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A Study to Assess the Safety and Tolerability of AZD1390 Given With Radiation Therapy in Patients With Brain Cancer

NCT03423628

Description:

This study will test an investigational drug called AZD1390 in combination with radiation therapy for the treatment of brain tumors. This is the first time AZD1390 is being given to patients. This study will test safety, tolerability and PK (how the drug is absorbed, distributed and eliminated) of ascending doses of AZD1390 in combination with distinct regimens of radiation therapy

Related Conditions:
  • Glioblastoma
  • Malignant Solid Tumor
Recruiting Status:

Recruiting

Phase:

Phase 1

Trial Eligibility

Document

Title

  • Brief Title: A Study to Assess the Safety and Tolerability of AZD1390 Given With Radiation Therapy in Patients With Brain Cancer
  • Official Title: A Phase I, Multicentre Study to Assess the Safety, Tolerability, and Pharmacokinetics of Ascending Doses of AZD1390 in Combination With Radiation Therapy in Patients With Glioblastoma Multiforme and Brain Metastases From Solid Tumors.

Clinical Trial IDs

  • ORG STUDY ID: D6940C00002
  • SECONDARY ID: 2017-002451-28
  • SECONDARY ID: 135803
  • NCT ID: NCT03423628

Conditions

  • Recurrent Glioblastoma Multiforme
  • Primary Glioblastoma Multiforme
  • Brain Neoplasms, Malignant
  • Leptomeningeal Disease (LMD)

Interventions

DrugSynonymsArms
AZD1390ATM inhibitorAZD1390 + Radiation Therapy

Purpose

This study will test an investigational drug called AZD1390 in combination with radiation therapy for the treatment of brain tumors. This is the first time AZD1390 is being given to patients. This study will test safety, tolerability and PK (how the drug is absorbed, distributed and eliminated) of ascending doses of AZD1390 in combination with distinct regimens of radiation therapy

Detailed Description

      This first time-in patients (FTIP), open-label, multicentre study of AZD1390 will be
      conducted in the United States and in the United Kingdom, and it consists of three treatment
      arms: Arm A, B, C. This Phase 1 study will assess safety and tolerability of AZD1390 in
      combination with radiation therapy (RT) in brain malignancies. The combination cohorts have
      been designed to assess escalating cumulative doses of AZD1390 in settings with 3 different
      radiation treatment regimens:

        -  Arm A: 35 Gy over 2 weeks with intensity-modulated radiation therapy (IMRT) in patients
           with recurrent Glioblastoma Multiforme (GBM)

        -  Arms B: 30 Gy over two weeks with whole brain radiation therapy (WBRT)/ partial brain
           radiation therapy (PBRT) in patients with brain metastases. **Arm B has now closed to
           recruitment**

        -  Arm C: 60 Gy over 6 weeks (IMRT) in patients with primary GBM Each arm provides standard
           of care RT for the disease setting indicated with the experimental agent being
           administered in dose escalating cohorts.
    

Trial Arms

NameTypeDescriptionInterventions
AZD1390 + Radiation TherapyExperimentalAZD1390 + Radiation Therapy
  • AZD1390

Eligibility Criteria

        Inclusion Criteria:

          -  Provision of formalin-fixed paraffin embedded tissue sample from primary or metastatic
             disease

          -  Karnofsky Performance Score of ≥60.

          -  Additional Inclusion Criteria Specific for Arm A:

               -  Histologically proven diagnosis of GBM. Patients who have had RT for low-grade
                  glioma (LGG) or grade 3 glioma and have subsequently relapsed to histologically
                  confirmed GBM can be considered

               -  A radiological diagnosis of recurrent/relapsed or progressive disease according
                  to RANO criteria.

               -  Completion of first-line radiation at least 6 months prior to study entry.

               -  Patients with tumor-induced seizures must be well controlled on a stable
                  anti-epileptic treatment

               -  Willing to receive anti-epileptic prophylaxis for the duration of study drug
                  administration.

          -  Additional Inclusion Criteria Specific for Arm B:

        **Arm B has now closed to recruitment**

          -  Histologically proven diagnosis of solid tumor malignancy and Magnetic Resonance (MR)
             imaging documenting brain lesions.

          -  Not eligible for Stereotactic Radiosurgery (SRS) treatment of brain tumor.

          -  Patient has not received any previous brain RT to the area that is to be irradiated.
             Prior PBRT may be allowed if there is not significant overlap between the prior and
             new radiation fields.

          -  Non-CNS malignant disease must be sufficiently controlled so that patients can be
             without additional systemic therapy for the required washout period before starting
             therapy until 5 days after the end of RT. Required washout period before starting the
             first dose of AZD1390 (Cycle 1) is 28 days for immune checkpoint inhibitors and 7 days
             for all other agents

          -  Not received radiation to the lung fields within the past 8 weeks.

          -  No history of seizures related to the brain metastases or LMD.

          -  Receiving PBRT (rather than WBRT) during Cycle 1 as standard of care for brain
             metastases

             • Additional Inclusion Criteria Specific for Arm C:

          -  Histologically proven primary diagnosis of GBM with unmethylated O6-methylguanine-DNA
             methyltransferase (MGMT). Grade 4 astrocytoma or histology with molecular features of
             GBM can be considered.

          -  Determination of MGMT promoter status by methylation-specific polymerase chain
             reaction (PCR) or pyrosequencing per local institutional guidelines is required to
             assess eligibility for this Arm.

          -  Patients will have to undergo mutational testing for Isocitrate dehydrogenase 1 (IDH1)
             on a tumor specimen before entering study. Patients are eligible for Arm C regardless
             of their IDH1 mutational status.

          -  No history of uncontrolled seizures after surgery for primary GBM (despite adequate
             antiepileptic therapy) or with need for concurrent administration of more than 2
             antiepileptic drugs.

