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Dose-Escalation Study of TPI 287 + Avastin Followed by Randomized Study of the Same Versus Avastin for Glioblastoma

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ClinicalTrials.gov Identifier: NCT01933815
Recruitment Status : Suspended (Business reasons)
First Posted : September 2, 2013
Last Update Posted : November 13, 2020
Sponsor:
Information provided by (Responsible Party):
Cortice Biosciences, Inc.

Brief Summary:

This trial is divided into two parts, a dose-escalation study (phase 1) and a randomized study (phase 2).

The purpose of the dose-escalation study (phase 1) is to determine the safety, maximum tolerated dose (MTD), and efficacy of TPI 287 in combination with Avastin (bevacizumab) in subjects who have glioblastoma multiforme (GBM) that has progressed following prior radiation therapy and temozolomide (TMZ).

The purpose of the randomized study (phase 2) is to determine the safety and efficacy of the phase 1 MTD of TPI 287 in combination with bevacizumab versus bevacizumab alone in subjects who have GBM that has progressed following prior radiation therapy and TMZ.


Condition or disease Intervention/treatment Phase
Glioblastoma Multiforme Drug: TPI 287 Drug: Bevacizumab Phase 1 Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 92 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 1/2 Dose-Escalation Study of TPI 287 in Combination With Bevacizumab Followed by Randomized Study of the Maximum Tolerated Dose of TPI 287 in Combination With Bevacizumab Versus Bevacizumab Alone in Adults With Recurrent Glioblastoma
Actual Study Start Date : August 2013
Estimated Primary Completion Date : November 2022
Estimated Study Completion Date : May 2023

Resource links provided by the National Library of Medicine

Drug Information available for: Bevacizumab

Arm Intervention/treatment
Experimental: TPI 287 + bevacizumab

All subjects in phase 1 & subjects randomized to the TPI 287 + bevacizumab arm in phase 2 will be administered a 1-hour IV infusion of TPI 287 once every 3 weeks (Days 1 & 22 of 42-day cycle) & a 30-90 minute IV infusion of bevacizumab once every 2 weeks (Days 1, 15, & 29).

In phase 1, the dose of TPI 287 will be escalated in sequential dose cohorts of 3 to 6, while the dose of bevacizumab remains constant (10 mg/kg). The first 5 dose levels will be 140, 150, 160, 170, & 180 mg/m2. Dose levels beyond 180 mg/m2 will be increased in increments of 20 mg/m2. Three subjects will be treated at a dose level halfway between the dose level that exceeds the MTD and the dose level immediately prior to further refine the MTD.

In phase 2, the dose of TPI 287 will be the MTD determined in phase 1, & the dose of bevacizumab will be the same as phase 1 (10 mg/kg).

Subjects may continue on treatment unless they meet one or more of the protocol discontinuation criteria.

Drug: TPI 287
TPI 287 is a microtubule inhibitor belonging to the taxane diterpenoid (taxoid) family, and specifically to the abeotaxane class. TPI 287 is an Investigational Drug.
Other Names:
  • TPI-287
  • NBT 287

Drug: Bevacizumab
Avastin (bevacizumab) is an FDA approved drug indicated for multiple cancers, including as a single agent for GBM for adult patients with progressive disease following prior therapy. Single agent effectiveness is based on improvement in objective response rate; no data is available demonstrating improvement in disease-related symptoms or survival with bevacizumab.
Other Name: Avastin

Active Comparator: Bevacizumab

All subjects randomized to the bevacizumab alone arm in phase 2 will be administered bevacizumab as a 30 to 90 minute IV infusion once every 2 weeks (Days 1, 15, and 29 of a 42-day cycle). The dose of bevacizumab will be 10 mg/kg.

Subjects will be withdrawn from the study if they meet one or more of the discontinuation criteria outlined in the protocol; however, treatment with bevacizumab may continue under the FDA approved labeling for bevacizumab at the discretion of the subject's doctor.

All subjects in phase 1 will be administered TPI 287 in combination with bevacizumab (i.e., there will be no bevacizumab alone arm during phase 1).

Drug: Bevacizumab
Avastin (bevacizumab) is an FDA approved drug indicated for multiple cancers, including as a single agent for GBM for adult patients with progressive disease following prior therapy. Single agent effectiveness is based on improvement in objective response rate; no data is available demonstrating improvement in disease-related symptoms or survival with bevacizumab.
Other Name: Avastin




Primary Outcome Measures :
  1. Phase 1: Safety of TPI 287 + bevacizumab in adults with GBM that progressed following radiation & TMZ as measured by AEs, physical/neurologic exam, KPS, weight, vital signs, hematology, serum chemistry, & urinalysis [ Time Frame: Continuously over study treatment through 4 weeks after last dose of study drug ]
  2. Phase 1: MTD of TPI 287 + bevacizumab in adults with GBM that progressed following radiation & TMZ [ Time Frame: Within 42 days of receiving the first dose of study drug ]
    The MTD will be defined as the highest dose level achieved at which no more than 1 out of 6 subjects experienced a DLT that initiated within 42 days of receiving the first dose of study drug.

