Testing the Ability of AMG 232 (KRT 232) to Get Into the Tumor in Patients With Brain Cancer

  • End date
    Dec 31, 2021
  • participants needed
  • sponsor
    National Cancer Institute (NCI)
Updated on 1 August 2021
biologic agent
serum pregnancy test
growth factor
karnofsky performance status
cytotoxic chemotherapy
neutrophil count
tumor cells
carcinoma in situ
bilateral tubal ligation
glioblastoma multiforme
brain tumor
vascular endothelial growth factor
malignant brain tumor
mdm2 inhibitor krt-232


This phase I trial studies the side effects and best dose of MDM2 inhibitor KRT-232 in treating patients with glioblastoma (brain cancer) that is newly diagnosed or has come back (recurrent). MDM2 inhibitor KRT-232 may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.



I. Determine the concentration and variability in concentration of MDM2 inhibitor KRT-232 (AMG 232 [KRT 232]) in brain and brain-associated tissue in patients with recurrent glioblastoma (GBM). (Part 1) II. Determine the maximum tolerated dose (MTD) of AMG 232 (KRT 232) given in combination with standard radiation following surgery for patients with newly diagnosed GBM harboring unmethylated MGMT promoters and wild-type TP53. (Part 2)


I. Determine the safety and toxicity of AMG 232 (KRT 232) in patients with recurrent GBM. (Part 1) II. Assess the variability of AMG 232 (KRT 232) concentration in tumor enhancing versus (vs.) infiltrative tissue. (Part 1) III. Assess the pharmacodynamic effect of AMG 232 (KRT 232) on p21 elevation. (Part 1) IV. Determine the safety of AMG 232 (KRT 232) given concurrently with radiation therapy (RT) and adjuvantly as monotherapy for patients with newly diagnosed GBM harboring unmethylated MGMT promoters and wild-type TP53. (Part 2) V. Assess AMG 232 (KRT 232) exposure and correlations with pharmacodynamic (PD) effect on p21 elevation. (Part 2) VI. Assess PD effect on MIC-1 elevation in serum. (Part 2)

OUTLINE: This is a phase 0, intratumoral pharmacokinetic (PK)/PD study of MDM2 inhibitor KRT-232 followed by a phase I dose-escalation study.

PART I: Patients with recurrent glioblastoma receive MDM2 inhibitor AMG 232 (KRT-232) orally (PO) once daily (QD) for 2 days. Within 3-6 hours of the last dose, patients undergo standard of care surgery. Upon recovery (within 45 days), patients with TP53 wild-type tumors continue to receive MDM2 inhibitor AMG 232 (KRT-232) PO QD on days 1-7. Cycles repeat every 21 days in absence of disease progression or unacceptable toxicity.

PART II: Within 6 weeks of standard of care surgery, patients with newly diagnosed glioblastoma undergo radiation therapy daily during weeks 1-6. Patients also receive MDM2 inhibitor AMG 232 (KRT-232) PO 2 times weekly (days 2, 4), 3 times weekly (days 2, 3, 5), 4 times weekly (days 2, 3, 4, 5), or 5 times weekly (days 1-5) for 6 weeks during radiation therapy.

PART II (EXPANSION COHORT): Patients receive MDM2 inhibitor AMG 232 (KRT-232) PO QD on days 1-7. Cycles repeat every 21 days in absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed every 2 months for the first two years from the off-treatment date, and then every 6 months until death.

Condition Glioma, gliosarcoma, Glioblastoma Multiforme, Recurrent Glioblastoma, TP53 wt Allele, Unmethylated MGMT Gene Promoter, Gliomas, glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma, MGMT-Unmethylated Glioblastoma
Treatment radiation therapy, laboratory biomarker analysis, pharmacological study, MDM2 Inhibitor AMG-232, MDM2 Inhibitor KRT-232
Clinical Study IdentifierNCT03107780
SponsorNational Cancer Institute (NCI)
Last Modified on1 August 2021


