Safety and Efficacy Study of Trans Sodium Crocetinate (TSC) in Newly Diagnosed Glioblastoma (GBM) Biopsy-Only Subjects (INTACT)

• ClinicalTrials.gov Identifier: NCT03393000
• Recruitment Status: Completed
• First Posted: January 8, 2018
• Last Update Posted: January 11, 2021
• Sponsor: Diffusion Pharmaceuticals Inc
• Information provided by (Responsible Party): Diffusion Pharmaceuticals Inc

Study Description

Brief Summary:

Open-label, randomized, controlled, phase 3 safety and efficacy registration trial.

Subjects will be randomized at baseline to the standard of care for first-line treatment of glioblastoma plus Trans Sodium Crocetinate (TSC) or the standard of care.

The standard of care for GBM will consist of temozolomide plus radiation therapy for 6 weeks followed by 28 days of rest followed by 6 cycles of post-radiation temozolomide treatment.

Condition or disease	Intervention/treatment	Phase
Glioblastoma	Drug: Trans Sodium Crocetinate plus SOC; Other: Standard of Care (SOC)	Phase 3

Detailed Description:

During the radiation treatment period subjects will receive:

1. Focal radiation delivered as 60 Gray/30 fractions scheduled at 2 Gray/day for 5 days each week (Monday through Friday) for 6 weeks.
2. Temozolomide 75mg/m2 orally once daily (usually administered the night preceding each radiation session) starting the evening before the first radiation session over a period of 42 calendar days with a maximum of 49 days.
3. TSC 0.25 mg/kg IV for 3 days each week (Monday, Wednesday, Friday) administered between 45 to 60 minutes prior to each radiation session.

Pneumocystis carinii pneumonia (PCP) prophylaxis is required during Temozolomide + radiation administration, regardless of lymphocyte count and is to continue until recovery of lymphocyte count to less than or equal to Grade 1.

During the 28-day rest period all subjects will receive no treatment.

During the post-radiation 6-cycle temozolomide treatment period subjects will receive:

All subjects will receive: 28-day oral temozolomide (150 mg/m2 first cycle and 200 mg/m2 all subsequent cycles as tolerated) administered on Day 1-5 (Monday through Friday) of each 28-day cycle.

Controls: Will receive oral temozolomide at night at home per the standard of care.

Subjects randomized to TSC: Will receive TSC 1.5 mg/kg (or the dose recommended by the Data Safety Monitoring Board) 1.5 to 2 hours before their temozolomide dose during the daytime for 3 days during the first week of each 28-day cycle (Days 1, 3, 5: Monday, Wednesday, Friday). The Tuesday, Thursday doses will be given at night at home. Long-acting antiemetics may be administered prior to daytime temozolomide dosing on Days 1, 3, 5.

In accordance with the FDA directive of August 22, 2017 the safety, tolerability and pharmacokinetics of TSC at doses between 0.25 mg/kg and up to 1.5 mg/kg in combination with concomitant temozolomide will be assessed via a dose escalation run-in prior to initiating the randomized trial.

The first eight (8) subjects enrolled in the 100-206 trial will be assigned (not randomized between treatments) at Baseline to undergo radiation plus temozolomide plus TSC treatment (0.25 mg/kg) for 6 weekly cycles followed by 4 weeks of rest in standard fashion. At the Week 10 clinic visit the same eight (8) subjects will be assigned to treatment with 2 subjects each assigned to TSC at doses of 0.25, 0.50, 1.0 and 1.5 mg/kg.

The first eight (8) subjects will be studied in parallel and all for two full 28-day cycles with inclusion of appropriate blood sampling collection for TSC and temozolomide pharmacokinetics.

The Data Safety Monitoring Board will examine the resultant safety data after 2 full cycles (Weeks 11 through 18 of post-radiation temozolomide treatment period; Days 1 to 56).

The eight (8) subjects that are a part of the dose-escalation run-in will continue at their assigned TSC dose (0.25, 0.5, 1.0, 1.5 mg/kg) for the Week 19 TSC dosing period.

