<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03237390</url>
  </required_header>
  <id_info>
    <org_study_id>MC1613</org_study_id>
    <secondary_id>NCI-2017-01316</secondary_id>
    <secondary_id>MC1613</secondary_id>
    <nct_id>NCT03237390</nct_id>
  </id_info>
  <brief_title>Ribociclib and Gemcitabine Hydrochloride in Treating Patients With Advanced or Metastatic Solid Tumors</brief_title>
  <official_title>Phase I Study of CDK4/6 Inhibitor Ribociclib (LEE011) Combined With Gemcitabine in Patients With Advanced Solid Tumors</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Mayo Clinic</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>National Cancer Institute (NCI)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
  </sponsors>
  <source>Mayo Clinic</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>Yes</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      This phase I trial studies the side effects and best dose of ribociclib and gemcitabine&#xD;
      hydrochloride in treating patients with solid tumors that have spread to other places in the&#xD;
      body. Ribociclib may stop the growth of tumor cells by blocking some of the enzymes needed&#xD;
      for cell growth. Drugs used in chemotherapy, such as gemcitabine hydrochloride, work in&#xD;
      different ways to stop the growth of tumor cells, either by killing the cells, by stopping&#xD;
      them from dividing, or by stopping them from spreading. Giving ribociclib and gemcitabine&#xD;
      hydrochloride may work better in treating patients with solid tumors.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      PRIMARY OBJECTIVES:&#xD;
&#xD;
      I. To describe the dose-limiting toxicities and identify the maximum tolerated dose (MTD) and&#xD;
      recommended phase II dose of the combination of ribociclib and gemcitabine hydrochloride&#xD;
      (gemcitabine) in patients with advanced solid tumors.&#xD;
&#xD;
      SECONDARY OBJECTIVES:&#xD;
&#xD;
      I. To describe the safety and tolerability of the combination of ribociclib and gemcitabine.&#xD;
&#xD;
      II. To describe the pharmacokinetic (PK) of ribociclib in combination with gemcitabine.&#xD;
&#xD;
      III. To describe preliminary evidence of efficacy of the combination of ribociclib and&#xD;
      gemcitabine.&#xD;
&#xD;
      TERTIARY OBJECTIVES:&#xD;
&#xD;
      I. To evaluate the correlation of CDK4/6, cyclin D1 and cyclin D3 amplification,&#xD;
      retinoblastoma (RB) and P16 expression in archived and biopsied tumor tissue with treatment&#xD;
      response.&#xD;
&#xD;
      OUTLINE: This is a dose-escalation study.&#xD;
&#xD;
      Patients receive gemcitabine hydrochloride intravenously (IV) over 30 minutes on days 1 and 8&#xD;
      and ribociclib orally (PO) once daily (QD) on days 8-14. Courses repeat every 21 days in the&#xD;
      absence of disease progression or unacceptable toxicity.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">January 4, 2018</start_date>
  <completion_date type="Actual">May 17, 2022</completion_date>
  <primary_completion_date type="Actual">May 17, 2022</primary_completion_date>
  <phase>Phase 1</phase>
  <study_type>Interventional</study_type>
  <study_design_info>
    <allocation>N/A</allocation>
    <intervention_model>Single Group Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Maximum tolerated dose</measure>
    <time_frame>Up to 21 days</time_frame>
    <description>Defined as the dose level below the lowest dose that induces dose-limiting toxicity in at least 2 patients (out of 6).</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Best response defined as best objective status recorded from the start of the treatment until disease progression/recurrence</measure>
    <time_frame>Up to 18 months</time_frame>
    <description>Responses will be summarized by simple descriptive summary statistics delineating complete and partial responses as well as stable and progressive disease in this patient population (overall and by tumor group). The number of responses may indicate further evaluation for specific tumor types in a phase II setting.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Confirmed response defined to be a stringent complete response, complete response, very good partial response, or partial response</measure>
    <time_frame>Up to 18 months</time_frame>
    <description>Responses will be summarized by simple descriptive summary statistics delineating complete and partial responses as well as stable and progressive disease in this patient population (overall and by tumor group). The number of responses may indicate further evaluation for specific tumor types in a phase II setting.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Incidence of adverse events</measure>
