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Ph II Erlotinib + Sirolimus for Pts w Recurrent Malignant Glioma Multiforme
This study is ongoing, but not recruiting participants.
First Received: January 29, 2008   Last Updated: February 22, 2009   History of Changes
Sponsors and Collaborators: Duke University
Genentech
OSI Pharmaceuticals
Information provided by: Duke University
ClinicalTrials.gov Identifier: NCT00672243
  Purpose

Primary objective:

To determine the 6-month progression free survival of patients with recurrent GBM treated with Erlotinib plus Sirolimus.

Secondary objectives:

To further define the safety and tolerability of Erlotinib plus Sirolimus when administered to patients with recurrent GBM; and to evaluate progression free survival, radiographic response and overall survival of patients with recurrent GBM treated with Erlotinib plus Sirolimus.


Condition Intervention Phase
Glioblastoma
Gliosarcoma
Drug: Erlotinib, Sirolimus
Phase II

Drug Information available for: Sirolimus Erlotinib hydrochloride Erlotinib
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Active Control, Single Group Assignment, Efficacy Study
Official Title: Phase II Trial of Erlotinib Plus Sirolimus for Patients With Recurrent Malignant Glioma Multiforme

Further study details as provided by Duke University:

Primary Outcome Measures:
  • 6 month progression-free survival. [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • a.Median PFS, radiographic response & overall survival b.Correlation of clinical response & pathological findings of EGFR expression, amplification, PTEN gene copy number & EGFR-vIII expression [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Gr 3 or greater, treatment related, non-hematologic toxicities [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 20
Study Start Date: April 2007
Estimated Study Completion Date: April 2010
Estimated Primary Completion Date: April 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
A: Experimental
Pts not receiving EIAEDs
Drug: Erlotinib, Sirolimus
Estimated date of study completion is 6-9 mths from study initiation. Pts will take both Erlotinib & Sirolimus on daily dosing schedule. Each cycle will last 28 days. Erlotinib administered orally, continuously once daily in fasting state for each 28-day cycle. Dose of Erlotinib represents standardized dosing previously established in prior ph I studies among pts w RMG. Erlotinib when administered as single agent were well tolerated up to daily doses of 200 mg & 650 mg for pts not on & on EAEDs. In ph I study, daily doses of Erlotinib up to 250 mg for pts not on EIAEDs & 450 mg for pts on EIAEDs were evaluated in combo w standard temozolomide dosing. Based on ph I study, recommended ph II dosing schedule of Erlotinib combo therapy is 200 mg/day for pts not on EIAEDs/day & 450 mg/day for those on EIAEDs. In current study, dose of Erlotinib will be 150 mg/day for pts not on CYP3A4-EIAEDs & 500 mg/day for pts on EIAEDs.
B: Experimental
Pts receiving EIAEDs
Drug: Erlotinib, Sirolimus
Estimated date of study completion is 6-9 mths from study initiation. Pts will take both Erlotinib & Sirolimus on daily dosing schedule. Each cycle will last 28 days. Erlotinib administered orally, continuously once daily in fasting state for each 28-day cycle. Dose of Erlotinib represents standardized dosing previously established in prior ph I studies among pts w RMG. Erlotinib when administered as single agent were well tolerated up to daily doses of 200 mg & 650 mg for pts not on & on EAEDs. In ph I study, daily doses of Erlotinib up to 250 mg for pts not on EIAEDs & 450 mg for pts on EIAEDs were evaluated in combo w standard temozolomide dosing. Based on ph I study, recommended ph II dosing schedule of Erlotinib combo therapy is 200 mg/day for pts not on EIAEDs/day & 450 mg/day for those on EIAEDs. In current study, dose of Erlotinib will be 150 mg/day for pts not on CYP3A4-EIAEDs & 500 mg/day for pts on EIAEDs.

Detailed Description:

The primary objective of this study will be to determine the 6-month progression free survival of patients with recurrent GBM treated with Erlotinib plus Sirolimus. This is an exploratory, single-arm, phase II study designed to assess the anti-tumor activity of a combinatorial regimen consisting of Erlotinib plus Sirolimus among patients with recurrent GBM. The combinatorial regimen of Erlotinib plus Sirolimus is rationally designed to simultaneously inhibit upstream (EGFR) and downstream (mTOR) mediators of PI3/AKT signaling. In a recently completed phase I study, we determined that an EGFR inhibitor (Gefitinib) can be safely combined with Sirolimus at dose levels that are routinely used in the monotherapy setting. Therefore, the primary endpoint of this study is the probability of progression-free survival at 6 months among recurrent GBM patients treated with standard doses of Erlotinib plus Sirolimus. An important secondary objective is to further assess the safety of Erlotinib and Sirolimus for patients with recurrent GBM.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Pts have confirmed diagnosis of recurrent primary WHO grade IV MG. Pts w recurrent disease whose diagnostic pathology confirmed GBM will not need re-biopsy. Pts w prior low-gr glioma / anaplastic glioma are eligible if histologic assessment demonstrates transformation to GBM
  • Age >18 yrs
  • Interval of >2 wk between prior surgical resection
  • Interval of >12 wks between prior XRT unless there is either: histopathologic confirmation of recurrent tumor; new enhancement on MRI outside of XRT treatment field; / progressive radiographic changes after XRT/temo as well as after adjuvant, post-XRT temo
  • Interval of >4 wks between chemo & enrollment on protocol unless: unequivocal evidence of tumor progression; & pt has recovered fully from all toxicity associated w prior surgery, XRT/chemo. Pts treated w chemo agents such as VP-16 who would normally be retreated after shorter intervals may be treated at usual starting time even if <4 wks from last prior dose chemo
  • Karnofsky performance score >70 percent
  • Hematocrit >29 percent, ANC >1,500 cells/microliter, platelets >100,000 cells/microliter
  • Serum creatinine <1.5 mg/dl, serum SGOT & bilirubin <1.5 x ULN; fasting plasma triglyceride & cholesterol < gr1
  • For pts on corticosteroids, dose should not be increasing for >7 days prior to baseline Gd-MRI of brain if medically appropriate
  • Pts in enzyme inducing antiepileptic drug cohort must be on stable dose of p450-inducing EIAED for >2 wks. Pts in non-EIAED cohort must not receive any p450-EIAED for >2 wks prior to & during participation in trial
  • Signed informed consent approved by IRB prior to pt entry
  • If sexually active, pts will take contraceptive measures for duration of treatments & for 3 months following discontinuation of Erlotinib
  • Pts who have had prior bevacizumab are eligible however interval of >6 weeks must have elapsed since their last dose

Exclusion Criteria:

  • Prior mTOR directed therapy
  • Prior EGFR-directed therapy
  • Female pts are pregnant/breast feeding, or adults of reproductive potential not employing effective method of birth control. Women of childbearing potential must have negative serum pregnancy test <72 hours prior to administration of Erlotinib
  • Co-medication that may interfere w study results
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection requiring IV antibiotics, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, hyperlipidemia not controlled w medication, psychiatric illness/social situations that would limit compliance w study requirements,/disorders associated w significant immunocompromise
  • Acute/chronic liver disease
  • Impairment of GI function/GI disease that may significantly alter absorption of Erlotinib
  • Pts who have received investigational drugs <4 wks prior to entry on study or who have not recovered from toxic effects of such therapy
  • Pts who have received biologic, immunotherapeutic/cytostatic agents <1 wk prior to entry on study/have not recovered from toxic effects of such therapy
  • Pt is <5 yrs free of another primary malignancy except: if other primary malignancy is not currently clinically significant/requiring active intervention,/if other primary malignancy is basal cell skin cancer/cervical carcinoma in situ. Existence of any other malignant disease is not allowed
  • Pts have had any surgery other than resection of brain tumor <2 wks prior to entry on study/have not recovered from side effects of such therapy
  • Pts unwilling to/unable to comply w protocol
  • Pts w acute/chronic renal insufficiency/those w acute renal insufficiency of any severity due to hepato-renal syndrome/in peri-operative liver transplantation period
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00672243

Locations
United States, North Carolina
Duke University Health System
Durham, North Carolina, United States, 27710
Sponsors and Collaborators
Duke University
Genentech
OSI Pharmaceuticals
Investigators
Principal Investigator: David Reardon, MD Duke University Health System
  More Information

Additional Information:
No publications provided

Responsible Party: Duke University Health System ( David A. Reardon, MD )
Study ID Numbers: 00000345
Study First Received: January 29, 2008
Last Updated: February 22, 2009
ClinicalTrials.gov Identifier: NCT00672243     History of Changes
Health Authority: United States: Institutional Review Board

Keywords provided by Duke University:
GBM
Brain tumor
Erlotinib
Sirolimus
Glioblastoma multiforme
Glioblastoma
Gliosarcoma3
Tarceva
Rapamune

Study placed in the following topic categories:
Erlotinib
Sirolimus
Glioblastoma
Immunologic Factors
Astrocytoma
Clotrimazole
Miconazole
Tioconazole
Protein Kinase Inhibitors
Immunosuppressive Agents
Temozolomide
Recurrence
Anti-Bacterial Agents
Brain Neoplasms
Neuroectodermal Tumors
Antifungal Agents
Neoplasms, Germ Cell and Embryonal
Neuroepithelioma
Glioma
Glioblastoma Multiforme
Gliosarcoma
Neoplasms, Glandular and Epithelial

Additional relevant MeSH terms:
Sirolimus
Glioblastoma
Anti-Infective Agents
Molecular Mechanisms of Pharmacological Action
Immunologic Factors
Antineoplastic Agents
Neoplasms, Nerve Tissue
Physiological Effects of Drugs
Antibiotics, Antineoplastic
Protein Kinase Inhibitors
Anti-Bacterial Agents
Neoplasms, Germ Cell and Embryonal
Therapeutic Uses
Antifungal Agents
Glioma
Erlotinib
Neoplasms by Histologic Type
Astrocytoma
Enzyme Inhibitors
Immunosuppressive Agents
Pharmacologic Actions
Neuroectodermal Tumors
Neoplasms
Neoplasms, Neuroepithelial
Gliosarcoma
Neoplasms, Glandular and Epithelial

ClinicalTrials.gov processed this record on May 07, 2009