In this pilot study the investigators will treat all patients known with Peutz-Jeghers syndrome (PJS) who are diagnosed with advanced malignancies with everolimus 10mg daily until disease progression. Most patients with PJS have an inherited LKB1 mutation leading to aberrant m-TOR activity. Their risk to develop malignancies or intestinal polyps is probably related to this constitutive mTOR signaling. The hypothesis is that mTOR inhibition is an effective anticancer treatment in PJS patients with advanced malignancies.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
10mg daily orally
Academic Medical Center
Amsterdam, Netherlands
Erasmus Medical Center
Rotterdam, Netherlands
To determine the response rate of Everolimus in patients with advanced cancer and PJS.
Determined with regular radiological scans once every 9 weeks and measured following RECIST 1.1
Time frame: During treatment, expected avarage of 12 months
To determine the overall survival of PJS patients treated with everolimus for advanced malignancies
The time between date of entering the study and date of death will be collected.
Time frame: avarage of 18 months
To determine the time to progression of PJS patients treated with everolimus for advanced malignancies.
Determined with regular radiological scans once every 9 weeks and measured following RECIST 1.1
Time frame: During treatment, expected avarage of 12 months
To determine the safety and toxicity of Everolimus in this patient population
Number of Participants with Adverse Events determined by the CTCAE 4.0 as a Measure of Safety and Tolerability
Time frame: During treatment, expected avarage of 12 months
To determine if there is an association between measured drug blood levels and treatment outcome measured as response to treatment determined by RECIST
Drug trough levels will be taken once every 3 weeks and stored frozen until measurement at the end of the study
Time frame: During treatment, expected avarage of 12 months
To assess markers for activated mTOR pathway (including phospho-S6 and phospho-4E BP1) in all pre-treatment tissue specimens and collected specimens during treatment and correlate with response to treatment.
All patients who are willing to undergo extra tissue collection will have a tumor and where possible a polyp biopsy before treatment and for tumor biopsy in week 2 and 4 and for polyps once every 6 months during treatment for biomarker investigations. The activity of mTOR and its downstream targets will be measured in the tumor as well as the arborization pattern and apoptosis activity in the polyps.
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Time frame: During treatment, expected avarage of 12 months