Investigator-Initiated Study of Imipramine Hydrochloride and Lomustine in Recurrent Glioblastoma

Inclusion Criteria:

• The subject is at least 18 years of age

• The subject has the ability to understand the purposes and risks of the study and tohave signed a written informed consent form approved by the investigator'sIRB/Ethics Committee

• The subject has histologically confirmed glioblastoma

• The subject has progression following standard combined modality treatment withradiation and temozolomide chemotherapy

• The subject has an ECOG (Eastern Cooperative Oncology Group) performance status ≤ 2

• The subject has a life expectancy of at least 3 months

• The subject has acceptable liver function:

• Bilirubin ≤ 1.5 times upper limit of normal

• AST (aspartate aminotransferase) (SGOT) and ALT (alanine transaminase 0 (SGPT) ≤ 3.0times upper limit of normal (ULN)

• The subject has acceptable renal function:

• Serum creatinine ≤ULN

• The subject has acceptable hematologic status (without hematologic support):

• ANC (absolute neutrophil count) ≥1500 cells/uL

• Platelet count ≥100,000/uL

• Hemoglobin ≥9.0 g/dL

• All women of childbearing potential (not surgically sterilized or at least 1 yearpost-menopausal) must have a negative serum pregnancy test. Additionally, male andfemale subjects must agree to use effective means of contraception (surgicalsterilization or the use or barrier contraception with either a condom or diaphragmin conjunction with spermicidal gel or an IUD) with their partner from entry intothe study through 6 months after the last dose.

Exclusion Criteria:

• The subject is receiving warfarin (or other coumarin derivatives) and is unable toswitch to low molecular weight heparin (LMWH) before the first dose of study drug.

• The subject has evidence of acute intracranial or intratumoral hemorrhage either byMRI or computerized tomography (CT) scan. Subjects with resolving hemorrhagechanges, punctate hemorrhage, or hemosiderin are eligible.

• The subject is unable to undergo MRI scan (eg, has pacemaker).

• The subject has received enzyme-inducing anti-epileptic agents within 14 days ofstudy drug (eg, carbamazepine, phenytoin, phenobarbital, primidone).

• The subject has not recovered to National Cancer Institute (NCI) Common TerminologyCriteria for Adverse Events (CTCAE) v5.0 Grade ≤ 1 from AEs (except alopecia, anemiaand lymphopenia) due to surgery, antineoplastic agents, investigational drugs, orother medications that were administered prior to study drug.

• The subject has evidence of wound dehiscence.

• The subject is pregnant or breast-feeding.

• The subject has a history of cardiac disease, including arrhythmia, conductionabnormality, congenital prolonged QT syndrome, myocardial infarction, unstableangina pectoris or congestive heart failure.

• A prolonged QTc rhythm noted during initial ECG >480 ms.

• The subject has serious intercurrent illness, such as:

• Hypertension (two or more blood pressure [BP] readings performed at screening of > 150 mmHg systolic or > 100 mmHg diastolic) despite optimal treatment

• Non-healing wound, ulcer, or bone fracture

• Untreated hypothyroidism

• Unhealed rectal or peri-rectal abscess

• Uncontrolled active infection

• Stroke, or transient ischemic attack within 6 months

• The subject has received any of the following prior anticancer therapy:

• Non-standard radiation therapy such as brachytherapy, systemic radioisotopetherapy (RIT), or intra-operative radiotherapy (IORT). Note: stereotacticradiosurgery (SRS) is allowed

• Non-bevacizumab systemic therapy (including investigational agents and small-molecule kinase inhibitors) or non-cytotoxic hormonal therapy (eg, tamoxifen)within 7 days or 5 half-lives, whichever is shorter, prior to first dose ofstudy drug

• Biologic agents (antibodies, immune modulators, vaccines, cytokines) within 21days prior to first dose of study drug

• Nitrosoureas or mitomycin C within 42 days, or metronomic/protracted low-dosechemotherapy within 14 days, or other cytotoxic chemotherapy within 28 days,prior to first dose of study drug

• Prior treatment with carmustine wafers

• Any current psychosis, uncontrolled mood disorder (as assessed by investigator) orsuicidal ideation. Additionally, current or history of bipolar disorder is excluded.

• Patients currently using SSRI, SNRI, MAO inhibitors, tramadol or trazodone who areunwilling to undergo taper.