    <time_frame>Up to 30 days after last dose</time_frame>
    <description>Number and severity of all adverse events (overall, by dose-level, and by tumor group) will be tabulated and summarized. Adverse events that are classified as either possibly, probably, or definitely related to study treatment. Non-hematologic toxicities will be evaluated via the ordinal Common Toxicity Criteria (CTC) standard toxicity grading. Hematologic toxicity measures of thrombocytopenia, neutropenia, and leukopenia will be assessed using continuous variables as the outcome measures (primarily nadir) as well as categorization via CTC standard toxicity grading. Overall toxicity incidence</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Pharmacokinetic (PK) of ribociclib</measure>
    <time_frame>Pre-ribociclib dose, 0.5, 1, 2, 4, 6, and 8 hours post dose on days 8 and 14 course 1 and pre-gemcitabine hydrochloride dose on day 1 course 2</time_frame>
    <description>A population PK model will be developed utilizing the PK time points collected, and then used to estimate individual area under the curves or clearance of ribociclib in combination with gemcitabine hydrochloride. The effect of the combination on PK of each drug will be evaluated by the model, along with other participant factors that may explain the inter-participant variability in pharmacokinetics.</description>
  </secondary_outcome>
  <other_outcome>
    <measure>CDK2/4/6, Cyclin D1 and Cyclin D3 amplification, retinoblastoma (RB) and P16 expression</measure>
    <time_frame>Up to 18 months</time_frame>
    <description>CDK2/4/6, Cyclin D1 and Cyclin D3 amplification, RB and P16 expression in archived and biopsied tumor tissue with be correlated with treatment response.</description>
  </other_outcome>
  <number_of_arms>1</number_of_arms>
  <enrollment type="Actual">43</enrollment>
  <condition>Advanced Malignant Solid Neoplasm</condition>
  <condition>Metastatic Malignant Solid Neoplasm</condition>
  <arm_group>
    <arm_group_label>Treatment (gemcitabine hydrochloride, ribociclib)</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Patients receive gemcitabine hydrochloride IV over 30 minutes on days 1 and 8 and ribociclib PO QD on days 8-14. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.</description>
  </arm_group>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Gemcitabine Hydrochloride</intervention_name>
    <description>Given IV</description>
    <arm_group_label>Treatment (gemcitabine hydrochloride, ribociclib)</arm_group_label>
    <other_name>dFdCyd</other_name>
    <other_name>Difluorodeoxycytidine Hydrochloride</other_name>
    <other_name>Gemzar</other_name>
    <other_name>LY-188011</other_name>
    <other_name>LY188011</other_name>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Laboratory Biomarker Analysis</intervention_name>
    <description>Correlative studies</description>
    <arm_group_label>Treatment (gemcitabine hydrochloride, ribociclib)</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Pharmacological Study</intervention_name>
    <description>Correlative studies</description>
    <arm_group_label>Treatment (gemcitabine hydrochloride, ribociclib)</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Drug</intervention_type>
    <intervention_name>Ribociclib</intervention_name>
    <description>Given PO</description>
    <arm_group_label>Treatment (gemcitabine hydrochloride, ribociclib)</arm_group_label>
    <other_name>Kisqali</other_name>
    <other_name>LEE-011</other_name>
    <other_name>LEE011</other_name>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Diagnosis of advanced/metastatic solid malignancy for which no standard treatment&#xD;
             option exists that will confer clinical benefit&#xD;
&#xD;
          -  Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1&#xD;
&#xD;
          -  Dose expansion phase only: must have at least one measurable lesion as defined by&#xD;
             Response Evaluation Criteria in Solid Tumors (RECIST) criteria&#xD;
&#xD;
          -  Ability to provide written informed consent which must be obtained prior to any&#xD;
             screening procedures and according to local guidelines&#xD;
&#xD;
          -  Life expectancy of &gt;= 12 weeks&#xD;
&#xD;
          -  Absolute neutrophil count &gt;= 1500/mm^3&#xD;
&#xD;
          -  Platelets &gt;= 100,000/mm^3&#xD;
&#xD;
          -  Hemoglobin &gt;= 9 g/dL&#xD;
&#xD;
          -  Potassium &gt;= lower limit of normal (LLN) range for the institution&#xD;
&#xD;
          -  Calcium &gt;= LLN (corrected for serum albumin, if albumin abnormal)&#xD;
&#xD;
          -  Magnesium &gt;= LLN&#xD;
&#xD;
          -  Sodium &gt;= LLN&#xD;
&#xD;
          -  Phosphorus &gt;= LLN; NOTE: Supplementation may be given before the first dose of study&#xD;
