Patients must have an electrocardiogram (ECG) within weeks prior to registration to screening step and must meet the following cardiac criteria:\r\n* Resting corrected QT interval (QTc) =< msec\r\n** NOTE: If the first recorded QTc exceeds msec, two additional, consecutive ECGs are required and must result in a mean resting QTc =< msec; it is recommended that there are -minute (+/- minutes) breaks between the ECGs\r\n* The following only need to be assessed if the mean QTc > msec\r\n** Check potassium and magnesium serum levels\r\n** Correct any identified hypokalemia and/or hypomagnesemia and may repeat ECG to confirm exclusion of patient due to QTc\r\n** For patients with heart rate (HR) - beats per minute (bpm), no manual read of QTc is required\r\n** For patients with baseline HR < or > bpm, manual read of QT by trained personnel is required, with Fridericia correction applied to determine QTc\r\n** Patient must not have hypokalemia (value < institutional lower limit of normal)\r\n* No factors that increase the risk of QTc prolongation or risk of arrhythmic events such as heart failure, congenital long QT syndrome, family history of long QT syndrome or unexplained sudden death under years of age or any concomitant medication known to prolong the QT interval\r\n** NOTE: Patient must be taken off prohibited medication prior to registration to the screening step (Step , , , ) and remain off these medications thereafter, unless permitted on a subprotocol for the management of treatment related toxicity; patient must be off the drug for at least half-lives prior to registration to the treatment step (Step , , , ); the medication half-life can be found in the package insert for Food and Drug Administration (FDA) approved drugs
Anticipated use of any concomitant medication during or within days before initiation of study treatment that is known to cause QT prolongation
Corrected QT interval (QTc) > msec; history of QT syndrome, Brugada syndrome or known history of QTc prolongation, or torsade de pointes
QTc > msec (based on the mean value of the triplicate electrocardiography [ECG]s), family or personal history of long or short QTc prolongation, or torsade de pointes (Tdp)
Corrected QT interval (QTc) using Fridericia's formula (QTcF) value > msec at Screening; family or personal history of long QTc syndrome or ventricular arrhythmias including ventricular bigeminy at Screening; previous history of drug induced QTc prolongation or the need for treatment with medications known or suspected of producing prolonged QTc intervals on electrocardiogram (ECG).
QTc > msec, or family or personal history of long or short QT syndrome, Brugada syndrome or known history of QTc prolongation, or Torsade de Pointes.
Patients who have ongoing cardiac dysrhythmias, atrial fibrillation, or prolongation of corrected QTc interval to > msec on out of electrocardiograms (EKGs) (if first EKG has QTc < , no need to repeat, if first EKG has QTc > repeat twice for a total of EKGs)
ENROLLMENT TO THE DOSE ESCALATION, EXPANSION AND PART II: History of QT syndrome, Brugada syndrome, known history of QTc prolongation, or Torsades de Pointes
EXPANDED ACCESS COHORT: History of QT syndrome, Brugada syndrome, known history of clinically significant QTc prolongation, or Torsades de Pointes
Subjects with baseline QT prolongation > msec
QTc prolongation > ms or other factors that increase the risk for QT interval prolongation (e.g., heart failure, hypokalemia [defined as serum potassium <. mEq/L that is persistent and refractory to correction], family history of long QT interval syndrome, or concomitant use of medications that may prolong QT interval)
Corrected QT interval (QTc) using Fridericia's formula (QTcF) value > msec at Screening; family or personal history of long QTc syndrome or ventricular arrhythmias including ventricular bigeminy at Screening; previous history of drug induced QTc prolongation or the need for treatment with medications known or suspected of producing prolonged QTc intervals on electrocardiogram (ECG).
Medications with a known risk of prolongation of QT interval
No previous history of corrected QT (QTc) prolongation as a result of medication that required discontinuation of that medication
Corrected QT interval using Fridericias formula value > msec at screening; family or personal history of long QTc syndrome or ventricular arrhythmias including ventricular bigeminy at screening; previous history of drug-induced QTc prolongation or the need for treatment with medications known or suspected of producing prolonged QTc intervals on electrocardiogram (ECG)
Concomitant use of a drug with a known risk of corrected QT interval (QTc) prolongation
Family history of long QTc syndrome; personal history of long QTc syndrome or previous drug-induced QTc prolongation of at least Grade (QTc > ms).
