Pomalidomide for Kaposi Sarcoma in People With or Without HIV

Sponsor

National Cancer Institute (NCI) (NIH)

Overall Status

Completed

CT.gov ID

NCT01495598

Collaborator

(none)

Enrollment

Location

Arms

124.2

Actual Duration (Months)

0.2

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Background:

Pomalidomide is a drug that can treat cancer through several mechanisms. It is taken by mouth (orally). Pomalidomide can help treat cancer by blocking certain factors that promote tumor growth or by stimulating the immune system to attack tumor cells. It also prevents the growth of new blood vessels that help cancer grow. Researchers want to see if pomalidomide can treat Kaposi sarcoma, a rare and potentially fatal skin cancer. Because Kaposi sarcoma may be associated with human immunodeficiency virus (HIV) infection, researchers want to test the drug in people with and without HIV infection.

Objectives:

To see if pomalidomide is a safe and effective treatment for Kaposi sarcoma in people with or without HIV.

Eligibility:

Individuals at least 18 years of age who have Kaposi sarcoma.
Participants may or may not have HIV infection.

Design:

Potential participants will be screened with a medical history and physical exam. Blood and saliva samples will be taken and a chest X-ray will be performed. A skin biopsy of a Kaposi sarcoma lesion may be performed if one has not already been done. Other imaging studies may be performed if needed.
Participants will take pomalidomide capsules every day for 3 weeks, followed by a 1-week break. These 28 days are one cycle of treatment.
Participants will have up six cycles of treatment, unless the lesions completely resolve sooner. If there are signs of improvement after six cycles but the lesions are not completely gone, up to another six cycles of treatment may be given.
Treatment will be monitored with frequent blood tests and other studies including photograph and other imaging of skin lesions.
Participants will have regular follow-up visits for 5 years after stopping treatment....

Condition or Disease	Intervention/Treatment	Phase
Kaposi Sarcoma Sarcoma, Kaposi	Drug: Pomalidomide	Phase 1/Phase 2

Detailed Description

Background:

Kaposi Sarcoma (KS) is an incurable, multicentric angioproliferative tumor that most frequently involves the skin. It is seen most frequently in people with HIV or other forms of immune compromise. Current therapies are limited by toxicities, including cumulative cardiotoxicity, while effective oral agents, agents deliverable in resource-limited settings, and agents deliverable long-term for relapsing disease are all lacking.

Objective:

The primary objective of this study is to:

Assess the safety, tolerability and pharmacokinetics of pomalidomide in subjects with Kaposi sarcoma, whether HIV associated or not.

Eligibility:

Age greater than or equal to 18 years
Measurable, pathologically confirmed KS
Any HIV status; HIV-associated KS subjects must be receiving and able to comply with HAART and have achieved an HIV viral load <10,000 copies/mL
Hematologic and biochemical parameters within prespecified limits at baseline
Willing to use effective birth control, as defined in the full protocol
For subjects enrolled in the anti-tumor activity assessment phase, if KS is HIV-associated it must be increasing despite HAART and HIV suppression for greater than or equal to 2 months, or stable despite HAART for greater than or equal to 3 months
No symptomatic pulmonary or visceral KS
No specific KS therapy within 4 weeks (6 weeks if that therapy was bevacizumab)
Neither pregnant nor breast feeding

Design:

This is an open label single agent phase I/II study of pomalidomide in patients with KS. In the phase I portion, up to six subjects will initially be treated with pomalidomide 5mg daily for 21 days of a 28 day cycle. Subject to toxicity evaluation, this dosage may be deescalated to 3mg daily for 21 days of a 28 day cycle in a second cohort of up to six subjects. If either dose proves tolerable, the study will proceed to the phase II portion, and additional subjects to a goal of 15 HIV positive and 10 HIV negative subjects evaluable for response will be added at the highest tolerable dose to gain preliminary information on activity.