             medication&#xD;
&#xD;
          -  International normalized ratio (INR) =&lt; 1.5&#xD;
&#xD;
          -  Serum creatinine =&lt; 1.5 mg/dL or creatinine clearance &gt;= 50 mL/min (calculated by&#xD;
             Cockcroft Gault equation)&#xD;
&#xD;
          -  Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =&lt; 2.5 x upper&#xD;
             limit of normal (ULN) or =&lt; 5 x ULN if liver metastases are present&#xD;
&#xD;
          -  Total bilirubin =&lt; 3.0 x ULN; if patient has known Gilbert?s syndrome direct bilirubin&#xD;
             =&lt; 1.5 x ULN&#xD;
&#xD;
          -  Standard 12-lead electrocardiography (ECG) with the following parameters at screening&#xD;
             (defined as the mean of the triplicate ECGs):&#xD;
&#xD;
               -  Fridericia's correction formula (QTcF) interval at screening &lt; 450 msec (using&#xD;
                  Fridericia? s correction)&#xD;
&#xD;
               -  Resting heart rate 50 to 100 beats per minute&#xD;
&#xD;
          -  Negative pregnancy test performed =&lt; 7 days prior to registration (women of&#xD;
             childbearing potential only)&#xD;
&#xD;
          -  Able to swallow ribociclib capsules&#xD;
&#xD;
          -  Willingness to return to enrolling institution for follow-up (during the active&#xD;
             monitoring phase of the study)&#xD;
&#xD;
          -  Willingness to provide mandatory blood samples for research purposes&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Previous anti-cancer chemotherapy, immunotherapy or investigational agents =&lt; 28 days&#xD;
             prior to registration&#xD;
&#xD;
          -  Received radiotherapy =&lt; 28 days or limited field radiation for palliation =&lt; 14 days&#xD;
             prior to registration, and who has not recovered to grade 1 or better from related&#xD;
             side effects of such therapy (exceptions include alopecia) and/or in whom &gt;= 25% of&#xD;
             the bone marrow was irradiated&#xD;
&#xD;
          -  Major surgery =&lt; 14 days prior to registration or has not recovered from major side&#xD;
             effects (tumor biopsy is not considered as major surgery)&#xD;
&#xD;
          -  Active clinically serious infections or other serious uncontrolled medical conditions&#xD;
&#xD;
          -  Impairment of gastrointestinal (GI) function or GI disease that may significantly&#xD;
             alter the absorption of the study drugs (e.g., ulcerative diseases, uncontrolled&#xD;
             nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection)&#xD;
&#xD;
          -  Baseline neuropathy of &gt; grade 2&#xD;
&#xD;
          -  Known hypersensitivity to any of the excipients of ribociclib&#xD;
&#xD;
          -  Known human immunodeficiency virus (HIV) patients with active and untreated disease&#xD;
&#xD;
          -  Central nervous system (CNS) involvement unless they meet ALL of the following&#xD;
             criteria:&#xD;
&#xD;
               -  &gt;= 28 days from prior therapy completion (including radiation and/or surgery) to&#xD;
                  registration&#xD;
&#xD;
               -  Clinically stable CNS tumor at the time of screening and not receiving steroids&#xD;
                  and/or enzyme-inducing anti-epileptic medications for brain metastases&#xD;
&#xD;
          -  Clinically significant, uncontrolled heart disease and/ or cardiac repolarization&#xD;
             abnormalities including any of the following:&#xD;
&#xD;
               -  History of unstable angina pectoris, symptomatic pericarditis, myocardial&#xD;
                  infarction, coronary artery bypass grafting or coronary angioplasty =&lt; 12 months&#xD;
                  prior to registration&#xD;
&#xD;
               -  History of documented congestive heart failure (New York Heart Association&#xD;
                  functional classification III - IV)&#xD;
&#xD;
               -  Documented cardiomyopathy&#xD;
&#xD;
               -  Left ventricular ejection fraction (LVEF) &lt; 50% as determined by echocardiogram&#xD;
                  (ECHO)&#xD;
&#xD;
               -  Clinically significant cardiac arrhythmias ( e.g ventricular tachycardia) , left&#xD;
                  bundle branch block, high-grade atrioventricular (AV) block ( e.g bifascucular&#xD;
                  block, Mobitz type II and third degree AV block)&#xD;
&#xD;
               -  Long QT syndrome or family history of idiopathic sudden death or congenital long&#xD;
                  QT syndrome, or any of the following:&#xD;
&#xD;
                    -  Risk factors for torsades de pointe (TdP) including uncorrected hypokalemia&#xD;
                       or hypomagnesemia, history of cardiac failure, or history of clinically&#xD;
                       significant/symptomatic bradycardia&#xD;
