Testing the Effect of an Anticancer Drug, Onvansertib, in Advanced-Stage Small Cell Lung Cancer

Inclusion Criteria

• Patients must have histologically or cytologically confirmed small cell lung cancer
• Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as > 20 mm with conventional techniques or as >10 mm with spiral CT scan
• Patient must have failed or found to be intolerant of standard frontline platinum-based regimens for extensive stage disease. Maintenance immunotherapy counts as part of the frontline therapy, while prior chemotherapy for limited stage disease will not count toward this total if completed more than 12 months before initiation of protocol therapy. Retreatment with the original chemotherapy regimen for sensitive relapsed SCLC counts as a separate line of treatment
• Adult patients with age > 18 years. Because no dosing or adverse event data are currently available on the use of onvansertib in patients < 18 years of age, children are excluded from this study but will be eligible for future pediatric single-agent trials, if applicable
• Ability to tolerate oral medicine
• Eastern Cooperative Oncology Group (ECOG) performance status =< 2
• Absolute neutrophil count > 1,500/mL
• Platelets > 100,000/mL
• Total bilirubin =< 1.5 x institutional upper limits of normal
• Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) < 3 x institutional upper limit of normal
• Creatinine =< 1.5 x institutional upper limits of normal OR creatinine clearance > 50 mL/min/1.73 m^2
• Negative serum pregnancy test within 48 hours before starting study treatment in women with childbearing potential
• The potential effects of onvansertib on the developing human fetus at the proposed doses are not fully known. For this reason and because cytotoxic agents are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, the patient should inform the treating physician immediately
• Ability to understand and the willingness to sign a written informed consent document
• Both men and women and members of all races and ethnic groups are eligible for this trial

Exclusion Criteria

• Treatment with chemotherapy (within 4 weeks; 6 weeks for nitrosoureas or mitomycin C); radiotherapy or biologic agents (within 2 weeks) prior to first dose of onvansertib or those persistent, clinically significant, grade >= 2 adverse events due to agents administered more than 4 weeks earlier
• Patients may not be receiving any other investigational agents (use of conventional external beam radiation therapy will be allowed during protocol therapy solely for palliation of localised painful lesions or bone lesions at risk of fracture provided the radiation field does not encompass any selected target lesions required for assessment)
• Patients with uncontrolled symptomatic brain metastases. Subjects with a history of central nervous system (CNS) metastases must have documentation of stable brain imaging after completion of definitive treatment and prior to first dose of study drug. Patients must be off or on a stable dose of corticosteroids (not more than 10mg prednisone or equivalent). Definitive treatment may include surgical resection, whole brain irradiation, and/or stereotactic radiation therapy
• Patients with active gastrointestinal (GI) disorders likely to impair the absorption of oral medications
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to onvansertib
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Patient with untreated or active hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are ineligible. Patients on stable doses of antiretroviral for at least six months and undetectable viral load will be enrolled with prior approval of the study sponsor. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated
• Patients who require ongoing treatment with any hematopoietic colony-stimulating growth factors (e.g., granulocyte colony-stimulating factor [G-CSF], granulocyte-macrophage colony-stimulating factor [GM-CSF]) =< 2 weeks prior to starting study drug
• Patients who have undergone major surgery =< 2 weeks prior to starting study drug or who have not recovered from side effects of such therapy
• Patient is unable or unwilling to abide by the study protocol or cooperate fully with the investigator