This is an open label, dose escalation, phase I study of the combination of MLN9708 plus Nelfinavir.
This is an open label, dose escalation, phase I study of the combination of MLN9708 MLN9708 plus Nelfinavir. It will use a 3+3 cohort design to determine the maximum tolerated dose of the combination, which will be defined as the highest dose cohort where \< 1/6 patients develop a dose limiting toxicity. The maximum tolerated dose cohort will be expanded to have at least 6 patients with biopsiable tumors who undergo pretreatment and post treatment tumor biopsies for molecular pharmacodynamic markers.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
MLN9708 is a second-generation reversible proteasome inhibitor which shows greater oral bioavailability, improved pharmacokinetics and enhanced antitumor activity compared with bortezomib (VELCADE®).
Nelfinavir is an oral HIV protease inhibitor approved by FDA in 1997, now available in generic form. It has a well established safety profile in HIV patients when administered at the recommended dose of 1250 mg PO BID. Nelfinavir was shown to induce ER stress in cancer cell lines and xenograft tumors leading to apoptosis and tumor growth inhibition.
Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire, United States
Maximum Tolerated Dose (MTD) of nelfinavir
If 0/3 patients experience dose limiting toxicity, 3 patients will be treated at the next dose level. If dose limiting toxicity attributable to the study drug(s) is experienced in exactly 1/3 patients, 3 more patients (for a total of 6) will be treated at that dose level. If no additional dose limiting toxicity is observed at the expanded dose level (i.e. 1/6 with dose limiting toxicity), the dose will be escalated. Escalation will terminate as soon as two or more patients experience any dose limiting toxicity attributable to the study drug(s), at a given dose level. If 2 or more dose limiting toxicities are observed in any cohort, no further escalation will take place, and the Maximum Tolerated Dose will have been exceeded.
Time frame: Approximately 1 year to establish MTD
The toxicity of MLN9708 when combined with nelfinavir based on CTCAE grading criteria v. 4.0
The toxicities observed at each dose level will be summarized in terms of type (organ affected or laboratory determination such as absolute neutrophil count), severity (by NCI Revised Common Toxicity Criteria and nadir or maximum values for the laboratory measures), time of onset (i.e. course number), duration, and reversibility or outcome. Tables will be created to summarize these toxicities and side effects by dose and by course.
Time frame: Approximately 18-24 months to observe toxicity
Pharmacokinetics of both MLN9708 and nelfinavir based on parameters estimated using WinNonLin
MLN2238 concentrations-time data will be plotted on a semi-logarithmic plot and the decay of the drug concentrations over time inspected. The data will initially be analyzed using a non-compartmental and the primary pharmacokinetic parameters estimated using WinNonLin.
Time frame: The study as a whole is estimated to be completed in 18-24 months.
Pharmacodynamics of MLN9708 based on peripheral blood mononuclear cells (PBMCs)
To explore the effect of nelfinavir on the pharmacodynamics of MLN9708 (as assessed by β1 and β5 inhibition in peripheral blood mononuclear cells (PBMCs), ATF-3, CHOP and GADD34 up-regulation in PBMCs.
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Time frame: The study as a whole is estimated to be completed in 18-24 months.
Pharmacodynamics of MLN9708 based on tumor tissue
To explore the effect of nelfinavir on the pharmacodynamics of MLN9708 based on tumor tissue apoptosis induction as detected by TUNEL stain, and activated caspase-3 cleavage in primary tumors.
Time frame: The study as a whole is estimated to be completed in 18-24 months.
The anti-tumor activity of the MLN9708/Nelfinavir
Disease assessments, including radiological imagining will occur initially after 9 weeks of therapy and then every 6 weeks thereafter.
Time frame: The study as a whole is estimated to be completed in 18-24 months.