Temsirolimus and Cixutumumab in Treating Patients With Locally Advanced, Metastatic, or Recurrent Soft Tissue Sarcoma or Bone Sarcoma

PRIMARY OBJECTIVES:

I. To determine the proportion of patients progression-free at 12 weeks (progression free
survival [PFS], defined as Response Evaluation Criteria In Solid Tumors (RECIST) 1.1
complete response [CR] + partial response [PR] + stable disease [SD]) with (A) Insulin-like
growth factor (IGF)-1receptor (R)+ soft tissue sarcomas; (B) IGF-1R+ bone tumors; or (C)
IGF-1R(-) sarcomas, who are treated weekly with intravenous A12 (cixutumumab) and
temsirolimus.

SECONDARY OBJECTIVES:

I. To determine the overall response rate (defined as CR + PR). II. To determine the overall
survival. III. To determine the correlation of clinical outcome with pre- and post-treatment
IGF-1R pathway related markers in plasma (pre and post therapy), archived tissue, and pre-
and post-treatment tumor biopsies.

OUTLINE:

Patients receive cixutumumab intravenously (IV) over 60 minutes and temsirolimus IV over 30
minutes on days 1, 8, 15, 22, 29, and 36. Courses repeat every 42 days in the absence of
disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for at least 4 weeks.

Inclusion Criteria:

- Patients must have histologically or cytologically confirmed sarcoma of soft tissue
or bone; all patients will have IGF-1R testing at Memorial Sloan-Kettering Cancer
Center (MSKCC) by immunohistochemistry (IHC); patients with confirmation of IGF-1R
status in pre-existing tumor specimens will be enrolled on one of three arms of the
study:

- Arm A: IHC IGF-1R (+) sarcomas of soft tissue

- Arm B: IHC IGF-1R (+) sarcomas of bone

- Arm C: Any IGF-1R (-) sarcomas

- Subjects must have metastatic and/or locally advanced or locally recurrent disease

- Patients treated at Memorial Sloan Kettering Cancer Center must consent to tumor
biopsies before therapy and after the 2nd week of therapy; subjects who do not have
accessible tumor for biopsy may be enrolled at the discretion of the Principal
Investigator

- Patients must have measurable disease by RECIST 1.1; measurable disease (a 'target'
lesion) is defined as at least one lesion that can be accurately measured in at least
one dimension (longest diameter to be recorded); each lesion must be >= 10 mm when
measured by computed tomography (CT) (CT scan slice thickness no greater than 5 mm);
>= 10 mm caliper measurement by clinical exam (lesions which cannot be accurately
measured with calipers should be recorded as non-measurable); and >= 20 mm by chest
x-ray

- A minimum of 1 and a maximum of 4 prior systemic therapy regimens for
recurrent/metastatic disease; the last dose of systemic therapy (include tyrosine
kinase inhibitors) must have been given at least 4 weeks prior to initiation of
therapy; patients receiving carmustine (BCNU) or mitomycin C must have received their
last dose of such therapy at least 6 weeks prior to initiation of therapy

- Patients with brain metastasis that have been treated with definitive surgery or
radiation and have been clinically stable for 3 months following the procedure with
no neurological signs or symptoms and no requirement for systemic glucocorticoids are
eligible for study

- Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1

- Absolute neutrophil count >= 1.5 x 10^9/l; patients with neutropenia on a familial
basis may still be enrolled on study; please contact the Principal Investigator (PI)
who will discuss the patient with Cancer Therapy Evaluation Program (CTEP)

- Platelets >= 100 x 10^9/l

- Total bilirubin =< 1.5 x upper limit of normal (ULN); in patients with bilirubin >
1-1.5 X ULN, the starting dose of temsirolimus is 15 mg/week

- Albumin >= 3 g/dL

- Aspartate aminotransferase (AST)/serum glutamic oxaloacetic transaminase
(SGOT)/alanine aminotransferase (ALT)/serum glutamate pyruvate transaminase (SGPT) =<
3.0 x institution ULN; in patients with ALT or AST elevated > 1.0- 3.0 X ULN, the
starting dose of temsirolimus is 15 mg/week

- Serum creatinine =< 1.5 x ULN

- Serum glucose =< 120 mg/dL; nonfasting or fasting; if a patient has a non-fasting
glucose of over 120 mg/dL, the patient may be retested in the fasting state to
determine if they are eligible for study; a non-fasting glucose of 120 or less
renders the patient eligible for study

- Fasting total cholesterol =< 300 mg/dL

- Fasting triglycerides =< 300 mg/dL; patients with neutropenia on a familial basis may
still be enrolled on study; please contact the PI who will discuss the patient with
CTEP

- Patients must not have current evidence of another malignancy

- Women of child-bearing potential and men must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) and have pregnancy testing
prior to study entry and for the duration of study participation (every 2 cycles of
therapy); should a woman become pregnant or suspect she is pregnant while
participating in this study, she should inform her treating physician immediately

- Adverse events related to prior tumor-specific therapy must have resolved to less
than or equal to National Cancer Institute (NCI) Common Terminology Criteria for
Adverse Events (CTCAE) (version 4.0) grade 1 prior to study entry (except alopecia)

- Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

- Patients who have had major surgery or a course of glucocorticoid therapy lasting
longer than 5 days within 4 weeks prior to entering the study, or those who have not
recovered from adverse events to =< NCI CTCAE (version 4.0) grade 1, associated with
surgery; excluded from such considerations are surgical changes not expected to
improve, e.g. removal of muscle tissue; patients may be on replacement
glucocorticoids for pre-existing glucocorticoid deficiency (e.g. Addison's disease)
or topical glucocorticoids for dermatological conditions (e.g. psoriasis)

- Patients must be >= 4 weeks beyond treatment of any systemic therapy, other
investigational therapy, biological, targeted agents or radiotherapy, and must have
recovered to =< Grade 1 toxicity or previous baseline for each toxicity; specifically
excluded are the laboratory examinations serum lipase or amylase (without overt
pancreatitis), hypophosphatemia, hypomagnesemia, and lymphopenia; patients may have
received palliative low dose radiotherapy to the limbs 1-4 weeks before this therapy
provided pelvis, sternum, scapulae, vertebrae, or skull were not included in the
radiotherapy field

- Patients may not have received prior IGFR1 inhibitors

- Patients may not have received prior mammalian target of rapamycin (mTOR) inhibitors
(such as sirolimus, everolimus, ridaforolimus, or temsirolimus)

- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to temsirolimus, A12, or other agents used in the study

- Patients with hyperglycemia, defined as fasting serum glucose above 120 mg/dl, or
those patients already on oral anti-diabetic or insulin therapy

- Uncontrolled intercurrent illness including, but not limited to, known ongoing or
active infection, including human immunodeficiency virus (HIV), active hepatitis B or
C, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia
(specifically, atrial fibrillation or ventricular dysrhythmias except ventricular
premature contractions), or psychiatric illness/social situations that would limit
compliance with study requirements

- Pregnant women and women who are breast-feeding