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MDM2 Inhibitor AMG-232 in Treating Patients With Recurrent or Newly Diagnosed Glioblastoma

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ClinicalTrials.gov Identifier: NCT03107780
Recruitment Status : Suspended (Other - Per CTEP Amendment Request)
First Posted : April 11, 2017
Last Update Posted : November 9, 2018
Sponsor:
Information provided by (Responsible Party):
National Cancer Institute (NCI)

Brief Summary:
This phase 0/I trial studies the side effects and best dose of MDM2 inhibitor AMG-232 in treating patients with glioblastoma that is newly diagnosed or has come back. MDM2 inhibitor AMG-232 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

Condition or disease Intervention/treatment Phase
Glioblastoma Gliosarcoma Recurrent Glioblastoma TP53 wt Allele Unmethylated MGMT Gene Promoter Other: Laboratory Biomarker Analysis Drug: MDM2 Inhibitor AMG-232 Other: Pharmacological Study Radiation: Radiation Therapy Phase 1

Detailed Description:

PRIMARY OBJECTIVES:

I. Determine the concentration and variability in concentration of MDM2 inhibitor AMG-232 (AMG 232) in brain and brain-associated tissue in patients with recurrent glioblastoma (GBM). (Part 1) II. Determine the maximum tolerated dose (MTD) of AMG 232 given in combination with standard radiation following surgery for patients with newly diagnosed GBM harboring unmethylated MGMT promoters and wild-type TP53. (Part 2)

SECONDARY OBJECTIVES:

I. Determine the safety and toxicity of AMG 232 in patients with recurrent GBM. (Part 1) II. Assess the variability of AMG 232 concentration in tumor enhancing versus (vs.) infiltrative tissue. (Part 1) III. Assess the pharmacodynamic effect of AMG 232 on p21 elevation. (Part 1) IV. Determine the safety of AMG 232 given concurrently with radiation therapy (RT) and adjuvantly as monotherapy for patients with newly diagnosed GBM harboring unmethylated MGMT promoters and wild-type TP53. (Part 2) V. Assess AMG 232 exposure and correlations with PD effect PD effect on p21 elevation. (Part 2) VI. Assess pharmacodynamic (PD) effect on MIC-1 elevation in serum. (Part 2)

OUTLINE: This is a phase 0, intratumoral pharmacokinetic (PK)/ pharmacodynamic (PD) study of MDM2 inhibitor AMG-232 followed by a phase I dose-escalation study.

PART I: Patients with recurrent glioblastoma receive MDM2 inhibitor AMG-232 orally (PO) once daily (QD) for 2 days. Within 3-6 hours of the last dose, patients undergo standard of care surgery. Upon recovery (within 45 days), patients with TP53 wild-type tumors continue to receive MDM2 inhibitor AMG-232 PO QD on days 1-7. Courses repeat every 21 days in absence of disease progression or unacceptable toxicity.

PART II: Within 6 weeks of standard of care surgery, patients with newly diagnosed glioblastoma undergo radiation therapy daily during weeks 1-6. Patients also receive MDM2 inhibitor AMG-232 PO once weekly for 6 weeks or 3 times weekly on days 2, 3, and 5 for 6 weeks or 2 times weekly on days 2 and 4 for 6 weeks during radiation therapy.

PART II (EXPANSION COHORT): Patients receive MDM2 inhibitor AMG-232 PO QD on days 1-7. Courses repeat every 21 days in absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 2 months for the first two years from the off-treatment date, and then every 6 months until death.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 86 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 0/I Study of AMG 232 Concentrations in Brain Tissue in Patients With Recurrent Glioblastoma and of AMG 232 in Combination With Radiation in Patients With Newly Diagnosed Glioblastoma and Unmethylated MGMT Promoters
Actual Study Start Date : February 26, 2018
Estimated Primary Completion Date : June 30, 2019
Estimated Study Completion Date : June 30, 2019

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Treatment (MDM2 inhibitor AMG-232)

PART I: Patients with recurrent glioblastoma receive MDM2 inhibitor AMG-232 PO QD for 2 days. Within 3-6 hours of the last dose, patients undergo standard of care surgery. Upon recovery (within 45 days), patients with TP53 wild-type tumors continue to receive MDM2 inhibitor AMG-232 PO QD on days 1-7. Courses repeat every 21 days in absence of disease progression or unacceptable toxicity.

