Full Text View
Tabular View
No Study Results Posted
Related Studies
Vorinostat, Isotretinoin and Carboplatin in Adults With Recurrent Glioblastoma Multiforme (GBM)
This study is currently recruiting participants.
Verified by M.D. Anderson Cancer Center, September 2009
First Received: November 6, 2007   Last Updated: September 14, 2009   History of Changes
Sponsor: M.D. Anderson Cancer Center
Collaborator: Merck
Information provided by: M.D. Anderson Cancer Center
ClinicalTrials.gov Identifier: NCT00555399
  Purpose

Primary Objective (Phase I):

1. To determine the maximum tolerated dose (MTD) of vorinostat/isotretinoin (cRA), carboplatin (CBT)/cRA and vorinostat/cRA/CBT combinations in adult patients with recurrent glioblastoma multiforme (GBM) and anaplastic gliomas.

Primary Objective (Phase II):

- To determine the efficacy of vorinostat/cRA versus CBT/cRA versus vorinostat/cRA/CBT in patients with recurrent GBM as determined by time to progression (TTP) using an adaptive randomization phase II trial design.

Secondary Objectives (Phase II):

  • To determine the radiological response, progression free survival at 6 months, overall survival and unexpected toxicity in the three treatment arms.
  • To obtain exploratory data regarding histone 3 and 4 acetylation and p21 levels in tumor tissue and peripheral monocytes in a subset of surgical patients and in non-surgical patients with available tissue from previous surgical procedures.
  • To evaluate the occurrence of symptoms and correlate to disease progression and tolerance to treatment using the MD Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT) self-reporting tool.

Condition Intervention Phase
Glioblastoma Multiforme
Anaplastic Glioma
Drug: Vorinostat
Drug: Carboplatin
Drug: Isotretinoin
Other: No Surgery
Procedure: Surgical Resection
Phase I
Phase II

Study Type: Interventional
Study Design: Treatment, Randomized, Open Label, Uncontrolled, Parallel Assignment, Safety/Efficacy Study
Official Title: Phase I/II Adaptive Randomized Trial of Vorinostat, Isotretinoin and Carboplatin in Adults With Recurrent Glioblastoma Multiforme

Resource links provided by NLM:


Further study details as provided by M.D. Anderson Cancer Center:

Primary Outcome Measures:
  • Maximum tolerated dose (MTD) [ Time Frame: Each 4 week period to accomodate 28 day cycles ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 189
Study Start Date: November 2007
Estimated Primary Completion Date: November 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Ph I: Arm 1: Experimental Drug: Vorinostat

Phase I/Arm 1: Level 0 = 300 mg PO x 14 days; Level I = 400 mg PO x 14 days; Level II = 500 mg PO x 14 days.

Phase I/Arm 3: Level -II = 300 mg PO x 14 days; Level -I = 400 mg PO x 14 days; Level 0 = 400 mg PO x 14 days; Level I = 500 mg PO x 14 days.

Drug: Isotretinoin

Phase I/Arm 1: Level 0 = 100 mg/m^2/day PO x 21 days; Level I = 100 mg/m^2/day PO x 21 days; Level II = 100 mg/m^2/day PO x 21 days.

Phase I/Arm 2: Level 0 = 100 mg/m^2/day PO x 21 days; Level I = 100 mg/m^2/day PO x 21 days; Level II = 100 mg/m^2/day PO x 21 days.

Phase I/Arm 3: Level -II = 100 mg/m^2/day PO x 21 days; Level -I = 100 mg/m^2/day PO x 21 days; Level 0 = 100 mg/m^2/day PO x 21 days; Level I = 100 mg/m^2/day PO x 21 days; Level II = 100 mg/m^2/day PO x 21 days.

Ph I: Arm 2: Experimental Drug: Carboplatin

Phase I/Arm 2: Level 0 = 4 mg/mL x min IV on Day 1; Level I = 5 mg/mL x min IV on Day 1; Level II = 6 mg/mL x min IV on Day 1.

Phase I/Arm 3: Level -II = 2 mg/mL x min IV on Day 1; Level -1 = 3 mg/mL x min IV on Day 1; Level 0 = 4 mg/mL x min IV on Day 1; Level I = 5 mg/mL x min IV

Drug: Isotretinoin

Phase I/Arm 1: Level 0 = 100 mg/m^2/day PO x 21 days; Level I = 100 mg/m^2/day PO x 21 days; Level II = 100 mg/m^2/day PO x 21 days.

Phase I/Arm 2: Level 0 = 100 mg/m^2/day PO x 21 days; Level I = 100 mg/m^2/day PO x 21 days; Level II = 100 mg/m^2/day PO x 21 days.

