5-Fluoro-2'-Deoxycytidine and Tetrahydrouridine in Treating Patients with Refractory Solid Tumors
This phase I trial studies the side effects and best dose of 5-fluoro-2'-deoxycytidine when given together with tetrahydrouridine in treating patients with solid tumors that has not responded to previous treatment (refractory). 5-fluoro-2'-deoxycytidine may work by changing how genes work in tumor cells and tetrahydrouridine may help keep 5-fluoro-2'-deoxycytidine from being broken down in the body.
Inclusion Criteria
- Patients must have histologically documented solid tumors whose disease has progressed on standard therapy that is known to be associated with a survival advantage or have disease for which there is no known standard therapy
- Patients must have measurable or evaluable disease
- Diagnosis of malignancy must be confirmed by the department of pathology at the institution where the patient is being enrolled prior to patient enrollment
- Patients must have completed any chemotherapy, radiation therapy, biologic therapy, or major surgery >= 4 weeks prior to enrollment (6 weeks for nitrosoureas or mitomycin C); patients must be >= 2 weeks since any prior administration of a study drug in a phase 0 or equivalent study, at the discretion of the principal investigator; patients must have recovered to eligibility levels from prior toxicity or adverse events; patients with bone metastases or hypercalcemia on intravenous (IV) bisphosphonate treatment prior to study entry may continue this treatment
- Age >= 18 years. Because no dosing or adverse event data are currently available on the use of FdCyd and THU in patients < 18 years of age, children are excluded from this study, but may be eligible for future pediatric phase I combination trials
- Karnofsky performance status >= 60%
- Life expectancy of greater than 3 months
- Absolute neutrophil count >= 1,500/mcL
- Platelets >= 100,000/mcL
- Total bilirubin =< 1.5 X institutional upper limit 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; =< 5 X upper limit of normal (ULN) for patients with liver metastases
- Creatinine < 1.5 X institutional upper limit of normal OR creatinine clearance >= 60 mL/min for patients with creatinine levels above 1.5 X institutional upper limit of normal
- Because FdCyd has been shown to be teratogenic in animals, pregnant women are excluded from this trial; nursing women are also excluded, as there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with FdCyd; women of childbearing potential must agree to either abstain from sexual intercourse or use two forms of acceptable birth control, including one barrier method, for 4 weeks prior to study entry, for the duration of study participation, and for 3 months after completion of study; men must use a latex condom every time they have sexual intercourse during therapy and for 3 months after study completion, even if they have had a successful vasectomy; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she or her partner should inform the treating physician immediately
- Ability to understand and the willingness to sign a written informed consent document
- Patients should not be receiving any other investigational agents
- Ability to swallow liquids
- Willingness to provide blood and urine samples, and biopsy samples if on the expansion phase of the study, for research purposes; for the expansion cohort, patients must have tumor amenable to biopsy (excisional or incision biopsies of skin or head and neck [H & N] lesions under visualization) and willingness to undergo a tumor biopsy or patient will be undergoing a procedure due to medical necessity during which the tissue may be collected, or archival tumor biopsy tissue from a previous research study or medical care is available for submission at registration; criteria for the submission of archival tissue are: * Tissue must have been collected within 3 months prior to registration * Patient has not received any intervening therapy for their cancer since the collection of the tumor sample * Tumor tissue must meet the minimum requirements
Exclusion Criteria
- Patients with clinically significant illnesses which would compromise participation in the study, including, but not limited to active or uncontrolled infection, immune deficiencies, known human immunodeficiency virus (HIV) infection requiring protease inhibitor therapy, hepatitis B, hepatitis C, uncontrolled diabetes, uncontrolled hypertension, symptomatic congestive heart failure, unstable angina pectoris, myocardial infarction within the past 6 months, uncontrolled cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
- Patients with known brain metastases or carcinomatous meningitis are excluded from this clinical trial, with the exception of patients whose brain metastatic disease status has remained stable for >= 2 months after treatment of the brain metastases; patients should be on stable doses of anti-seizure medications; these patients may be enrolled at the discretion of the principal investigator
- History of allergic reactions attributed to fluoropyrimidine (e.g., capecitabine, fluorouracil, fluorodeoxyuridine) or tetrahydrouridine
- Malabsorption syndrome or other conditions that would interfere with intestinal absorption
Additional locations may be listed on ClinicalTrials.gov for NCT01534598.
See trial information on ClinicalTrials.gov for a list of participating sites.
PRIMARY OBJECTIVE:
I. Establish the safety and tolerability of oral 5-fluoro-2'-deoxycytidine (FdCyd) in combination with oral tetrahydrouridine (THU) administered on an intermittent schedule in 21-day cycles to patients with refractory solid tumors.
EXPLORATORY OBJECTIVES:
I. Determine the pharmacokinetics of oral FdCyd and oral THU.
II. Document preliminary evidence of activity of oral FdCyd and oral THU.
III. Determine the clinical benefit rate (complete response [CR] + partial response [PR] + stable disease [SD] at 4 months) in patients treated with study drug combination at the maximum tolerated dose (MTD).
IV. Determine effect of study treatment on re-expression of p16 and other select genes silenced by methylation in circulating tumor cells and tumor biopsies.
V. Evaluate the effect of study treatment on deoxyribonucleic acid (DNA) (cytosine-5)-methyltransferase 1 and 3 (DNMT1 and DNMT3) expression in tumor biopsies.
OUTLINE: This is a dose-escalation study of 5-fluoro-2-deoxycytidine.
Patients receive tetrahydrouridine orally (PO) once daily (QD) or twice daily (BID) and 5-fluoro-2-deoxycytidine PO QD or BID on days 1-3 and 8-10, 1-4 and 8-11, 1-5 and 8-12, 1-6 and 8-13, or 1-7 and 8-14. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo computed tomography (CT) or magnetic resonance imaging (MRI) during screening and on the trial. Patients also undergo blood and urine sample collection as well as tissue biopsy on the trial.
After completion of study treatment, patients are followed up for 30 days.
Trial PhasePhase I
Trial Typetreatment
Lead OrganizationNational Cancer Institute Developmental Therapeutics Clinic
Principal InvestigatorA P Chen
- Primary ID9127
- Secondary IDsNCI-2013-01132, 12-C-0066, 120066, CDR0000727075
- ClinicalTrials.gov IDNCT01534598