This clinical trial is designed with two treatment stages: Stage 1: one cycle of study drug treatment prior to initiation of first-line standard radiation in all study participants. Stage 2: two additional cycles of study drug treatment (8 weeks total) concomitantly with standard of care radiation (\~6 weeks) for participants with pathology-confirmed MGMT (enzyme O-6-methylguanine-DNA methyltransferase) unmethylated GBM only. The co-primary endpoints of the study are 1) feasibility of completing Stage 1 of treatment prior to radiation in all study participants and starting radiation within 6 weeks, and 2) safety of study drug across both treatment parts. The investigators will additionally evaluate the radiographic response rate after the first cycle of drug in all patients based upon RANO 2.0 (Response Assessment in Neuro-Oncology) criteria as well as safety of study drug in all patients (secondary endpoints). Exploratory endpoints will include characterization of ERK (extracellular signal-regulated kinase) and FAK (Focal adhesion kinase) dependence in pre-treatment tissue (by immunohistochemistry and/or 'omics) and correlation of expression and co-mutations with response and survival. A total of up to 22 evaluable patients can be enrolled in this study. Evaluable patients are those who have received at least one dose of study drug treatment. Patients who do not start drug will be replaced, up to a total of 28 patients.
Patients with a presumptive diagnosis of high-grade glioma based on frozen pathology and measurable (by RANO2.0 2D criteria) residual enhancing disease on post-operative MRI will be screened and consented within 2 weeks of surgery. All participants will start treatment within 2 weeks of surgery and receive study drug for one cycle at the FDA-approved dose (avutometinib 3.2 mg orally twice weekly and defactinib 200 mg orally twice a day; 3 wks on/1 wk off). Co-primary endpoint for all participants will be safety of the study intervention in this population and feasibility of receiving study drug and starting radiation therapy within 6 weeks of surgery. After one cycle of drug, all patients whose pathology reveals MGMT unmethylated, IDH (enzyme isocitrate dehydrogenase 1)-wildtype Glioblastoma, WHO (World Health Organization) Grade 4 will remain on study drug treatment: they will receive 2 additional cycles of study drug (8 weeks total) and concurrently with standard-of-care radiation (6 weeks total). These participants will remain on study until their post-radiation MRI 4 weeks after completing radiation, or 30 days after last dose of study drug, whichever is later. Co-primary endpoint for this sub-population will be safety of study drug administration for 3 cycles before and during radiation therapy (as measured by CTCAE v6, TRAEs (Treatment Related Adverse Events). Those who do not qualify for the radiation phase will be taken off treatment with study drug and receive standard-of-care therapy. A safety assessment period will be conducted for the first 6 patients with MGMT unmethylated, IDH-wild type Glioblastoma, WHO grade 4. Enrollment will be paused until all 6 patients are through the safety assessment period, which is a total of 16 weeks from the start of Cycle 1 Day 1 (C1D1) until 4 weeks after last dose of study drug. After treatment, all participants will come off treatment and be followed for progression, treatments, and survival. Evaluable participants are those who receive at least one dose of Avutometinib and defactinib.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
22
avutometinib 3.2 mg orally twice weekly and defactinib 200 mg orally twice a day for 3 weeks on/1 week off (one cycle = 4 weeks total)
Patients whose final pathology is MGMT promoter unmethylated GBM will receive an additional 2 cycles of avutometinib/defactinib concurrently with radiation (without temozolomide).
Emory University
Atlanta, Georgia, United States
Johns Hopkins SKCCC
Baltimore, Maryland, United States
Universidad Central del Caribe
Bayamón, Puerto Rico
Proportion of evaluable patients who complete at least 75% of the oral study drug intervention
Feasibility of a pre-radiation (pre-RT) therapeutic treatment
Time frame: 4 weeks
Safety as assessed by Number of patients who experience grade 3 and Grade 4 adverse events
Using CTCAE v6.0, toxicity will be assessed starting with C1D1 and continue until 4 weeks after the last dose of study drug (evaluated 16 weeks from start of treatment; total study period). Number of patients who experience grade 3 and Grade 4 events based on the 6.0 CTCAE Assessment tool.
Time frame: From start of treatment (day 0) up to 16 weeks post start of treatment
Radiographic response rate
Participants with Radiographic response following 1 cycle (4weeks) of study drug by bi-dimensional enhancing criteria determined by RANO 2.0
Time frame: 4 weeks
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