MLN9708 and Vorinostat in Patients With Advanced p53 Mutant Malignancies

Study Groups:

If you are found to be eligible to take part in this study, you will be assigned to a dose
level of MLN9708 and vorinostat based on when you join this study. Up to 4 dose levels of the
MLN9708 and vorinostat combination will be tested. Up to 6 participants will be enrolled at
each dose level combination. The first group of participants will receive the lowest dose
level combination. Each new group will receive a higher dose of either MLN9708 or vorinostat
than the group before it, if no intolerable side effects were seen. This will continue until
the highest tolerable dose combination of MLN9708 and vorinostat is found or all 4 dose
levels are filled. Up to an additional 14 participants will be enrolled in the highest dose
level of the study drug combination.

The dose of the study drug combination that you receive may be lowered if you have
intolerable side effects.

Study Drug Administration:

Each study cycle is 28 days.

You will take MLN9708 capsules by mouth every 7 days (on Days 1, 8, and 15 of every cycle).
You should swallow MLN9708 capsules whole with 8 ounces (1 cup) of water. Each capsule should
be swallowed separately with a sip of water. Do not break, chew, or open the capsules. Each
dose should be taken on an empty stomach, at least 1 hour before or 2 hours after a meal. If
you miss a dose, take it as soon as you remember, as long as the next scheduled dose is at
least 72 hours (3 days) away. You should not take a double dose to make up for a missed dose.
If you vomit after taking a dose, wait until the next scheduled dose. Do not take an
additional dose.

You will take vorinostat capsules by mouth on Days 1-21 of each cycle, followed by a break of
7 days. You should swallow vorinostat capsules whole with water. Do not break, chew, or open
the capsules. Vorinostat should be taken with food. If you miss a dose, take it as soon as
you remember, as long as the next scheduled dose is at least 12 hours away. You should not
take a double dose to make up for a missed dose. If you vomit after taking a dose, wait until
the next scheduled dose. Do not take an additional dose.

It is important that you tell your doctor if you have any side effects while on this study.
If you have side effects or abnormal test results, you may be asked to return to the clinic
for more tests until the side effects or abnormal test results improve. Your dose of study
drug may be changed and/or you may be given drugs to help control the side effects.

Study Visits:

One (1) time each week during Cycle 1:

° Blood (about 6 teaspoons) will be drawn for routine tests and to check your liver and
kidney function.

On Day 1 of Cycles 2 and beyond:

- You will have a physical exam.

- Blood (about 6 teaspoons) will be drawn for routine tests.

- If your doctor thinks it is needed, urine will be collected for routine tests.

At the end of Cycles 2 and beyond:

- You will have a CT, PET, and/or MRI scan to check the status of the disease. If your
doctor thinks it is needed, you may have measurement sooner.

- If the study doctor thinks it is needed, blood (about 1 teaspoon) will be drawn to
measure tumor markers. Tumor markers can be used to check the status of the disease.

Any time the doctor thinks it is needed:

- Blood (about 6 teaspoons) will be drawn for routine tests.

- If you can become pregnant, blood (about 1 teaspoon) will be collected for a pregnancy
test.

- You will have an EKG to check your heart function.

Length of Study:

You may continue taking the study drugs for as long as the doctor thinks it is in your best
interest. You will no longer be able to take the study drug if the disease gets worse, if
intolerable side effects occur, if you develop new health problems, or if you are no longer
able to follow study directions.

You may choose to stop taking the study drugs at any time. You should tell the study doctor
right away if you are thinking about no longer taking part in this study. The study doctor
will talk to you about how to safely stop taking the study drugs.

Your participation on the study will be over after the end-of-study visit.

End of Study Visit:

Within 30 days after your last dose of the study drugs, the following tests and procedures
will be performed:

- You will have a physical exam.

- Blood (about 7 teaspoons) will be drawn for routine tests, tests of your kidney and
liver function, and tumor marker testing.

- You will have a CT, PET, and/or MRI scan to check the status of the disease. If your
doctor thinks it is needed, you may have a scan performed sooner.

This is an investigational study. MLN9708 is not FDA approved or commercially available.
MLN9708 is currently being used for research purposes only. Vorinostat is FDA approved and
commercially available to treat advanced cutaneous T-cell lymphoma.

The study doctor can explain how the study drugs are designed to work.

Up to 56 patients will take part in this study. All will be enrolled at MD Anderson.