PART II: Within 6 weeks of standard of care surgery, patients with newly diagnosed glioblastoma undergo radiation therapy daily during weeks 1-6. Patients also receive MDM2 inhibitor AMG-232 PO once weekly for 6 weeks or 3 times weekly on days 2, 3, and 5 for 6 weeks or 2 times weekly on days 2 and 4 for 6 weeks during radiation therapy.

PART II (EXPANSION COHORT): Patients receive MDM2 inhibitor AMG-232 PO QD on days 1-7. Courses repeat every 21 days in absence of disease progression or unacceptable toxicity.

Other: Laboratory Biomarker Analysis
Correlative studies

Drug: MDM2 Inhibitor AMG-232
Given PO
Other Names:
  • AMG 232
  • AMG-232

Other: Pharmacological Study
Correlative studies

Radiation: Radiation Therapy
Undergo radiation therapy
Other Names:
  • Cancer Radiotherapy
  • Irradiate
  • Irradiated
  • irradiation
  • Radiation
  • Radiotherapeutics
  • RADIOTHERAPY
  • RT
  • Therapy, Radiation




Primary Outcome Measures :
  1. Pharmacokinetics (PK) parameters with target inter-tumor drug concentration at >= 25 nm (Part 1) [ Time Frame: Up to 3 years ]
    Part 2 of the trial will proceed only if at least one of the doses yielded a 50% PK response rate. If both doses reached 50% PK response rate, both doses will be studied in Part 2 of the trial.

  2. Maximum tolerated dose (MTD) of MDM2 inhibitor AMG-232 when combined with concomitant radiation therapy (Part 2) [ Time Frame: Up to 16 weeks ]
    MTD will be determined according to dose limiting toxicities graded by National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 (Beginning April 1, 2018 version 5.0 will be utilized for adverse event reporting). The target dose-limiting toxicity (DLT) rate is 33%. If the MTD is not reached among the pre-specified doses, the dose for the expanded cohort will be the highest dose studied for which the DLT rate is less than 33%.


Secondary Outcome Measures :
  1. Incidence of adverse events assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 (Beginning April 1, 2018 version 5.0 will be utilized for adverse event reporting) (Part 1) [ Time Frame: Up to 30 days following the last dose of study drug ]
    Will be used for scoring toxicity and adverse events. The severity and frequency of toxicity will be tabulated by the tested dose or doses, or combination regimens using descriptive statistics. The proportion of patients who experienced grade 3 or above toxicities will be estimated along with 95% confidence intervals by each type of toxicity.

  2. Variability of MDM2 inhibitor AMG-232 concentration in tumor enhancing vs. infiltrative tissue (Part 1) [ Time Frame: Up to 3 years ]
    Will be summarized using descriptive statistics.

  3. p21 elevation in tissue (Part 1) [ Time Frame: Up to 3 years ]
    Will be coded as binary outcome either elevated or not elevated compared to a reference value from archived tumor tissues in matched patient population. A proportion of patients with elevated p21 will be estimated using a binomial distribution along with 95% confidence interval.

  4. Incidence of adverse events assessed by CTCAE version 4.0 (Beginning April 1, 2018 version 5.0 will be utilized for adverse event reporting) (Part 2) [ Time Frame: Up to 10 weeks ]
    Will be used for scoring toxicity and adverse events. The severity and frequency of toxicity will be tabulated by the tested dose or doses, or combination regimens using descriptive statistics. The proportion of patients who experienced grade 3 or above toxicities will be estimated along with 95% confidence intervals by each type of toxicity.

  5. MIC-1 elevation in serum (Part 2) [ Time Frame: Up to 3 years ]
    The PK variables and changes in MIC-1 will be tabulated and descriptive statistics (e.g., geometric means and coefficients of variation) calculated for each dose level. PK parameters and MIC-1 changes will be compared across dose level using non-parametric statistical testing techniques.

