Erlotinib in Treating Patients With Recurrent Malignant Glioma or Recurrent or Progressive Meningioma

National Cancer Institute (NCI)136 enrolled

Overview

Phase I/II trial to study the effectiveness of erlotinib in treating patients who have recurrent malignant glioma or recurrent or progressive meningioma. Erlotinib may stop the growth of tumor cells by blocking the enzymes necessary for tumor cell growth.

OBJECTIVES: Phase 1 I. Determine the maximum tolerated dose of erlotinib in patients with recurrent malignant glioma or recurrent or progressive meningioma. II. Determine the safety profile of this drug in these patients. III. Determine the pharmacokinetics of this drug in these patients. Phase 2 I. Determine the 6-month progression-free survival (recurrent malignant glioma) II.12-month survival of patients treated with this drug (stable glioblastoma post radiation therapy) Phase 2 - Secondary Recurrent Malignant Glioma I. Objective Tumor Response rate associated with erlotinib therapy in recurrent or progressive malignant glioma. III. 12-month survival of patients treated with this drug Determine the safety profile of this drug in these patients. IV.. Determine the pharmacokinetics of this drug in these patients OUTLINE: This is a dose-escalation, multicenter study. Patients are stratified according to study phase (I vs II), concurrent enzyme-inducing antiepileptic drugs (EIAEDs) (yes vs no), histology (recurrent GBM vs recurrent anaplastic glioma vs recurrent meningioma vs stable GBM), preoperative candidacy (yes vs no), and concurrent steroids (yes vs no). Phase I: Patients concurrently receiving EIAEDs receive oral erlotinib once daily. Courses repeat every 4 weeks in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of erlotinib until the maximum tolerated dose (MTD) is determined. The MTD is the dose preceding that at which at least 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Phase II: Once the MTD is determined, additional patients concurrently receiving EIAEDs are treated with erlotinib as above at the phase II dose. Patients not concurrently receiving EIAEDs are treated with erlotinib as above at a predetermined dose. Patients are followed for survival.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * One of the following diagnoses: * Histologically confirmed intracranial malignant glioma * Glioblastoma multiforme (GBM), anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic mixed oligoastrocytoma, or malignant astrocytoma not otherwise specified * Original histology of low-grade glioma allowed provided a subsequent histology of malignant glioma is confirmed * Histologically or radiographically confirmed recurrent or progressive benign or malignant meningioma * Progressive disease or tumor recurrence on MRI or CT scan * Phase I: No more than 3 prior relapses and no more than 2 prior chemotherapy\* or biologic therapy regimens * Phase II: No more than 2 prior relapses and no more than 2 prior chemotherapy\* or biologic therapy regimens * Patients with progressive disease must have failed prior radiotherapy\* that was completed at least 4 weeks ago * Patients with progressive disease between 4 and 12 weeks after completion of external beam radiotherapy must have clear evidence of progression on MRI * Patients with GBM who have completed external beam radiotherapy and do not show progression are eligible * Patients with progressive disease after interstitial brachytherapy or stereotactic radiosurgery must have confirmed true progression rather than radiation necrosis based upon positron-emission tomography, thallium scanning, MRI, or surgical documentation * Measurable or evaluable disease * Performance status - Karnofsky 60-100% * More than 8 weeks * WBC at least 3,000/mm\^3 * Absolute neutrophil count at least 1,500/mm\^3 * Platelet count at least 100,000/mm\^3 * Hemoglobin at least 10 mg/dL (transfusion allowed) * Bilirubin less than 1.5 times upper limit of normal (ULN) * SGOT less than 1.5 times ULN * Creatinine less than 1.5 mg/dL * None of the following ophthalmic abnormalities: * Abnormalities of the cornea (e.g., dry eye syndrome or Sjögren's syndrome) * Congenital abnormality (e.g., Fuch's dystrophy) * Abnormal slit-lamp examination using a vital dye (e.g., fluorescein or Bengal-Rose) * Abnormal corneal sensitivity test (Schirmer test or similar tear production test) * Patients found to have dry eyes on examination but have an otherwise normal examination allowed * No active infection * No other serious concurrent medical illness * No other malignancy within the past 3 years except nonmelanoma skin cancer or carcinoma in situ of the cervix * No other disease that would obscure toxicity or dangerously alter drug metabolism * No significant medical illness that would preclude study participation * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective barrier contraception during and for 12 weeks after study participation * See Disease Characteristics * At least 1 week since prior thalidomide * At least 1 week since prior interferon * At least 4 weeks since prior SU5416 or other experimental biologic agents * See Disease Characteristics * No prior chemotherapy (including polifeprosan 20 with carmustine implant \[Gliadel wafers\]) for patients with stable GBM * At least 2 weeks since prior vincristine * At least 3 weeks since prior procarbazine * At least 6 weeks since prior nitrosoureas * At least 1 week since prior tamoxifen * See Disease Characteristics * Recovered from prior radiotherapy * No more than 6 weeks since prior external beam radiotherapy for patients with GBM without evidence of progression * Recovered from prior surgery * Recovered from prior therapy * At least 1 week since prior noncytotoxic agents (e.g., isotretinoin) except radiosensitizers * At least 4 weeks since prior cytotoxic therapy * At least 4 weeks since prior tipifarnib or imatinib mesylate * No prior erlotinib or other epidermal growth factor receptor inhibitors * No concurrent combination antiretroviral therapy for HIV-positive patients

