Phase Ib: To estimate the MTD and/or RP2D of INC280 in combination with buparlisib in patients with recurrent glioblastoma.Phase II: To estimate the anti-tumor activity of INC280 single agent and in combination with buparlisib in patients with…
ID
Source
Brief title
Condition
- Miscellaneous and site unspecified neoplasms benign
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
-Phase Ib: Incidence of dose limiting toxicities (DLTs)
-Phase II: Progression free survival rate (PFSR)
-Surgical arm: Concentrations of INC280 and buparlisib in tumor
Secondary outcome
-Type, frequency, and severity of adverse events and serious adverse events.
-Tolerability: dose interruptions, reductions and dose intensity.
-Plasma concentration of INC280 and buparlisib, and PK parameters, including
but not limited to Cmax, Tmax, AUCtau, and T1/2.
-Overall response rate (ORR)
-Overall survival (OS)
Background summary
Glioblastoma accounts for over 50% of all gliomas with an annual incidence rate
of 3 to 4 cases per 100,000 persons, resulting in 240,000 new cases worldwide
each year. The current standard treatment consists of neurosurgery followed by
radiotherapy and adjuvant temozolomide.
Almost all patients will experience recurrent disease, and the median
progression-free survival (PFS) is approximately 6 months.
Bevacizumab is approved for the treatment of recurrent glioblastoma. However,
most patients experience relapse. Options for salvage remain extremely limited.
Hence novel agents targeting relevant pathways are desperately needed.
Genetically, glioblastoma is characterized by complex chromosome abnormalities
that control the process of cellular proliferation, survival, invasion and
angiogenesis. Recent insights into the biology of gliomas suggested that
deregulation of PI3K signaling pathways and activation of tyrosine kinase
receptors including cMET, play essential roles in tumor initiation and
maintenance.
In glioblastoma, loss of PTEN function by mutation or gene deletion is the most
the common form of PI3K pathway deregulation. A wide spectrum of PI3K pathway
inhibitors are currently in clinical development, including buparlisib.
Preclinical evidence suggested PTEN deficient cancers depend more on PIK3CB.
Therefore, buparlisib, which has demonstrated clear evidence of target
inhibition, preliminary antitumor activity, and good brain penetrance
capability, is a good treatment option for inhibiting PTEN in glioblastoma.
Inhibition of MET signaling can have potent anti-tumor effects, including
regression of human glioblastoma tumor xenografts. MET inhibitors (like INC280)
are currently being evaluated in clinical trials in several cancers. In view of
the complex, heterogeneous nature of glioblastoma, and the clinical activity
observed in current ongoing trials, outcome remains grave. Hence, new or novel
approaches aimed at improving the outcome for patients with recurrent
glioblastoma are needed.
The development of combination therapy strategically targeting multiple steps
at the PI3K and MET signaling pathways may improve the approach in this group
of patients who failed first or second-line treatment after recurrent
glioblastoma.
Study objective
Phase Ib: To estimate the MTD and/or RP2D of INC280 in combination with
buparlisib in patients with recurrent glioblastoma.
Phase II: To estimate the anti-tumor activity of INC280 single agent and in
combination with buparlisib in patients with recurrent glioblastoma.
Surgical arm: To estimate the concentrations of INC280 and buparlisib in tumor
tissue (tumor sample).
Study design
A multi-center, open-label, phase Ib/II study.
Intervention
Treatment with INC280 single agend and in combination with BKM120 (buparlisib).
Study burden and risks
-Possible toxicity derived from the study treatment. The known adverse events
are documented in the informed consent form.
-The study assessments are used in routine practice: venepuncture (fasting),
echocardiogram or MUGA scan, CT scan or MRI, ECG, lumbar puncture. A flowchart
with all these assessments can be found in the informed consent form.