The Data Safety Monitoring Board will recommend an acceptable TSC dose, if different than 1.5 mg/kg, for the post-radiation temozolomide treatment period prior to the Week 23 TSC dosing period for the eight (8) subjects that are a part of the dose-escalation run-in.

Thereafter, subjects will enter the 100-206 trial and be randomized at Baseline between TSC plus standard of care or the standard of care.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 22 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Open-label, randomized, controlled
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Open-label, Randomized, Controlled, Phase 3 Safety and Efficacy Study of Trans Sodium Crocetinate With Radiation Therapy and Temozolomide in Newly Diagnosed Glioblastoma (GBM) Biopsy-Only Subjects
• Actual Study Start Date: January 16, 2018
• Actual Primary Completion Date: November 6, 2020
• Actual Study Completion Date: November 6, 2020

Arms and Interventions

Arm	Intervention/treatment
Experimental: Trans Sodium Crocetinate plus SOC; Trans Sodium Crocetinate plus the Standard of Care (SOC): SOC composed of radiation and temozolomide for 6 weeks followed by 4 weeks of rest followed by six (6) 28-day cycles of temozolomide	Drug: Trans Sodium Crocetinate plus SOC; Trans Sodium Crocetinate (TSC) plus the Standard of Care (SOC): SOC composed of radiation and temozolomide for 6 weeks followed by 4 weeks of rest followed by six (6) 28-day cycles of temozolomide; Other Name: Trans Sodium Crocetinate (TSC) plus Standard of Care
Active Comparator: Standard of Care (SOC); Standard of Care (SOC): SOC composed of radiation and temozolomide for 6 weeks followed by 4 weeks of rest followed by six (6) 28-day cycles of temozolomide	Other: Standard of Care (SOC); Standard of Care (SOC): SOC composed of radiation and temozolomide for 6 weeks followed by 4 weeks of rest followed by six (6) 28-day cycles of temozolomide; Other Name: Standard of Care

Outcome Measures

Primary Outcome Measures :

1. Overall Survival (OS) [ Time Frame: All subjects will be followed for 24 months ]
   Overall survival will be calculated from randomization to the time of death from any cause

Secondary Outcome Measures :

1. Progression Free Survival (PFS) [ Time Frame: All subjects will be followed for 24 months ]
   Progression free survival will be calculated from the date of randomization to the date of first progression or death or last follow-up per Response Assessment in Neuro-Oncology (RANO) and modified RANO criteria
2. Objective Response Rate (ORR) [ Time Frame: All subjects will be followed for 24 months ]
   Durable objective response rate (Complete Response [CR], Partial Response [PR]) will be estimated via radiological assessment per Response Assessment in Neuro-Oncology (RANO) and modified RANO criteria
3. Karnofsky Performance Scale (KPS) [ Time Frame: All subjects will be followed for 24 months ]
   Functional status will be assessed by the investigators using the Karnofsky Performance Scale (KPS): total KPS scores range from 100 (normal), 90 (minor signs of disease), 80 (some sign or symptoms), 70 (unable to carry on normal activity), 60 (requires occasional assistance), 50 (requires considerable assistance), 40 (disabled), 30 (severely disabled), 29 (very sick), 10 (moribund) to 0 (dead); total KPS score will be used to assess eligibility at baseline (KPS > 60) and to assess subjects performance through the trial relative to baseline
4. Quality of Life (EQ-5D-5L) [ Time Frame: All subjects will be followed for 24 months ]
   Quality of life will be assessed using the EQ-5D-5L visual analog scale: The EQ-5D-5L will be used by the subject to assess their view of their quality of life; This scale is numbered from 0 to 100 with 100 meaning the best health the subject can imagine to 0 meaning the worst health the subject can imagine; the subject will complete this scale at baseline and at the end of radiation treatment, again prior to and at the end of post-radiation treatment
5. Corticosteroid Use [ Time Frame: All subjects will be followed for 24 months ]
   Corticosteroid medication use will be assessed throughout the trial