&#xD;
                    -  Concomitant use of medication(s) with a known risk to prolong the QT&#xD;
                       interval and/or known to cause torsades de pointe that cannot be&#xD;
                       discontinued (within 5 half-lives or =&lt; 7 days prior to registration) or&#xD;
                       replaced by safe alternative medication&#xD;
&#xD;
                    -  Inability to determine the QT interval on screening (QTcF, using Fridericia?&#xD;
                       s correction)&#xD;
&#xD;
          -  Systolic blood pressure &gt; 160 mmHg or &lt; 90 mmHg&#xD;
&#xD;
          -  Any other concurrent severe and/or uncontrolled medical condition that would, in the&#xD;
             investigator?s judgment, cause unacceptable safety risks, contraindicate patient&#xD;
             participation in the clinical study or compromise compliance with the protocol (e.g.,&#xD;
             chronic pancreatitis, chronic active hepatitis, active untreated or uncontrolled&#xD;
             fungal, bacterial or viral infections etc.)&#xD;
&#xD;
          -  Currently receiving any of the following medications and cannot be discontinued 7 days&#xD;
             prior to starting the study&#xD;
&#xD;
               -  Herbal supplements including grapefruit, grapefruit hybrids, pummelos,&#xD;
                  star-fruit, Seville oranges or products containing the juice of each; orange&#xD;
                  juice is allowed&#xD;
&#xD;
               -  Known strong inducers or inhibitors of CYP3A4/5 including grapefruit, grapefruit&#xD;
                  hybrids, pomelos, star-fruit, and Seville oranges&#xD;
&#xD;
               -  Medications known to have a narrow therapeutic window and are predominantly&#xD;
                  metabolized through CYP3A4&#xD;
&#xD;
          -  Currently receiving or has received systemic corticosteroids (=&lt; 14 days prior to&#xD;
             registration, or who have not fully recovered from side effects of such treatment);&#xD;
             NOTE: The following uses of corticosteroids are permitted: single doses, topical&#xD;
             applications (e.g., for rash), inhaled sprays (e.g., for obstructive airways&#xD;
             diseases), eye drops or local injections (e.g., intra-articular)&#xD;
&#xD;
          -  History of non-compliance to medical regimen or inability to grant consent&#xD;
&#xD;
          -  Currently receiving warfarin or other warfarin-derived anticoagulant for treatment,&#xD;
             prophylaxis or otherwise; Note: Therapy with heparin, direct oral anticoagulants, low&#xD;
             molecular weight heparin (LMWH) or fondaparinux is allowed&#xD;
&#xD;
          -  Participation in a prior investigational study =&lt; 30 days prior to enrollment or&#xD;
             within 5 half-lives of the investigational product, whichever is longer&#xD;
&#xD;
          -  Failure to recover from all adverse events/toxicities related to prior anticancer&#xD;
             therapies to grade 1 per National Cancer Institute (NCI)-Common Terminology Criteria&#xD;
             for Adverse Events (CTCAE) version 4.03; NOTE: Exception: patients with any grade of&#xD;
             alopecia are allowed to enter the study&#xD;
&#xD;
          -  Child-Pugh score B or C (for cirrhosis patients only)&#xD;
&#xD;
          -  Pregnant or nursing (lactating) women, where pregnancy is defined as the state of a&#xD;
             female after conception and until the termination of gestation, confirmed by a&#xD;
             positive human chorionic gonadotropin (hCG) laboratory test&#xD;
&#xD;
          -  Women of child-bearing potential, defined as all women physiologically capable of&#xD;
             becoming pregnant, unless they are using highly effective methods of contraception&#xD;
             throughout the study and for 8 weeks after study drug discontinuation; highly&#xD;
             effective contraception methods include:&#xD;
&#xD;
               -  Total abstinence when this is in line with the preferred and usual lifestyle of&#xD;
                  the patient; periodic abstinence (e.g., calendar, ovulation, symptothermal,&#xD;
                  post-ovulation methods) and withdrawal are not acceptable methods of&#xD;
                  contraception&#xD;
&#xD;
               -  Female sterilization (have had surgical bilateral oophorectomy with or without&#xD;
                  hysterectomy), total hysterectomy, or tubal ligation at least 6 weeks before&#xD;
                  taking study treatment; in case of oophorectomy alone, only when the reproductive&#xD;
                  status of the woman has been confirmed by follow up hormone level assessment&#xD;
&#xD;
               -  Male sterilization (at least 6 months prior to screening), the vasectomized male&#xD;
