The purpose of this phase 2, two arm, biomarker-driven study is to determine if treatment of O-6-methylguanine-DNA methyltransferase (MGMT) unmethylated glioblastoma with VAL-083 improves overall survival (OS), compared to historical control, in the adjuvant or recurrent setting.
Recurrent GBM is characterized by a dismal prognosis, with a median overall survival of 6.9 months. While a standard of care is established for the initial treatment of GBM - radiation with concurrent and adjuvant temozolomide chemotherapy - management of recurrent disease (NCCN, 2014) remains suboptimal. Treatment options include repeat surgery, re-irradiation, or chemotherapy (including experimental targeted therapies, biologic agents, and immunotherapies). Only a minority of patients has response to these treatments, and the resultant benefits in progression-free and overall survival are in the order of weeks to months. Prognosis and response to therapy are known to be better in patients with a methylated MGMT promoter gene. Epigenetic silencing of MGMT by promoter methylation is an important factor in predicting outcome for patients with GBM treated with temozolomide. Approximately 66% of GBM tumors are MGMT unmethylated (high expression of MGMT), which through a MGMT repair mechanism, confers resistance to temozolomide, the standard chemotherapy treatment of GBM. VAL-083, Dianhydrogalactitol (DAG), unlike temozolomide, is demonstrated to be active independent of MGMT resistance mechanisms, in vitro. Thus, it may provide a treatment option for those patients that are considered likely to be poor responders to temozolomide. This is a non-comparative, two arm, biomarker-driven study with VAL-083 in GBM patients with either recurrent disease (Group 1) or newly diagnosed GBM patients requiring maintenance therapy after chemoradiation with temozolomide (Group 2). Group 1: A total of up to 83 patients with recurrent/progressive GBM will be enrolled. This will include 35 patients treated at 40 mg/m2 and up to 48 patients treated at 30 mg/m2. Group 2: Up to an additional 36 newly diagnosed GBM patients who have completed chemoradiation treatment with temozolomide and received no subsequent maintenance temozolomide will be enrolled. Eligible patients will receive VAL-083 IV on days 1, 2, and 3, for up to 12, 21-day treatment cycles or until they fulfill one of the criteria for study discontinuation (disease progression, death, intolerable toxicities, investigator's judgment, or withdrawal of consent). Disease status will be evaluated with clinical and MRI evaluation every other 21-day cycle, while the patient is receiving VAL-083 treatment, and then approximately every 42 ± 7 days while remaining on study. Symptom burden will be evaluated using the MD Anderson Symptom Inventory-Brain Tumor (MDASI-BT) completed by patients at baseline and at the time of each imaging evaluation. Interval medical histories, targeted physical exams, neurologic evaluations, complete blood counts, and other laboratory and safety assessments will be performed approximately every 21-days. Blood samples will be taken at Cycle 1 Day 1 pre-dose, 15 ± 5 min, 30 ± 5 min, 60 ± 10 min, 120 ± 10 min, 240 ± 15 min, and 360 ± 15 min after the end of the of iv infusion with VAL-083 to determine the PK profile and dose-exposure relationship of VAL-083. Toxicity will be evaluated and documented using the NCI CTCAE version 4. This study will take approximately 36 months to enroll.
The dosing regimen for patients will be VAL-083 (30 mg/m2) administered IV for 3 consecutive days at the beginning of every 21-day cycle. Patients will continue to receive VAL 083, for up to 12, 21-day treatment cycles or until they fulfill one of the criteria for study discontinuation.
University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Overall Survival
Length of time from start of treatment (Day 1) until patient death
Time frame: Every 30 days from randomization until patient death
Estimate Progression-free Survival
Time from start of treatment (Day 1) until to the first occurrence of progression or patient death, whichever occurs first
Time frame: Every 30 days from randomization until disease progression or patient death, whichever occurs earlier
Estimate Median Progression-Free Survival
The median length of time from start of treatment (Day 1) until to the first occurrence of progression or patient death, whichever occurs first
Time frame: Every 30 days from randomization until disease progression or patient death, whichever occurs earlier
Estimate Median Overall Survival
The median length of time from start of treatment (Day 1) until patient death
Time frame: Every 30 days from randomization until patient death
Estimate Overall Response Rate
Overall number of tumor complete response (CR) or partial response (PR) determined via MRI assessment
Time frame: Every 42 days from randomization to achievement of either complete response (CR) or partial response (PR)
Estimate Duration of Response
Length of time tumor continues to demonstrate either complete response (CR) or partial response (PR) via MRI assessment
Time frame: Every 42 days from the first occurrence of a documented, objective response until the time of relapse or patient death
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
118
Safety evaluation of VAL-083 in patients
To confirm safety and tolerability of VAL-083 using NCI CTCAE v.4 to assess adverse events
Time frame: From randomization up to 28 days following last study treatment
Patient Quality of Life Assessment
MD Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT)
Time frame: Every 42 days from randomization until disease progression
Plasma Pharmacokinetics
PK profile and dose-exposure relationship of VAL-083
Time frame: Cycle 1 Day 1 predose, 15 ± 5 min, 30 ± 5 min, 60 ± 10 min, 120 ± 10 min, 240 ± 15 min, and 360 ± 15 min after the end of the of iv infusion of VAL-083