A Phase II Study of Temsirolimus and Bevacizumab in Recurrent Glioblastoma Multiforme
Inclusion Criteria:
- Written informed consent
- Histological verification of primary GBM and failure after radiotherapy and
temozolomide (TMZ)
- Previously treated with VEGF-directed therapy with bevacizumab
- Previously received radiotherapy and temozolomide
- More than 4 weeks since any of the following prior treatments: chemotherapy (6 weeks
for nitrosoureas or mitomycin C)
- Radiotherapy to nontarget lesions or lesions that are not to be biopsied
VEGF-directed therapy (including bevacizumab)
- Investigational agents
- More than 6 months since prior major surgery or open biopsy and recovered (only 6
weeks required if operation is for recurrent GBM)
- No concurrent medications or substances known to affect or with the potential to
affect the activity or pharmacokinetics of the following:
- Temsirolimus
- Bevacizumab
- CYP450 isoenzymes
- ECOG performance status 0-1
- WBC ≥ 3,000 mm³
- Absolute neutrophil count ≥ 1,500/mm³
- Platelet count ≥ 100,000/mm³
- Bilirubin and phosphate normal
- AST and ALT ≤ 2.5 times upper limit of normal
- Creatinine normal OR creatinine clearance ≥ 60 mL/min
- Urine protein: creatinine ratio < 1.0 OR 24-hour urine protein < 1,000 mg
- Fasting cholesterol < 350 mg/dL (cholesterol medications are allowed)
- Fasting triglycerides < 400 mg/dL
- PT INR ≤ 1.5
- Hematocrit < 41% (for males) or < 38% (for females)
- Fertile females must use an approved contraceptive (p-pills, IUD, depot
injection of gestagen, subdermal implantation, hormonal vaginal ring or
transdermal depot plaster), throughout the study and 3 months after
discontinuation of study drugs. Fertile men must use dobbelt barrier method
(preservative with sperm inhibiting creme) or female partner uses the above
mentioned contraceptive.
- Fertile males must use preservatives.
Exclusion Criteria:
- Clinically significant cardiovascular disease, including the following:
- Cerebrovascular accident within the past 6 months
- Transient ischemic attack within the past 6 months
- Myocardial ischemia within the past 6 months
- Myocardial infarction within the past 6 months
- Other thromboembolic event within the past 6 months
- Unstable angina within the past 6 months
- Uncontrolled hypertension (i.e., hypertension despite maximal therapy)
- New York Heart Association class II-IV heart disease
- Congestive heart failure
- Serious cardiac arrhythmia requiring medication
- Clinically significant peripheral vascular disease
- Uncontrolled intercurrent illness
- Ongoing or active infection
- One of the following within the past 6 months
- Abdominal fistula
- Gastrointestinal perforation
- Intra-abdominal abscess
- Serious or nonhealing wound, ulcer, or bone fracture
- Psychiatric illness or social situations that would preclude study compliance
- Uncontrolled diabetes
- Hemoglobin A1c > 7%
- Concurrent non-study related surgical procedures
- Concurrent treatment with CYP3A4 inducers or inhibitors
- Other concurrent anticancer agents or therapies
- Significant traumatic injury within the past 28 days
- History of allergic reactions to compounds of similar chemical or biological
composition to temsirolimus or bevacizumab
- Hypersensitivity to Chinese hamster ovary cell products or other recombinant human
antibodies (e.g., infliximab)
- Pregnancy or nursing
- Patients previously intolerant to bevacizumab
- Anticoagulant therapy