Phase I/Arm 3: Level -II = 100 mg/m^2/day PO x 21 days; Level -I = 100 mg/m^2/day PO x 21 days; Level 0 = 100 mg/m^2/day PO x 21 days; Level I = 100 mg/m^2/day PO x 21 days; Level II = 100 mg/m^2/day PO x 21 days.

Ph I: Arm 3: Experimental Drug: Vorinostat

Phase I/Arm 1: Level 0 = 300 mg PO x 14 days; Level I = 400 mg PO x 14 days; Level II = 500 mg PO x 14 days.

Phase I/Arm 3: Level -II = 300 mg PO x 14 days; Level -I = 400 mg PO x 14 days; Level 0 = 400 mg PO x 14 days; Level I = 500 mg PO x 14 days.

Drug: Carboplatin

Phase I/Arm 2: Level 0 = 4 mg/mL x min IV on Day 1; Level I = 5 mg/mL x min IV on Day 1; Level II = 6 mg/mL x min IV on Day 1.

Phase I/Arm 3: Level -II = 2 mg/mL x min IV on Day 1; Level -1 = 3 mg/mL x min IV on Day 1; Level 0 = 4 mg/mL x min IV on Day 1; Level I = 5 mg/mL x min IV

Drug: Isotretinoin

Phase I/Arm 1: Level 0 = 100 mg/m^2/day PO x 21 days; Level I = 100 mg/m^2/day PO x 21 days; Level II = 100 mg/m^2/day PO x 21 days.

Phase I/Arm 2: Level 0 = 100 mg/m^2/day PO x 21 days; Level I = 100 mg/m^2/day PO x 21 days; Level II = 100 mg/m^2/day PO x 21 days.

Phase I/Arm 3: Level -II = 100 mg/m^2/day PO x 21 days; Level -I = 100 mg/m^2/day PO x 21 days; Level 0 = 100 mg/m^2/day PO x 21 days; Level I = 100 mg/m^2/day PO x 21 days; Level II = 100 mg/m^2/day PO x 21 days.

Ph II: Arm 1
Non-Surgical
Other: No Surgery
No Surgery
Ph II: Arm 2
Surgical Arm
Procedure: Surgical Resection
Surgical Resection for recurrent Glioblastoma Multiforme

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients with histologically proven supratentorial glioblastoma multiforme, gliosarcoma or anaplastic glioma will be eligible for the Phase I component of this protocol. Anaplastic gliomas include anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic mixed oligoastrocytoma, or malignant glioma NOS. Patients will be eligible if the original histology was low-grade glioma and a subsequent histological diagnosis of a malignant glioma is made. Only patients with histologically proven supratentorial glioblastoma multiforme or gliosarcoma will be eligible for the Phase II component.
  • Patients must have shown unequivocal evidence for tumor recurrence or progression by MRI scan and should have failed radiation therapy. The scan done prior to study entry documenting progression will be reviewed by the treating physician to document changes in tumor dimension to confirm recurrence. Patients with prior therapy that included interstitial brachytherapy or stereotactic radiosurgery must have confirmation of true progressive disease rather than radiation necrosis.
  • Patients may have had up to 2 prior relapses provided the functional status and other eligibility criteria for enrollment are met.
  • All patients must sign an informed consent indicating that they are aware of the investigational nature of this study in keeping with the policies of this hospital.
  • The baseline on-study MRI should be performed within 14 days (+ 3 working days) prior to registration and on a steroid dosage that has been stable or decreasing for at least 5 days. If the steroid dose is increased between the date of imaging and the initiation of therapy (or at that time), a new baseline MRI is required. The same type of scan, i.e., MRI, must be used throughout the period of protocol treatment for tumor measurement.
  • Patients having undergone recent resection of recurrent or progressive tumor will be eligible as long as they have recovered from the effects of surgery. Evaluable or measurable disease following resection of recurrent tumor is not mandated for eligibility into the study. To best assess the extent of residual measurable disease post-operatively, a MRI should be done no later than 96 hours in the immediate post-operative period or 4-6 weeks post-operatively.
  • Patients must be 18 years old or older.
  • Patients must have a Karnofsky performance status equal or greater than 60.
  • Patients must have recovered from the toxic effects of prior therapy to < grade 2 non hematological or grade 2 or lesser hematological toxicity per CTC ver 3 (except deep vein thrombosis): 4 weeks from prior cytotoxic therapy and/or at least two weeks from vincristine, 6 weeks from nitrosoureas, 3 weeks from procarbazine administration, and 1 week for non-cytotoxic agents, e.g., interferon, tamoxifen, cis-retinoic acid, etc. (radiosensitizer does not count). Patients who receive anticancer agents for non-therapeutic purposes unrelated to this study
  • (9. continued) (such as presurgically for obtaining pharmacology data for the agent) will be eligible to enter the study provided they have recovered from the toxic effects of the agent if any. Because the trial is based on the hypothesis that the combination of agents used will be synergistic in their effects, and that HDAC inhibition will potentially overcome resistance to retinoids, prior treatment with cRA is allowed. Any questions related to the definition of non-cytotoxic agents should be directed to the Study Chair.
  • Patients must have adequate bone marrow function (ANC = or > 1,500/mm^3 and platelet count of = or > 100,000/mm^3), adequate liver function (SGPT = or < 3 times normal and alkaline phosphatase = or < 2 times normal, bilirubin = or <1.5 mg/dl), adequate renal function (BUN and creatinine = or <1.5 times institutional normal) and normal serum amylase and lipase prior to starting therapy. Elevated cholesterol and triglycerides are not a contraindication to study enrollment, but should be managed as clinically appropriate.
  • Patients must be willing and able to comply with the FDA mandated iPLEDGE program for treatment with isotretinoin (cRA). Patients must sign specific informed consents for treatment with cRA, as mandated by iPLEDGE guidelines. Women of childbearing potential must not be pregnant, must not be breast-feeding and must practice adequate contraception during and one month after participation in the study. Male patients on treatment with vorinostat must agree to use an adequate method of contraception for the duration of the study, and for 30 days after the last dose of study medication.
  • Prior treatment with carboplatin is not allowed.

