Clinical Trials /

Study to Evaluate Pharmacokinetics and Pharmacodynamics of Evolocumab in rHGG

NCT04937413

Description:

This Phase 0 surgical window of opportunity trial seeks to evaluate the pharmacokinetic (PK) and pharmacodynamic (PD) properties of an FDA-approved proprotein convertase/ kexin type 9 serine protease inhibitor (PCSK9i) in patients with primary and recurrent World Health Organization (WHO) grade IV malignant glioma. The investigators intend to evaluate whether a clinically licensed PCSK9i called evolocumab (also known as Repatha) can be repurposed as a potential immunotherapeutic for high grade glioma by testing its ability to access the intracranial space. The primary objective is to evaluate whether evolocumab crosses the blood brain barrier (BBB) and is measurable in the resected tumor specimens of patients with primary and recurrent high grade glioma or glioblastoma.

Related Conditions:
  • Glioblastoma
  • High-Grade Glioma, NOS
Recruiting Status:

Not yet recruiting

Phase:

Early Phase 1

Trial Eligibility

Document

Title

  • Brief Title: Study to Evaluate Pharmacokinetics and Pharmacodynamics of Evolocumab in rHGG
  • Official Title: A Phase 0/Surgical Window-of-opportunity Study to Evaluate the Pharmacokinetics and Pharmacodynamics of Evolocumab in Patients With Recurrent High-grade Glioma or Glioblastoma

Clinical Trial IDs

  • ORG STUDY ID: Pro00108375
  • NCT ID: NCT04937413

Conditions

  • Malignant Glioma
  • Glioblastoma

Interventions

DrugSynonymsArms
EvolocumabRepathaSingle dose of evolocumab

Purpose

This Phase 0 surgical window of opportunity trial seeks to evaluate the pharmacokinetic (PK) and pharmacodynamic (PD) properties of an FDA-approved proprotein convertase/ kexin type 9 serine protease inhibitor (PCSK9i) in patients with primary and recurrent World Health Organization (WHO) grade IV malignant glioma. The investigators intend to evaluate whether a clinically licensed PCSK9i called evolocumab (also known as Repatha) can be repurposed as a potential immunotherapeutic for high grade glioma by testing its ability to access the intracranial space. The primary objective is to evaluate whether evolocumab crosses the blood brain barrier (BBB) and is measurable in the resected tumor specimens of patients with primary and recurrent high grade glioma or glioblastoma.

Detailed Description

      A maximum of 10 participants will receive 420 mg (the maximum single dose) of evolocumab
      subcutaneously into their thigh, abdomen or upper arm 7-14 days prior to surgical de-bulking
      of their tumor. After de-bulking, leftover tissue not required for histological analysis will
      be collected, and the level of evolocumab will be quantified. At two time points, prior to
      injection of evolocumab and at time of their surgery, participants will have peripheral blood
      drawn to analyze serum levels of the drug (for comparison to levels found in their leftover
      tissue). The investigators will follow-up with participants about 2 weeks after surgery at
      their post-operative visit.

      A matched cohort of resected tumor specimens from patients who were not treated with
      evolocumab from the Duke Brain Tumor Center Biorepository will be used as a comparison for
      the primary objective and 2 of the 3 secondary objectives of this study comparing brain tumor
      tissue specimens of patients who did and did not receive evolocumab with respect to lipid
      metabolism and tumor cells expressing MHC-I.
    

Trial Arms

NameTypeDescriptionInterventions
Single dose of evolocumabExperimental420 mg of evolocumab subcutaneous injection 7-14 days before scheduled surgery for malignant glioma
  • Evolocumab

Eligibility Criteria

        Inclusion Criteria:

          -  Adult patients ≥ 18 years old

          -  Newly diagnosed or recurrent high grade glioma (HGG) or glioblastoma (GBM) (if
             recurrent, prior pathology report indicating HGG or GBM)

          -  Adequate hematologic function within 21 days prior to starting evolocumab defined as
             follows:

               1. Hemoglobin ≥ 10 g/dl (Note: the use of transfusion or other intervention to
                  achieve Hgb ≥ 10.0 g/dl is acceptable)

               2. Leukocytes ≥ 1,500/mm3

               3. Absolute Neutrophil Count (ANC) ≥ 1,000/mm3

               4. Platelets ≥ 100,000/mm3

          -  Adequate renal function within 21 days prior to starting evolocumab defined as
             calculated creatinine clearance (CrCL) of ≥ 30 mL/min/1.73m2 by the Cockcroft-Gault
             formula

          -  Adequate hepatic function within 7 days prior to starting evolocumab defined as
             follows:

               1. Total bilirubin ≥ 1.5 x institutional upper limit of normal (ULN) (Note: Patients
                  with known Gilbert disease without other clinically significant liver
                  abnormalities are not excluded.)

               2. AST(SGOT) and ALT(SGPT) ≥ 1.5 × ULN

          -  Negative serum pregnancy test (in females of childbearing potential) within 48 hours
             of starting evolocumab.

        Exclusion Criteria:

          -  Any patient with a history of a serious hypersensitivity reaction to evolocumab or any
             of the excipients in evolocumab

          -  Patients with severe hepatic impairment outside of the range defined in the inclusion
             criteria within 7 days of starting evolocumab.

          -  History or evidence of central nervous system bleeding as defined by stroke or
             intraocular bleed (including embolic stroke) not associated with any antitumor surgery
             within 6 months before enrollment

          -  Infection requiring intravenous antibiotics that was completed < 1 week of study
             enrollment (day 1) with the exemption of prophylactic antibiotics for long line
             insertion or biopsy

          -  Females of reproductive potential and males who are unwilling to practice an
             acceptable method(s) of effective birth control while on study through 1 month (2
             half-lives) after receiving the last dose of study drug.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Presence of evolocumab in surgical tumor tissue and tissue from a matched control group
Time Frame:At time of surgical resection
Safety Issue:
Description:Determined by mass spectrometry

Secondary Outcome Measures

Measure:Level of lipid metabolism within the surgical tumor tissue and tissue from a matched control group
Time Frame:At time of surgical resection
Safety Issue:
Description:Determined by fluorescence-activated cell sorting (FACS)
Measure:Major histocompatibility complex-1 (MHC-I) expression within the surgical tumor tissue and tissue from a matched control group
Time Frame:At time of surgical resection
Safety Issue:
Description:Determined by FACS
Measure:Correlation between serum and surgical tumor tissue levels of evolocumab
Time Frame:2 weeks
Safety Issue:
Description:Using serum taken before receiving evolocumab (7-14 days before surgery) and serum taken at the time of surgery

Details

Phase:Early Phase 1
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Duke University

Trial Keywords

  • Pro00108375
  • Khasraw
  • PCSK9i
  • Evolocumab
  • Glioma
  • Glioblastoma

Last Updated

June 28, 2021