This phase I trial studies the side effects and best dose of trametinib with or without whole brain radiation therapy in treating patients with brain metastases. Trametinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Drugs, such as trametinib, may make tumor cells more sensitive to radiation therapy. Giving trametinib with whole brain radiation therapy may be a better treatment for brain metastases.
PRIMARY OBJECTIVES: I. To identify the maximally tolerated dose of trametinib to be used in combination with whole brain radiation therapy in patients with brain metastases. (Cohort A) II. To quantify trametinib in resected brain metastatic lesions utilizing high performance liquid chromatography/tandem mass spectrometry (LC/MS/MS) and compare to quantification of adjacent tissues: brain margin, arachnoid, and cerebrospinal fluid (CSF). (Cohort B) SECONDARY OBJECTIVES: I. To evaluate the tolerability and feasibility of the combination of trametinib and radiation therapy to brain for brain metastases. II. To evaluate the objective response rate per Response Evaluation Criteria in Solid Tumors (RECIST) criteria of combination trametinib and radiation therapy. III. To evaluate the local control rate, as measure from the time of study enrollment until the time of death. IV. To evaluate the neurologic progression-free survival, as measured from the time of study enrollment until the time of progression within the brain or death. V. To evaluate overall survival, as measured from the time of study enrollment until the time of death. TERTIARY OBJECTIVES: I. To quantify cyclin D1, p27, phosphorylated mitogen-activated protein kinase 1 (pERK)-1/2, phosphorylated v-akt murine thymoma viral oncogene homolog 1 (pAKT), phosphatase and tensin homolog gene (PTEN), phosphorylated mammalian target of rapamycin (pMTOR), phosphorylated ribosomal protein S6 kinase (pS6K), and ribosomal protein S6 (pS6) of resected metastatic brain lesions via quantitative immunohistochemistry (IHC) and compare to the IHC profile of the primary tumor. OUTLINE: This is a dose-escalation study of trametinib. Patients are assigned to 1 of 2 treatment cohorts. COHORT A: Patients receive trametinib orally (PO) once daily (QD) for 4 weeks. Beginning in week 2, patients undergo whole brain radiation therapy five days a week for 3 weeks. Treatment continues for 4 weeks in the absence of disease progression or unacceptable toxicity. COHORT B: Patients receive trametinib PO QD on days 1-14 followed by surgical resection of the tumor. After completion of study treatment, patients are followed up for 4 weeks, every 2 months for 1 year, every 3 months for 3 years, and then every 6 months thereafter.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
10
Correlative studies
Correlative studies
Undergo surgical resection of the tumor
Given PO
Undergo whole-brain radiation therapy
Ohio State University Comprehensive Cancer Center
Columbus, Ohio, United States
Frequency of dose-limiting toxicities (DLT), defined as the maximum dose level of trametinib where at most 1 of 6 patients experience DLT (Cohort A)
Frequency of DLTs will be assessed by assessed according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse (CTCAE) version 5.0. DLTs will be summarized by dose level.
Time frame: Up to 8 weeks
Quantification of trametinib in resected brain metastatic lesions utilizing high performance liquid chromatography/tandem mass spectrometry (Cohort B)
Trametinib quantification will also be completed in brain margin, arachnoid, and cerebrospinal fluid.
Time frame: Up to day 28
Overall tolerability and toxicity of the regimen, as assessed by adverse events and their grade and attribution for each dose level, graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse (CTCAE) version 5.0
Will summarize observed adverse events and their grade and attribution for each dose level, and patterns reflecting tolerability of the regimen explored through graphical analysis and descriptive summaries. In addition, overall tolerability and toxicity of the regimen will also be evaluated, including reasons for treatment discontinuation as well as the number of patients who successfully complete treatment will be summarized by dose level.
Time frame: Up to 8 weeks
Objective response rate per Response Evaluation Criteria in Solid Tumors
The overall response rate will be assessed as the number of patients who achieve a partial or complete response to therapy divided by the total number of evaluable patients. Assuming that this measure is binomially distributed, the proportion will be estimated and corresponding 95% binomial confidence intervals generated.
Time frame: Up to 3 years
Local control rate
Local control rate will be measured from time of study enrollment until the time of progression within the irradiated site.
Time frame: Up to 2 years
Neurologic progression-free survival
Described graphically and quantitatively using the methods of Kaplan and Meier.
Time frame: Time from study entry to the time of progression within the brain or until time of death, assessed up to 2 years
Overall survival
Described graphically and quantitatively using the methods of Kaplan and Meier.
Time frame: Time from study entry to the time of death due to any cause, assessed up to 2 years
Proportion of patients who complete treatment per protocol
Assessed as a measure of tolerability.
Time frame: Up to 4 weeks
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