Description:
This protocol has a 2-part design:
This phase 2 study is an open-label, multicenter, dose-escalation and expansion study to
assess the safety, tolerability, recommended phase 2 dose (RP2D), pharmacokinetics (PK) and
clinical activity of paxalisib in patients with newly-diagnosed glioblastoma (GBM) with
unmethylated MGMT promoter status as adjuvant therapy following surgical resection and
initial chemoradiation with temozolomide (TMZ).
Title
- Brief Title: Safety, Pharmacokinetics and Efficacy of Paxalisib (GDC-0084) in Newly-diagnosed Glioblastoma
- Official Title: A Phase 2 Study to Evaluate the Safety, Pharmacokinetics, and Efficacy of the PI3K/mTOR Inhibitor Paxalisib (GDC-0084) Administered to Patients With Glioblastoma Characterized by Unmethylated O6-methylguanine-methyltransferase Promoter Status Following Surgical Resection and Standard Concomitant Chemoradiation Therapy With Temozolomide
Clinical Trial IDs
- ORG STUDY ID:
NVGN-0084-201
- NCT ID:
NCT03522298
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Paxalisib (GDC-0084) | | Dose Escalation and Expansion Cohorts |
Purpose
This protocol has a 2-part design:
This phase 2 study is an open-label, multicenter, dose-escalation and expansion study to
assess the safety, tolerability, recommended phase 2 dose (RP2D), pharmacokinetics (PK) and
clinical activity of paxalisib in patients with newly-diagnosed glioblastoma (GBM) with
unmethylated MGMT promoter status as adjuvant therapy following surgical resection and
initial chemoradiation with temozolomide (TMZ).
Detailed Description
Stage 1 Dose-Escalation and Maximum Tolerated Dose The dose-escalation portion of the study
(Stage 1) will use a standard "3 + 3" design to determine the MTD for QD dosing.
Approximately 6 - 12 patients with newly diagnosed GBM will be enrolled in Stage 1.
The MTD for QD dosing will be determined. The initial dose level for QD dosing will be 60 mg
(Dose Level 0). This dose is based on the phase 1 findings outlined in the rationale in the
protocol, adding 1 dose level to test for a potential MTD increase.
Dose-escalation will occur in Stage 1:
- The initial dose (Dose Level 0) for QD MTD determination in Step 1 will be 60 mg. Dose
levels will increase in 15 mg steps;
- The dose-escalation portion of the study (Stage 1) will use a standard "3 + 3" design to
assess the safety, tolerability, and PK of paxalisib administered orally in 28-day
cycles;
Decisions regarding dose-escalation and selection will be made by a Cohort Review Committee
(CRC).
All AEs, including DLTs, will be reported, with severity assessed according to National
Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 4.03.
After determination of the MTD, patients continue to receive their protocol-assigned dose
levels of paxalisib until progression of their disease or an unacceptable toxicity, whichever
occurs first.
Stage 2 Expansion stage (2) of the study will be a two-arm, randomized, open-label expansion
study to further characterize the safety, tolerability and PK of paxalisib as well as to
provide a preliminary assessment of single-agent activity of paxalisib in patients with GBM.
Approximately 20 patients will be enrolled in the expansion cohort in 2 treatment arms (10
per am) to examine the PK of paxalisib in fed and fasted-conditions, according to the defined
study eligibility criteria.
Stage 2 of the study will be initiated with recruitment of new patients as soon as the MTD
has been determined.
Patients enrolled in Stage 2 may continue the study at the dose allocated until disease
progression or unacceptable toxicity.
Trial Arms
Name | Type | Description | Interventions |
---|
Dose Escalation and Expansion Cohorts | Experimental | This is an open-label study.
Patients in Stage 1 will be enrolled and sequentially assigned to a dose cohort.
The initial cohort will receive an oral dose of 60 mg paxalisib QD (4 x 15 mg capsules). Patients of future dose cohorts will receive paxalisib at increasing levels with 15 mg steps until a dose-limiting toxicity occurs (DLT) occurs. The dose level where <1/3 of the patients exhibit a DLT will be determined the Maximum Tolerated Dose (MTD).
In stage 1, dose escalation will occur for QD dosing.
In stage 2, the expansion phase, patients will receive doses of oral paxalisib at the MTD in stage 1, until disease progression or an unacceptable toxicity, whichever occurs first.
