Phase I Trial of DNA-PK Inhibitor (Peposertib) in Combination With Radiation and Adjuvant Temozolomide in Newly Diagnosed MGMT Unmethylated and Recurrent Glioblastoma
Summary
This phase I trial investigates the side effects and best dose of Peposertib, and to see how well it works in combination with radiation therapy in treating patients with newly diagnosed MGMT unmethylated glioblastoma or gliosarcoma. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Peposertib may further stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Chemotherapy drugs, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving Peposertib with radiation therapy may work better than radiation therapy alone in treating patients with glioblastoma or gliosarcoma.
Detailed description
PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) of Peposertib in combination with standard of care radiation dose (60 Gy, 2 Gy/fraction over 6 weeks) in patients with newly diagnosed MGMT unmethylated glioblastoma (GBM). (Stage I) II. To determine the ability of Peposertib to cross the blood brain barrier and to evaluate their pharmacodynamic properties in resected tissue. (Stage II) SECONDARY AND EXPLORATORY OBJECTIVES: I. To evaluate the dose limiting toxicities (DLT). (Stage I) (Secondary Objective) II. To determine the overall response rate (ORR), median progression free survival (mPFS) and median overall survival (mOS) of Peposertib in combination with radiation. (Stage I) (Secondary Objective) II. To determine the overall response rate (ORR), median progression free survival (mPFS) and median overall survival (mOS) of Peposertib in combination with radiation. (Stage II) (Exploratory Objective) CORRELATIVE OBJECTIVES: I. To evaluate pharmacodynamic properties of Peposertib. II. To assess the alterations in tumor immune microenvironment as a result of deoxyribonucleic acid (DNA)-dependent protein kinase (DNA-PK) inhibition. OUTLINE: This is a dose-escalation study of Peposertib. Patients are assigned to 1 of 2 stages. STAGE I (CONCURRENT): Patients undergo standard of care radiation therapy daily (Monday-Friday) for 30 fractions. Patients also receive Peposertib orally (PO) on each day of radiation therapy and given 1-2 hours before each treatment fraction. Treatment continues for 6 weeks in the absence of disease progression or unacceptable toxicity. STAGE I (ADJUVANT): Patients receive temozolomide PO once daily (QD) on days 1-5. Treatment repeats every 28 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. STAGE II (CONCURRENT): Patients receive Peposertib and undergo standard of care radiation therapy as in Stage I. Within 1-14 days after the completion of radiation therapy, patients undergo surgical resection. STAGE II (ADJUVANT): Patients receive temozolomide as in Stage I. After completion of study treatment, patients are followed up every 3 months.
Arms & interventions
- DrugPeposertib
Given PO
- RadiationRadiation Therapy
Undergo radiation therapy
- ProcedureResection
Undergo surgical resection
- DrugTemozolomide
Given PO
Outcome measures
Primary
Maximum tolerated dose (MTD) (Stage I)
Will employ the Bayesian optimal interval to find the MTD.
Time frame: Within the first 10 weeks of study treatment
Ability of Peposertib (M3814) to cross the blood brain barrier (Stage II)
Ability of the investigational drug to cross the blood brain barrier will be tested by measuring concentration of the drug within the blood and the resected brain tumor tissue. This will be correlated with biomarkers of deoxyribonucleic acid (DNA) damage in brain tumor tissue, blood, and hair follicle.
Time frame: At 1, 2, and 4 hours after drug administration on fraction day 1 and at pre-dose and 1, 2, and 4 hours after drug administration on fraction day 10
Secondary
Dose-limiting toxicities (DLT) (Stage I)
Time frame: Within the first 10 weeks of study treatment
Overall response rate (Stage I)
Time frame: Up to 3 years
Median progression-free survival (Stage I)
Time frame: From study enrollment until time of first occurrence of disease progression, relapse, or death due to disease, assessed up to 3 years
Median overall survival (Stage I)
Time frame: Up to 3 years
Overall response rate (Stage II)
Time frame: Up to 3 years
Median progression-free survival (Stage II)
Time frame: From study enrollment until time of first occurrence of disease progression, relapse, or death due to disease, assessed up to 3 years
Median overall survival (Stage II)
Time frame: Up to 3 years
Eligibility criteria
Study locations (1)
M D Anderson Cancer Center
Houston, Texas, 77030