Primary Outcome Measures:
- Maximum tolerated dose of VNP40101M (Phase I) [ Designated as safety issue: Yes ]
- Toxicity (Phase I and II) [ Designated as safety issue: Yes ]
- AGT expression in peripheral blood (Phase I and II) [ Designated as safety issue: No ]
- Correlation of MGMT methylation status and other methylation patterns with outcome [ Designated as safety issue: No ]
- Progression-free survival at 6 months
(Phase II) [ Designated as safety issue: No ]
- Overall survival (Phase II) [ Designated as safety issue: No ]
- Complete and partial response rates (Phase II) [ Designated as safety issue: No ]
- Cerebrospinal fluid penetration (Phase II) [ Designated as safety issue: No ]
OBJECTIVES:
- To determine the maximum tolerated dose (MTD) of VNP40101M when administered with temozolomide in patients with progressive or relapsed (first relapse) malignant glioma. (Phase I)
- To record the toxicities of VNP40101M when administered with temozolomide. (Phase I and II)
- To measure the level of AGT expression in peripheral blood monocytes before treatment with temozolomide and just prior to the administration of VNP40101M. (Phase I and II)
- To determine MGMT methylation status as well as other methylation patterns in blood and tissue from patients treated with this regimen and correlate with outcome. (Phase I and II)
- To determine the 6- and 12-month progression-free survival rates of patients treated with this regimen. (Phase II)
- To determine overall survival of patients treated with this regimen. (Phase II)
- To determine the complete and partial response rates in patients treated with this regimen. (Phase II)
- To determine CSF penetration of VNP40101M once the MTD is reached from phase I and correlate with serum/plasma pharmacokinetics. (Phase II)
OUTLINE:
- Phase I: Patients receive oral temozolomide on days 1-7 and VNP40101M IV over 15-30 minutes 2 hours after the last dose of temozolomide on day 7. Treatment repeats every 7 weeks in the absence of disease progression or unacceptable toxicity.
Cohorts of 3-6 patients receive escalating doses of VNP40101M until the maximum tolerated dose (MTD) is determined The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose limiting toxicity.
- Phase II: Patients receive oral temozolomide and VNP40101M as in phase I. VNP40101M is given at the MTD determined in phase I.
In both phases, patients complete the Functional Assessment of Cancer Therapy-Brain (FACT-BR) questionnaire on day 1 of each course.
Blood is collected for in vitro isolation of mononuclear cells for analysis of O^6 alkylguanine DNA alkyltransferase on days 1 and 7 of course 1. Blood, plasma, CSF, and formalin-fixed paraffin-embedded tissue blocks are collected for gene methylation studies, including MGMT, at baseline and on day 1 of each course.