Patients will be randomized in a 1:1 ratio to fed or fasted schedules. | |
Eligibility Criteria
Inclusion Criteria:
Patients must meet all the following inclusion criteria to be eligible for enrollment into
the study:
1. Age ≥ 18 years;
2. Life expectancy > 12 weeks;
3. Present with histologically confirmed intracranial (supratentorial) unmethylated MGMT
promotor status GBM (WHO Grade lV astrocytoma) with a MGMT status that has been
confirmed by validated PCR or validated alternate genomic analysis;
4. Have undergone maximal surgical resection of their tumor and within 6 weeks of surgery
received initial treatment with XRT/TMZ which consisted of XRT by external beam to a
partial brain field in daily fractions of 2.0 Gray (Gy), to a planned total dose to
the tumor of 60.0 Gy, in conjunction with TMZ oral QD 75 mg/m2 in accordance with the
Stupp regimen;
5. Must have measurable disease, according to RANO criteria for inclusion in the
expansion cohort. Patients with non-measurable disease can be included in the
dose-escalation cohorts;
6. KPS ≥ 70;
7. Cranial magnetic resonance imaging (MRI) must have been performed within 7 days prior
to or on the day of the Randomization/Week 1 Visit;
8. Stable or decreasing corticosteroid dose within 7 days prior to the first dose;
9. Adequate bone marrow/hematological function within 7 days prior to Day 1;
10. Adequate liver and renal function within 14 days prior to Day 1;
11. International normalized ratio (INR) or prothrombin time (PT) (secs) and activated
partial thromboplastin time (aPTT) within 7 days prior to randomization:
12. Patients must be willing to forego other drug therapy against the tumor while enrolled
in the study.
Exclusion Criteria:
1. Previous radiotherapy to the brain or cytotoxic drug therapy (including Gliadel®
wafers) in addition to the required postoperative radiation plus TMZ, non-cytotoxic
drug therapy, or experimental drug therapy directed against the brain tumor prior to
this regimen, will be excluded. Patients may have received or be receiving
corticosteroids, analgesics, and other drugs to treat symptoms or prevent
complications but the dose must be stable at treatment start. NOTE: 5 aminolevulinic
acid-mediated photodynamic therapy administered prior to surgery to aid in optimal
surgical resection is not considered a chemotherapy agent;
2. Any prior or anticipated concomitant treatment involving a medical device (such as
Optune®) applying tumor treating fields (TTF);
3. QT interval time of ≥ 470 msec;
4. Undetermined/indeterminate MGMT status;
5. Diabetic patients; prediabetic patients treated with metformin;
6. Use of any CYP3A4 inducing or inhibiting agents;
7. Significant medical illnesses;
8. Women who are pregnant or who are lactating;
9. Diagnosed with infratentorial GBM, a tumor outside of brain or gliomatosis cerebri;
10. Evidence of recent hemorrhage on postoperative MRI of the brain;
11. Any previous malignancy; except for adequately controlled limited basal cell carcinoma
of the skin, squamous carcinoma of the skin or carcinoma in situ of the cervix, or one
which has been absent for ≥3 years;
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Dose limiting toxicities (DLTs) |
Time Frame: | 12 months |
Safety Issue: | |
Description: | The recommended Phase 2 dose and schedule. DLTs according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 4.03. |
Secondary Outcome Measures
Measure: | Incidence of treatment-emergent adverse events (TEAEs) |
Time Frame: | 24 months |
Safety Issue: | |
Description: | TEAEs defined as any AE occurring or worsening on/after the first study drug dose and within 28 days after the last dose date. AEs will be coded according to the Medical Dictionary for Regulatory Activities (MedDRA). |
Measure: | Incidence of serious adverse events (SAEs) |
Time Frame: | 24 months |
Safety Issue: | |
Description: | AEs will be coded according to the Medical Dictionary for Regulatory Activities (MedDRA). |
Measure: | Incidence of treatment-emergent Grade 3/4 clinical laboratory abnormalities. |
Time Frame: | 24 months |
Safety Issue: | |
Description: | Clinical laboratory values will be graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE), version 4.03, for applicable tests. |
Measure: | Change in electrocardiogram (ECG) parameter QTc. |
Time Frame: | 24 months |
Safety Issue: | |
Description: | The number and percentage of patients with an increase of QTc to a value ≥ 500 msec or a change from baseline of at least 60 msec will be presented overall and by visit. |
Measure: | Change in left ventricular ejection fraction (LVEF). |
Time Frame: | 24 months |
Safety Issue: | |
Description: | The number and percentage of patients with a drop in LVEF to a value of ≤ 45% from baseline will be presented overall and by visit. |
Measure: | Progression-free survival interval using RANO Criteria. |
Time Frame: | 24 months |
Safety Issue: | |
Description: | |
Measure: | Overall survival using RANO Criteria. |
Time Frame: | 24 months |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | Kazia Therapeutics Limited |
Trial Keywords
- newly diagnosed
- unmethylated O6 methylguanine-methyltransferase (MGMT) promoter status
Last Updated
June 9, 2020