                  partner should be the sole partner for that patient&#xD;
&#xD;
               -  Use of oral, injected or implanted hormonal methods of contraception or placement&#xD;
                  of an intrauterine device (IUD) or intrauterine system (IUS), or other forms of&#xD;
                  hormonal contraception that have comparable efficacy (failure rate &lt; 1%), for&#xD;
                  example hormone vaginal ring or transdermal hormone contraception&#xD;
&#xD;
               -  Note: In case of use of oral contraception, women should have been stable on the&#xD;
                  same pill for a minimum of 3 months before taking study treatment; Note: Oral&#xD;
                  contraceptives are allowed but should be used in conjunction with a barrier&#xD;
                  method of contraception due to unknown effect of drug-drug interaction&#xD;
&#xD;
               -  Note: Women are considered post-menopausal and not of child bearing potential if&#xD;
                  they have had 12 months of natural (spontaneous) amenorrhea with an appropriate&#xD;
                  clinical profile (e.g. age appropriate, history of vasomotor symptoms) is she&#xD;
                  considered not of child bearing potential&#xD;
&#xD;
          -  Sexually active males unless they use a condom during intercourse while taking the&#xD;
             drug and for 21 days after stopping treatment and should not father a child in this&#xD;
             period; Note: A condom is required to be used also by vasectomized men in order to&#xD;
             prevent delivery of the drug via seminal fluid&#xD;
&#xD;
          -  Known standard therapy for the patient?s disease that is potentially curative or&#xD;
             definitely capable of extending life expectancy&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Alex Adjei</last_name>
    <role>Principal Investigator</role>
    <affiliation>Mayo Clinic</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Mayo Clinic Hospital</name>
      <address>
        <city>Phoenix</city>
        <state>Arizona</state>
        <zip>85054</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Mayo Clinic in Florida</name>
      <address>
        <city>Jacksonville</city>
        <state>Florida</state>
        <zip>32224-9980</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Mayo Clinic</name>
      <address>
        <city>Rochester</city>
        <state>Minnesota</state>
        <zip>55905</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <link>
    <url>https://www.mayo.edu/research/clinical-trials</url>
    <description>Mayo Clinic Clinical Trials</description>
  </link>
  <verification_date>September 2022</verification_date>
  <study_first_submitted>July 31, 2017</study_first_submitted>
  <study_first_submitted_qc>July 31, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">August 2, 2017</study_first_posted>
  <last_update_submitted>January 4, 2023</last_update_submitted>
  <last_update_submitted_qc>January 4, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">January 5, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Neoplasms</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Gemcitabine</mesh_term>
  </intervention_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03237390
org study id: MC1613
secondary id: NCI-2017-01316
secondary id: MC1613
nct id: NCT03237390
lead sponsor: 
collaborator: 
has dmc: Yes
is fda regulated drug: Yes
is fda regulated device: No
This phase I trial studies the side effects and best dose of ribociclib and gemcitabine
      hydrochloride in treating patients with solid tumors that have spread to other places in the
      body. Ribociclib may stop the growth of tumor cells by blocking some of the enzymes needed
      for cell growth. Drugs used in chemotherapy, such as gemcitabine hydrochloride, work in
      different ways to stop the growth of tumor cells, either by killing the cells, by stopping
      them from dividing, or by stopping them from spreading. Giving ribociclib and gemcitabine
      hydrochloride may work better in treating patients with solid tumors.
PRIMARY OBJECTIVES:

      I. To describe the dose-limiting toxicities and identify the maximum tolerated dose (MTD) and
      recommended phase II dose of the combination of ribociclib and gemcitabine hydrochloride
      (gemcitabine) in patients with advanced solid tumors.

      SECONDARY OBJECTIVES:

      I. To describe the safety and tolerability of the combination of ribociclib and gemcitabine.

      II. To describe the pharmacokinetic (PK) of ribociclib in combination with gemcitabine.

      III. To describe preliminary evidence of efficacy of the combination of ribociclib and
      gemcitabine.