Inclusion Criteria:

1. Male or female patients 18 years or older.

2. Voluntary written consent must be given before performance of any study related
procedure not part of standard medical care, with the understanding that consent may
be withdrawn by the patient at any time without prejudice to future medical care.

3. Female patients who: • Are postmenopausal for at least 1 year before the screening
visit, OR • Are surgically sterile, OR • If they are of childbearing potential, agree
to practice 2 effective methods of contraception, at the same time, from the time of
signing the informed consent form through 90 days after the last dose of study drug,
AND • Must also adhere to the guidelines of any treatment-specific pregnancy
prevention program, if applicable, OR • Agree to practice true abstinence when this is
in line with the preferred and usual lifestyle of the subject. (Periodic abstinence
[eg, calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are
not acceptable methods of contraception.)

4. Male patients, even if surgically sterilized (ie, status post-vasectomy), must agree
to one of the following: • Agree to practice effective barrier contraception during
the entire study treatment period and through 90 days after the last dose of study
drug, OR • Must also adhere to the guidelines of any treatment-specific pregnancy
prevention program, if applicable, OR • Agree to practice true abstinence when this is
in line with the preferred and usual lifestyle of the subject. (Periodic abstinence
(eg, calendar, ovulation, symptothermal, post-ovulation methods] and withdrawal are
not acceptable methods of contraception.)

5. Patients must have a diagnosis with solid tumors and lymphomas, either refractory to
standard therapy or for which no effective standard therapy that conveys clinical
benefit.

6. Patients must have a p53 mutation which is defined as cytoplasmic positivity by
immunohistochemistry and/or next gene mutation sequencing.

7. Eastern Cooperative Oncology Group (ECOG) performance status and/or other performance
status 0, 1, or 2.

8. Patients must meet the following clinical laboratory criteria:Absolute neutrophil
count (ANC) >/= 1,000/mm^3 and platelet count >/= 75,000/mm^3. Platelet transfusions
to help patients meet eligibility criteria are not allowed within 3 days before study
enrollment.Total bilirubin aminotransferase (ALT) and aspartate aminotransferase (AST) creatinine clearance >/= 30 mL/min.

9. Patients may receive local palliative radiation therapy immediately before or during
the treatment if the radiation therapy is not delivered to the sole target lesions.

10. Measurable or evaluable disease will be included as assessed by RECIST 1.1.

Exclusion Criteria:

1. Female patients who are lactating or have a positive blood pregnancy test during the
screening period.

2. Failure to have fully recovered (ie, of prior chemotherapy.

3. Major surgery within 14 days before first dose of study drug..

4. Radiotherapy within 14 days before first dose of study drug. If the involved field is
small, 7 days will be considered a sufficient interval between treatment and study
initiation.

5. Active uncontrolled central nervous system involvement.

6. Infection requiring systemic antibiotic therapy or other serious infection within 14
days before first dose of study drug.

7. Evidence of current uncontrolled cardiovascular conditions, including uncontrolled
hypertension, uncontrolled cardiac arrhythmias, symptomatic congestive heart failure,
unstable angina, or myocardial infarction within the past 6 months.

8. Systemic treatment, within 14 days before the first dose of MLN9708, with strong
inhibitors of CYP1A2 (fluvoxamine, enoxacin, ciprofloxacin), strong inhibitors of
CYP3A (clarithromycin, telithromycin, itraconazole, voriconazole, ketoconazole,
nefazodone, posaconazole) or strong CYP3A inducers (rifampin, rifapentine, rifabutin,
carbamazepine, phenytoin, phenobarbital), or use of Ginkgo biloba or St. John's wort.

9. Ongoing or active systemic infection, active hepatitis B or C virus infection, or
known human immunodeficiency virus (HIV) positive.

10. Any serious medical or psychiatric illness that could, in the investigator's opinion,
potentially interfere with the completion of treatment according to this protocol.

11. Known allergy to any of the study medications, their analogues, or excipients in the
various formulations of any agent.

12. Known GI disease or GI procedure that could interfere with the oral absorption or
tolerance of MLN9708 including difficulty swallowing.

13. Diagnosed or treated for another malignancy within 2 years before first dose of study
drug. or previously diagnosed with another malignancy and have any evidence of
residual disease. Patients with nonmelanoma skin cancer or carcinoma in situ of any
type are not excluded if they have undergone complete resection.

14. Patient has >/= Grade 2 peripheral neuropathy

15. Participation in other clinical trials, including those with other investigational
agents not included in this trial, within 21days of the start of this trial and
throughout the duration of this trial.