Protein Phosphatase 2A Inhibitor in Recurrent Glioblastoma

  • STATUS
    Recruiting
  • End date
    Aug 31, 2022
  • participants needed
    25
  • sponsor
    National Cancer Institute (NCI)
Updated on 12 September 2021
platelet count
renal function
recurrent disease
glioblastoma multiforme
astrocytoma
gliosarcoma
brain tumor
recurrent glioblastoma
oligodendroglioma
renal function test

Summary

Background

The brain is separated from the rest of the blood stream by the blood-brain barrier. This is like a filter that protects the brain. But is also a challenge when medicines need to get into the brain. Researchers want to give the new drug LB100 to people before brain tumor surgery. They will measure how much LB100 is in the blood and how much gets into the brain. This may help with the use of LB100 to treat brain tumors in the future.

Objective

To see if LB100 can pass into the brain.

Eligibility

People at least 18 years old with a brain tumor that requires surgery

Design

Participants will be screened with:

Physical exam

Medical history

Blood tests

Neurosurgery evaluation

Scans

Heart tests

Tumor sample. This can be from a previous procedure.

Participants will have their brain surgery at the Clinical Center.

Participants will get a dose of the study drug through a plastic tube in a vein for 2 hours during surgery.

Participants will have blood taken 7 times in the 8 hours after getting the study drug.

Tumor samples will be taken during surgery.

Participants will have a heart test after getting the study drug. Sticky pads on the skin will measure electrical activity of the heart.

Two-three weeks after leaving the hospital, participants will have a follow-up visit. They will have a physical exam and blood tests.

One month after surgery, they will be contacted in person or by phone to see how they are doing.

Description

Background
  • Primary gliomas are an incurable disease in spite of aggressive multimodality therapy consisting of craniotomy, irradiation, and chemotherapy. Therapeutic options for patients with recurrent glioma are limited, and there is an unmet need to identify more effective agents.
  • LB100, a water soluble small molecule novel protein phosphatase 2A (PP2A) inhibitor, was commercially developed through a CRADA based on our previous intramural research. This compound has shown to be effective in a variety of cancer types in both in vitro and in vivo models. Preclinical studies indicate LB100 has in vitro and in vivo activity as a single agent as well as potentiating the effect of cytotoxic agents including temozolomide, docetaxel, doxorubicin, and ionizing radiation. LB100 is active in combination with temozolomide or doxorubicin against xenografts of glioblastoma, neuroblastoma, pheochromocytoma, breast cancer, fibrosarcoma, and melanoma.
  • A complete phase I study of LB100 has established its safety and the recommended phase II dose (2.33 mg/m^2, daily for three days every 3 weeks).
  • Although it is a polar compound, rodent studies suggest LB100 has activity in the brain.
  • Whether LB100 can across the human blood brain barrier (BBB), and at what concentration relative to the plasma level is not known. Characterizing these parameters is important
    because
  • 1) Our ongoing in vitro studies indicate that LB100 has distinct mechanisms of action at different drug concentrations (e.g. nM versus uM);
  • 2) There are other brain tumors lacking effective medical therapies but without a BBB. Characterizing the LB100 BBB penetration profile will assist in defining its optimal clinical indication.
    Objective

-To determine the pharmacokinetic (PK) properties of LB100 in glioma tumor tissues.