Known QT interval prolongation
Corrected QT (QTc) interval > . seconds (males) or > . seconds (females), or known history of QTc prolongation or Torsade de Pointes (TdP)
Previous history of grade or worse drug-induced QTc prolongation requiring treatment withdrawal
QT prolongation and/or familiar history of QT prolongation and uncontrolled cardiac arrhythmias
History of cardiac disease, including: (a) myocardial infarction within months of the start of study, (b) history of QTc prolongation or QTc >= msec on screening EKG, history of additional risk factors for torsade de pointes (e.g., heart failure, hyperkalemia), and family history of long QT syndrome; (c) use of concomitant drugs that prolong QT/QTc interval; (d) New York Heart Association class III or IV heart disease, (e), active ischemia or any other uncontrolled cardiac condition such as angina pectoris, clinically signification cardiac arrhythmia requiring therapy
PART GROUP EXCLUSION CRITERIA: Subjects who are currently receiving treatment with agents that are known to cause QTc prolongation in humans; agents causing a strong signal will be prohibited
PART GROUP A EXCLUSION CRITERIA: Subjects who are currently receiving treatment with agents that are known to cause QTc prolongation in humans; agents causing a strong signal will be prohibited
PART GROUP EXCLUSION CRITERIA: Subjects who are currently receiving treatment with agents that are known to cause QTc prolongation in humans; agents causing a strong signal will be prohibited
PHASE I AND II SCLC AND UROTHELIAL CARCINOMA EXPANSION COHORT: Prolongation of QT/corrected QT (QTc) interval (QTc interval > msec) using the Fridericia method of QTc analysis or family history of long QT syndrome; if single reading is above these minimum ranges, then repeat test in triplicate and evaluate eligibility based on average value
mCRPC EXPANSION COHORT: Prolongation of QT/QTc interval (QTc interval > msec) using the Fridericia method of QTc analysis or family history of long QT syndrome; if single reading is above these minimum ranges, then repeat test in triplicate and evaluate eligibility based on average value
Corrected QT interval (QTc) value > msec at screening; family or personal history of long QTc syndrome or ventricular arrhythmias including ventricular bigeminy at screening; previous history of drug-induced QTc prolongation or the need for treatment with medications known or suspected of producing prolonged QTc intervals on electrocardiogram (EKG); if QTc prolongation on screening EKG is felt to be related to electrolyte imbalance, an EKG can be repeated after correction of electrolytes
known and possible risk for QT prolongation
QTc > ms, history of Qtc prolongation or predisposition for QTc prolongation or family history of sudden cardiac death or QT prolongation
Corrected QT (QTc) interval > msec, family or personal history of long or short QT syndrome, Brugada syndrome or known history of QTc prolongation or Torsade de Pointes
History of QT prolongation associated with other medications that required discontinuation of that medication
Baseline QTc > msec measured by Fridericia's formula (QTcF) and/or previous history of QT prolongation while taking other medications. Concomitant use of medications associated with a high incidence of QT prolongation is not allowed.
Patient has a history or current evidence of clinically significant heart disease including:\r\n* Clinically significant congestive heart failure, unstable angina pectoris\r\n* Clinically significant cardiac arrhythmia\r\n* Myocardial infarction during the last months, and/or a current electrocardiogram (ECG) tracing that is abnormal in the opinion of the treating Investigator\r\n* Corrected QT interval (QTc) prolongation > msec (Bazett's formula)\r\n* Congenitally long QT syndrome, and/or current anti-arrhythmic therapy, and / or has received any marketed or experimental compound in the last week prior to entering the study with known effects of QT prolongation
Ponatinib\r\n* Female and male patients who are fertile must agree to use an effective form of contraception with their sexual partners from randomization through months after the end of treatment\r\n* Discontinuation of any medications known to contribute significantly to the risk of QT prolongation at least hours prior to start of study drug; Levaquin and Zofran are an exception; of note, certain agents that prolong the corrected QT interval (QTc) may be allowed but only after discussion with the chemotherapy pharmacist; should the investigator believe that therapy with a potentially QT prolonging medication is vital to an individual subjects care, then additional electrocardiograms (ECGs) should be done at the investigators discretion to ensure the subjects safety\r\n* Serum lipase =< . x ULN\r\n* Serum amylase =< . x ULN
Nilotinib\r\n* Normal QTc interval on screening ECG evaluation, defined as < msec for men and < msec for women\r\n* Discontinuation of any medications known to contribute significantly to the risk of QT prolongation at least hours prior to start of study drug; Levaquin and Zofran are an exception; of note, certain agents that prolong the corrected QT interval may be allowed but only after discussion with the chemotherapy pharmacist; should the investigator believe that therapy with a potentially QT prolonging medication is vital to an individual subjects care, then additional ECGs should be done at the investigators discretion to ensure the subjects safety
Receiving treatment with any medication known to produce QT prolongation within days of study entry
Baseline QTc > msec or previous history of QT prolongation while taking other medications
Concomitant use of medications associated with a high incidence of QT prolongation
Corrected QT (QTc) interval > msec (based on the mean value of the triplicate electrocardiography [ECG]s), family or personal history of long or short QT syndrome, Brugada syndrome or known history of QTc prolongation or Torsade de Pointes.