Exclusion Criteria:

  • Patients with a history of any other cancer (except non-melanoma skin cancer or carcinoma in-situ of the cervix or bladder), unless in complete remission and off of all therapy for that disease for a minimum of 3 years.
  • Patients must not have: a) active infection; b) disease that will obscure toxicity or dangerously alter drug metabolism, especially liver disease; c) serious intercurrent medical illness; d) prior recurrence with other HDAC inhibitors. However, patients who have received anticancer agents for non-therapeutic purposes (for eg., as part of a pharmacology study without therapeutic intent) will remain eligible; e) grade 2 or higher peripheral neuropathy.
  • Pregnant and breast feeding women.
  • Patients receiving valproic acid (VPA), an anticonvulsant drug with HDAC inhibitor properties, will be excluded, unless they are switched to an alternative agent prior to treatment initiation. No wash out period is required.
  • Patients on previous treatment with carboplatin.
  • Patients with a known allergy to any component of vorinostat, or a known allergy to carboplatin and/or isotretinoin.
  • Patient must be able to tolerate the procedures required in this study including periodic blood sampling, study related assessments, and management at the treating institution for the duration of the study. Inability to comply with protocol or study procedures (for example, an inability to swallow tablets) will be an exclusion criteria.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00555399

Contacts
Contact: Vinay K. Puduvalli, MD 713-792-2883

Locations
United States, Texas
U.T.M.D. Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Principal Investigator: Vinay K. Puduvalli, MD            
Sponsors and Collaborators
M.D. Anderson Cancer Center
Merck
Investigators
Principal Investigator: Vinay K. Puduvalli, MD U.T.M.D. Anderson Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: U.T.M.D. Anderson Cancer Center ( Vinay K. Puduvalli, MD/Associate Professor )
Study ID Numbers: 2006-0709
Study First Received: November 6, 2007
Last Updated: September 14, 2009
ClinicalTrials.gov Identifier: NCT00555399     History of Changes
Health Authority: United States: Institutional Review Board

Keywords provided by M.D. Anderson Cancer Center:
Glioblastoma Multiforme
Anaplastic Glioma
Vorinostat
Suberoylanilide Hydroxamic Acid
SAHA
MSK-390
Zolinza
Isotretinoin
Accutane
13-cis-Retinoic Acid
Carboplatin
Paraplatin
CBT

Additional relevant MeSH terms:
Anticarcinogenic Agents
Anti-Inflammatory Agents
Glioblastoma
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Neoplasms, Nerve Tissue
Physiological Effects of Drugs
Keratolytic Agents
Sensory System Agents
Neoplasms, Germ Cell and Embryonal
Therapeutic Uses
Isotretinoin
Anti-Inflammatory Agents, Non-Steroidal
Glioma
Analgesics
Dermatologic Agents
Neoplasms by Histologic Type
Astrocytoma
Vorinostat
Enzyme Inhibitors
Carboplatin
Protective Agents
Pharmacologic Actions
Neuroectodermal Tumors
Neoplasms
Analgesics, Non-Narcotic
Tretinoin
Peripheral Nervous System Agents
Antirheumatic Agents
Neoplasms, Neuroepithelial

ClinicalTrials.gov processed this record on November 09, 2009