Study Design

Study Type:

Interventional

Actual Enrollment :

28 participants

Allocation:

Non-Randomized

Intervention Model:

Sequential Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Phase I/II Study of the Safety, Pharmacokinetics and Efficacy of Pomalidomide (CC-4047) in the Treatment of Kaposi Sarcoma in Individuals With or Without HIV

Actual Study Start Date :

Jan 10, 2012

Actual Primary Completion Date :

May 17, 2022

Actual Study Completion Date :

May 17, 2022

Arms and Interventions

Arm	Intervention/Treatment
Experimental: 1/Phase 1 Up to six subjects will initially be treated with pomalidomide 5mg daily for 21 days of a 28 day cycle	Drug: Pomalidomide 5 mg p.o. for 21 of 28 days
Experimental: 2/ Phase 2 15 HIV positive and 10 HIV negative subjects evaluable for response will be treated with Pomalidomide 5mgdaily for 21 days of a 28 day cycle	Drug: Pomalidomide 5 mg p.o. for 21 of 28 days

Arm

Intervention/Treatment

Experimental: 1/Phase 1

Up to six subjects will initially be treated with pomalidomide 5mg daily for 21 days of a 28 day cycle

Drug: Pomalidomide

5 mg p.o. for 21 of 28 days

Experimental: 2/ Phase 2

15 HIV positive and 10 HIV negative subjects evaluable for response will be treated with Pomalidomide 5mgdaily for 21 days of a 28 day cycle

Drug: Pomalidomide

5 mg p.o. for 21 of 28 days

Outcome Measures

Primary Outcome Measures

Assess the safety, tolerability and pharmacokinetics of pomalidomide in subjects with Kaposi sarcoma, whether HIV associated or not, at a dose derived from solid tumor studies. [6 -12 months]
Adverse event frequency, response rates and drug level measurements in the blood

Secondary Outcome Measures

antitumor effect of pomalidomide [study closure]
Explore in a preliminary manner the antitumor effect of pomalidomide at the established tolerated dose
safety, tolerability and antitumor effect of a second course of pomalidomide [additional 48 weeks after 5 years follow-up]
Adverse event frequency, response rates and drug level measurements in blood
quality of life [6-12 months]
Assess changes in quality of life subjects receiving pomalidomide
pomalidomide pharmacokinetics [6-12 months]
Assess the variation in pomalidomide pharmacokinetics in relation to common antiretroviral agents, especially potentially nephrotoxic agents such as tenofovir

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

INCLUSION CRITERIA:
Age greater than or equal to 18 Years.
Any HIV status.
Kaposi sarcoma pathologically confirmed by Department of Pathology, Clinical Center, National Institutes of Health.
At least five measurable KS lesions with no previous local radiation, surgical or intralesional cytotoxic therapy that would prevent response assessment for that lesion.
ECOG Performance Status less than or equal to 2
Life expectancy greater than or equal to 6 months
For patients with HIV-associated KS:
Must be receiving, and adherent to, a HAART regimen consistent with current clinical guidelines.
Must have been receiving HAART for at least one month.
Must have achieved an HIV VL <10,000 copies/mL.
The following hematological parameters:
Hemoglobin greater than or equal to 10 g/dL
Platelets greater than or equal to 75,000 cells/mm(3)
Absolute neutrophil count (ANC) greater than or equal to 1000 cells/mm3
The following biochemical parameters:
Estimated or measured creatinine clearance greater than or equal to 45mL/minute
Serum alanine aminotransferase (ALT) less than or equal to 2.5 times upper limit of normal
Serum aspartate aminotransferase (AST) less than or equal to 2.5 times upper limit of normal
Bilirubin less than or equal to 1.5 times upper limit of normal unless the patient is receiving protease inhibitor therapy (e.g. indinavir, ritonavir, nelfinavir, or atazanavir) known to be associated with increased bilirubin, in which case total bilirubin less than or equal to 7.5 mg/dL with direct fraction less than or equal to 0.7 mg/dL.
Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL within 14 days prior to and again within 24 hours before starting pomalidomide and must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control, one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before she starts taking pomalidomide. FCBP must also agree to ongoing pregnancy testing. Men must agree to use a latex condom during sexual contact with a FCBP even if they have had a vasectomy. All subjects must be counseled at a minimum of every 28 days about pregnancy precautions and risks of fetal exposure. Risks of Fetal Exposure, Pregnancy Testing Guidelines and Acceptable Birth Control Methods, and also
All study participants must agree to be registered into the mandatory POMALYST REMS program, and be willing and able to comply with the requirements of the POMALYST REMS program.
Females of reproductive potential must be willing to adhere to the scheduled pregnancy testing as required in the POMALYST REMS program.
Able to take aspirin 81mg daily or if intolerant of aspirin, able to take a substitute thromboprophylaxis such as low molecular weight heparin at a thromboprophylactic dose (such as enoxaparin 0.5mg/kg once daily).
Willing and able to give informed consent.
For subjects with HIV-associated entered after a tolerable dose has been determined,