-Completion of questionnaires ( 8 times)
-Collection of urine during 24 hours (possibly once)
-Adequate contraception
-Frequent study visits
Raapopseweg 1
Arnhem 6824 DP
NL
Raapopseweg 1
Arnhem 6824 DP
NL
Listed location countries
Age
Inclusion criteria
** 18 years of age.
*Histologically confirmed diagnosis of glioblastoma after initial tumor resection with radiographic evidence of recurrent tumor per RANO criteria.
*Phase I: Documented evidence of PTEN mutations, homozygous deletion of PTEN or PTEN negative (H Score < 10) by IHC confirmed by local documentation (phase Ib only) or central assessment
*Phase II: Documented evidence of PTEN mutations, homozynous deletion of PTEN or PTEN negative (H score < 10) by IHC or c-Met amplification (GCN > 5) by FISH, all assessed centrally. Fusion transcripts or mutant c-Met (based on local data) may be eligible for single agent arm after documented agreement with Novartis.
*Must have received the following treatment for glioblastoma:
*Prior adjuvant treatment with radiotherapy and temozolomide;
*A maximum of two prior chemotherapy/antibody regimens (including bevacizumab or other direct VEFG/VEGFR inhibitors) for recurrent disease are permitted.
*Representative archival glioblastoma sample (formalin-fixed paraffine
embedded tissue) must be available.
*ECOG performance status * 2.
*Able to swallow and retain oral medication.
*Patients in the surgical arm only: patients with recurrent glioblastoma must be eligible for surgical resection as deemed by the site Investigator.
Exclusion criteria
*Prior or current treatment with a c-MET inhibitor or HGF-targeting therapy
*Prior treatment with a PI3K and/or mTOR inhibitors for glioblastoma (applicable for combination treatment arm only).
*Receiving treatment with medications that are known strong inhibitors or inducers of CYP3A, and cannot be discontinued 7 days prior to the start of the treatment and during the course of the study.
* Receiving treatment with medications that are known CYP3A or CYP1A2 substrates with narrow therapeutic index, and cannot be discontinued during the course of the study.
* Receiving treatment with long acting proton pump inhibitors, and cannot be discontinued 3 days prior to the start of INC280 treatment and during the course of the study.
*Currently being treated with Enzyme Inducing Anti-Epileptic Drug (EIAED). If previously on an EIAED, the patient must be off of it for at least 2 weeks prior to study treatment.
*Currently receiving warfarin or other coumadin-derived anticoagulants for treatment, prophylaxis or otherwise.
*Currently receiving increasing or chronic treatment ( > 5 days) with corticosteroids or another immunosuppressive agent.
*History of acute or chronic pancreatitis or any risk factors that may increase the risk of pancreatitis.
*Active cardiac disease or a history of cardiac dysfunction.
*Impairment of gastrointestinal (GI) function or GI disease that might significantly alter the absorption of study drug
*Medically documented history of or active major depressive episode, bipolar disorder (I or II), obsessive-compulsive disorder, schizophrenia, a history of suicidal attempt or ideation, or homicidal ideation (e.g. risk of doing harm to self or others), or patients with active severe personality disorders (defined according to DSM- IV).
*Anxiety * CTCAE grade 3
*Any of the following baseline laboratory values:
*Hemoglobin < 9 g/dL
*Platelet count < 75 x 109/L
*Absolute neutrophil count (ANC) < 1.0 x 109/L
*INR > 1.5
*Serum lipase > normal limits for the institution
*Asymptomatic serum amylase > grade 2
*Potassium, magnesium, and calcium (corrected for albumin) > normal limits for the institution
*Total bilirubin >1.5 x ULN
*Serum creatinine >1.5 x ULN or creatinine clearance * 45 mL/min
*Alanine aminotransferase (AST) or aspartate aminotransferase (ALT) > 3.0 ULN (or > 5.0 x ULN if liver metastases are present)
*Fasting plasma glucose > 120mg/dL or > 6.7 mmol/L
*HbA1c > 8%.
* Pregnant or nursing (lactating) women
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EudraCT | EUCTR2013-000699-14-NL |
ClinicalTrials.gov | NCT01870726 |
CCMO | NL45781.041.13 |