  3. Phase 2: Efficacy of phase 1 MTD of TPI 287 + bevacizumab versus bevacizumab alone in adults with GBM that progressed following radiation and TMZ as measured by median PFS [ Time Frame: Baseline & on Day 1 of each 42-day treatment cycle starting with Cycle 2, and/or as clinically indicated ]
    The Response Assessment in Neuro-Oncology (RANO) working group recommendations for updated response criteria for high-grade gliomas (Wen et al. 2010) will be used to determine response for this trial.


Secondary Outcome Measures :
  1. Phase 1: Efficacy of TPI 287 + bevacizumab in adults with GBM that progressed following radiation and TMZ as measured by median progression free survival (PFS), overall response rate, & progression free survival rate at 4 & 6 months (PFS4 & PFS6) [ Time Frame: Baseline & on Day 1 of each 42-day treatment cycle starting with Cycle 2, and/or as clinically indicated ]
  2. Phase 2: Safety of TPI 287 + bevacizumab versus bevacizumab alone in adults with GBM that progressed following radiation & TMZ as measured by AEs, physical/neurologic exam, KPS, weight, vital signs, hematology, serum chemistry, & urinalysis [ Time Frame: Continuously over study treatment through 4 weeks after last dose of study drug ]
  3. Phase 2: Efficacy of phase 1 MTD of TPI 287 + bevacizumab versus bevacizumab alone in adults with GBM that progressed following radiation and TMZ as measured by overall survival and overall response rate [ Time Frame: Overall response rate: baseline & on Day 1 of each 42-day treatment cycle starting with Cycle 2, and/or as clinically indicated; overall survival: up to two years after randomization ]


Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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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:

  1. Histologically proven GBM
  2. Disease progression following radiation and TMZ
  3. Up to 2 prior relapses allowed
  4. Baseline MRI within 17 days of Day 1 & on steroid dosage that has been stable or decreasing for at least 5 days
  5. Recent resection of recurrent or progressive tumor allowed as long as at least 4 weeks have elapsed from date of surgery and the subject has recovered from surgery
  6. Life expectancy >12 weeks
  7. Eighteen years old or older
  8. KPS equal to or greater than 70
  9. Recovered from toxic effects of prior therapy to < Grade 2 per National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) prior to Day 1. Minimum duration required between prior therapy and Day 1 is:

    1. At least 12 weeks from completion of radiation therapy except if there is unequivocal evidence for tumor recurrence in which case at least 4 weeks
    2. 4 weeks from prior cytotoxic therapy
    3. 4 weeks from prior experimental drug
    4. 6 weeks from nitrosoureas
    5. 3 weeks from procarbazine
    6. 1 week for non-cytotoxic agents, such as interferon, tamoxifen, & cis-retinoic acid
  10. Adequate bone marrow function (absolute neutrophil count > 1,500/mm3 and platelet count of > 100,000/mm3), adequate liver function [ALT and AST <3 x upper limit normal (ULN), alkaline phosphatase <2 x ULN, and total bilirubin <1.5 mg/dL], & adequate renal function (BUN and creatinine <1.5 x ULN)
  11. Minimum hemoglobin of 9 g/dL
  12. Males & women of childbearing potential must agree to abstain from sex or use an adequate method of contraception for the duration of study, & for 6 months after last dose of study drug
  13. Signed & dated informed consent prior to Screening evaluations

Exclusion Criteria:

  1. Radiographic evidence of contrast-enhancing tumor crossing midline, leptomeningeal dissemination, gliomatosis cerebri or infratentorial tumor
  2. Evidence or suspicion of disease metastatic to sites remote from the supratentorial brain
  3. Prior treatment with bevacizumab or other anti-vascular endothelial growth factor (VEGF) drugs
  4. Prior treatment with tyrosine-kinase inhibitors targeting VEGF, platelet-derived growth factor, fibroblast growth factor, tyrosine kinase with immunoglobulin-like and epidermal growth factor-like domains 2 (TIE-2), or angiopoietin (or their receptors)
  5. Prior treatment with histone deacetylase inhibitors or mammalian target of rapamycin (mTOR) inhibitors
  6. Prior treatment with TPI 287
  7. Treatment with Enzyme-Inducing Anti-Epileptic Drugs within 2 weeks prior to Day 1
  8. Treatment with drugs or herbal supplements known to be strong inhibitors/inducers of cytochrome P450 3A4 or cytochrome P450 2C8 within 2 weeks prior to Day 1
  9. Received more than one course of radiation therapy or more than a total dose of 65 Gy. May have received radiosurgery as part of initial therapy; however, the dose counts against the total dose limit.
  10. Prior taxane, vincristine, or other microtubule inhibitor chemotherapies for treatment of GBM or other malignancy
  11. Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to Day 1 or anticipation of need for major surgical procedure during the course of the study
  12. Core biopsy or other minor surgical procedure, excluding placement of a vascular access device, within 7 days prior to Day 1
  13. Any condition, including the presence of clinically significant laboratory abnormalities, which places subject at unacceptable risk if he/she were to participate in the study or confounds the ability to interpret data from the study, including:

    1. Active infection including known AIDS or Hepatitis C or with a fever ≥38.5°C within 3 days prior to enrollment
    2. Diseases or conditions that obscure toxicity or dangerously alter drug metabolism
    3. Serious intercurrent medical illness (e.g., symptomatic congestive heart failure)
  14. Any serious medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from providing informed consent
  15. Inadequately controlled hypertension (defined as systolic blood pressure >140 mmHg and/or diastolic blood pressure > 90 mmHg)
  16. Prior history of hypertensive crisis or hypertensive encephalopathy
  17. New York Heart Association Grade II or greater congestive heart failure
  18. History of myocardial infarction or unstable angina within 6 months prior to Day 1
  19. History of stroke or transient ischemic attack within 6 months prior to Day1
  20. Significant vascular disease (e.g., aortic aneurysm, requiring surgical repair or recent peripheral arterial thrombosis) within 6 months prior to Day 1
  21. History of hemoptysis (≥ 1/2 teaspoon of bright red blood per episode) within 1 month prior to Day 1
  22. Evidence of bleeding diathesis or significant coagulopathy (in the absence of therapeutic anticoagulation)
  23. Grade 2 or higher peripheral neuropathy per NCI CTCAE
  24. History of abdominal fistula or gastrointestinal perforation within 6 months prior to Day 1
  25. Serious, non-healing wound, active ulcer, or untreated bone fracture
  26. Proteinuria at Screening. Subjects with a urine dipstick protein ≥2+ at Screening should undergo a 24-hour urine collection and must demonstrate ≤1g of protein in 24 hours to be eligible
  27. Known hypersensitivity to inactive ingredient of bevacizumab
  28. Known hypersensitivity to inactive ingredient of TPI 287
  29. Pregnancy or lactation
  30. Inability to comply with protocol

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): NCT01933815


Locations
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United States, Alabama
University of Alabama at Birmingham
Birmingham, Alabama, United States, 35249
United States, Missouri
Washington University School of Medicine
Saint Louis, Missouri, United States, 63110
United States, New Jersey
John Theurer Cancer Center at Hackensack University Medical Center
Hackensack, New Jersey, United States, 07601
United States, New York
The Long Island Brain Tumor Center at Neurological Surgery, P.C.
Commack, New York, United States, 11725
The Long Island Brain Tumor Center at Neurological Surgery, P.C.
Lake Success, New York, United States, 11042
University of Rochester Medical Center
Rochester, New York, United States, 14642
United States, Ohio
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States, 43210
United States, Texas
Memorial Hermann Hospital
Houston, Texas, United States, 77030
United States, Washington
Swedish Neuroscience Institute
Seattle, Washington, United States, 98122
Sponsors and Collaborators
Cortice Biosciences, Inc.
Investigators
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Principal Investigator: J. P. Duic, M.D. The Long Island Brain Tumor Center at Neurological Surgery, P.C.
Principal Investigator: Samuel A. Goldlust, M.D. John Theurer Cancer Center at Hackensack University Medical Center
Principal Investigator: Louis B. Nabors, III, M.D. University of Alabama at Birmingham
Principal Investigator: Sigmund Hsu, M.D. Memorial Hermann Hospital
Principal Investigator: Nimish Mohile, M.D. University of Rochester
Principal Investigator: Tara L. Benkers, M.D. Swedish Neuroscience Institute
Principal Investigator: Jian Campian, M.D. Washington University School of Medicine
Principal Investigator: Pierre Giglio, M.D. The Ohio State University Wexner Medical Center
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Responsible Party: Cortice Biosciences, Inc.
ClinicalTrials.gov Identifier: NCT01933815    
Other Study ID Numbers: TPI-287-17
First Posted: September 2, 2013    Key Record Dates
Last Update Posted: November 13, 2020
Last Verified: November 2020
Keywords provided by Cortice Biosciences, Inc.:
Glioblastoma multiforme
Glioblastoma
Radiotherapy
Temozolomide
TPI 287
Taxoid
Avastin
Bevacizumab
Additional relevant MeSH terms:
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Glioblastoma
Astrocytoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Bevacizumab
Antineoplastic Agents, Immunological
Antineoplastic Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors