This study will evaluate the addition of regorafenib to standard of care treatment with TMZ as adjuvant therapy, and in combination with TMZ+RT as concomitant therapy. The standard of care for newly diagnosed GBM (ndGBM) includes surgical resection to the extent that is safely feasible, followed by RT plus concomitant TMZ chemotherapy, and up to 6 months of adjuvant TMZ. The dose escalation will be explored following a "3+3" design, escalating oral doses of regorafenib in combination with adjuvant (maintenance) TMZ (cohort A) to estimate the MTD of regorafenib as adjuvant (maintenance) therapy. After finding the MTD in the Adjuvant Therapy dose escalation, the Concomitant Therapy (cohort B) dose escalation will start, exploring escalating oral doses of regorafenib in combination with concomitant TMZ+RT, to estimate the MTD of regorafenib as concomitant therapy.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
21
Cohort A (Adjuvant/Maintenance Phase). The Adjuvant (Maintenance) Therapy dose escalation will explore three dose levels of regorafenib (e.g., 80 mg, 120 mg and 160 mg; level-1: regorafenib 40 mg will be evaluated in case of DLT during regorafenib 80 mg) administered in combination with adjuvant TMZ to evaluate the initial toxicity of regorafenib and TMZ Cohort B (Concomitant Phase) Therapy dose escalation will explore three dose levels of regorafenib (e.g., 80 mg, 120 mg and 160 mg; level -1: regorafenib 40 mg will be evaluated in case of DLT during regorafenib 80 mg) administered in combination with TMZ and RT.
Following a "3+3" design, in cohort A three patients will be administered temozolomide 150-200 mg/m2 for 5 consecutive days every 28 days until 6-12 cycles and regorafenib daily for 21 days, with a 1-week washout period at dose of 80 mg (level 1), 120 mg (level 2), or 160 mg (level 3) (regorafenib 40 mg- level -1). As a general rule, one cycle will last 28 days (day 1-28); however, in the event of treatment prolongation, the cycle period will be extended. In cohort B,During concomitant therapy phase: temozolomide 75 mg/m2/die for 42 (max 49 days) consecutive days (concomitant with radiation therapy).
Istituto Oncologico Veneto IRCCS
Padua, Italy
Humanitas Research Hospital
Rozzano, Italy
Number of patients with a Dose Limiting Toxicity (DLT)
Time frame: During dose escalation, the DLT evaluation period will be two cycles from Day -1 of Cycle 1 of adjuvant phase (cohort A) or from Day 1 to last day of the concomitant RT phase (Cohort B). (each cycle is 28 days)
Number of patients with ≥1 adverse event (AE) using the NCI CTCAE v5.0
* Grade 3 diarrhea, nausea, vomiting, and loss of appetite if lasting for ≥ 7 consecutive days; * Grade 3 electrolyte imbalance if lasting for ≥ 7 consecutive days; * Grade 3 dermal toxicity if lasting for ≥ 7 consecutive days; * Grade 3 fatigue for ≥ 7 consecutive days; * Grade 4 T-Bil, AST (GOT) and/or ALT (GPT) elevations,
Time frame: evaluation period will be two cycles from Day -1 of Cycle 1 of adjuvant phase (cohort A) or from Day 1 to last day of the concomitant RT phase (Cohort B). (each cycle is 28 days)
Number of patients discontinuing study treatment due to an AE
Number of patients discontinuing study treatment due to an AE
Time frame: evaluation period will be two cycles from Day -1 of Cycle 1 of adjuvant phase (cohort A) or from Day 1 to last day of the concomitant RT phase (Cohort B). (each cycle is 28 days)
Pharmacokinetics parameters - AUC
area under the plasma concentration versus time curve
Time frame: evaluation period will be two cycles from Day -1 of Cycle 1 of adjuvant phase (cohort A) or from Day 1 to last day of the concomitant RT phase (Cohort B). (each cycle is 28 days)
Best response to treatment according to RANO criteria
Tumor response according to RANO criteria
Time frame: from date of randomization until the date of first occurrence of disease progression or death, whichever come first,assessed up to 32 months
Progression-free survival
Survival time without tumor progression
Time frame: from the start of radiotherapy until the date of first occurrence of disease progression or death whichever come first,assessed up to 32 months
EORTC QLQ-C30
Survey with evaluations at screening, concurrently to brain MRI assessment and at the end of treatment
Time frame: from the start of radiotherapy until the date of first occurrence of disease progression or death whichever come first,assessed up to 32 months
Pharmacokinetics parameters - Tmax
Time to peak drug concentration
Time frame: evaluation period will be two cycles from Day -1 of Cycle 1 of adjuvant phase (cohort A) or from Day 1 to last day of the concomitant RT phase (Cohort B). (each cycle is 28 days)
Pharmacokinetics parameters - Cmax
Peak plasma concentration
Time frame: evaluation period will be two cycles from Day -1 of Cycle 1 of adjuvant phase (cohort A) or from Day 1 to last day of the concomitant RT phase (Cohort B). (each cycle is 28 days)
Overall survival
Time frame: from the start of radiotherapy until death ,assessed up to 32 months
Brain module BN20
Survey with evaluations at screening, concurrently to brain MRI assessment and at the end of treatment
Time frame: from the start of radiotherapy until the date of first occurrence of disease progression or death whichever come first,assessed up to 32 months
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