  6. MDM2 inhibitor AMG-232 exposure assessed by liquid chromatography/tandem mass spectrometry (Part 2) [ Time Frame: Up to 3 years ]
    A full pharmacokinetic profile of AMG 232 will be proposed in this study to assess exposure-response relationships with various pharmacodynamic (PD) endpoints (i.e., MIC-1 changes, toxicity, and efficacy). Correlation with PD effect on p21 elevation will be determined.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must have a Karnofsky performance status >= 60% (i.e. the patient must be able to care for himself/herself with occasional help from others)
  • Absolute neutrophil count >= 1,500/ul
  • Platelets >= 100,000/ul
  • Hemoglobin >= 10 g/dL (transfuse as necessary to raise levels, no transfusions within 7 days of start)
  • Total bilirubin =< 1.5 x institutional upper limit of normal (ULN)
  • Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional ULN
  • Alkaline phosphatase < 2.0 x ULN
  • Creatinine =< institutional ULN
  • Creatinine clearance >= 60 ml/min/1.73 m^2 for patients with creatinine levels above institutional normal
  • Activated partial thromboplastin time (APTT)/partial thromboplastin time (PTT) =< 1.5 x institutional ULN
  • Corrected QT interval (QTc) =< 470 msec (based on average of screening triplicates)
  • Patients must be able to provide written informed consent
  • Patients must have magnetic resonance imaging (MRI) within 21 days of starting treatment; patients must be able to tolerate MRI with gadolinium
  • Patients must be maintained on a stable corticosteroid regimen (no increase for 5 days) prior to the baseline MRI
  • Women of childbearing potential must have a negative serum pregnancy test prior to study entry; women of child-bearing potential must agree to use adequate contraception prior to study entry and for the duration of study participation through 5 weeks (women) after receiving the last dose of AMG 232; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately; men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 3 months after completion of AMG 232 administration; adequate methods of effective birth control include sexual abstinence (men, women); vasectomy; or a condom with spermicide (men) in combination with barrier methods, hormonal birth control or intrauterine device (IUD) (women); bilateral tubal ligation (women)
  • Patients must have no concurrent malignancy except curatively treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix, breast, or bladder; patients with prior malignancies must be disease-free for >= five years
  • Patients must be able to swallow oral medications
  • PART 1 PATIENTS (SURGICALLY ELIGIBLE RECURRENT GBM)
  • Part 1 patients must have prior histologically proven glioblastoma that is progressive or recurrent following radiation therapy +/- chemotherapy
  • Part 1 patients must be undergoing repeat surgery that is clinically indicated as determined by their care providers
  • Part 1 patients must have a tumor tissue form indicating availability of archived tissue from initial resection at diagnosis of glioblastoma completed and signed by a pathologist
  • Part 1 patients may have an unlimited number of prior therapy regimens
  • Part 1 patients must have recovered from severe toxicity of prior therapy; the following intervals from previous treatments are required to be eligible:

    • 12 weeks from the completion of radiation
    • 6 weeks from a nitrosourea chemotherapy or mitomycin C
    • 3 weeks from a non-nitrosourea chemotherapy
    • 4 weeks from any investigational (not Food and Drug Administration [FDA]-approved) agents
    • 2 weeks from administration of a non-cytotoxic, FDA-approved agent, except bevacizumab/ vascular endothelial growth factor receptor (VEGFR) inhibitors (e.g., erlotinib, hydroxychloroquine, etc.)
    • 6 weeks from bevacizumab/VEGFR inhibitors
  • PART 2 PATIENTS (NEWLY DIAGNOSED GBM)
  • Part 2 patients must have histologically confirmed glioblastoma or gliosarcoma
  • Part 2 patients must have recovered from the immediate post-operative period
  • Part 2 patients must have tumor MGMT methylation status of unmethylated; results of routinely used methods for MGMT methylation testing (e.g. mutagenically separated polymerase chain reaction [MSPCR] or quantitative polymerase chain reaction [PCR]) are acceptable
  • Part 2 patient must show evidence of wild-type (WT) p53 status on somatic tissue specimens as assessed by deoxyribonucleic acid (DNA) sequencing
  • Part 2 patients must not have received prior radiation therapy, chemotherapy, immunotherapy or therapy with biologic agent (including immunotoxins, immunoconjugates, antisense, peptide receptor antagonists, interferons, interleukins, tumor infiltrating lymphocytes [TIL], lymphokine-activated killer [LAK] or gene therapy), or hormonal therapy for their brain tumor; glucocorticoid therapy is allowed

Exclusion Criteria:

