or retinal pigment epithelial detachment (RPED) in the eye unaffected by uveal melanoma; intraocular pressure (IOP) >21mmgHG or uncontrolled glaucoma
History of interstitial lung disease or pneumonitis
Patients with known Hepatitis B or C
Refractory nausea and vomiting, active gastrointestinal disease (e.g. inflammatory bowel disease), or significant bowel resection that would preclude adequate absorption
Patients taking vitamin E supplements while on study
Have known or suspected brain metastases or spinal cord compression, unless the condition has been asymptomatic, has been treated with surgery and / or radiation, and has been stable for at least 4 weeks prior to the first dose of study medication
Any unresolved toxicity CTCAE Grade 2 from previous anti-cancer therapy, except for alopecia
Have evidence of any other significant clinical disorder or laboratory finding that, as judged by the investigator, makes it undesirable for the patient to participate in the study
Patients being actively treated for a secondary malignancy
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