To determine the maximum tolerated dose (MTD) and dose limiting toxicities (DLT) of the combination of temsirolimus and pemetrexed, as well as the response rate. The starting dose (Dose Level 1) and schedule of pemetrexed will be 500 mg/m\^2 given every 3 weeks and the starting dose (Dose Level 1) for temsirolimus will be 15 mg given weekly for 3 weeks, to complete 1 cycle. In subsequent cohorts, dose will be escalated or de-escalated. Enrollment to each cohort is based on toxicity experienced at that dose level.
* To determine the maximum tolerated dose (MTD) of temsirolimus that could be administered weekly in combination with pemetrexed. * To determine the dose-limiting toxicity (DLT) of temsirolimus and pemetrexed as well as other toxicities of this combination therapy. * To describe the response rate of the combination in patients with relapsed/refractory non-small cell lung cancer (NSCLC). * To describe phospho-Akt and phospho-S6 levels in circulating mononuclear cells before and after treatment. * To determine the response rates in patients with NSCLC when treated with temsirolimus and pemetrexed. * To evaluate progression-free survival in patients with NSCLC when treated with temsirolimus and pemetrexed. * To determine the one-year survival rates in patients with NSCLC when treated with temsirolimus and pemetrexed. * To describe phospho-Akt and phospho-S6 levels in circulating mononuclear cells before and after treatment.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
12
Washington University School of Medicine
St Louis, Missouri, United States
Phase I Only: Maximum Tolerated Dose (MTD) of Pemetrexed That Could be Administered Weekly in Combination With Temsirolimus
The starting dose and schedule of pemetrexed will be 500 mg/m2 given every 3 weeks and the starting dose for temsirolimus will be 15 mg given weekly for 3 weeks, to complete 1 cycle. In subsequent cohorts, dose will be escalated or de-escalated. Enrollment to each cohort is based on toxicity experienced at that dose level. The maximum tolerated dose (MTD) is defined as the dose level immediately below the dose level at which 2 patients of a cohort experience dose-limiting toxicity during the first cycle. Six patients will be enrolled at the maximum tolerated dose to ensure that no more than 2 DLTs occur at the MTD. Dose escalations will proceed until the MTD has been reached.
Time frame: Completion of first cycle by all enrolled patients in Phase I portion of study
Phase I Only: Maximum Tolerated Dose (MTD) of Temsirolimus That Could be Administered Weekly in Combination With Pemetrexed
The starting dose and schedule of pemetrexed will be 500 mg/m2 given every 3 weeks and the starting dose for temsirolimus will be 15 mg given weekly for 3 weeks, to complete 1 cycle. In subsequent cohorts, dose will be escalated or de-escalated. Enrollment to each cohort is based on toxicity experienced at that dose level. The maximum tolerated dose (MTD) is defined as the dose level immediately below the dose level at which 2 patients of a cohort experience dose-limiting toxicity during the first cycle. Six patients will be enrolled at the maximum tolerated dose to ensure that no more than 2 DLTs occur at the MTD. Dose escalations will proceed until the MTD has been reached.
Time frame: Completion of first cycle by all enrolled patients in Phase I portion of study
Phase I Only: Number of Participants Who Experience Dose-limiting Toxicities (DLT) of Temsirolimus and Pemetrexed
DLT will be defined as occurring within the first cycle of Phase I only and will be graded according to the Common Terminology Criteria for Adverse Events v 3.0 (CTCAE) * Any grade 3 or higher hematologic toxicity with the exception of anemia. * Any grade 3 or higher non-hematologic toxicity related to study therapy (except alopecia). * Grade 3 or 4 pneumonitis or esophagitis. * Treatment delay of temsirolimus for more than 14 consecutive days due to study-related toxicity. * Treatment delay of pemetrexed therapy for more than 14 consecutive days because of study-related toxicity.
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Time frame: Completion of first cycle (approximately 21 days)
Phase I and Phase II: Overall Response Rate (Complete Response + Partial Response)
* Only those patients who have measurable disease present at baseline, have received at least one cycle of therapy, and have had their disease re-evaluated will be considered evaluable for response. * Complete response (CR)-disappearance of all target lesions and disappearance of all non-target lesions and normalization of tumor marker level. * Partial response (PR)-at least a 30% decrease in the sum of the longest diameter (LD) of the target lesions taking as reference the baseline sum LD
Time frame: 2 years
Phase I Only: Phospho-Akt Levels in Circulating Mononuclear Cells
Time frame: Cycle 1 Day 1, one hour post completion of initial temsirolimus dose, and Cycle 1 Day 8
Phase I Only: Phospho-S6 Levels in Circulating Mononuclear Cells
Time frame: Cycle 1 Day 1, one hour post completion of initial temsirolimus dose, and Cycle 1 Day 8
Phase 2 Only: Progression-free Survival (PFS)
PFS is defined as the duration of time from start of treatment to time of progression.
Time frame: 2 years from completion of treatment
Phase 2 Only: Survival Rate
Time frame: 1 year after start of treatment
Phase 2 Only: Phospho-Akt Levels in Circulating Mononuclear Cells
Time frame: Cycle 1 Day 1, one hour post completion of initial temsirolimus dose, and Cycle 1 Day 8
Phase 2 Only: Phospho-S6 Levels in Circulating Mononuclear Cells Before and After Treatment
Time frame: Cycle 1 Day 1, one hour post completion of initial temsirolimus dose, and Cycle 1 Day 8