Phase I Pharmacodynamic and "High Content" Study of the Gamma-Secretase Inhibitor RO4929097 in Patients With Recurrent Malignant Gliomas (MGs) Targeting p75NTR to Inhibit Brain Tumor Initiating Cells (BTICs) and Recurrent Invasive Gliomas
Phase I Pharmacodynamic and "High Content" Study of the Gamma-Secretase Inhibitor RO4929097 in Patients With Recurrent Malignant Gliomas (MGs) Targeting p75NTR to Inhibit Brain Tumor Initiating Cells (BTICs) and Recurrent Invasive Gliomas
This phase I trial is studying the side effects and best dose of RO4929097 in treating patients with recurrent invasive gliomas. RO4929097 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth
PRIMARY OBJECTIVES:
I. Determine, in patients with recurrent MGs (many of whom receive dexamethasone, a moderate CYP3A4 inducer), the safety and maximum-tolerated dose of RO4909297 administered at 2 dose levels.
II. Determine the pharmacokinetics, intratumoral drug concentration, target modulation, and evidence of any treatment effect in the malignant glioma tumor tissue by R04929097 administered at the dose found in Part A.
SECONDARY OBJECTIVES:
I. Determine the pharmacokinetic (PK) profile of RO4909297 in patients with recurrent MGs (many of whom receive dexamethasone, a moderate CYP3A4 inducer).
II. Determine the progression-free survival of patients with recurrent malignant glioma following treatment with R04929097.
III. Determine if the RPTD dose of RO4929097 significantly inhibits p75^NTR cleavage and processing.
IV. Determine the effects of RO4929097 on the establishment and growth of BTIC cultures in neurosphere growth conditions, effects on proliferation, ability to self-renewal, and ability to differentiate along lineage-specific pathways.
V. Determine the ability of RO4929097 to inhibit Notch signaling, by assessing downstream target activation, in glioma tissue of patients with recurrent MG.
VI. Determine the association between a number of serum, tumor, and BTIC markers and response to R04929097.
OUTLINE: This is a multicenter, dose-escalation (part A) study followed by an open-label (part B) study.
PART A: Patients receive oral RO4929097 once daily on days 1-3, 8-10, and 15-17. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
PART B: Patients receive oral RO4929097 once daily on days 1-7 and undergo surgery on day 8. Beginning 28 days later, patients receive oral RO4929097 once daily on days 1-3, 8-10, and 15-17. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Post resection tumor specimens are collected for correlative studies, including pharmacokinetic and biomarker assays.
After completion of study therapy, patients are followed up at 30 days and then every 3 month for up to 6-12 months.
Inclusion Criteria:
Patients must have radiographic progression of a histologically confirmed glioblastoma, high-grade astrocytoma, NOS, anaplastic mixed oligo-astrocytoma, or anaplastic oligodendroglioma
Patients must have at least one enhancing lesion that can be accurately measured as > 1 X 1 cm on a MRI
Prior treatment must include radiotherapy (with or without temozolomide)
For Part B only, surgical resection should be considered a reasonable therapeutic option for a patient that can tolerate surgical resection
There must be sufficient tissue available for evaluation of p75^NTR status from a prior surgery (using immunohistochemistry on fixed tissue or, in uncommon cases in which frozen tissue is available from a prior surgery, western blot) (part B)
ECOG performance status < 2 (Karnofsky > 50%)
Life expectancy of greater than 4 weeks
Absolute neutrophil count > 1,500/mcL
Platelets > 100,000/mcL
Hemoglobin > 90 g/L (or > 9 g/dL)
Total bilirubin < 2.0 mg/dL
BUN < 25 mg/dL
AST/ALT < 3 X institutional upper limit of normal
Creatinine within institutional normal limits OR creatinine clearance > 60 mL/min
No major medical illnesses or psychiatric impairments that, in the investigator's opinion, would prevent administration or completion of protocol therapy
Not pregnant or nursing
Negative serum pregnancy test
Fertile patients must use two forms of contraception (i.e., barrier contraception and one other method of contraception) at least 4 weeks prior to study entry, during, and for 12 months after completion of study therapy
Able to swallow pills
Patients with a history of seizures need to have had no generalized seizures in the last month prior to entering the study
No history of allergic reactions attributed to compounds of similar chemical or biologic composition to RO4929097
No malabsorption syndrome or other condition that would interfere with intestinal absorption
Patients who are serologically positive for hepatitis A, B, or C, and have a resulting positive serological test, or have a history of liver disease, other forms of hepatitis, or cirrhosis are ineligible
No uncontrolled hypocalcemia, hypomagnesemia, hyponatremia, hypophosphatemia, or hypokalemia (within 7 days prior to study treatment), despite adequate electrolyte supplementation
No uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia other than chronic, stable atrial fibrillation, or psychiatric illness/social situations that would limit compliance with study requirements
HIV-positive patients on combination antiretroviral therapy are ineligible
Baseline QTc ≤ 450 msec (male) or QTc ≤ 470 msec (female)
No history of risk factors for QT interval prolongation, including, but not limited to, family or personal history of long QT syndrome, recurrent syncope without known etiology, or sudden unexpected death
No history of torsades de pointes or other significant cardiac arrhythmias or the need for concomitant meds with known potential to prolong QT interval or antiarrhythmics
Use of food that may interfere with the metabolism of RO4929097 is prohibited, including grapefruit or grapefruit juice
Patients must have recovered from the effects of any prior treatment (systemic chemotherapy/radiotherapy) or surgery (<CTCAE grade 2 toxicities related to prior therapy)
Patients who have had chemotherapy, surgery, or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study are not eligible
Patients may not be receiving any other investigational agents
Patients cannot be receiving enzyme-inducing anti-epileptic drugs (EIAEDs)
No concurrent medications that are strong inducers/inhibitors or substrates of CYP3A4
Stable or decreasing steroid dose within 5 days prior to registration required
No medications with narrow therapeutic indices that are metabolized by cytochrome P450 (CYP450), including warfarin sodium (Coumadin®)
No other investigational or commercial agents or therapies may be administered with the intent to treat the patient's malignancy
No re-irradiation (any technique) is allowed
If a patient elects to have a new resection of his/her tumor in the absence of progression of the disease, treatment will be discontinued and no re-challenge will be allowed after this additional surgery