This phase IB/II trial is designed to investigate the safety and survival benefits for patients with recurrent grade-4 with unmethylated MGMT promoter treated with Bortezomib and Temozolomide in a specific schedule.
Patients harbouring tumours with functional O6 methylguanine DNA methyltransferase (MGMT) DNA repair enzyme efficiently repair the DNA damage inflicted by Temozolomide and gain limited benefit from this chemotherapy. Bortezomib depletes the MGMT enzyme, restoring the tumour´s susceptibility to Temozolomide, if the chemotherapy is administered in the precise schedule when the MGMT enzyme is depleted. Additionally, Bortezomib inhibits the growth of tumour cells by blocking autophagy flux. Temozolomide causes genotoxic stress in cancer cells that in turn respond by inducing protective processes such as autophagy. If both autophagy and MGMT DNA repair enzyme are blocked a priori, the efficacy of Temozolomide will be enhanced. Thus, pre-treating the tumour with Bortezomib prior to administration of Temozolomide leads to DNA repair enzyme depletion and blockade of autophagy-induced survival signals. The combined effect will sensitize the tumour to therapy, improve chemotherapy efficacy and prolong patient survival outcomes. Hypothesis: Pretreatment with Bortezomib administered prior to Temozolomide will sensitize recurrent GBM with unmethylated MGMT promoter to standard TMZ in palliative setting. Objective: * Assessment of safety and tolerability of Bortezomib administered with Temozolomide. * Determining the optimal dose of TMZ, when administered as combination therapy * Estimate the progression free survival (PFS) and overall survival (OS) of patients with recurrent or progressed glioblastoma after pre-treatment with Bortezomib prior to combination with Temozolomide. Key secondary objectives * Tumour response to the therapy assessed by RANO and NANO criteria * Determine physiological, molecular and biochemical changes in blood and tumour tissue that correlate with treatment responses.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
63
In the Phase IB of the study the following dose escalation of TMZ will be performed: The first cohort of 3 patients will receive 150 mg/m2 of IMP (TMZ) for 5 days q4w. If one patient in this cohort develops a dose limiting toxicity, another cohort of 3 patients will be treated at the same dose level until 2 or more patients in the group of 3-6 develop DLT.
The patientes will be treated with the maximum recommended starting dose of Temozolomide and Bortezomib established in the IB phase of the study
Haukeland University Hospital
Bergen, Norway
RECRUITINGOslo University Hospital
Oslo, Norway
RECRUITINGBortezomib-Temozolomide Maximum tolerated dose
En intra- and inter-patient dose escalation period of TMZ administered after Bortezomib
Time frame: 6 months
Overall survival
Overall survival at 1 year
Time frame: 1 year
Progression free survival
Progression free survival at 6 months
Time frame: 6 months
Time to progression
Median time
Time frame: 4 years
Biomarkers of treatment response
Identification of novel tumor biomarkers by determining physiological, molecular and biochemical changes in blood and tumor tissue that correlate with treatment responses
Time frame: 4 years
Tumour responses
Assessed by contrast enhanced MRI according to RANO criteria
Time frame: 4 years
Clinical response
Assessment of the neurologic status according to NANO criteria
Time frame: 4 years
Toxicity assessment
SAE, all grades hematologic and non hematologic toxicity
Time frame: 4 years
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