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Phase I Study of Zactima (ZD6474) Plus Imatinib Mesylate and Hydroxyurea for Patients With Recurrent Malignant Glioma

Phase 1
18 Years
Not Enrolling
Glioblastoma, Gliosarcoma

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Trial Information

Phase I Study of Zactima (ZD6474) Plus Imatinib Mesylate and Hydroxyurea for Patients With Recurrent Malignant Glioma

vascular endothelial growth factor (VEGF) angiogenic & Phosphoinositide 3-kinase
inhibitor/Protein Kinase B (PI3K/AKT) mitogenic cascades are 2 upregulated cell signalling
pathways in MG that contribute to several hallmark phenotypic features of these tumors.
Regimen of Zactima + imatinib mesylate represents novel anti-glioma strategy because it
targets 3 key mediators of dysregulated cell signalling involving VEGF & PI3K-AKT pathways
including VEGFR, epidermal growth factor receptor (EGFR) & platelet derived growth
factor(PDGFR). Furthermore by combining Zactima w imatinib mesylate, VEGF & PI3-k/AKT
pathways can potentially inhibit multiple mediators of each of these pathways. Regarding
PI3-K/AKT signalling, regimen can inhibit activation of EGFR & PDGFR. Regarding VEGF
signalling, regimen has potential to inhibit 3 components of VEGFR directed angiogenesis.
1st, Zactima can directly inhibit VEGFR activation. 2nd, both Zactima & imatinib mesylate
can indirectly decrease activity of VEGF pathway by diminishing positive input from
activated PI3-K/AKT signalling. 3rd, imatinib mesylate may inhibit PDGF-regulated pericyte
maturation of tumor blood vessels.

We have previously demonstrated that regimen of imatinib mesylate + hydroxyurea is active
regimen among recurrent glioblastoma multiforme (GBM) pts. Furthermore this activity appears
substantially better than that reported for imatinib mesylate alone. Although mechanism of
enhanced activity for imatinib mesylate when combo w hydroxyurea is unclear, it is logical
to build upon combo of imatinib mesylate + hydroxyurea in subsequent studies rather than
imatinib mesylate alone. Current study will therefore determine MTD of Zactima when combo w
standard doses of imatinib mesylate & hydroxyurea among RMG pts. Ph II study will then be
performed, incorporating maximum tolerated dose (MTD) of Zactima + imatinib mesylate in
order to evaluate anti-glioma potential of regimen.

Inclusion Criteria:

- Pts have baseline evaluations performed ≤14days prior to 1st dose of study drug
unless otherwise specified. Written informed consent must be obtained from pt prior
to enrollment

- Pts w MG who are presenting in 1st, 2nd or 3rd recurrence or relapse

- Pts may not have tumor biopsy <1 wk or surgical resection <2wks

- For stratum of non-EIAED pts, each pt be off all EIAEDs for >2 wks prior to starting
study drug; similarly for stratum of EIAED pts, each pt be on EIAED for >2 wks prior
to starting study drug

- Pts should be on non-increasing dose of steroids for >7 days prior to obtaining
baseline Gd-MRI of brain

- Pts should be on non-increasing dose of steroids for >7 days prior to starting study

- Multifocal disease is eligible

- Age >18yrs

- Karnofsky Performance Status (KPS) of >70

- Absolute neutrophil count (ANC) > 1.0 x 10 9/L

- Hgb>g/dL

- Platelets>100 x 10 9/L

- Serum creatinine<1.5 x upper limit of normal (ULN)/measured 24hr creatinine clearance
(CrCl) >50 milliliters/min/1.73m

- Life ≥12wks

- Written informed consent obtained prior to any screening procedures

Exclusion Criteria:

- Serum bilirubin >1.5x ULN of reference range

- Serum creatinine >1.5 x Upper Limit of the Reference Range (ULRR)/CrCl <50

- K<4.0 mmol/L despite supplementation; serum Ca/Mg out of normal range despite

- alanine aminotransferase (ALT) or aspartate aminotransferase (AST) >2.5 x ULRR

- Evidence of severe/uncontrolled systemic disease or any concurrent condition which in
Investigator's opinion makes it undesirable for pt to participate in trial or which
would jeopardize compliance w protocol

- Clinically significant cardiac event such as myocardial infarction; New York Heart
Association (NYHA) classification of heart disease >2 within 3 months before
entry;/presence of cardiac disease that, in opinion of Investigator, increases risk
of ventricular arrhythmia or dysfunction; ejection fraction<50 percent prior to study

- History of arrhythmia-symptomatic/requires treatment/asymptomatic sustained
ventricular tachycardia. Atrial fibrillation, controlled on medication is not

- Previous history of corrected QT interval (QTc) prolongation as result from other
medication that required discontinuation of that medication

- Congenital long QT syndrome/1st degree relative with unexplained sudden death under
40 years

- Presence of left bundle branch block

- QTc with Bazett's correction that is unmeasurable/>480 msec on screening ECG. If pt
has QTc >480 msec on screening ECG, screen ECG may be repeated twice. Average QTc
from 3 screening ECGs must be <480 msec in order for pt to be eligible for study

- Any concomitant medication that may cause QTc prolongation, induce Torsades de
Pointes/induce cytochrome P450 3A4 (CYP3A4) function except for EIAEDs

- Hypertension not controlled by medical therapy

- Currently active diarrhea that may affect ability of pt to absorb study
regimen/tolerate diarrhea

- Pregnant/breast feeding

- Previous/current malignancies of other histologies <1yr, w exception of cervical
carcinoma in situ & adequately treated basal cell/squamous cell carcinoma of skin

- Receipt of any investigational agents within 30 days prior to commencing study
treatment unless pt has recovered from all anticipated toxicities of investigational

- Last dose of prior chemo discontinued <4 wks before start of study therapy unless pt
has recovered from all anticipated toxicities of chemo

- Last radiation therapy (XRT) <4wks before start of study therapy, unless pt has
recovered from all anticipated toxicities of XRT

- Any unresolved toxicity > Common Terminology Criteria (CTC) grade 1 from previous
anti-cancer therapy

- Previous enrollment/randomization of treatment in present study

- Major surgery <4 wks/incompletely healed surgical incision before starting study

- Pts who have received prior oral VEGFR, EGFR/PDGFR-directed therapies

- Pts who are taking warfarin sodium

Type of Study:


Study Design:

Allocation: Non-Randomized, Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

To determine MTD & dose-limiting toxicity (DLT) & Zactima when combo w Imatinib mesylate & Hydroxyurea among pt w Recurrent MG

Outcome Time Frame:

6 months

Safety Issue:


Principal Investigator

Annick Desjardins, MD, FRCPC

Investigator Role:

Principal Investigator

Investigator Affiliation:

Duke University Health System


United States: Food and Drug Administration

Study ID:




Start Date:

November 2007

Completion Date:

April 2009

Related Keywords:

  • Glioblastoma
  • Gliosarcoma
  • GBM
  • Brain tumor
  • Zactima
  • Gleevec
  • Hydroxyurea
  • Glioblastoma
  • Gliosarcoma
  • Recurrent malignant glioma
  • ZD6474
  • Malignant glioma
  • Imatinib
  • Droxia
  • Hydrea
  • Hydroxycarbamide
  • Vandetanib
  • Glioblastoma
  • Glioma
  • Gliosarcoma



Duke University Health SystemDurham, North Carolina  27705