Tivantinib and Topotecan Hydrochloride in Treating Patients With Advanced or Metastatic Solid Tumors

PRIMARY OBJECTIVES:

I. To establish the recommended phase 2 dose (RP2D) for the combination of ARQ 197
(tivantinib) and intravenous (IV) topotecan (topotecan hydrochloride).

II. To describe the toxicities of ARQ 197 and IV topotecan at each dose studied.

III. To characterize the pharmacokinetic behavior of ARQ 197 given concurrent use of IV
topotecan.

IV. To document all clinical responses to ARQ 197 with IV topotecan.

OUTLINE: This is a dose-escalation study of tivantinib and topotecan hydrochloride.

Patients receive tivantinib orally (PO) twice daily (BID) on days 1-21, topotecan
hydrochloride IV over 30 minutes on days 1-5, and pegfilgrastim subcutaneously (SC) on day 6.
Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

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

Inclusion Criteria:

- Patients must have histologically confirmed malignancy that is metastatic or
unresectable and for which standard curative or palliative measures do not exist or
are no longer effective; for the expansion group, patients must have histologically or
cytologically confirmed small cell lung cancer previously treated with one or more
chemotherapy or chemoradiotherapy regimens, at least one of which must have been
platinum-based

- As of amendment dated 01/24/2014 the study will not be pursuing an expansion
cohort in small cell lung cancer

- Karnofsky >= 60%

- Life expectancy of greater than 12 weeks

- Hemoglobin >= 9.0 g/dL

- Leukocytes >= 3,000/mcL

- Absolute neutrophil count >= 1,500/mcL

- Platelets >= 100,000/mcL

- Total bilirubin =< 1.5 X institutional upper limit of normal

- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
[SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
=< 2.5 X institutional upper limit of normal (=< 5 X institutional upper limit of
normal if the rise can be attributed to liver metastases)

- Serum creatinine =< 1.5 X institutional upper limit of normal OR creatinine clearance
>= 60 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal

- Women of child-bearing potential and men must agree to use adequate contraception
(hormonal or barrier method of birth control; abstinence) prior to study entry and for
the duration of study participation; should a woman become pregnant or suspect she is
pregnant while she or her partner is participating in this study, she should inform
her treating physician immediately; men treated or enrolled on this protocol must also
agree to use adequate contraception prior to the study, for the duration of study
participation, and 4 months after completion of ARQ 197 administration

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

Exclusion Criteria:

- Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for
nitrosoureas or mitomycin C) prior to entering the study or those who have not
recovered from adverse events due to agents administered more than 4 weeks earlier

- Patients who are receiving any other investigational agents

- Patients with untreated brain metastases should be excluded from this clinical trial;
however patients with stable brain disease (off corticosteroids) at least 2 weeks
after completion of appropriate therapy for their brain metastases are eligible;
patients who require enzyme-inducing anti-convulsants (EIAC) should be switched to
non-EIAC and be on a stable dose of the new agent for at least 2 weeks prior to
treatment on this protocol

- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to ARQ 197 or topotecan

- The metabolism and consequently overall pharmacokinetics of ARQ 197 could be altered
by inhibitors and/or inducers or other substrates of cytochrome P450 2C19 (CYP2C19)
and cytochrome P450 3A4 (CYP3A4); while inhibitors/inducers of these cytochrome P450
isoenzymes are not specifically excluded, investigators should be aware that ARQ 197
exposure may be altered by the concomitant administration of these drugs; caution
should be applied when CYP2C19 inhibitors such as omeprazole, fluvoxamine,
fluconazole, ticlopidine, rabeprazole, fluoxetine, and moclobemide, or strong CYP3A4
inhibitors such as atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole,
nefazodone, nelfinavir, ritonavir, saquinavir, ciprofloxacin, telithromycin,
troleandomycin (TAO), or voriconazole, are used as concomitant therapy; because the
lists of these agents are changing, it is important to consult an updated list; as
part of the enrollment/informed consent procedures, the patient will be counseled on
the risk of interactions with other agents, and what to do if new medications need to
be prescribed or if the patient is considering a new over-the-counter medicine or
herbal product

- History of congestive heart failure defined as class II to IV per New York Heart
Association (NYHA) classification; active coronary artery disease (CAD); clinically
significant bradycardia or other uncontrolled, cardiac arrhythmia defined as >= grade
3 according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse
Events (CTCAE), version 4.0, or uncontrolled hypertension; myocardial infarction
occurring within 6 months prior to study entry (myocardial infarction occurring > 6
months prior to study entry is permitted)

- Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, or psychiatric illness/social situations that would limit compliance with
study requirements

- Pregnant women are excluded from this study; breastfeeding should be discontinued if
the mother is treated with ARQ 197

- Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral
therapy are ineligible

- Patients previously treated with topotecan are ineligible

- Patients previously treated with ARQ 197 are ineligible

- Patients unable to swallow ARQ 197 pills are ineligible