Ixazomib Citrate and Erlotinib Hydrochloride in Treating Patients with Advanced, Metastatic, Relapsed, or Refractory Solid Tumors

Inclusion Criteria

• Patients with advanced or metastatic cancer that is refractory to standard therapy or that has relapsed after standard therapy or has no standard therapy that increases survival by at least three months
• All prior treatment-related toxicities must be Common Terminology Criteria for Adverse Events (CTCAE) (version 4.0) less than or equal to grade 2 (except alopecia) at the time of screening however clinically relevant adverse events (AEs) that will impact on the adverse drug event (ADE) of the study drugs or safety of the subject must have resolved to grade 1 or better
• Absolute neutrophil count greater than or equal to 1.5 x 10^9 cells/L
• Hemoglobin greater than or equal to 8.0 g/dL
• Platelets greater than or equal to 75 x 10^9/L
• Creatinine less than or equal to 1.5 x upper limit of normal (ULN) with calculated creatinine clearance greater than 30 ml/min
• Total bilirubin less than or equal to 1.5 x ULN
• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and/or alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) less than or equal to 3 x ULN
• Life expectancy of at least 3 months in the opinion of investigator
• Able to swallow and retain orally administered medication and does not have any clinically significant gastrointestinal abnormalities that may alter absorption such as malabsorption syndrome or major resection of the stomach or bowels
• Measurable disease as defined by RECIST criteria (version 1.1)
• Patients with Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1
• Having archival paraffin tissue is ideal for the correlative study but it is not mandatory
• Voluntary written consent must be given before performance of any study related procedure not part of standard medical care, with the understanding that consent may be withdrawn by the patient at any time without prejudice to future medical care
• Female patients who: are postmenopausal for at least 1 year before the screening visit, OR are surgically sterile, OR if they are of childbearing potential, agree to practice 2 effective methods of contraception, at the same time, from the time of signing the informed consent form through 90 days after the last dose of study drug, OR agree to practice true abstinence when this is in line with the preferred and usual lifestyle of the subject; (periodic abstinence [e.g., calendar, ovulation, symptothermal, post-ovulation methods]), and latex or non-latex condom with or without a spermicidal agent, diaphragm with spermicide; cervical cap with a spermicide; sponge with a spermicide
• Male patients, even if surgically sterilized (i.e., status post-vasectomy), must agree to one of the following: a) agree to practice effective barrier contraception during the entire study treatment period and through 90 days after the last dose of study drug, OR b) latex or non-latex condom with or without a spermicidal agent, diaphragm with spermicide; cervical cap with a spermicide; sponge with a spermicide
• DOSE EXPANSION COHORT:
• Non-small cell lung cancer: 1) we will enroll non-small cell lung cancer patients with documented EGFR mutation who failed treatment with anti-EGFR therapy (e.g. erlotinib or afatinib) and tested negative for EGFR T790M mutation; we will allow patients with positive EGFR T790M mutation if they have progressed on third generation anti-EGFR therapy (e.g. CO-1686 or AZD9291) or medically not suitable/candidate for the third generation anti-EGFR therapy; failure from anti-EGFR therapy will be defined as progressive disease by RECIST (version 1.1) after at least two months of therapy
• Pancreatic ductal adenocarcinoma: 1) pancreatic ductal adenocarcinoma patient with KRAS point mutation at codon G12 or G13; in addition to the above inclusion criteria, first 5 patients from both non-small cell lung cancer and pancreatic ductal adenocarcinoma patients will need to agree to mandatory pre- and post-treatment tumor biopsies

Exclusion Criteria

• Any serious and/or unstable pre-existing medical disorder (aside from malignancy exception above), psychiatric disorder, or other conditions that could interfere with subject’s safety, obtaining informed consent or compliance to the study procedures, in the opinion of the investigator
• Radiotherapy completed within 2 weeks prior to treatment initiation; radiotherapy completed > 2 weeks prior to treatment initiation is allowed if all procedure-related toxicities resolved
• Patients who were receiving prior therapy will require wash out period of either more than 2 weeks or more than 5 half-lives whichever shorter
• Have a known immediate or delayed hypersensitivity reaction or idiosyncrasy to drugs chemically related to study drug, or excipients or to dimethyl sulfoxide (DMSO)
• Current use of a prohibited medication
• Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression; if these were treated and clinically stable for 4 weeks, patient can be considered for the trial
• Patient who is on strong inducer/inhibitor of CYP3A needs to be off the medication prior to treatment initiation unless it is medically necessary for the patient
• Female patients who are lactating or have a positive serum pregnancy test suggestive of pregnancy and not as a tumor marker during the screening period; if pregnancy is tested positive, treating physician will further investigate if the patient is pregnant or not; treating physician may consider repeating the serum beta-hCG at next follow up visit or refer patient to obstetrical/gynecological (OB/GYN) for further evaluation
• Major surgery within 14 days before enrollment
• Infection requiring systemic antibiotic therapy or other serious infection within 14 days before study enrollment
• Evidence of current uncontrolled cardiovascular conditions, including uncontrolled hypertension, uncontrolled cardiac arrhythmias, symptomatic congestive heart failure, unstable angina, or myocardial infarction within the past 6 months
• Ongoing or active systemic infection, active hepatitis B or C virus infection, or known human immunodeficiency virus (HIV) positive
• Diagnosed or treated for another malignancy within 2 years before study enrollment or previously diagnosed with another malignancy and have any evidence of residual disease; patients with nonmelanoma skin cancer or carcinoma in situ of any type are not excluded if they have undergone complete resection
• Patient has greater than or equal than grade 2 peripheral neuropathy, or grade 1 with pain on clinical examination during the screening period
• Patients that have previously been treated with ixazomib, or participated in a study with ixazomib whether treated with ixazomib or not