Yes No Not Sure

Inclusion Criteria

Patients must have a Karnofsky performance status >= 60% (i.e. the patient must be able to care for himself/herself with occasional help from others)
Patients must be 18 years of age or older
Absolute neutrophil count >= 1,500/ul
Platelets >= 100,000/ul
Hemoglobin >= 10 g/dL (transfuse as necessary to raise levels, no transfusions within 7 days of start)
Total bilirubin =< 1.5 x institutional upper limit of normal (ULN)
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional ULN
Alkaline phosphatase < 2.0 x ULN
Creatinine =< institutional ULN
Creatinine clearance >= 60 ml/min/1.73 m^2 for patients with creatinine levels above institutional normal
Activated partial thromboplastin time (APTT)/partial thromboplastin time (PTT) =< 1.5 x institutional ULN
Corrected QT interval (QTc) =< 470 msec (based on average of screening triplicates)
Patients must be able to provide written informed consent
Patients must have magnetic resonance imaging (MRI) within 21 days of starting treatment; patients must be able to tolerate MRI with gadolinium
Patients must be maintained on a stable corticosteroid regimen (no increase for 5 days) prior to the baseline MRI
Women of childbearing potential must have a negative serum pregnancy test prior to study entry; women of child-bearing potential must agree to use adequate contraception prior to study entry and for the duration of study participation through 5 weeks (women) after receiving the last dose of AMG 232 (KRT 232); should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately; men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 3 months after completion of AMG 232 (KRT 232) administration; adequate methods of effective birth control include sexual abstinence (men, women); vasectomy; or a condom with spermicide (men) in combination with barrier methods, hormonal birth control or intrauterine device (IUD) (women); bilateral tubal ligation (women)
Patients must have no concurrent malignancy except curatively treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix, breast, or bladder; patients with prior malignancies must be disease-free for >= five years
Patients must be able to swallow oral medications
Part 1 patients must have prior histologically proven glioblastoma that is progressive or recurrent following radiation therapy +/- chemotherapy
Part 1 patients must be undergoing repeat surgery that is clinically indicated as determined by their care providers
Part 1 patients must have a tumor tissue form indicating availability of archived tissue from initial resection at diagnosis of glioblastoma completed and signed by a pathologist
Part 1 patients may have an unlimited number of prior therapy regimens
Part 1 patients must have recovered from severe toxicity of prior therapy; the following intervals from previous treatments are required to be eligible
weeks from the completion of radiation
weeks from a nitrosourea chemotherapy or mitomycin C
weeks from a non-nitrosourea chemotherapy
weeks from any investigational (not Food and Drug Administration [FDA]-approved) agents
weeks from administration of a non-cytotoxic, FDA-approved agent, except bevacizumab/VEGFR inhibitors (e.g., erlotinib, hydroxychloroquine, etc.)
weeks from bevacizumab/VEGFR inhibitors
Part 2 patients must have histologically confirmed glioblastoma or gliosarcoma
Part 2 patients must have recovered from the immediate post-operative period
Part 2 patients must have tumor MGMT methylation status of unmethylated; results of routinely used methods for MGMT methylation testing (e.g. mutagenically separated polymerase chain reaction [MSPCR] or quantitative polymerase chain reaction [PCR]) are acceptable
Part 2 patient must show evidence of wild-type (WT) p53 status on somatic tissue specimens as assessed by deoxyribonucleic acid (DNA) sequencing
Part 2 patients must not have received prior radiation therapy, chemotherapy, immunotherapy or therapy with biologic agent (including immunotoxins, immunoconjugates, antisense, peptide receptor antagonists, interferons, interleukins, tumor infiltrating lymphocytes [TIL], LAK or gene therapy), or hormonal therapy for their brain tumor; glucocorticoid therapy is allowed

Exclusion Criteria

Patients receiving any other investigational agents are ineligible
Part 1 patients who have not recovered to < Common Terminology Criteria for Adverse Events (CTCAE) grade 2 toxicities related to prior therapy are ineligible
Patients on enzyme-inducing anti-epileptic drugs (EIAED) are not eligible for treatment on this protocol; patients may be on non-enzyme inducing anti-epileptic drugs or not be taking any anti-epileptic drugs; patients previously treated with EIAED may be enrolled if they have been off the EIAED for 10 days or more prior to the first dose of AMG 232 (KRT 232)
Patients with a history of hypersensitivity or allergic reactions attributed to compounds of similar chemical or biologic composition to AMG 232 (KRT 232) are ineligible; the AMG 232 (KRT 232) investigator brochure can be referenced for more information
Patients may not use herbal or non-traditional medications while receiving AMG 232 (KRT 232) therapy; all herbal medicines (e.g., St. John's wort), and supplements consumed by the subject within the 30 days prior to receiving the first dose of AMG 232 (KRT 232) should be reviewed by the principal investigator
Treatment with medications known to cause QTc interval prolongation within 7 days of study day 1 is not permitted unless approved by the sponsor; use of ondansetron is permitted for treatment of nausea and vomiting
Drugs known to be CYP3A4 substrates with narrow therapeutic windows (such as alfentanil, astemizole, cisapride, dihydroergotamine, pimozide, quinidine, sirolimus, or terfenadine) or CYP2C8 substrates are not allowed; patients must be switched to alternative drugs at least 14 days prior to receiving the first dose of AMG 232 (KRT 232); those patients who cannot switch to alternative drugs will be excluded from the study; please note that the list of drugs above is not an exhaustive list; refer to reliable sources such as the FDA website (Drug development and drug interactions), or Micromedex when evaluating potential drug-interactions
Patients may not be on warfarin, factor Xa inhibitors and direct thrombin inhibitors; Note: low molecular weight heparin and prophylactic low dose warfarin are permitted; APTT/PTT must meet the inclusion criteria; subjects taking low dose warfarin must have their international normalized ratio (INR) followed closely
Patients with uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements, are ineligible; patients with active infection requiring IV antibiotics within 2 weeks of study day 1 are excluded; patients with myocardial infarction within 6 months of study day 1, symptomatic congestive heart failure (New York Heart Association [NYHA] class III and higher), unstable angina, or cardiac arrhythmia requiring medication are excluded
Patients with gastrointestinal (GI) tract disease causing the inability to take oral medication, malabsorption syndrome, requirement for intravenous alimentation, prior surgical procedures affecting absorption, uncontrolled inflammatory GI disease (e.g., Crohn's disease, ulcerative colitis), are ineligible
Patients with history of bleeding diathesis are ineligible
Patients with positive hepatitis B surface antigen (HepBsAg), positive hepatitis total core antibody with negative HBsAG, or detectable hepatitis C virus ribonucleic acid (RNA) by a polymerase-chain reaction (PCR) assay are ineligible (screening is generally done by hepatitis C antibody [HepCAb], followed by hepatitis C virus RNA by PCR if HepCAb is positive)
Pregnant women are excluded from this study as no studies evaluating the reproductive toxicity of AMG 232 (KRT 232) have been conducted to date; the teratogenic potential of AMG 232 (KRT 232) in laboratory animals, if any, is unknown; because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with AMG 232 (KRT 232), breastfeeding should be discontinued if the mother is treated with AMG 232 (KRT 232) through 1 week after receiving the last dose of study drug
Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with AMG 232 (KRT 232); in addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy
Patients with a planned use of Novo-TTF (Optune) are ineligible
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