This phase II trial is studying how well RO4929097 works in treating patients with advanced non-small cell lung cancer who have recently completed treatment with front-line chemotherapy. RO4929097 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.
PRIMARY OBJECTIVES: I. To assess clinical activity of the gamma-secretase inhibitor RO4929097 in patients with non-small cell lung cancer (NSCLC) who have recently completed front-line chemotherapy for advanced disease. II. To assess whether percent change in tumor size 6 weeks after initiation of RO4929097 correlates with tumor expression of Notch pathway markers and stem cell markers and/or with host genotype polymorphisms for selected components of the Notch pathway. SECONDARY OBJECTIVES: I. To assess whether response by RECIST criteria and TTF correlate with tumor expression of Notch pathway markers and stem cell markers and/or with host genotype polymorphisms for selected components of the Notch pathway. II. To compare tumor expression of Notch pathway and stem cell markers in this patient population with expression of these markers in tumors from our tumor bank from chemo-naive NSCLC patient. III. To correlate expression of Notch pathway markers with expression of stem cell markers. IV. To correlate host genotype polymorphisms for selected components of the Notch pathway and other stem cell pathways with tumor expression of Notch pathway and stem cell markers. V. To correlate the presence of tumor EGFR activating mutations with: a) notch expression, b) stem cell marker expression, and c) response to RO4929097. VI. To assess change in expression of Notch pathway markers and stem cell markers over the 3 days of therapy in a subset of patients and to correlate this with: a) subsequent response to therapy and TTF, b) changes of each marker over the first 3 days of therapy with changes in the other markers of interest and with changes in level of tumor cell apoptosis by TUNEL assay. VII. For patients in whom pre chemotherapy tissue can be obtained, we will compare the post chemotherapy (pre RO4929097) expression of Notch pathway and stem cell markers to those observed in the pre chemotherapy tissue. OUTLINE: Patients receive oral gamma-secretase inhibitor RO4929097 once daily on days 1-3, 8-10, and 15-17. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Blood and tumor tissue samples are collected for pharmacogenetic, pharmacodynamic, and biomarker studies by IHC, FISH, and TUNEL assay. After completion of study therapy, patients are followed up periodically.
Study Type
INTERVENTIONAL
Given orally
Correlative studies
Correlative studies
M D Anderson Cancer Center
Houston, Texas, United States
Response Rate by Response Evaluation Criteria in Solid Tumors (RECIST)
Percentage of participants with response per RECIST version 1.1: Complete Response (CR):Disappearance all target lesions. Any pathological lymph nodes with reduction in short axis to \<10 mm. Partial Response (PR): At least 30% decrease in sum of diameters of target lesions, reference baseline sum diameters. Progressive Disease (PD): At least 20% increase in sum of diameters of target lesions, reference smallest sum on study (includes baseline sum if that is smallest on study). In addition to relative increase of 20%, sum must demonstrate an absolute increase of at least 5 mm. (Note: appearance of 1 or more new lesions also considered progressions). Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, reference smallest sum diameters while on study. Best response recorded from treatment start until disease progression/recurrence (reference for progressive disease the smallest measurements recorded since treatment started).
Time frame: Response evaluation every 6 weeks (in addition to baseline scan, confirmatory scans approximately 6-7 (not less than 4) weeks following initial documentation of objective response). Expected follow up to 5 years, actual study period 9/2010 to 4/2014.
Percentage of Tumor Shrinkage as a Continuous Variable
Response is reported as a continuous variable, as % change in tumor size from baseline. Pearson and Spearman correlation coefficients will be used. Reported with 95% two-sided confidence intervals.
Time frame: 6 weeks
Proportion of Tumors Expressing the Expression of Tumor Notch Markers and Stem Cell Markers of Interest in This Population vs Tumor Bank Population
For participants having biopsies both before and after the agent, paired comparisons of post-therapy to pre-therapy results for the Notch IHC scores will be used. Researchers will assess changes from pre-therapy to post-therapy using a Wilcoxon Signed Rank Test (Wilcoxon rank sum tests). Spearman coefficients will be used to correlate tumor expression of Notch pathway markers with expression of stem cell markers.
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Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
6
Time frame: Up to day 3
Proportion of Tumors Expressing the Expression of Tumor Notch Markers and Stem Cell Markers of Interest in Participants With Versus Without a Particular Host Genotype Polymorphism
Wilcoxon rank sum tests will be used. For participants having biopsies both before and after the agent, paired comparisons of post-therapy to pre-therapy results for the Notch IHC scores will be used. Researchers will assess changes from pre-therapy to post-therapy using a Wilcoxon Signed Rank Test (Wilcoxon rank sum tests).
Time frame: Up to day 3
Proportion of Tumors Expressing the Expression of Tumor Notch Markers and Stem Cell Markers of Interest in Participants With vs Without Epidermal Growth Factor Receptor (EGFR) Activating Mutations
Wilcoxon rank sum tests will be used. Compared using Fisher Exact Tests. For participants having biopsies both before and after the agent, paired comparisons of post-therapy to pre-therapy results for the Notch IHC scores will be used. Researchers will assess changes from pre-therapy to post-therapy using a Wilcoxon Signed Rank Test (Sum Test). Spearman coefficients will be used to correlate tumor expression of Notch pathway markers with expression of stem cell markers.
Time frame: Up to day 3
Proportion of Tumors Expressing the Expression of Tumor Notch Markers and Stem Cell Markers of Interest in Participants With vs Without Response by RECIST Criteria
Wilcoxon rank sum tests will be used.
Time frame: Up to day 3
Proportion of Tumors Expressing the Expression of Tumor Notch Markers and Stem Cell Markers of Interest in Participants With vs Without Tumor Progression
Tumor Immunohistochemistry (IHC) scores for Notch pathway and stem cell markers used in comparison to tumor progression; and progression evaluated in using international criteria proposed by revised RECIST guideline (version 1.1). Changes in the largest diameter (unidimensional measurement) of the tumor lesions and the shortest diameter in the case of malignant lymph nodes are used in the RECIST criteria. Wilcoxon rank sum tests will be used. Compared using Fisher Exact Tests.
Time frame: Up to 3 months
Correlation of Tumor Shrinkage/Response With Biomarker Expression
Correlate percent change in tumor size at 6 weeks (or at time off study, if therapy is stopped earlier due to tumor progression) with tumor Immunohistochemistry (IHC) scores for Notch pathway and stem cell markers; Tumor % shrinkage with RO4929097 will correlate with pre-therapy tumor expression of Notch pathway members, with expression of stem cell markers, and with changes in these over the first cycle of therapy.
Time frame: 6 weeks
Progression-free Survival
Time from initiation of study drug until death, progression of tumor, or for worsening of tumor that did not meet RECIST 1.1 criteria but that did require discontinuation of therapy, assessed up to 5 years
Time frame: Baseline up to 5 years