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 70 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Male or female subjects who are at least 18 to 70 years of age
2. Have histologically confirmed GBM
3. The only surgical consideration is biopsy. Subjects who had gross total resection, partial resection and/or debulking are excluded.
4. Measurable (>10mm x 10mm) contrast enhancing disease.
5. Limited disturbance of tumor during biopsy.
6. Surgical and pathology reports that document surgery was limited to biopsy and histologic confirmation.
7. Life expectancy of at least 3 months.
8. Subjects must have a Karnofsky score (KPS) of ≥ 60 at Screening.
9. Glucocorticoid therapy allowed.
10. Tumor Treatment Field (TT Fields) therapy allowed.
11. If female, the subject must have a negative serum or urine pregnancy test at Screening unless meeting non-productive potential criteria.
12. Subjects must have hematologic and renal functions as specified: Absolute neutrophil count ≥ 1500/mm3, platelets ≥ 100,000/mm3, Hgb ≥ 9.0g/dL, creatinine ≤ 1.7mg/dL, total bilirubin ≤ 1.5mg/dL, blood urea nitrogen (BUN) within 2 times the upper limit of normal, transaminases ≤ 4 times above the upper limits of the institutional norm.
13. The subject or subject's medical power of attorney has provided written consent to participate in this study.

Exclusion Criteria:

1. Subjects who had gross total tumor resection, partial resection, and/or debulking surgery.
2. Subjects must not have had prior RT, chemotherapy (including Gliadel wafer), immunotherapy or therapy with a biologic agent, or hormonal therapy.
3. Subject who is pregnant or lactating.
4. Subject with a serious concurrent infection or medical illness that would jeopardize the ability of the subject to receive study treatment with reasonable safety.
5. Subject who cannot undergo MRI.
6. Subject receiving concurrent chemotherapeutics or investigational agents within 30 days of study entry, including gliadel wafers or gliasite application.
7. Subjects with other uncontrolled medical conditions, e.g. myocardial infarction, cerebrovascular accident, diabetes or hypertension.
8. Subjects diagnosed with another malignancy within 3 years prior to study start with the exception of adequately treated basal cell carcinoma, squamous cell carcinoma, non-melanomatous skin cancer or carcinoma in situ of the uterine cervix.
9. CTCAE Version 4, Grade 4 non-hematological toxicity (except for alopecia, nausea, vomiting).

Contacts and Locations

Locations

United States, California

University of California

Irvine, California, United States, 92868

Scott Peak, M.D.

Redwood City, California, United States, 94063

John Wayne Cancer Institute @ Providence Saint John's Health Center

Santa Monica, California, United States, 90404

United States, Georgia

Piedmont Cancer

Atlanta, Georgia, United States, 30318

John B. Amos Cancer Center

Columbus, Georgia, United States, 31904

United States, Minnesota

Abbott Northwestern Hospital

Minneapolis, Minnesota, United States, 55407

United States, New Jersey

John Theurer Cancer Center

Hackensack, New Jersey, United States, 07601

United States, New Mexico

UNM Comprehensive Cancer Center

Albuquerque, New Mexico, United States, 87102

United States, New York

North Shore University Hospital

Manhasset, New York, United States, 11030

Mount Sinai Hospital

New York, New York, United States, 10029

United States, Oregon

Providence Portland Medical Center

Portland, Oregon, United States, 97213

United States, South Carolina

Scott Lindhorst, M.D.

Charleston, South Carolina, United States, 29425

United States, Texas

Neuro Oncology Associates

Dallas, Texas, United States, 75246

Sponsors and Collaborators

Diffusion Pharmaceuticals Inc

Investigators

• Study Director: Harry N Cook, RPH/MBA; Diffusion Pharmaceuticals Inc

More Information

• Responsible Party: Diffusion Pharmaceuticals Inc
• ClinicalTrials.gov Identifier: NCT03393000
• Other Study ID Numbers: 100-206
• First Posted: January 8, 2018
• Last Update Posted: January 11, 2021
• Last Verified: January 2021

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

Additional relevant MeSH terms:

Glioblastoma; Astrocytoma; Glioma; Neoplasms, Neuroepithelial; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms by Histologic Type; Neoplasms; Neoplasms, Glandular and Epithelial; Neoplasms, Nerve Tissue; Vitamin A; Vitamins; Micronutrients; Nutrients; Growth Substances; Physiological Effects of Drugs