Concomitant use of drugs known to cause QT prolongation (Note: Ondansetron at doses ? mg or less is allowed)
Treatment with medications known to cause QTc interval prolongation within days of study day is not permitted unless approved by the sponsor; use of ondansetron is permitted for treatment of nausea and vomiting
Treatment with medications known to cause QTc interval prolongation within days of study day unless is not permitted unless approved by the sponsor; use of ondansetron is permitted for treatment of nausea and vomiting
Any of the following cardiac criteria:\r\n* Mean resting corrected QT interval (QTc using Fridericias formula [QTcF]) > msec obtained from electrocardiograms \r\n* Congenital or family history of long or short QT syndrome, Brugada syndrome, known history of QTc prolongation or torsades de pointes within months of entering the study\r\n* Abnormal echocardiogram at baseline (left ventricular ejection fraction [LVEF] < % and shortening fraction [SF] < %)
Drugs which have an increased risk for QTc prolongation should be avoided
Patients must not have a screening corrected QT Fridericias formula (QTcF) interval > msec based on the average of the triplicate electrocardiograms (EKGs) performed within days prior to registration; NOTE: triplicate EKGs are required at other timepoints; patients must not have any family or personal history of long or short QT syndrome, Brugada syndrome or known history of QTc prolongation, or torsade de pointes
Patients must not have a screening QTcF interval > msec based on the average of the triplicate EKGs performed within days prior to step re-registration; NOTE: triplicate EKGs are required at other timepoints; patients must not have any family or personal history of long or short QT syndrome, Brugada syndrome or known history of QTc prolongation, or torsade de pointes
Patients with corrected QT interval (QTc) prolongation greater than Common Terminology Criteria for Adverse Events (CTCAE) grade (> msec); in addition, patients should not be receiving non-study medications known to prolong QTc
QTc prolongation defined as a QTc interval >= msecs or other significant electrocardiogram (EKG) abnormalities are ineligible; Note: if unsure about EKG abnormality, the treating physician should discuss this with Drs. Sherman or Bible
Mean resting corrected QT interval (QTc) calculated using Fridericia's formula (QTcF) > msec obtained from electrocardiograms (ECGs); family or personal history of long or short QT syndrome; Brugada syndrome or known history of QTc prolongation or torsade de pointes within months of the subject entering the study.
QTc interval >. seconds (males) or >. (females), or known history of QTc prolongation or Torsade de Pointes (TdP)
Corrected QT interval duration prolongation
No marked baseline prolongation of QT/QTc interval
Patients who are currently receiving treatment with agents that are known to cause QTc prolongation in humans (Refer to Appendix )
A clinically significant electrocardiogram (ECG) abnormality (ie, corrected QT interval [QTc] interval greater than msec when electrolyte balance is normal), or a history of risk factors for torsade de pointes, hypokalemia, long QT syndrome, or the use of concomitant medications resulting in a prolongation of QTc interval.
Known history or predisposition to QT interval prolongation
Prolongation of QT/QTc interval
Patients with risk factors for QTc prolongation or Torsade de Pointes.
