TCRBCLs are difficult to recognize without immunoperoxidase studies. Patients with TCRBCL have clinical features similar to patients with other large B-cell lymphomas, except they may have more splenomegaly and advanced-stage disease; they should receive combination chemotherapy directed at large-cell lymphomas.

BACKGROUND:The current study was conducted to evaluate the efficacy of sorafenib, an oral vascular endothelial growth factor receptor tyrosine kinase inhibitor, when added to standard radiotherapy and temozolomide in the firstline treatment of patients with glioblastoma multiforme. METHODS: After initial surgical resection or biopsy, patients with newly diagnosed glioblastoma multiforme received concurrent radiotherapy (2.0 grays [Gy]/day; total dose, 60 Gy) and temozolomide (at a dose of 75 mg/m 2 orally daily), followed by 6 months of maintenance therapy with temozolomide (at a dose of 150 mg/m 2 orally on Days 1-5 every 28 days) and sorafenib (at a dose of 400 mg orally twice daily). Patients were re-evaluated every 2 months; the primary endpoint of the trial was progression-free survival (PFS). RESULTS: A total of 47 patients were treated; 34 had undergone previous debulking surgery. Nineteen patients withdrew from treatment before the initiation of maintenance therapy with temozolomide and sorafenib (12 because of early tumor progression). Twenty-eight patients (60% of enrolled patients) received 4 months of maintenance therapy with temozolomide and sorafenib, and 9 patients (19%) completed the planned 6 months of maintenance therapy. The median PFS for the entire group was 6 months (95% confidence interval [95% CI], 3.7-7 months), with a 1-year PFS rate of 16%. The median overall survival was 12 months (95%CI, 7.2-16 months). Maintenance therapy with temozolomide and sorafenib was found to be well tolerated by most patients, with no grade 3/4 toxicity (according to the National Cancer Institute Common Toxicity Criteria [version 3.0]) reported to occur in >10% of patients. CONCLUSIONS: The addition of sorafenib did not appear to improve the efficacy of treatment when compared with the results expected with standard therapy. A substantial percentage of patients (40%) did not receive any maintenance sorafenib, most often because of early disease progression. The administration of angiogenesis inhibitors concurrently with radiotherapy and temozolomide may optimize the opportunity to improve therapy.

AUY922 produced a median PFS which compares favorably to historical controls of placebo (6 weeks) for patients refractory to treatment with imatinib. While diarrhea and ocular toxicities were common, the majority of patients received treatment until disease progression.

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Sarcoidosis is a disease process of unknown cause that exhibits heterogeneous clinical manifestations. Although the mediastinum and lungs are most commonly involved, the granulomatous process may also affect the skeleton, skin, eyes, kidneys, spleen, and liver. A 51-year-old woman with low back pain and no history of cancer was found to have a suspicious lesion at L4 on magnetic resonance imaging. Findings of bone scintigraphy were consistent with multiple metastases, and computed tomography of the chest identified two small indeterminate pulmonary nodules. Similarly, findings of fluorodeoxyglucose positron emission tomography were consistent with widespread skeletal metastases, but a primary tumor was not identified. Biopsy of a left femur lesion was diagnostic of active sarcoidosis with no evidence of cancer.

No abstract

e13045 Background: BKM120 is an oral pan-class I PI3 kinase (PI3K) inhibitor, with demonstrated CNS penetration. Enhanced PI3K signaling is common in GBM (56-75% of cases), and is associated with poor survival (Chakravarti et al, 2004). This phase I study was designed to determine the maximum tolerated dose (MTD) of BKM120 in combination with a standard dose of bevacizumab as treatment for patients with relapsed/refractory GBM or other refractory solid tumors. Methods: Patients with relapsed/refractory GBM or other refractory solid tumors for which bevacizumab was an appropriate therapy received BKM120 with bevacizumab in a standard 3+3 dose escalation design. Bevacizumab 10 mg/kg IV was administered days 1 and 15 of 28-day cycles, with escalating doses of BKM 120 self-administered daily. Patients were evaluated for response after 8 weeks; treatment continued until disease progression or unacceptable toxicity. Results: Twelve patients were treated at 2 BKM120 dose levels, DL 1 = 60 mg/day and DL 2 = 80 mg/day. DL 1 (n = 6) tumor types included: 2 GBM, 2 colorectal and 2 NSCLC with treated brain metastases. Dose-limiting toxicity (DLT) of G4 delirium was observed in 1 GBM patient. Three additional patients were enrolled, and no further DLTs occurred. DL 2 (n = 6) tumor types included: 3 GBM and 3 colorectal. DLTs were observed in 2 of 6 patients: 1 colorectal (G3 rash, G3 stomatitis, G3 dehydration, and G2 worsening vomiting), and 1 GBM (G3 ataxia and G3 mental status changes). 6 patients had CNS symptoms possibly related to treatment, including mood alteration (3 GBM and 1 colorectal), delirium, hallucinations, and mental status change (1 GBM patient each). Common treatment-related toxicities (all grades) included: dyspepsia (42%), nausea (33%), ALT elevation (25%), dehydration (25%), proteinuria (25%), rash (25%), and thrombocytopenia (25%). No objective responses were documented; however, 1 colorectal patient remains on treatment with stable disease for 8 months. Conclusions: The addition of BKM120 to standard dose bevacizumab was tolerated at a dose of 60 mg/day. A phase II study with this combination is currently underway in patients with relapsed/refractory GBM. Clinical trial information: NCT01349660.

