Lenalidomide, Sunitinib, and Cyclophosphamide in Treating Patients With Stage IV Eye Melanoma

National Institutes of Health Clinical Center (CC)

Status and phase: Terminated; Phase 2

Conditions: Malignant Conjunctival Neoplasm; Intraocular Melanoma

Treatments: Drug: lenalidomide; Drug: sunitinib malate; Drug: cyclophosphamide

Study type: Interventional

Funder types: NIH

Identifiers

NCT00482911

NCI-07-C-0134

070134

Details and patient eligibility

About

RATIONALE: Lenalidomide may stop the growth of tumor cells by blocking blood flow to the tumor. Sunitinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as cyclophosphamide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving lenalidomide together with sunitinib and low doses of cyclophosphamide once a day may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving lenalidomide together with sunitinib and cyclophosphamide works in treating patients with stage IV eye melanoma.

Full description

OBJECTIVES:

Primary

• Determine the response rate in patients with stage IV ocular melanoma treated with lenalidomide, sunitinib malate, and low-dose metronomic cyclophosphamide.

Secondary

• Determine the toxicity of this regimen in these patients.
• Determine the progression-free survival of patients treated with this regimen.
• Obtain blood, urine, and tissue samples from these patients, when easily accessible, to determine the effects of this regimen on pathways thought to have been modulated by this regimen in pre-clinical studies.

OUTLINE: This is nonrandomized, uncontrolled, open-label study.

Patients receive oral lenalidomide, oral sunitinib malate*, and oral low-dose cyclophosphamide once daily on days 1-28. Treatment repeats every 28 days for up to 2 years in the absence of disease progression or unacceptable toxicity.

NOTE: *Some patients will not receive sunitinib malate during course 1.

After completion of study treatment, patients are followed every 3 months for 2 years, every 4 months for 3 years and then annually thereafter.

Enrollment: 12 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed ocular melanoma

  • Stage IV disease

• Measurable disease

• No active brain metastases

  • Patients with brain metastases must have had a complete excision or radiotherapy and remain asymptomatic with stable disease by magnetic resonance imaging (MRI) or computed tomography (CT) scan for ≥ 6 months

PATIENT CHARACTERISTICS:

• Eastern Cooperative Oncology Group (ECOG) performance status 0-2

• Life expectancy > 3 months

• Granulocyte count > 1,500/mm^3

• Platelet count > 100,000/mm^3

• Creatinine ≤ 1.5 mg/dL OR creatinine clearance > 60 mL/min

• Bilirubin ≤ 2.0 mg/dL

• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 10 times upper limit of normal (ULN)

• Prothrombin time (PT)/partial thromboplastin time (PTT)/International Normalized Ratio (INR) normal

• Not pregnant or nursing

• Negative pregnancy test

• Fertile patients must use one highly effective method of contraception (with an additional method) or barrier methods of contraception for ≥ 4 weeks before, during, and for ≥ 4 weeks after completion of study therapy

• Ejection fraction normal by echocardiogram

• No acute, critical illness, including serious untreated infection

• No history of any of the following:

  • Unstable or newly diagnosed angina pectoris
  • Myocardial infarction within the past 6 months
  • New York Heart Association class II-IV heart disease
  • Congestive heart failure
  • Chronic obstructive lung disease requiring oxygen therapy
  • Chronic uncontrollable hypertension
  • Uncontrolled seizure activity

• No known human immunodeficiency virus (HIV) positivity

• No known hypersensitivity reaction to thalidomide, lenalidomide, sunitinib malate, or cyclophosphamide

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• Recovered from all prior therapy
• At least 4 weeks since prior surgery, chemotherapy (6 weeks for mitomycin C, nitrosoureas, or carboplatin), hormonal therapy, radiotherapy, or biological therapy
• No concurrent grapefruit or grapefruit juice
• No other concurrent antitumor therapy

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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12 participants in 2 patient groups

Cohort 1-lenalidomide & cyclophosphamide

Experimental group

Description:

Participants first started on 2 Interventions (Dose A-QD) in Cycle 1, with 10 mg Lenalidomide (Len) once daily and 50 mg Cyclophosphamide (Cyc) once daily; 25 mg Sunitinib (Sun) was added once daily as a 3rd Intervention (Dose B-QD) from Cycle 2 onwards. Doses were adjusted in subsequent cycles depending on toxicity, including incremental step downs to 5/25/12.5 mg Len/Cyc/Sun once daily (Dose C-QD) or once every other day (Dose C-QOD).

Treatment:

Drug: cyclophosphamide

Drug: lenalidomide

Cohort 2-sunitinib & cyclophosphamide

Experimental group

Description:

2 participants started Cycle 1 with Dose B as described above and had adjusted-dosing as described for Cohort 1. The remaining 7 participants began Cycle 1 with 10 mg Len, 25 mg Cyc and 12.5 mg Sun once daily (Dose D-QD). Doses were adjusted in subsequent cycles depending on toxicity, including step up to 10/50/12.5 mg Len/Cyc/Sun once daily (Dose E-QD) and step down to Dose D once every other day (Dose D-QOD).

Treatment:

Drug: cyclophosphamide

Drug: sunitinib malate