Corrected QT interval (QTc) > msec; excluded are patients who may develop prolongation of QTc; these conditions include patients with hypokalemia or hypomagnesemia, patients with congenital long QT syndrome, patients taking anti-arrhythmic medicines or other medicinal products that lead to QT prolongation, and cumulative high-dose anthracycline therapy
Treatment with medications known to cause corrected QT (QTc) interval prolongation within days of study day is not permitted unless approved by the sponsor; use of ondansetron is permitted for treatment of nausea and vomiting
Taking medications with QT prolongation risk or interval or inducing Torsade de pointes Additional exclusion criteria for PDR/QBM-
Mean resting corrected QT interval (QTc), calculated using Fridericias formula, > msec obtained from electrocardiograms (ECGs), family or personal history of long or short QT syndrome, Brugada syndrome or known history of QTc prolongation or Torsade de Pointes within months of the patient entering in the study
Corrected QT interval using Fridericias formula (QTcF) value > msec at screening; family or personal history of long corrected QT (QTc) syndrome or ventricular arrhythmias including ventricular bigeminy at screening; previous history of drug-induced QTc prolongation or the need for treatment with medications known or suspected of producing prolonged QTc intervals on electrocardiogram (ECG)
Patients who are currently receiving treatment with agents that are known to cause QTc prolongation or inducing Torsade de Pointes in humans and are unable to discontinue or switch to an alternate medication
Patients with Common Terminology Criteria for Adverse Events (CTCAE) grade cardiac arrhythmias may be considered for inclusion if the arrhythmias are stable, asymptomatic, and unlikely to affect patient safety; patients will be excluded if they have ongoing cardiac dysrhythmias of CTCAE grade >= , corrected QT interval (QTc) prolongation > ms, or other factors that increase the risk for QT interval prolongation (eg, heart failure, hypokalemia [defined as serum potassium < . mEq/L that is persistent and refractory to correction], or family history of long QT interval syndrome)
Patients taking drugs that can cause significant QTc/QTf prolongation unless able to be switched to non-QTc/QTf prolonging medication or on a stable dose without significant QT prolongation (> msec)
QTc greater than msec or a family or personal history of long or short QT syndrome, Brugada syndrome or know history of QTc prolongation, or Torsade de Pointes (TdP).
At increased risk for developing prolonged QT interval, including hypokalemia or hypomagnesemia, unless corrected to within normal limits prior to first dose of SNX-; congenital long QT syndrome or a history of torsade de pointes; currently receiving anti-arrhythmics or other medications that may be associated with QT prolongation.
Corrected QT interval (QTc) > msec; history of QT syndrome, Brugada syndrome or known history of QTc prolongation, or torsade de pointes
Corrected QT interval using Fridericia's formula (QTcF) value > msec at screening; family or personal history of long QTc syndrome or ventricular arrhythmias including ventricular bigeminy; previous history of drug-induced QTc prolongation or the need for treatment with medications known or suspected of producing prolonged QTc intervals on electrocardiogram (ECG)
Patients taking drugs leading to significant QTc prolongation unless able to be switched to non-QTc prolonging medication without risk of worsening underlying condition and meet all other inclusion criteria
No clinical evidence of heart failure or history of untreated ejection fraction below the lower limit of normal per institutional standards, or significant QT prolongation (> grade , msec) no history of congenital long QT syndrome, and no use of drugs known to increase the risk of torsades de point - patients may be eligible for study if the drug can be changed to another agent with less risk
QTcF > msec, family or personal history of long QTc syndrome or ventricular bigeminy; previous history of drug-induced QTc prolongation or the need for medications known or suspected of producing prolonged QTc intervals on ECG
Treatment with medications known to cause corrected QT (QTc) interval prolongation within days of study day is not permitted unless approved by the sponsor; use of ondansetron is permitted for treatment of nausea and vomiting
Patients with any of the following:\r\n* History of myocardial infarction within six months\r\n* Patients with corrected QT (QTc) prolongation > msec or other significant electrocardiogram (ECG) abnormality noted within days of treatment\r\n** For patients enrolled in the Phase -T portion of the protocol, the QTc should not exceed msec\r\n* New York Heart Association (NYHA) classification of III or IV\r\n* If cardiac function assessment is clinically indicated or performed: left ventricular ejection fraction (LVEF) less than normal per institutional guidelines, or < %, if threshold for normal not otherwise specified by institutional guidelines\r\n* Condition requiring concurrent use of drugs or biologics with pro-arrhythmic potential