4048 Background: Proteasome inhibitors (PI) such as bortezomib and carfilzomib (CFZ) have improved the treatment of MM; however, resistance invariably develops and MM remains an incurable disease. Changes in histone modification are commonly found in human cancers including MM, and several histone deacetylase inhibitors (HDACi) are in clinical development. Preclinical studies demonstrate synergistic anti-MM activity of the combination of HDACi and PI through dual inhibition of the proteasome and aggresome pathways. Panobinostat (PAN) is an oral pan-HDACi which has shown synergy with bortezomib in clinical studies. This Phase I/II trial will determine the maximum tolerated dose (MTD) and evaluate the safety and efficacy of the combination of PAN and CFZ in relapsed/refractory pts with MM. When the MTD has been determined, the trial will continue to enroll pts with relapsed/refractory MM at the recommended dose. Methods: The dose escalation portion of the study will determine the maximum tolerated dose (MTD) of 4 planned dose levels with the combination of CFZ and PAN using a standard 3+3 dose escalation design. Dose modifications are not permitted during cycle 1 unless a pt experiences a dose limiting toxicity (DLT). DLTs are defined as: G4 neutropenia, febrile neutropenia, G4 thrombocytopenia or G3 thrombocytopenia with bleeding, G2 neuropathy with uncontrolled pain, any G3 non-hematologic drug-related toxicity requiring a dose reduction, or pts who are unable to receive 75% of the required dose due to toxicity. PAN is administered orally three times weekly during weeks 1 and 3 of each cycle (Days 1, 3, 5, 15, 17, 19). CFZ is administered IV over 10 min for doses < 27mg/m2 and over 30 min for doses >27 mg/m2 on Days 1, 2, 8, 9, 15, and 16 of each 28-day cycle. AEs are assessed according to CTCAE Version 4 and responses are assessed using IMWG criteria (plus MRs as per the EBMT criteria). Results: Ten pts have been enrolled to date across 3 dose levels and completed the DLT window. The dose levels explored to date are: level 1, CFZ 20/27 and PAN 20 mg; level 2 CFZ 20/36 and PAN 20 mg; and level 3, CFZ 20/45 and PAN 20 mg. The median age of pts was 65.5 (range 42–75). The median number of prior therapies was 3 (range 1–7); all pts had prior bortezomib (10% bortezomib refractory) and 40% were refractory to their last treatment. Nine pts are currently on study and 1 pt from DL1 discontinued due to progressive disease. No DLTs have been observed to date, there have been no dose reductions and there have been no deaths on study. Treatment related hematologic AEs were G3 thrombocytopenia observed in 40% of pts in dose levels 1–3, followed by neutropenia in 10% of pts from DL 1. No G4 hematologic and only 1 G3 non-hematologic AEs were observed. The most common treatment related non-heme AEs were GI with grade 1/2 nausea and vomiting occurring in 70% of pts (60% G1 & 10% G2), diarrhea in 60% of pts (40% G1, 10% G2 & 10% G3). Other mild to moderate adverse events occurring in >1 pt were; fatigue 50% of pts (30% G1, 20% G2), fever/chills 50% (G1), dry mouth 30% (G1), congestion 20% (G2), dysgusia 20% (10% G1, 10% G2), epitaxis 20% (G2), hypocalcemia 20% (G1), and liver function 20% (G1). Grade 2 peripheral neuropathy was reported in 1 patient. Of the 10 pts treated, 9 are evaluable for response (10% VGPR, 40% PR, 10% MR, and 30% SD). The median number of cycles for the evaluable pts is 5 (range 2–8). Conclusions: The combination of PAN and CFZ is well tolerated in relapsed/refractory MM patients. There have been no DLTs or dose reductions reported to date. MTD has not been reached at the current dose of CFZ 20/45 and PAN 20. The majority of AEs reported were manageable and expected. Early efficacy results are encouraging, and dose escalation to CFZ 20/45 and PAN 30 is planned. Disclosures: Off Label Use: Off-label use of the combo Panobinostat and Carfilomib in the treatment of relapsed/refractory Multiple Myeloma.