      TERTIARY OBJECTIVES:

      I. To evaluate the correlation of CDK4/6, cyclin D1 and cyclin D3 amplification,
      retinoblastoma (RB) and P16 expression in archived and biopsied tumor tissue with treatment
      response.

      OUTLINE: This is a dose-escalation study.

      Patients receive gemcitabine hydrochloride intravenously (IV) over 30 minutes on days 1 and 8
      and ribociclib orally (PO) once daily (QD) on days 8-14. Courses repeat every 21 days in the
      absence of disease progression or unacceptable toxicity.
allocation: N/A
intervention model: Single Group Assignment
primary purpose: Treatment
masking: None (Open Label)
measure: Maximum tolerated dose
time frame: Up to 21 days
description: Defined as the dose level below the lowest dose that induces dose-limiting toxicity in at least 2 patients (out of 6).
measure: Best response defined as best objective status recorded from the start of the treatment until disease progression/recurrence
time frame: Up to 18 months
description: Responses will be summarized by simple descriptive summary statistics delineating complete and partial responses as well as stable and progressive disease in this patient population (overall and by tumor group). The number of responses may indicate further evaluation for specific tumor types in a phase II setting.
measure: Confirmed response defined to be a stringent complete response, complete response, very good partial response, or partial response
time frame: Up to 18 months
description: Responses will be summarized by simple descriptive summary statistics delineating complete and partial responses as well as stable and progressive disease in this patient population (overall and by tumor group). The number of responses may indicate further evaluation for specific tumor types in a phase II setting.
measure: Incidence of adverse events
time frame: Up to 30 days after last dose
description: Number and severity of all adverse events (overall, by dose-level, and by tumor group) will be tabulated and summarized. Adverse events that are classified as either possibly, probably, or definitely related to study treatment. Non-hematologic toxicities will be evaluated via the ordinal Common Toxicity Criteria (CTC) standard toxicity grading. Hematologic toxicity measures of thrombocytopenia, neutropenia, and leukopenia will be assessed using continuous variables as the outcome measures (primarily nadir) as well as categorization via CTC standard toxicity grading. Overall toxicity incidence
measure: Pharmacokinetic (PK) of ribociclib
time frame: Pre-ribociclib dose, 0.5, 1, 2, 4, 6, and 8 hours post dose on days 8 and 14 course 1 and pre-gemcitabine hydrochloride dose on day 1 course 2
description: A population PK model will be developed utilizing the PK time points collected, and then used to estimate individual area under the curves or clearance of ribociclib in combination with gemcitabine hydrochloride. The effect of the combination on PK of each drug will be evaluated by the model, along with other participant factors that may explain the inter-participant variability in pharmacokinetics.
measure: CDK2/4/6, Cyclin D1 and Cyclin D3 amplification, retinoblastoma (RB) and P16 expression
time frame: Up to 18 months
description: CDK2/4/6, Cyclin D1 and Cyclin D3 amplification, RB and P16 expression in archived and biopsied tumor tissue with be correlated with treatment response.
arm group label: Treatment (gemcitabine hydrochloride, ribociclib)
arm group type: Experimental
description: Patients receive gemcitabine hydrochloride IV over 30 minutes on days 1 and 8 and ribociclib PO QD on days 8-14. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
intervention type: Drug
intervention name: Gemcitabine Hydrochloride
description: Given IV
arm group label: Treatment (gemcitabine hydrochloride, ribociclib)
other name: dFdCyd
other name: Difluorodeoxycytidine Hydrochloride
other name: Gemzar
other name: LY-188011
other name: LY188011
intervention type: Other
intervention name: Laboratory Biomarker Analysis
description: Correlative studies
arm group label: Treatment (gemcitabine hydrochloride, ribociclib)
intervention type: Other
intervention name: Pharmacological Study
description: Correlative studies
arm group label: Treatment (gemcitabine hydrochloride, ribociclib)
intervention type: Drug
intervention name: Ribociclib
description: Given PO
arm group label: Treatment (gemcitabine hydrochloride, ribociclib)
other name: Kisqali
other name: LEE-011
other name: LEE011
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
last name: Alex Adjei
role: Principal Investigator
affiliation: Mayo Clinic
facility: 
facility: 
facility: 
country: United States
url: https://www.mayo.edu/research/clinical-trials
description: Mayo Clinic Clinical Trials
responsible party type: Sponsor
mesh term: Neoplasms
mesh term: Gemcitabine