Everolimus, Fluorouracil, Leucovorin, Panitumumab, and Oxaliplatin in Treating Patients With Solid Tumors That Did Not Respond to Treatment

OBJECTIVES:

Primary

- To determine the maximum tolerated dose of everolimus in combination with sequential
fluorouracil (5-FU) and leucovorin calcium, panitumumab, modified 5-FU, leucovorin
calcium, and oxaliplatin (mFOLFOX6), and mFOLFOX6 with panitumumab in patients with
refractory solid tumors.

Secondary

- To determine the adverse event profile of these regimens.

- To correlate response with S6-phosphorylation and AKT-phosphorylation in available
archived tumor samples.

- To evaluate preliminary evidence of antitumor activity of these regimens using RECIST
criteria for a subset of patients with measurable disease.

OUTLINE: This is a dose-escalation study. Cohorts of patients are enrolled into treatment
groups 1 or 2. If a final cohort of patients is reached in groups 1 and/or 2, additional
cohorts of patients are enrolled into treatment group 3.

- Group 1: Patients receive oral everolimus once daily on days 1-28. Patients also
receive leucovorin calcium IV followed by fluorouracil IV continuously over 46 hours
beginning on day 1. Treatment repeats every 28 days in the absence of disease
progression or unacceptable toxicity.

- Group 2: Patients receive oral everolimus once daily on days 1-28 and panitumumab IV
over 30-90 minutes on day 1. Treatment repeats every 28 days in the absence of disease
progression or unacceptable toxicity.

- Group 3: Patients receive oral everolimus once daily on days 1-28, leucovorin calcium
IV followed by fluorouracil IV continuously over 46 hours beginning on day 1, and
oxaliplatin IV over 2-4 hours on day 1. Some patients may also receive panitumumab IV
over 30-90 minutes on day 1. Treatment repeats every 28 days in the absence of disease
progression or unacceptable toxicity.

Archived tumor samples are assessed for phospho-AKT, phospho-S6K, and phospho-S6 by
immunohistochemistry.

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

DISEASE CHARACTERISTICS:

- Histologically confirmed malignant solid tumor

- Advanced or unresectable disease

- No standard therapeutic option available

- Evaluable disease (according to RECIST criteria) that has not been previously
irradiated

- Prior radiotherapy to the marker lesion(s) allowed provided there is evidence of
progression since radiotherapy

- Brain metastases allowed provided the following criteria are met:

- CNS-directed treatment was given and was completed > 3 months ago

- CNS disease has been clinically and radiographically stable for ≥ 8 weeks

PATIENT CHARACTERISTICS:

- ECOG performance status 0-2

- Absolute neutrophil count ≥ 1,500/µL

- Platelet count ≥ 100,000/µL

- Creatinine clearance ≥ 60 mL/min

- Total bilirubin ≤ 1.2 mg/dL

- Transaminases ≤ 5 times upper limit of normal (ULN)

- Magnesium ≥ lower limit of normal

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception during and for 24 weeks (females)
or for 4 weeks (males) after completion of study therapy

- Willing to avoid pregnancy for 3 months after completion of study therapy

- No neuropathy ≥ grade 2

- No concurrent life-threatening acute medical illness

- No impairment of gastrointestinal function or gastrointestinal disease that may
significantly alter the absorption of everolimus (e.g., ulcerative disease,
uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel
resection)

- No active bleeding diathesis

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- At least 3 weeks since prior major surgery, radiotherapy (including radiotherapy
involving the abdomen or spine), chemotherapy, or other systemic anticancer therapy
and recovered

- At least 4 weeks since prior investigational drugs

- No concurrent CYP3A4 inducers or inhibitors that cannot be substituted by a different
agent

- No concurrent oral anti-vitamin K medication (except for low-dose warfarin)

- No concurrent colony stimulating factors during the first course of treatment