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.
PRIMARY OBJECTIVES: I. To determine the maximum tolerated dose (MTD) of Peposertib (M3814) 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 M3814 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 M3814 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 M3814 in combination with radiation. (Stage II) (Exploratory Objective) CORRELATIVE OBJECTIVES: I. To evaluate pharmacodynamic properties of M3814. 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.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
29
Given PO
Undergo radiation therapy
Undergo surgical resection
Given PO
M D Anderson Cancer Center
Houston, Texas, United States
RECRUITINGMaximum 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
Dose-limiting toxicities (DLT) (Stage I)
A DLT is defined as a clinically significant adverse event considered at least possibly related to M3814 in combination with radiation during the first 10 weeks of study treatment (4 weeks after completion of radiation and DNA damage response \[DDR\] inhibitors) for both stage I and stage II patients.
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)
Progression-free survival will be evaluated using the Kaplan-Meier product-limit survival curve methodology and will be compared to historical controls. Median progression free survival will be estimated using Kaplan-Meier estimates and associated two-sided 95% confidence intervals.
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)
Overall survival will be evaluated using the Kaplan-Meier product-limit survival curve methodology and will be compared to historical controls.
Time frame: Up to 3 years
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