RATIONALE: Drugs used in chemotherapy, such as temozolomide and VNP40101M, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Temozolomide may also stop the growth of tumor cells by blocking blood flow to the tumor. PURPOSE: This phase I/II trial is studying the side effects and best dose of VNP40101M when given together with temozolomide and to see how well it works in treating patients with progressive or relapsed malignant glioma.
OBJECTIVES: * To determine the maximum tolerated dose (MTD) of VNP40101M when administered with temozolomide in patients with progressive or relapsed (first relapse) malignant glioma. (Phase I) * To record the toxicities of VNP40101M when administered with temozolomide. (Phase I and II) * To measure the level of AGT expression in peripheral blood monocytes before treatment with temozolomide and just prior to the administration of VNP40101M. (Phase I and II) * To determine MGMT methylation status as well as other methylation patterns in blood and tissue from patients treated with this regimen and correlate with outcome. (Phase I and II) * To determine the 6- and 12-month progression-free survival rates of patients treated with this regimen. (Phase II) * To determine overall survival of patients treated with this regimen. (Phase II) * To determine the complete and partial response rates in patients treated with this regimen. (Phase II) * To determine CSF penetration of VNP40101M once the MTD is reached from phase I and correlate with serum/plasma pharmacokinetics. (Phase II) OUTLINE: * Phase I: Patients receive oral temozolomide on days 1-7 and VNP40101M IV over 15-30 minutes 2 hours after the last dose of temozolomide on day 7. Treatment repeats every 7 weeks in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of VNP40101M until the maximum tolerated dose (MTD) is determined The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose limiting toxicity. * Phase II: Patients receive oral temozolomide and VNP40101M as in phase I. VNP40101M is given at the MTD determined in phase I. In both phases, patients complete the Functional Assessment of Cancer Therapy-Brain (FACT-BR) questionnaire on day 1 of each course. Blood is collected for in vitro isolation of mononuclear cells for analysis of O\^6 alkylguanine DNA alkyltransferase on days 1 and 7 of course 1. Blood, plasma, CSF, and formalin-fixed paraffin-embedded tissue blocks are collected for gene methylation studies, including MGMT, at baseline and on day 1 of each course.
Study Type
INTERVENTIONAL
CLORETAZINE will be administered intravenously on day 7. The starting dose of CLORETAZINE will be 100 mg/m2 given within 3 hours after the last dose of Temodar on day 7. CLORETAZINE will be given as an IV infusion over 15-30 minutes via a freely flowing peripheral or central intravenous line. CLORETAZINE will be escalated by 50 mg/m2 for the second cohort then by 25 mg/m2 increments in the following cohorts of 3-6 patients using a standard phase I trial design until a MTD is determined. If dose level 2 has two DLTs then patients will be accrued to a new dose level of 125 mg/m2. Prior to receiving Cloretazine, blood will be drawn for gene methylation studies.
Temozolomide will be given orally at a dose of 75mg/m2 daily on day 1 through 7. There will be no dose modification for this agent. Prior to receiving Temozolomide, blood will be drawn for gene methylation studies.
Hematology-Oncology Associates of Illinois
Chicago, Illinois, United States
Northwestern University
Chicago, Illinois, United States
MTD of CLORETAZINE
To determine the MTD of CLORETAZINE when administered with Temodar® in patients with malignant gliomas in first or second relapse
Time frame: At the end of phase one
Progression-free survival rate
To determine the 6 and 12 month progression-free survival rate.
Time frame: End of Phase II
Toxicities of CLORETAZINE when administered with Temodar®.
To record the toxicities of CLORETAZINE when administered with Temodar®. (Toxicity is assessed continuously through routine medical monitoring of the patient throughout each cycle and all adverse events are recorded cumulatively on the case report forms).
Time frame: Adverse events are monitored at screening/baseline;day one; termination visit; followup until death.
MGMT Methylation Status
To determine MGMT methylation status as well as other methylation patterns in blood correlate with outcome.
Time frame: Baseline and day seven of every cycle
Determine overall survival
To determine overall survival.
Time frame: All patients will be followed until death
Response rate to CLORETAZINE after Temodar® in patients with malignant gliomas in first or second relapse
To determine the response rate to CLORETAZINE after Temodar® in patients with malignant gliomas in first or second relapse.
Time frame: Day one of every cycle
Record the toxicities of CLORETAZINE when administered after Temodar
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Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
14
To record the toxicities of CLORETAZINE when administered after Temodar®
Time frame: Continuously after the first dose;within thirty days of each administration of investigational agent
Measure the level of AGT expression
To measure the level of AGT expression in peripheral blood monocytes before treatment with Temodar® and just prior to the administration of CLORETAZINE.
Time frame: Day seven of every cycle
CSF penetration of CLORETAZINE
To determine CSF penetration of CLORETAZINE once the MTD is reached from phase I and correlate with serum/plasma PK
Time frame: Day seven of cycle one of Phase 2 only