Impaired cardiac function including ongoing cardiac dysrhythmias of grade > , ejection fraction < %, atrial fibrillation of any grade, or corrected QT (QTc) prolongation > ms, or other factors that increase the risk of QT prolongation (i.e. family history of long QT interval syndrome, hypokalemia defined as serum potassium < . mEq/L)
Concurrent administration of crizotinib and agents that can cause corrected QT (QTc) prolongation is not permitted
Corrected QT interval (QTc) > msec on electrocardiogram (by Bazetts; average of triplicate recordings at the discretion of the principal investigator [PI]) will exclude patients from entry on study; medications that are known to cause QTc interval prolongation are prohibited for patients entering on trial; patients for whom a given medication that may cause QTc interval prolongation cannot be discontinued, may be eligible at the discretion of the study PI, provided QTc interval criteria is met at enrollment
Subject has symptomatic or untreated central nervous system (CNS) metastases; any type of active seizure disorder; febrile neutropenia; ? Grade peripheral neuropathy; peritoneal or pleural effusions requiring a tap more frequently than every days; QT interval corrected (QTc) prolongation or a prior history of serious arrhythmias or significant abnormalities on screening ECG; previously experienced a severe reaction to a liposomal product or a taxane; received IV treatment for bacterial/fungal infection within days of screening.
Patients with current evidence of significant cardiovascular disease (New York Heart Association class III or IV cardiac disease), symptomatic congestive heart failure, dilated/hypertrophic or restrictive cardiomyopathy, myocardial infarction (within the past months), unstable angina, unstable arrhythmia or a need for anti-arrhythmic therapy (use of medications for rate control for atrial fibrillation is allowed such as calcium channel blockers and beta-blockers, if stable medication for at least last month prior to initiation of MK- treatment and medication not listed as causing torsades de pointes), or evidence of acute ischemia on electrocardiogram (ECG); marked baseline prolongation of QT/QTc interval, e.g., repeated demonstration of a QTc interval > msec*; long QT syndrome; the required use of concomitant medication that may cause torsades de pointes or may cause a significant prolongation of the QTc\r\n*Note: Due to difficulties assessing QTc in patients with heart block, they may be eligible if deemed safe by a cardiologist
Corrected QT interval (QTc) using Fridericia's formula value > msec at screening; family or personal history of long QTc syndrome or ventricular arrhythmias including ventricular bigeminy at screening; previous history of drug induced QTc prolongation or the need for treatment with medications known or suspected of producing prolonged QTc intervals on electrocardiogram (ECG).
Patients with Common Terminology Criteria for Adverse Events (CTCAE) grade cardiac arrhythmias may be considered for inclusion if the arrhythmias are stable, asymptomatic, and unlikely to affect patient safety; patients will be excluded if they have ongoing cardiac dysrhythmias of CTCAE grade >= , corrected QT interval (QTc) prolongation > ms, or other factors that increase the risk for QT interval prolongation (eg, heart failure, hypokalemia [defined as serum potassium < . mEq/L that is persistent and refractory to correction], or family history of long QT interval syndrome)
Baseline QTc > msec and/or previous history of QT prolongation while taking other medications.
Concomitant use of medications associated with a high incidence of QT prolongation is not allowed.
Baseline ATc> msec and/or previous history of QT prolongation.
Treatment with antiarrythmic drugs and any medication known to cause QTc prolongation within weeks before screening and during the study
At increased risk for developing prolonged QT interval, including hypokalemia or hypomagnesemia, unless corrected to within normal limits prior to first dose of SNX-; congenital long QT syndrome or a history of torsade de pointes; currently receiving anti-arrhythmics or other medications that may be associated with QT prolongation
Patients who are currently receiving treatment with agents that are known to cause QTc prolongation in humans.
Known history of QT prolongation or is taking any medication known to lead to QT prolongation
Concomitant medication that may cause Torsade de Pointes, i.e. prolongation of the QT interval > msec
History of familial long QT syndrome, or use of medications that may cause QTc interval prolongation
Patient has a QT interval prolongation > ms at screening. If a patient has a prolonged QT interval and the prolongation is deemed to be due to a pacemaker upon Investigator evaluation (ie, the patient otherwise has no cardiac abnormalities), then the patient may be eligible to participate in the study following discussion with the Medical Monitor.