          -  Willing to receive anti-epileptic prophylaxis for the duration of study drug
             administration

        Exclusion Criteria:

          -  Administration of chemotherapy or any investigational drug in the 28 days or
             carmustine (CCNU) or lomustine (BCNU) in the 6 weeks prior to receiving the first dose
             of treatment in Arms A and C. Administration of checkpoint inhibitors within 28 days
             prior to first dose of treatment and any other agent within 7 days of beginning study
             treatment in Arm B. Hormonal therapies are allowed during study treatment for patients
             in Arm B.

          -  History of severe brain-injury or stroke.

          -  Patient not eligible for sequential MRI evaluations are not eligible for this study.

          -  History of epileptic disorder or any seizure history unrelated to tumor

          -  Treatment with Strong inhibitors or inducers of CYP3A4 within 2 weeks prior to
             receiving study drug

          -  Concurrent therapy with other seizurogenic medications.

          -  Past medical history of interstitial lung disease (ILD), drug-induced ILD, radiation
             pneumonitis which required steroid treatment, or any evidence of clinically active
             ILD.

          -  Concurrent severe and/or uncontrolled medical condition (e.g., severe COPD).

          -  Prior treatment with pneumotoxic drugs, e.g. busulfan, bleomycin, within the past
             year. If prior therapy in lifetime, then excluded if history of pulmonary toxicities
             from administration. Patients who have received treatment with nitrosoureas (e.g.,
             carmustine, lomustine) in the year before study entry without experiencing lung
             toxicity are allowed on study.

          -  History or presence of myopathy or raised creatine kinase (CK) >5 x upper limit of
             normal (ULN) on 2 occasions at screening.

          -  Cardiac dysfunction defined as: Myocardial infarction within six months of study
             entry, NYHA (New York Heart Association) Class II/III/IV heart failure, unstable
             angina, unstable cardiac arrhythmias

          -  Evidence of severe pulmonary infections, as judged by the investigator

          -  With the exception of alopecia, any unresolved toxicities from prior therapy greater
             than National Cancer Institute Common Terminology Criteria for Adverse Events (NCI
             CTCAE 4.03) Grade 1 at the time of starting study treatment and patients with chronic
             Grade 2 unresolved toxicities may be eligible
      
Maximum Eligible Age:130 Years
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Incidence of dose-limiting toxicities (DLTs)
Time Frame:From the start of treatment until the end of the DLT period (approximately 6 weeks for Arm A, 3 weeks for Arm B and 10 weeks for Arm C)
Safety Issue:
Description:DLTs will be used to calculate the maximum tolerated dose (MTD). The MTD of AZD1390 is the maximum dose at which <=25% patients experience a DLT.

Secondary Outcome Measures

Measure:Event free survival (EFS) for Arms A and C only
Time Frame:From the start of treatment until the patient is off study (approximately 1 year)
Safety Issue:
Description:Defined as the time from the first dose of AZD1390 until the occurrence of any of the following events: Tumor progression or recurrence based on RANO criteria Secondary malignancy Change in tumor treatment due to increase clinical symptoms Death due to any cause
Measure:Objective response rate defined by RANO criteria for Arms A and C only
Time Frame:Every 8 weeks starting from 4 weeks after RT until the end of the study (approximately 1 year)
Safety Issue:
Description:The proportion of patients achieving a complete or partial tumor response (CR or PR) according to RANO criteria.
Measure:Objective response rate defined by RANO-BM criteria for Arm B only. **Arm B has now closed to recruitment**
Time Frame:From screening until the patient is off study, approximately 8 weeks
Safety Issue:
Description:The proportion of patients achieving a complete or partial tumor response (CR or PR) according to RANO-BM criteria.
Measure:Objective response rate defined by RECIST 1.1 criteria for Arm B only. **Arm B has now closed to recruitment**
Time Frame:From screening until the patient is off study, approximately 8 weeks
Safety Issue:
Description:The proportion of patients achieving a complete or partial tumor response (CR or PR) according to RECIST 1.1 criteria.
Measure:Maximum Observed Plasma Concentration (Cmax) of AZD1390
Time Frame:At predefined intervals throughout the AZD1390 treatment period (approximately 5 weeks for Arm A, 2 weeks for Arm B and 9 weeks for Arm C)
Safety Issue:
Description:Blood samples will be collected to assess plasma concentrations of AZD1390 at a series of timepoints to derive Cmax
Measure:Time to observed Cmax (Tmax) for AZD1390
Time Frame:At predefined intervals throughout the AZD1390 treatment period (approximately 5 weeks for Arm A, 2 weeks for Arm B and 9 weeks for Arm C)
Safety Issue:
Description:Blood samples will be collected to assess plasma concentrations of AZD1390 at a series of timepoints to derive Tmax
Measure:Area under the plasma concentration-time curve (AUC) for AZD1390
Time Frame:At predefined intervals throughout the AZD1390 treatment period (approximately 5 weeks for Arm A, 2 weeks for Arm B and 9 weeks for Arm C)
Safety Issue:
Description:Blood samples will be collected to assess plasma concentrations of AZD1390 at a series of timepoints to derive AUC
Measure:Renal clearance (CLR) for AZD1390
Time Frame:At predefined intervals throughout the AZD1390 treatment period (approximately 5 weeks for Arm A and 9 weeks for Arm C)
Safety Issue:
Description:Urine samples will be collected to assess urine concentrations of AZD1390 at a series of timepoints to derive renal clearance

Details

Phase:Phase 1
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:AstraZeneca

Trial Keywords

  • glioblastoma
  • Ataxia-telangiectasia mutated kinase (ATM) inhibition
  • radiation therapy

Last Updated

August 2, 2021