Last updated on January 2020

Zotiraciclib (TG02) Plus Dose-Dense or Metronomic Temozolomide Followed by Randomized Phase II Trial of Zotiraciclib (TG02) Plus Temozolomide Versus Temozolomide Alone in Adults With Recurrent Anaplastic Astrocytoma and Glioblastoma


Brief description of study

Background

Zotiraciclib (TG02) is an investigational drug that penetrates the blood-brain barrier and might treat brain tumors. Temozolomide (TMZ) is a drug used to treat brain tumors.

Objective

To find out if Zotiraciclib (TG02) is safe, and to find out if it in combination with TMZ is as effective as TMZ alone in people with brain tumors.

Eligibility

People ages 18 and older with a brain tumor that has progressed after standard treatment

Design

In phase I part, the Bayesian optimal interval (BOIN) design will be used to find the MTD of Zotiraciclib (TG02) for Arm 1 (dose dense TMZ) and Arm 2 (metronomic TMZ) independently.

In Phase II part, a Bayesian design based on posterior probability will be used to monitor eficacy.

Participants will be screened with:

  • Medical history
  • Physical exam
  • Blood and urine tests
  • MRI of the brain if they have not had one in 14 days
  • Heart test
  • Tissue sample from prior surgeries

Participants will take Zotiraciclib (TG02) plus TMZ by mouth in 28-day cycles.

  • Some will take TMZ for 7 days on and 7 days off. Others will take it every day.
  • They will all take Zotiraciclib (TG02) three days before Cycle 1, and then on four days during every cycle.
  • They will all get treatment to prevent vomiting and diarrhea before and for 24 hours after each Zotiraciclib (TG02) dose.
  • They will all keep a diary of when they take the drugs and their symptoms.

Participants will have study visits. These include:

  • Physical exam, heart test, quality of life questionnaire, brain MRI, and urine tests every 4 weeks
  • Blood tests every 2 weeks

Participants will continue treatment until their disease gets worse or they have intolerable side effects.

Participants will also be enrolled in another protocol to test molecular markers for their brain tumor.

Detailed Study Description

Background
  • Zotiraciclib (TG02) is a pyrimidine-based multi-kinase inhibitor that has been shown to have inhibitory effects on CDKs, Janus Kinase 2 (JAK2) and Fm-like tyrosine kinase 3 (Flt3). It is orally administered and penetrates blood brain barrier (BBB). There is clinical experience in using Zotiraciclib (TG02) as both a single agent and in combination with other chemotherapy agents for cancer treatment.
  • Temozolomide (TMZ) is an oral alkylating agent that has proven efficacy in anaplastic glioma and glioblastoma. It was approved by the U.S. Food and Drug Administration (FDA) to treat anaplastic astrocytoma and glioblastoma in adults. Both a dose-dense (dd) schedule, 7 days on and 7 days off and a metronomic (mn) daily dosing schedule have been used to treat recurrent high-grade gliomas.
  • Our preclinical data have demonstrated that Zotiraciclib (TG02) down-regulates CDK9 activity and its target proteins, such as anti-apoptotic protein Mcl-1, XIAP and survivin. A treatment with Zotiraciclib (TG02) and TMZ has synergistic anti-glioma effects in a variety of glioma models with different genetic background. This serves as the basis for this proposed clinical trial.
    Objectives

Phase I:

-To determine the maximum tolerated dose (MTD) of Zotiraciclib (TG02) plus TMZ using both the dd and mn TMZ schedules in adult patients with recurrent anaplastic astrocytoma or glioblastoma/gliosarcoma.

Phase II:

-To determine the efficacy of Zotiraciclib (TG02) plus TMZ versus TMZ alone in patients with recurrent WHO grade III or IV astrocytoma as determined by progression free survival.

Eligibility
  • Documented pathology diagnosis of anaplastic astrocytoma [WHO grade III], or glioblastoma/gliosarcoma (WHO grade IV) with recurrent disease. If the pathology diagnosis is anaplastic glioma or anaplastic oligoastrocytoma, evidence of either intact 1p/19q chromosomes or molecular features suggesting astrocytic tumor must be present. (including, but not limited to ATRX and/or TP53 mutation)
  • No prior use of bevacizumab as a treatment for brain tumor.
  • No more than two prior relapses for Phase I and no more than one prior relapse for Phase II.
  • Patients must have recurrent disease, either histologically proven or with imaging suggestive of recurrent disease
  • Tumor tissues available for review to confirm the histologic diagnosis.
  • Tumor tissue blocks available for molecular profiling analysis.
Design
  • Phase I:
  • This portion of the study is conducted in two stages: The MTD finding and cohort extension. Two treatment arms and several dose levels are planned.
  • In the MTD finding part, TMZ with two alternate schedules (dd and mn) in combination with Zotiraciclib (TG02) will be administered.
  • A cohort extension of both arms will be performed at each MTD and the treatment arm with a better progression free survival at 4 months (PFS4) will be selected for the combination treatment arm for Phase II.
  • Pharmacokinetic, pharmacogenetic studies and neutrophil analysis will be performed during the cohort extension of both arms.
  • A maximum of 72 patients will be enrolled to this component for the trial.
  • Phase II:
  • Patients will be randomized between two competing treatment arms: ("winner" of dd vs mn) TMZ + Zotiraciclib (TG02) versus dd/mn TMZ alone using a Bayesian clinical trial design. The dosage for the combination arm will be derived from the MTD determined in the Phase I

component of the study.

  • The treatment schedule will be identical to that described above in the phase I component, with each cycle comprising 28 days.
  • Patients will continue treatment until tumor progression or unacceptable toxicity occurs.
  • At progression, patients randomized to the control arm (Temozolomide [TMZ] alone) will be offered the opportunity to continue TMZ and additional treatment with Zotiraciclib (TG02).

Clinical Study Identifier: NCT02942264

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