Baseline QTc > msec or previous history of QT prolongation while taking other medications
Subjects with a high probability of Long QT Syndrome or QTc interval prolongation of more than or equal to msec on at least two separate ECGs, following correction of any electrolyte imbalance.
Patient has a QTcF value of > msec; family or personal history of long QTc syndrome or ventricular arrhythmias including ventricular bigeminy; previous history of drug-induced QTc prolongation
Corrected QT (QTc) prolongation with other medications; if the medication can be discontinued and an alternative medication started that does not cause QTc prolongation, the patient would be eligible; if no alternative medication is available and the medication cannot be discontinued for medical reasons, then the patient would not be eligible
Cardiovascular disease, including recent history of or currently clinically symptomatic and uncontrolled congestive heart failure, arrhythmia, angina, corrected QT (QTc) prolongation or other QTc risk factors, myocardial infarction; patients with Common Terminology Criteria for Adverse Events (CTCAE) grade cardiac arrhythmias may be considered for inclusion if the arrhythmias are stable, asymptomatic, and unlikely to affect patient safety; patients will be excluded if they have ongoing cardiac dysrhythmias of CTCAE grade >= , corrected QT interval (QTc) prolongation > ms, or other factors that increase the risk for QT interval prolongation (e.g., heart failure, hypokalemia [defined as serum potassium < . mEq/L that is persistent and refractory to correction], or family history of long QT interval syndrome)
Baseline QTc ? msec and no previous history of QT prolongation while taking other medications.
Subjects with personal or family history of QT prolongation, uncorrected electrolyte abnormalities, congestive heart failure, bradyarrhythmia, conduction disturbances and those taking antiarrhythmic medicinal products or other medicinal products that lead to QT prolongation or electrolyte abnormalities; relevant information will be collected during medical history taking
Patients with a known pathologic prolongation of the corrected QT (QTc)
Previous history of Corrected QT Interval (QTc ) prolongation resulting from medication that required discontinuation of that medication
Subjects taking any concomitant medication that may cause QTc prolongation, induce Torsades de Pointes are not eligible if QTc ? msec.
Patients with current evidence of significant cardiovascular disease (New York Heart Association class III or IV cardiac disease), symptomatic congestive heart failure, dilated/hypertrophic or restrictive cardiomyopathy, myocardial infarction (within the past months), unstable angina, unstable arrhythmia or a need for anti-arrhythmic therapy (use of medications for rate control for atrial fibrillation is allowed such as calcium channel blockers and beta-blockers, if stable medication for at least last month prior to initiation of romidepsin treatment and medication not listed as causing Torsades de Pointes), or evidence of acute ischemia on electrocardiogram (ECG); marked baseline prolongation of QT/QTc interval, e.g., repeated demonstration of a QTc interval > msec*; long QT syndrome; the required use of concomitant medication that may cause Torsades de Pointes or may cause a significant prolongation of the QTc\r\n* Note: due to difficulties assessing QTc in patients with heart block, they may be eligible if deemed safe by a cardiologist; if a patient must take ondansetron as their antiemetic, their QTc may NOT be over (no exception for patients with heart block)
Abnormal ECGs (ie, QT prolongation - QTc > msec, signs of cardiac enlargement or hypertrophy, bundle branch block, signs of ischemia or necrosis and Wolff Parkinson White patterns)
Corrected QT (QTc) prolongation with other medications that required discontinuation of that medication
Has a known history of QT prolongation or is taking any medication that is known to lead to QT prolongation
A history of clinically significant electrocardiography (EKG) abnormalities, including QT prolongation, a family history of prolonged QT interval syndrome, or myocardial infarction (MI) within months of study entry; patients with rate-controlled atrial fibrillation/flutter will be allowed on study
Mean resting corrected QT interval (QTc), calculated using Fridericias formula, > msec obtained from electrocardiograms (ECGs), family or personal history of long or short QT syndrome, Brugada syndrome or known history of QTc prolongation or torsade de pointes within months of the patient entering in the study
A history of clinically significant electrocardiogram (EKG) abnormalities, including QT prolongation, a family history of prolonged QT interval syndrome, or myocardial infarction (MI) less than year ago with ensuing unstable EKG