This phase I trial studies the side effects and best dose of EphA2 siRNA in treating patients with solid tumors that have spread to other places in the body and usually cannot be cured or controlled with treatment (advanced) or have come back after a period of improvement (recurrent). EphA2-targeting DOPC-encapsulated siRNA may slow the growth of tumor cells by shutting down the activity of a gene that causes tumor growth.
PRIMARY OBJECTIVES: I. To determine the safety and tolerability (toxicity profile) of EphA2-targeting DOPC-encapsulated siRNA (EphA2 siRNA) delivered via neutral liposome (1,2-dioleoyl-sn-glycero-3-phosphatidylcholine or DOPC) administered intravenously in patients with advanced/recurrent malignancies. II. To determine the maximal tolerated dose (MTD) or maximal administered dose (MAD) using a modified toxicity probability interval (mTPI) design. SECONDARY OBJECTIVES: I. To determine efficacy (EphA2 expression modulation) at the MTD or MAD. II. To evaluate the effect of EphA2 siRNA-DOPC on tumor and endothelial cell apoptosis. III. To record the clinical activity (objective response, duration of response, and time to treatment progression) of intravenous (IV) EphA2 siRNA -DOPC. IV. To describe the symptom burden of patients receiving siRNA-EphA2-DOPC treatment. EXPLORATORY OBJECTIVES: I. To determine the pharmacokinetic profile of siRNA-EphA2-DOPC in blood. II. To determine the effect of EphA2 siRNA-DOPC on tumor perfusion, apparent diffusion, and metabolism by radiographic imaging (dynamic contrast-enhanced-magnetic resonance imaging \[DCE-MRI\], diffusion weighted \[DW\]-MRI and fludeoxyglucose F-18-positron emission tomography \[18FDG-PET\]). III. To determine the impact of EphA2 siRNA-DOPC on surrogate biomarkers in blood (cell-free deoxyribonucleic acid \[DNA\], plasma/serum markers \[vascular endothelial growth factor (VEGF), caveolin 1 (CAV1), soluble EphrinA1\], and exosomes). OUTLINE: This is a dose-escalation study. Patients receive EphA2-targeting DOPC-encapsulated siRNA IV over 120 minutes on days 1 and 4. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up periodically.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
49
Given IV
Correlative studies
Correlative studies
M D Anderson Cancer Center
Houston, Texas, United States
Toxicity profile of ephrin type-A receptor 2-targeting 1,2-dioleoyl-sn-glycero-3-phosphatidylcholine-encapsulated short-interfering ribonucleic acid
Will be graded according to Common Terminology Criteria for Adverse Events version 4.0
Time frame: Up to 5 years
Maximal tolerated dose or maximal administered dose
Will be defined as the dose level with the smallest difference among all tried doses. Will be determined using modified toxicity probability interval design.
Time frame: Up to 21 days
Percent of patients with ephrin type-A receptor 2 expression modulation, defined as a 50% decrease from baseline expression
Will be calculated along with 90% exact confidence intervals.
Time frame: Up to 5 years
Changes in ephrin type-A receptor 2 expression
Tissue effects will be assessed in core biopsy samples collected pre-treatment and course 1 day 2 or day 3 (timed with biomarker assessment).
Time frame: Baseline to up to day 4 of course 1
Changes in endothelial and tumor cell apoptosis conducted by terminal deoxynucleotidyl transferase dUTP nick end labeling assay
Analysis will be performed for both between (dose-effect) and within (changes from baseline) patient cohorts.
Time frame: Up to 5 years
Objective response
The best response recorded from the start of the treatment until disease progression/recurrence
Time frame: Up to 5 years
Duration of response
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measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).
Time frame: Up to 5 years
Time to treatment progression
The duration of time from study entry to time of recurrence or death, whichever occurs first.
Time frame: Up to 5 years