  • Patients receiving any other investigational agents are ineligible
  • Part 1 patients who have not recovered to < Common Terminology Criteria for Adverse Events (CTCAE) grade 2 toxicities related to prior therapy are ineligible
  • Patients with a history of hypersensitivity or allergic reactions attributed to compounds of similar chemical or biologic composition to AMG 232 are ineligible
  • Patients on enzyme-inducing anti-epileptic drugs (EIAED) are not eligible for treatment on this protocol; patients may be on non-enzyme inducing anti-epileptic drugs or not be taking any anti-epileptic drugs; patients previously treated with EIAED may be enrolled if they have been off the EIAED for 10 days or more prior to the first dose of AMG 232
  • Patients may not use herbal or non-traditional medications while receiving AMG 232 therapy; all herbal medicines (e.g., St. John's wort), vitamins, and supplements consumed by the subject within the 30 days prior to receiving the first dose of AMG 232 should be reviewed by the principal investigator
  • Drugs known to be CYP3A4 substrates with narrow therapeutic windows (such as alfentanil, astemizole, cisapride, dihydroergotamine, pimozide, quinidine, sirolimus, or terfanide) or CYP2C8 substrates are not allowed; patients must be switched to alternative drugs at least 14 days prior to receiving the first dose of AMG 232; those patients who cannot switch to alternative drugs will be excluded from the study
  • Treatment with medications known to cause QTc interval prolongation within 7 days of study day 1 is not permitted unless approved by the sponsor; use of ondansetron is permitted for treatment of nausea and vomiting
  • Patients may not be on warfarin, factor Xa inhibitors and direct thrombin inhibitors; Note: low molecular weight heparin and prophylactic low dose warfarin are permitted; APTT/PTT must meet the inclusion criteria; subjects taking warfarin must have their international normalized ratio (INR) followed closely
  • Patients with uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements, are ineligible; patients with active infection requiring IV antibiotics within 2 weeks of study day 1 are excluded; patients with myocardial infarction within 6 months of study day 1, symptomatic congestive heart failure (New York Heart Association [NYHA] class III and higher), unstable angina, or cardiac arrhythmia requiring medication are excluded
  • Patients with gastrointestinal (GI) tract disease causing the inability to take oral medication, malabsorption syndrome, requirement for intravenous alimentation, prior surgical procedures affecting absorption, uncontrolled inflammatory GI disease (e.g., Crohn's disease, ulcerative colitis), are ineligible
  • Patients with history of bleeding diathesis are ineligible
  • Patients with positive hepatitis B surface antigen (HepBsAg), positive hepatitis total core antibody with negative HBsAG, or detectable hepatitis C virus ribonucleic acid (RNA) by a polymerase-chain reaction (PCR) assay (screening is generally done by hepatitis C antibody (HepCAb), followed by hepatitis C virus RNA by PCR if HepCAb is positive)
  • Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with AMG 232 through 1 week after receiving the last dose of study drug
  • Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with AMG 232; in addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy
  • Patients with a planned use of Novo-TTF (Optune) are ineligible

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03107780


Locations
United States, Maryland
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, United States, 21287
United States, Massachusetts
Massachusetts General Hospital Cancer Center
Boston, Massachusetts, United States, 02114
Dana-Farber Cancer Institute
Boston, Massachusetts, United States, 02215
United States, Michigan
Henry Ford Hospital
Detroit, Michigan, United States, 48202
United States, North Carolina
Wake Forest University Health Sciences
Winston-Salem, North Carolina, United States, 27157
United States, Pennsylvania
University of Pennsylvania/Abramson Cancer Center
Philadelphia, Pennsylvania, United States, 19104
University of Pittsburgh Cancer Institute (UPCI)
Pittsburgh, Pennsylvania, United States, 15232
Sponsors and Collaborators
National Cancer Institute (NCI)
Investigators
Principal Investigator: Brian Alexander National Cancer Institute (NCI)

Responsible Party: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT03107780     History of Changes
Other Study ID Numbers: NCI-2017-00568
NCI-2017-00568 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
ABTC-1604 ( Other Identifier: Adult Brain Tumor Consortium )
ABTC-1604 ( Other Identifier: CTEP )
UM1CA137443 ( U.S. NIH Grant/Contract )
First Posted: April 11, 2017    Key Record Dates
Last Update Posted: November 9, 2018
Last Verified: October 2018

Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
Glioblastoma
Gliosarcoma
Astrocytoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue