Overview

Background

High-grade neuroendocrine carcinomas (HGNEC) are cancers that develop in different parts of the body, including the digestive tract, genitals, neck, and head. One drug (belinostat), combined with 2 other drugs (etoposide and cisplatin), is approved to treat HGNEC. But some people may have a gene variant that affects how quickly their body gets rid of the drug; these people may do better with different dosages of belinostat.

Objective

To test higher or lower doses of belinostat based on gene variants in people with HGNEC.

Eligibility

People aged 18 years and older with HGNEC.

Design

Participants will be screened. They will have a physical exam with blood tests. Some blood will be used for genetic testing. They will have imaging scans and a test of their heart function. Samples of tumor tissue may be collected.

All 3 study drugs (belinostat, etoposide, cisplatin) are given through a tube attached to a needle inserted into a vein. Treatment will be given in 21-day cycles.

For cycles 1 through 6: Participants will come to the clinic for the first 4 days. They will be given all 3 drugs. Imaging scans and other tests will be repeated. Each visit will last 4 to 8 hours.

After cycle 6: Participants may continue treatment with belinostat alone. They will come to the clinic for the first 3 days of each cycle. They may continue treatment for up to 5 years if the drug is helping them.

Participants will have a follow-up visit 30 days after their last dose of belinostat. Then they will receive follow-up visits by phone or email every 3 to 6 months.

Eligibility

-INCLUSION CRITERIA:

1. Participants must have histologically confirmed diagnosis of Extrapulmonary High-Grade Neuroendocrine Neoplasms (HGNENs) for which there is no known standard therapy capable of extending life expectancy.
2. Age >= 18 years.
3. Participants with neuroendocrine prostate cancer may continue ongoing LHRH agonist therapy.
4. Participants with bone metastases or hypercalcemia who began intravenous bisphosphonate treatment prior to study entry may continue this treatment while on study.
5. Evaluable (measurable or non-measurable) disease, per RECIST 1.1.
6. ECOG performance status <=2 at screening
7. Participants must have adequate organ and marrow function as defined below:
   • Leukocytes >=3,000/mcL
   • Hemoglobin >= 10 g/dL
   • Absolute neutrophil count (ANC) >=1,500/mcL
   • Platelets >=100,000/mcL
   • Aspartate aminotransferase (AST) or serum glutamic-oxaloacetic transaminase (SGOT) / Alanine aminotransferase (ALT) or serum glutamic-pyruvic transaminase (SGPT): <=3 X institutional upper limit of normal
   • Total bilirubin <= 1.5 x institutional upper limit of normal (ULN).

     NOTE: In participants with Gilbert s syndrome, a total bilirubin <= 3.0 X ULN is
     allowed
       -  Serum Creatinine <= 1.5 X institutional ULN OR
       -  An estimated Creatinine clearance (CrCL) >=60 mL/min/1.73 m^2 based on the
          Cockcroft Gault equation
       -  Prothrombin time (PT) / International normalized ratio (INR) and Partial
          thromboplastin time (PTT) <= 1 X institutional ULN

8. Hepatitis B virus (HBV)-infected participants can be enrolled if HBV DNA is

     undetectable. Hepatitis C virus (HCV)-infected participants can be enrolled if HCV
     RNA level is undetectable

9. Women of child-bearing potential (WOCBP) must agree to use effective contraception

     (hormonal, intrauterine device (IUD), tube ligation, a partner has had a previous
     vasectomy, abstinence) prior to study entry, during the study, and for 14 months for
     women after the last dose of the study drug(s). Men with partners of childbearing
     potential must agree to use effective contraception (abstinence, condoms, previous
     vasectomy) or request partners to use effective contraception (per above) during the
     study and for 11 months after the last dose of study therapy.

10. Breastfeeding participants must be willing to discontinue breastfeeding starting

     with prior to study entry, during the study, and for 3 months after the last dose of
     the study drug(s).

11. Willing to comply with study procedures and follow-up.

12. Participants must be able to understand and be willing to sign a written informed

consent document.

EXCLUSION CRITERIA:

1. Participants with prior investigational drug, chemotherapy, immunotherapy or any prior radiotherapy (except for palliative bone directed therapy) within the past 14 days prior to the first drug administration. Additionally, FDA-approved hormonal therapy for the treatment or prevention of other malignancies (e.g., breast cancer, prostate cancer) may be continued where in the opinion of the investigator stopping such therapies may increase the risk of disease progression. Potential drug-drug interactions with the hormonal agent will be assessed by the investigator prior to enrollment.
2. History of allergic reactions attributed to compounds of similar chemical or biologic composition to belinostat, cisplatin, etoposide or other agents used in study. Participants with a history of allergic reactions to medications containing polysorbate 80 will be evaluated on a case-by-case basis.
3. Participants with treated brain metastases are not eligible except if follow-up brain imaging after central nervous system (CNS)-directed therapy shows no evidence of progression.
4. Participants who have not recovered (CTCAE <= grade 1) from non heme adverse events due to prior treatments, except for alopecia, or stable grade 2 tinnitus (not interfering with ADL's) or baseline hearing loss by audiometry or stable grade 2 sensory neuropathy (moderate symptoms; limiting instrumental ADL) without pain or motor component, and not interfering with ADL's.
5. Participants taking strong UGT1A1 inhibitors or CYP3A4 inhibitors or inducers must discontinue their use a minimum of 5 half-lives prior to starting treatment on this trial
6. Participants with platinum-refractory disease.
7. Participants who have had another histone deacetylase inhibitor (e.g., valproic acid, vorinostat) for at least 2 weeks prior to enrollment.
8. Participants who have had radiation to the pelvis or other bone marrow-bearing sites will be considered on a case-by-case basis and may be excluded if the bone marrow reserve is not considered adequate (>25% of bone marrow).
9. Pregnancy (confirmed with beta-Human chorionic gonadotropin (HCG) serum or urine pregnancy test performed in WOCBP at screening)
10. Significant cardiovascular disease (New York Heart Association Class III or IV cardiac disease), myocardial infarction within the past 6 months, unstable angina, unstable arrhythmia, or a need for anti-arrhythmic therapy (use of medication to control heart rate in participants with atrial fibrillation is allowed, if stable medication for at least last month prior to enrollment and medication not listed as causing Torsade de Points), or evidence of acute ischemia on ECG.
11. Baseline prolongation of QT/QTc interval, i.e., defined as an average QTc interval > 450 msec calculated using the Fridericia formula for QT correction; Long QT Syndrome; or the required use of concomitant medication that may cause Torsade de Pointes.
12. Participants with HIV infection if CD4 count <200 cells per cubic millimeter before treatment initiation
13. Uncontrolled intercurrent illness that would limit compliance with study requirements.