FR901228 in Treating Patients With Unresectable Stage III or Stage IV Malignant Melanoma

Phase II Trial of Depsipeptide (NSC 630176) in Advanced Malignant Melanoma

RATIONALE: Drugs used in chemotherapy, such as FR901228, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing.

PURPOSE: This phase II trial is studying how well FR901228 works in treating patients with unresectable stage III or stage IV malignant melanoma.

OBJECTIVES:

Primary

• Determine the response rate in patients with unresectable stage III or stage IV malignant melanoma treated with FR901228 (depsipeptide).

Secondary

• Determine the progression-free and overall survival of patients treated with this drug.
• Determine the toxicity profile of this drug in these patients.

OUTLINE: This is a multicenter study.

Patients receive FR901228 (depsipeptide) intravenously (IV) over 4 hours on days 1, 8, and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 3 months for 2 years and then every 6 months for 1 year.

PROJECTED ACCRUAL: A total of 22-40 patients will be accrued for this study within 18 months.

Inclusion Criteria:

• Stage III unresectable or American Joint Committee on Cancer (AJCC) stage IV cutaneous, mucosal, ocular, or unknown primary melanoma with measurable disease by physical examination or imaging studies.
• Palpable cutaneous or nodal metastases suitable for punch, trucut, or similar biopsy if the patient agrees.
• Normal electrocardiogram (EKG)
• Left ventricular ejection fraction (LVEF) > 40% by Multi Gated Acquisition Scan (MUGA)
• Corrected QT (QTc) < 500 msec
• Age greater than or equal to 18
• Negative pregnancy test
• Fertile patients must use effective contraception
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2
• Normal organ and marrow function
• Patients on hydrochorthiazide should be switched to a potassium-sparing diuretic or another antihypertensive
• At least 4 weeks since prior radiotherapy
• Patients with cardiac hypertrophy may be enrolled but should be carefully monitored.

Exclusion Criteria:

• Prior FR901228 (depsipeptide)
• Prior chemotherapy
• Other concurrent chemotherapy
• Active central nervous system (CNS) metastases by brain computed tomography (CT) scan or magnetic resonance imaging (MRI)
• History of coronary atherosclerotic heart disease
• History of myocardial infarction
• History of congestive heart failure
• Non-melanoma malignancy within the past 5 years except carcinoma in situ or squamous cell or basal cell skin cancer
• Pregnant or nursing women
• Conditions that in the opinion of the investigator would interfere with the ability of the patient to complete this protocol
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to Depsipeptide
• Co-medication with an agent that causes QTc prolongation
• Human immunodeficiency virus (HIV) positive patients receiving combination anti-retroviral therapy
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, or psychiatric illness/social situations that would limit compliance with study requirements
• Concurrent radiotherapy
• Left ventricular hypertrophy (LVH) on their baseline EKG tracing