Eligibility
  • Patients with histologically proven glioblastoma and grades II-III astrocytomas and oligodendrogliomas.
  • A clear clinical indication for another surgical resection must be present.
  • Subjects must be greater than or equal to 18 years old.
  • Karnofsky performance status of greater than or equal to 60%.
  • Patients must have adequate organ function.
Design
  • This is a two stage Phase II, open label, single institution study to determine the PK and PD profile of LB100.
  • The dose (established from a Phase I study) will be 2.33 mg/m^2 delivered intravenously over 2 hours.
  • PK and PD effect of LB100 treated tissues will only be evaluated with pathologic confirmation of recurrent tumor. Resected material demonstrating chemoradiation treatment effect or inflammatory response will not be included in the analysis.
  • PK will be determined by quantitating LB100 in tumor tissues removed at various time points.
  • The primary endpoint is PK response, defined as a binary variable indicating the presence/absence of LB100 in tumor tissues.
  • PD effect is defined as statistically significant elevation of phospho-proteins in treated tumor tissues compared to untreated glioma specimens. Untreated inter-patient baseline variance and standard deviation (SD) will be calculated. Post-treatment PD effect difference greater than 2.5 times the baseline SD is statistically significant at the .05 significance level. Due to relatively small sample size, t-distribution is to be used to calculate the cutoff defining the PD response.
  • Up to 25 patients may be enrolled to obtain 8 evaluable subjects. A two-stage design will be used. Five patients will be initially treated. If at least one of five demonstrates PK activity, 3 additional subjects will be enrolled. PK effect will be declared to be significant if at least 2 of the 8 patients demonstrate a PK response (presence of LB100 in tumor tissue).

Details
Condition Oligodendroglioma, Glioma, Glioblastoma Multiforme, Gliomas, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, glioblastoma, giant cell glioblastoma, glial tumor, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV, Astrocytoma, Grades II, III and IV
Treatment LB-100
Clinical Study IdentifierNCT03027388
SponsorNational Cancer Institute (NCI)
Last Modified on12 September 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Patients must have histologically confirmed glioblastoma/gliosarcoma, grades II-III astrocytoma and oligodendroglioma confirmed by the Laboratory of Pathology, NCI
Patients must have recurrent disease for which there is a clinical indication for resection
Age greater than or equal to18 years
Karnofsky greater than or equal to 60%
Patients must have adequate bone marrow function (WBC greater than or equal to 3,000/uL ANC greater than or equal to 1,500/mm^3, platelet count of greater than or equal to 100,000/mm^3, and hemoglobin greater than or equal to 10 gm/dL), adequate liver function (SGOT and bilirubin < 2 times ULN). These tests must be performed within 14 days prior to registration. Eligibility level for hemoglobin may be reached by transfusion
Patients must have a serum creatinine of <=1.7 mg/dL. If the serum creatinine is greater than 1.7 mg/dl, a 24-hour urine creatinine clearance will be obtained and if the result of this study is within normal limits _, the patient would be eligible to enroll onto study. This test must be performed within 28 days prior to registration. (_ Normal Creatinine Clearance Range: Male: 90 - 130 ml/min; Female: 80 - 125 ml/min)
Patients must be in adequate general medical health to safely tolerate a craniotomy
Tumor tissue blocks or at least 20 unstained slides from a prior diagnosis will be requested. H&E to confirm diagnosis must be available. The 20 unstained slides is preferred, but not required
At the time of registration, all subjects must be removed greater than or equal to 28 days from any investigational agents
The effects of LB100 on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. 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
Ability of subject to understand and the willingness to sign a written informed consent document indicating that they are aware of the investigational nature of this study, and that this is not a therapeutic clinical trial

Exclusion Criteria

Patients who are receiving any other investigational agents
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
Patients unwilling to undergo craniotomy
Pregnant women are excluded from this study because the safety of PP2A inhibition on a developing fetus has not been established. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with LB100, breastfeeding should be discontinued if the mother is treated with LB100
Patients may not have had prior chemotherapy or biologic therapy in the 4 weeks prior to study entry. For patients who have been treated with targeted therapy, 5 half-lives of that therapy (or 28 days, whichever is shorter) must have passed prior to enrollment in the study
HIV-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with LB100. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated
Patients who are receiving strong CYP450 inducers or inhibitors are ineligible
Recruitment Strategies
Patients with recurrent disease will be identified at the Outpatient Clinic of
the Neuro-Oncology Branch, Clinical Center
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