IMC-A12 With Mitotane vs Mitotane Alone in Recurrent, Metastatic, or Primary ACC That Cannot Be Removed by Surgery

This is an interventional treatment trial for Recurrent Adrenocortical Carcinoma Read More

Inclusion Criteria:

• Histologically confirmed adrenocortical carcinoma

  • Documented unresectable recurrent, unresectable advanced, or metastatic disease

• At least 1 lesion that can be accurately measured by RECIST criteria as ≥ 20 mm by conventional radiologic techniques or as ≥ 10 mm by spiral CT scan or MRI

  • Patients with disease in an irradiated field as the only site of measurable disease allowed provided there has been a clear progression of the lesion
• No tumors potentially resectable by surgical excision alone
• No known or suspected leptomeningeal disease or brain metastases
• ECOG performance status 0-2
• Life expectancy ≥ 12 weeks
• ANC ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3
• Hemoglobin ≥ 9 g/dL (transfusion allowed)
• Serum creatinine ≤ 1.5 times upper limit of normal (ULN) OR calculated creatinine clearance ≥ 60 mL/min
• AST or ALT ≤ 3 times ULN
• Total bilirubin ≤ 1.5 times ULN
• HbA1c < 8 within the past 4 weeks
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 3 months after completion of study therapy
• Able to take oral medications
• No poor gastrointestinal absorption

• Patients with diabetes mellitus are eligible provided they meet all of the following criteria:

  • Blood glucose is normal (random glucose ≤ 150 mg/dL)
  • HgbA1c ≤ 8 within the past 4 weeks
  • On a stable dietary or therapeutic regimen for the past 2 months
• No active uncontrolled infection

• No severe disease or condition that, in the judgement of the investigator, would make the patient inappropriate for study participation, including, but not limited to:

  • Bleeding diathesis
  • Uncontrolled chronic kidney or liver disease
  • Uncontrolled diabetes
  • History of cardiac history
  • Myocardial infarction within the past 6 months
  • Congestive heart failure
  • Unstable angina pectoris
  • Cardiac arrhythmia
  • Uncontrolled hypertension

• No current malignancy or previous malignancy with a disease-free interval of < 2 years at the time of diagnosis

  • Patients with adequately treated basal cell or squamous cell carcinoma of the skin, carcinoma in situ of the cervix or skin, or stage A low-grade prostate cancer are eligible
• No known hypersensitivity to monoclonal antibody therapy or mitotane
• No known HIV or hepatitis B or C infection
• No serious medical or psychiatric disorder that would interfere with patient safety or informed consent
• All significant toxic effects of prior surgery resolved to ≤ grade 1 according to NCI CTCAE v. 3.0 criteria
• Mitotane for < 8 weeks prior to study entry AND tolerated it well
• No prior IGFR-directed therapy

• No prior systemic antitumor therapy (cytotoxic chemotherapy, biologic, immunotherapy, or targeted therapy)

  • Prior incomplete surgical resections or radiofrequency ablation or radiotherapy will not be considered as prior therapy provided measurable sites of disease remain
  • Prior adjuvant chemotherapy or mitotane will not be considered as prior antitumor therapy unless it was completed < 6 months before study enrollment
• No prior radiotherapy to > 20% of bone marrow

• More than 4 weeks since prior and no concurrent radiotherapy

  • Radiotherapy for palliation of symptoms related to metastases is permitted provided that it is > 4 weeks from study initiation, and does not involve target/measureable lesions that are followed for drug treatment response evaluation
• No concurrent mitotane ≥ 8 weeks prior to study
• No concurrent tumor resection or tumor-directed surgery
• No other concurrent anticancer or investigational therapy