Locations (7)

University of California Los Angeles

Los Angeles, California, United States

University of California San Francisco

San Francisco, California, United States

National Cancer Institute Neuro-Oncology Branch

Bethesda, Maryland, United States

Memorial Sloan Kettering Cancer Center

New York, New York, United States

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

University of Texas Southwestern Medical Center

Dallas, Texas, United States

University of Wisconsin

Madison, Wisconsin, United States

Outcomes

Primary Outcomes

Number of Dose Limiting Toxicity (DLT) Each Dose Level Phase I

DLT Definition: any grade 3 thrombocytopenia and grade 4 anemia and neutropenia; any non-hematologic grade 3 toxicity; failure to recover from toxicities to be eligible for re-treatment with erlotinib within 2 weeks of the last dose of erlotinib.

Time frame: 28 days

Define Maximum Tolerated Dose (MTD) of Erlotinib by Phase 1 Cohorts

standard 3+3 dose escalation design 3 patients in each dose level, observed for 28 days before enrollment to next level. if none of the patients experienced DLT dose escalated, if 1 of 3 experienced DLT 3 more enrolled at that level, if none of the 3 additional pts had DLT escalate to next level, if one or more of the additional pts experienced DLT, the MTD was exceeded and 3 more patients were treated at the next lower dose (if only 3 pts treated at the lower dose). The MTD is the dose at which 0/3 or 1/6 patients have experienced a DLT with the next higher dose having at least 2/3 or 2/6 patients encountering DLT.

Time frame: cycle 1 - 28 days

6 Months Progression-free Survival in Recurrent Malignant Gliomas (Phase II)

Progression: 25% increase in the sum of products of all measurable lesions over smallest sum observed (over BL if no decrease), OR clear worsening of any evaluable disease, OR appearance of any new lesion/site, OR failure to return for evaluation due to death or deteriorating condition (unless clearly unrelated to this cancer).

Time frame: 6 months

Secondary Outcomes

Percent of Participants With a Grade 3 or 4 Adverse Events Phase 1

CTCAE

Time frame: 1 year

1 Year Survival - Phase II Newly Diagnosed GBM Post RT

12 month survival for newly diagnosed stable GBM post RT treated with erlotinib post RT

Time frame: At 1 year

Overall Survival Newly Diagnosed GBM Post RT

Overall Survival defined as Time from Start of treatment to time of death due to any cause

Time frame: 2 years

Response Rate (Complete or Partial Response) Graded Using Modified RECIST Criteria Phase II

Measurable: Bidimensionally measurable lesions w/ clearly defined margins by MRI Evaluable: Unidimensionally measurable lesions, masses w/margins not clearly defined. Complete Response (CR): Complete disappearance of all measurable/evaluable disease. No new lesions. No evidence of non-evaluable disease. Patients on minimal/no steroids. Partial Response (PR): \>/= to 50% decrease under baseline in the sum of products of perpendicular diameters of all measurable lesions. No progression of evaluable disease. Responders must be on same/decreasing doses of dexamethasone. Stable/No Response: Does not qualify for CR, PR, or progression. Progression: 25% increase in the sum of products of all measurable lesions over smallest sum observed (over BL if no decrease), OR clear worsening of any evaluable disease, OR appearance of any new lesion/site, OR failure to return for evaluation due to death or deteriorating condition (unless clearly unrelated to this cancer).

Time frame: At 1 year

Percent of Patients With One or More Grade 3-5 Toxicity Described Based on the CTC Severity Grading Phase II

Summarized by descriptive statistics.

Time frame: Up to 1 year

Time of Peak Plasma Concentration Per Dose Level Phase I (on Anticonvulsants) -