KS lesions must be either:

Increasing despite HAART and HIV suppression below the limit of detection (48 copies/mL) in the two months prior to screening or
Stable despite HAART for at least three months. Stable disease must be symptomatic (examples of symptomatic disease include disease associated with pain, edema, psychological distress and/or social withdrawal). This is to gain preliminary information about pomalidomide activity without confounding due to HAART initiation.

EXCLUSION CRITERIA:

Symptomatic pulmonary KS.
Symptomatic visceral KS (except for non-ulcerating disease restricted to the oral cavity).
Specific KS therapy, including cytotoxic chemotherapy but not including HAART, within the past 4 weeks (6 weeks if the therapy was bevacizumab).
Use of other anticancer treatments or agents within the past 4 weeks (6 weeks if the therapy was a monoclonal antibody).
History of malignant tumors other than KS, unless:
In complete remission for greater than or equal to 1 year from the time response was first documented or
Completely resected basal cell carcinoma or
In situ squamous cell carcinoma of the cervix or anus.
History of infection meeting any of the following criteria:
Any infection that would be scored as grade 4 by CTCAE that occurred within six weeks of study screening.
Any infection that would be scored as grade 3 by CTCAE that occurred within two weeks of study screening.
History of fungal and mycobacterial infections, unless at least six weeks has passed since the completion of induction antimicrobial therapy. Patients may be receiving consolidation therapy for infections of these types.
Any abnormality that would be scored as a greater than or equal to grade 3 toxicity by

CTCAE, except:

Obesity is not considered an abnormality for the purposes of eligibility assessment unless in the opinion of the Principal Investigator or Lead Associate Investigator its clinical consequences in a particular subject places the subject at unacceptable risk if they were to participate in the study or confounds the ability to interpret data from the study.
Lymphopenia
Asymptomatic hyperuricemia, hypophosphatemia, or creatine kinase (CK) Elevations
Direct manifestations of KS
Direct manifestations of HIV infection, except for neurologic or cardiac manifestations
Direct manifestations of HIV therapy, except for neurologic or cardiac manifestations.
History of venous or arterial thromboembolism, unless:
Line-related thrombosis without embolus occurring greater than or equal to 1 year prior to screening.

Complications resulting from atherosclerotic coronary artery disease, peripheral vascular disease, or cerebrovascular disease (including infarction) are not considered exclusion criteria unless in the opinion of the Principal Investigator or Lead Associate Investigator their clinical consequences in a particular subject places the subject at unacceptable risk if they were to participate in the study orconfounds the ability to interpret data from the study

Known drug-related, inherited, or acquired procoagulant disorder including prothrombin gene mutation 20210, antithrombin III deficiency, protein C deficiency, protein S deficiency and antiphospholipid syndrome but not including heterozygosity for the Factor V Leiden mutation or the presence of a lupus anticoagulant in the absence of other criteria for the antiphospholipid syndrome.
Pregnancy.
Breast feeding (if lactating, must agree not to breast feed while taking pomalidomide).
Prior therapy with pomalidomide.
Known hypersensitivity to thalidomide, lenalidomide or pomalidomide. including prior development of erythema nodosum if characterized by a desquamating rash while taking thalidomide, lenalidomide or pomalidomide.
Any condition, including the presence of laboratory abnormalities, which in the opinion of the Principal Investigator or Lead Associate Investigator places the subject at unacceptable risk if they were to participate in the study or confounds the ability to interpret data from the study.