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1-Methyl-d-Tryptophan in Treating Patients With Relapsed or Refractory Solid Tumors
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), October 2008
Sponsors and Collaborators: Vanderbilt-Ingram Cancer Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00788086
  Purpose

RATIONALE: 1-methyl-d-tryptophan may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

PURPOSE: This phase I trial is studying the side effects and best dose of 1-methyl-d-tryptophan in treating patients with relapsed or refractory solid tumors.


Condition Intervention Phase
Cancer
Drug: 1-methyl-d-tryptophan
Procedure: flow cytometry
Procedure: fluorescence activated cell sorting
Procedure: high performance liquid chromatography
Procedure: immunohistochemistry staining method
Procedure: laboratory biomarker analysis
Procedure: pharmacological study
Phase I

Genetics Home Reference related topics: bladder cancer breast cancer retinoblastoma
MedlinePlus related topics: Cancer Soft Tissue Sarcoma
Drug Information available for: Parathyroid Thyroid Tryptophan
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label
Official Title: A Phase I Study of 1-Methyl-D-Tryptophan (D-1MT) in Patients With Relapsed or Refractory Solid Tumors

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Dose-limiting toxicity and maximum tolerated dose of oral D-1MT [ Designated as safety issue: Yes ]
  • Pharmacokinetics (i.e., bioavailability, biodistribution, and accumulation) of oral D-1MT [ Designated as safety issue: No ]
  • Systemic levels of kynurenine as a biomarker of systemic IDO activity [ Designated as safety issue: No ]

Estimated Enrollment: 30
Study Start Date: August 2008
Estimated Primary Completion Date: January 2011 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Establish the toxicities of 1-methyl-d-tryptophan (D-1MT) and define any dose-limiting toxicities if they occur below the maximum doses in patients with relapsed or refractory solid tumors.
  • Establish the pharmacokinetics of D-1MT following a single dose and following daily dosing for 7 or 21 days.
  • Preliminarily characterize effects of D-1MT on serum kynurenine levels as a biomarker for systemic indoleamine 2,3-dioxygenase activity.
  • Define a dose to incorporate into phase II testing based on toxicities, pharmacokinetics, and biologic changes in tryptophan breakdown products.

Secondary

  • Observe patients for objective evidence of antitumor responses and time to disease progression.
  • Evaluate the circulating regulatory T-cell (Treg) population and the effect of D-1MT administration on the frequency and phenotype of this population.
  • Evaluate the relationship and changes in serum kynurenine and tryptophan levels with respect to the Treg population.

OUTLINE:

  • Cycle A (week 1): Patients receive oral 1-methyl-d-tryptophan (D-1MT) on day 1.
  • Cycle B (weeks 2-3): Patients receive oral D-1MT on days 1-7.
  • Cycle C (beginning in week 4): Patients receive oral D-1MT on days 1-21. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.

Blood and urine samples are collected periodically for pharmacokinetic analysis. Plasma samples are assessed for levels of D-1MT, tryptophan, and kynurenine via high performance liquid chromatography (HPLC) and for levels of regulatory CD4+, CD25+, and Foxp3 T cells via fluorescence activated cell sorting analysis. Urine samples are analyzed for clearance of D-1MT via HPLC. Tumor tissue from pre-existing samples is analyzed for indoleamine 2,3-dioxygenase (IDO) activity via IHC.

After completion of study therapy, patients are followed every 3 months for 1 year.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed solid tumor malignancy

    • Recurrent or refractory disease
    • No available curative therapy or patient refused standard therapy
  • Measurable or evaluable disease
  • No active CNS metastases or carcinomatous meningitis

    • Patients with CNS metastases are eligible provided it has been at least 3 months since prior therapy to the brain and are off all steroids without progressing CNS disease

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • Life expectancy > 4 months
  • ANC ≥ 1,200/mm^3
  • Platelet count ≥ 100,000/mm^3
  • Absolute lymphocyte count ≥ 800/mm^3
  • Hemoglobin ≥ 9.0 g/dL
  • Serum total bilirubin ≤ 1.5 times upper limit of normal (ULN)
  • ALT and AST ≤ 2.5 times ULN
  • Serum creatinine ≤ 1.5 times ULN OR creatinine clearance ≥ 50 mL/min
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 1 month after completion of study therapy
  • Normal EKG (benign variants or abnormalities associated with any condition currently responding to appropriate care [e.g., controlled hypertension with minimal or moderate left ventricular hypertrophy, or controlled atrial fibrillation] allowed)
  • No significant or uncontrolled cardiovascular disease, including any of the following:

    • Uncontrolled hypertension (patients eligible if BP ≤ 150/90 mmHg on stable antihypertensive regimen)
    • NYHA class II-IV congestive heart failure
    • Peripheral vascular disease ≥ grade 2
    • Significant ventricular arrhythmias requiring medication
    • Myocardial infarction or unstable angina within the past 6 months
  • No history of gastrointestinal disease causing malabsorption or obstruction, including, but not limited to, any of the following:

    • Crohn's disease
    • Celiac sprue
    • Tropical sprue
    • Bacterial overgrowth/blind loop syndrome
    • Gastric bypass surgery
    • Strictures
    • Adhesions
    • Achalasia
    • Bowel obstruction
    • Extensive small bowel resection
  • No other active malignancy
  • No active uncontrolled infection requiring antibiotics within the past week (including unexplained fever > 38.1°C or 100.6°F)
  • No history of or active autoimmune disease (e.g., systemic lupus erythematosus, rheumatoid arthritis, scleroderma, or dermatomyositis)
  • No condition, psychiatric or otherwise, that would preclude informed consent, consistent follow up, or compliance with any aspect of the study (e.g., untreated schizophrenia or other significant cognitive impairment)
  • No HIV or hepatitis B or C positive serology
  • No other acquired/inherited immunodeficiencies
  • No residual toxicity from prior therapy > grade 1

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • At least 4 weeks since prior major surgery or systemic chemotherapy
  • At least 2 weeks since prior localized radiotherapy
  • No prior organ transplantation
  • No concurrent immunosuppressive therapy including systemic corticosteroid therapy, methotrexate, cyclosporine, tacrolimus, or sirolimus

    • Concurrent inhaled or topical corticosteroids allowed
  • No concurrent supplements containing L-tryptophan or its derivatives
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00788086

Locations
United States, Tennessee
Vanderbilt-Ingram Cancer Center - Cool Springs Recruiting
Nashville, Tennessee, United States, 37064
Contact: Jeffrey A. Sosman     615-936-3048        
Vanderbilt-Ingram Cancer Center at Franklin Recruiting
Nashville, Tennessee, United States, 37064
Contact: Jeffrey A. Sosman     615-936-3048        
Vanderbilt-Ingram Cancer Center Recruiting
Nashville, Tennessee, United States, 37232-6838
Contact: Clinical Trials Office - Vanderbilt-Ingram Cancer Center     800-811-8480        
Sponsors and Collaborators
Vanderbilt-Ingram Cancer Center
Investigators
Principal Investigator: Jeffrey A. Sosman, MD Vanderbilt-Ingram Cancer Center
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Responsible Party: Vanderbilt-Ingram Cancer Center ( Jeffrey A. Sosman )
Study ID Numbers: CDR0000618086, VU-VICC-PHI-0814, NLGC-NLG-2100, IRB#080257, VICTR-1855
Study First Received: November 7, 2008
Last Updated: November 7, 2008
ClinicalTrials.gov Identifier: NCT00788086  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
adult meningioma
adult teratoma
benign teratoma
carcinoma of the appendix
chondrosarcoma
chordoma
clear cell sarcoma of the kidney
congenital mesoblastic nephroma
desmoid tumor
fallopian tube cancer
gastrointestinal stromal tumor
hereditary neoplastic syndrome
malignant conjunctival neoplasm
malignant giant cell tumor of bone
ovarian sarcoma
ovarian stromal cancer
ovarian teratoma
peripheral nervous system neoplasm
peripheral primitive neuroectodermal tumor of the kidney
peritoneal cavity cancer
phosphaturic mesenchymal tumor
pleuropulmonary blastoma
pulmonary carcinoid tumor
recurrent adrenocortical carcinoma
recurrent adult brain tumor
recurrent adult malignant fibrous histiocytoma of bone
recurrent adult primary liver cancer
recurrent adult soft tissue sarcoma
recurrent adult spinal cord neoplasm
recurrent anal cancer

Study placed in the following topic categories:
Bone Neoplasms
Histiocytoma, Benign Fibrous
Malignant mesenchymal tumor
Retinoblastoma
Ewing's sarcoma
Kaposi sarcoma
Lung Neoplasms
Metastatic squamous neck cancer with occult primary
Oral cancer
Laryngeal carcinoma
Neuroepithelioma
Rectal cancer
Tryptophan
Vaginal Neoplasms
Non-small cell lung cancer
Sarcoma, Clear Cell
Breast Neoplasms
Testicular Neoplasms
Gall bladder cancer
Carcinoma
Brain Neoplasms
Urethral cancer
Sarcoma
Uterine sarcoma
Gallbladder Neoplasms
Esophageal Diseases
Aggressive fibromatosis
Anus Neoplasms
Carcinoma, Non-Small-Cell Lung
Conjunctival Neoplasms

Additional relevant MeSH terms:
Therapeutic Uses
Psychotropic Drugs
Antidepressive Agents, Second-Generation
Central Nervous System Agents
Pharmacologic Actions
Antidepressive Agents

ClinicalTrials.gov processed this record on January 16, 2009