Continuous 24h Intravenous Infusion of Mithramycin, an Inhibitor of Cancer Stem Cell Signaling, in People With Primary Thoracic Malignancies or Carcinomas, Sarcomas or Germ Cell Neoplasms With Pleuropulmonary Metastases

Objectives

• To find the highest safe dose of mithramycin that can be given to people with chest cancer who have certain genes over 24 hours instead of spread out over a longer period of time. To see if mithramycin given as a 24-hour infusion shrinks tumors

Design

Participants will be admitted to the hospital overnight. A small plastic tube (catheter) will be inserted in the arm or chest. They will get mithramycin through the catheter over about 24 hours. If they do not have bad side effects or their cancer does not worsen, they can repeat the treatment every 14 days. Participants will have multiple visits for each treatment cycle. These include repeats of certain screening tests. After stopping treatment, participants will have weekly visits until they recover from any side effects.

Eligibility

Inclusion Criteria

Diagnosis: Patients with measurable inoperable, histologically confirmed non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), esophageal carcinoma, thymic epithelial neoplasms, germ cell tumors, malignant pleural mesotheliomas or chest wall sarcomas, as well as patients with gastric, colorectal, pancreas or renal cancers, germ cell tumors and sarcomas metastatic to thorax are eligible.

Histologic confirmation of disease in the Laboratory of Pathology, CCR, NCI, NIH.

Germline ABCB4 (CC) and ABCB11 (GG or GC) genotypes determined by pharmacogenomics analysis of peripheral blood mononuclear cells.

Disease amenable to biopsy via percutaneous approach or other minimally invasive procedures such as thoracoscopy, bronchoscopy, laparoscopy, or GI endoscopy

Age greater than or equal to18

ECOG status 0-2

Patients must have had, or refused first-line standard chemotherapy for their inoperable malignancies.

Patients must have had no chemotherapy, biologic therapy, or radiation therapy for their malignancy for at least 30 days prior to treatment. Patients may have received localized radiation therapy to non-target lesions provided that the radiotherapy is completed 14 days prior to commencing therapy, and the patient has recovered from any toxicity. At least 3 half-lives must have elapsed since monoclonal antibody treatment. At least six weeks must have elapsed between mitomycin C or nitrosourea treatment.

Patients must have adequate organ and marrow function as defined below:

Hematologic and Coagulation Parameters:

1. Peripheral ANC greater than or equal to 1500/mm(3)
2. Platelets greater than or equal to 100,000/ mm(3) (transfusion independent)
3. Hemoglobin greater than or equal to 8 g/dL (PRBC transfusions permitted)
4. PT/PTT within normal limits ( 11.6 – 15.2 / 25.3 – 37.3 sec)

Hepatic Function:

1. Bilirubin (total) < 1.5 times upper limit of normal (ULN)
2. LT (SGPT) less than or equal to 3.0 times ULN
3. Albumin > 2 g/dL

Renal Function:

1. Creatinine within normal institutional limits or creatinine clearance greater than or equal to 60 mL/min/1.73 m(2) for patients with creatinine levels above institutional normal.
2. Normal ionized calcium, magnesium and phosphorus (can be on oral supplementation)

Cardiac Function: Left ventricular ejection fraction (EF) >40% by echocardiogram, MUGA, or cardiac MR.

Ability of subject to understand, and be willing to sign informed consent

Female and male patients (and when relevant their partners) must be willing to practice birth control (including abstinence) during and for two months after treatment if female of childbearing potential or male having sexual contact with a female of childbearing potential.

Patients must be willing to undergo 2 tumor biopsies

Exclusion Criteria

Clinically significant systemic illness (e.g. serious active infections or significant cardiac, pulmonary, hepatic or other organ dysfunction), that in the judgment of the PI would compromise the patient s ability to tolerate protocol therapy or significantly increase the risk of complications.

Patients with cerebral metastases

Patients with any of the following pulmonary function abnormalities will be excluded:

FEV, < 30% predicted; DLCO, < 30% predicted (post-bronchodilator); pO2 < 60 mm Hg or pCO2 greater than or equal to 55 mm Hg on room air arterial blood gas.

Patients with evidence of active bleeding, intratumoral hemorrhage or history of bleeding diatheses, unless specifically occurring as an isolated incident during reversible chemotherapy-induced thrombocytopenia.

Patients on therapeutic anticoagulation Note: prophylactic anticoagulation (i.e. intralumenal heparin) for venous or arterial access devices is allowed.

Patients who are concurrently receiving or requiring any of the following agents, which may increase the risk for mithramycin related toxicities, such as hemorrhage:

1. Thrombolytic agents
2. Aspirin or salicylate-containing products, which may increase risk of hemorrhage
3. Dextran
4. Dipyridamole
5. Sulfinpyrazone
6. Valproic acid
7. Clopidogrel

Lactating or pregnant females (due to risk to fetus or newborn, and lack of testing for excretion in breast milk).

Patients with history of HIV, HBV or HCV due to potentially increased risk of mithramycin toxicity in this population.

Hypersensitivity to mithramycin

Patients who in the opinion of the investigator may not be able to comply with the safety monitoring requirements of the study.