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Phase I/II Adaptive Randomized Trial of Bevacizumab Versus Bevacizumab Plus Vorinostat in Adults With Recurrent Glioblastoma


Phase 1/Phase 2
18 Years
N/A
Open (Enrolling)
Both
Brain Cancer

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Trial Information

Phase I/II Adaptive Randomized Trial of Bevacizumab Versus Bevacizumab Plus Vorinostat in Adults With Recurrent Glioblastoma


Phase I:

The Study Drugs:

Vorinostat is designed to cause chemical changes in different groups of proteins that are
attached to DNA (the genetic material of cells), which may slow the growth of cancer cells
or cause the cancer cells to die.

Bevacizumab is designed to prevent or slow down the growth of cancer cells by blocking the
growth of blood vessels.

Study Drug Administration:

If you are found to be eligible to take part in this study, you will be assigned to receive
1 of 2 dose levels of vorinostat based on when you join this study. Unless you have side
effects, you will remain in the same dose level for the entire study. The first 3
participants will receive the lower dose level. The next 3 participants will receive a
higher dose, if no intolerable side effects were seen.

- On Days 1-7 and 15-21 of every 28-day cycle, you will take vorinostat by mouth 1 time a
day.

- In addition, no matter which dose level you are assigned to, you will receive
bevacizumab by vein over 30-90 minutes on Days 1 and 15 of every cycle.

Vorinostat capsules should be swallowed whole and should not be opened. If a capsule is
damaged or broken, spills of powder from vorinostat capsules should be cleaned up carefully.
If you come in contact with the powder, you should wash your hands thoroughly. If the
spill is on a surface, the area must be washed at least 3 times with rubbing alcohol,
followed by water. Vorinostat capsules should be stored at room temperature (59°-86°F
[15°-30°C]) in a dry area. You should take vorinostat with food,but not a high fat meal.

Study Visits:

At Weeks 1 and 3 of Cycle 1, blood (about 1 teaspoon) will be drawn for routine tests.

At Week 2 of Cycle 1:

- Your blood pressure will be recorded.

- Blood (about 3 teaspoons) will be drawn for routine tests and to check your blood's
ability to clot normally.

- Urine will be collected to check kidney function.

At Week 4 of Cycles 1-2 and then every other cycle after that (Cycles 4, 6, 8, and so on):

- You will be asked about any drugs you may be taking and if you have had any side
effects.

- You will have a physical exam, including measurement of your vital signs.

- You will have a neurological exam.

- Your performance status will be recorded.

- You will have a brain MRI and DCE-MRI scans to check the status of the disease.

- Blood (about 3 teaspoons) will be drawn for routine tests and to check your blood's
ability to clot normally.

- If you are able to become pregnant, you will have a blood (about 1 teaspoon) pregnancy
test.

- Urine will be collected to check kidney function.

At Week 2 of Cycles 2 and beyond:

- Your blood pressure will be recorded.

- Blood (about 1 teaspoon) will be drawn for routine tests.

At Week 4 of Cycles 3, 5, 7, and so on:

- Your blood pressure will be measured.

- Blood (about 3 teaspoons) will be drawn for routine tests and to check your blood's
ability to clot normally.

- If you are able to become pregnant, you will have a blood (about 1 teaspoon) pregnancy
test.

- Urine will be collected to check kidney function.

Length of Study:

You may take the study drugs for up to 1 year. You may continue to receive the study drugs
beyond 1 year if your doctor decides that it is in your best interest. You will be taken off
study early if the disease gets worse or you have intolerable side effects.

Your participation on this study will end once you complete the end-of-dosing visit and
long-term follow-up.

End-of-Dosing Visit:

After you are no longer taking the study drugs, you will have an end-of-dosing visit. At
this visit, the following tests and procedures will be performed:

- You will have a physical exam, including measurement of your vital signs.

- You will have a neurological exam.

- Your performance status will be recorded.

- Blood (about 2 teaspoons) will be drawn for routine tests.

- You will have a brain MRI and DCE-MRI scans to check the status of the disease.

- If you are able to become pregnant, you will have a blood (about 1 teaspoon) pregnancy
test.

Long-Term Follow-Up:

After you are no longer taking part in the study, every 3 months after that, you may be
called and asked how you are feeling. This phone call should take about 5-10 minutes.

This is an investigational study. Bevacizumab is FDA approved and commercially available
for treatment of some types of brain cancer. Vorinostat is FDA approved and commercially
available for some types of lymphoma. The use of these drugs in this combination is
investigational.

Up to 108 participants will take part in this study. Up to 18 patients will be enrolled in
the Phase 1 portion of this study. Up to 6 will be enrolled at MD Anderson.

Phase II:

The Study Drugs:

Vorinostat is designed to cause chemical changes in different groups of proteins that are
attached to DNA (the genetic material of cells), which may slow the growth of cancer cells
or cause the cancer cells to die.

Bevacizumab is designed to prevent or slow down the growth of cancer cells by blocking the
growth of blood vessels.

Study Groups:

If you are found to be eligible to take part in this study, you will be randomly assigned
(as in the flip of a coin) to 1 of 2 groups. If you are on of the first 20 participants in
the Phase 2 part of the study, you will be randomly assigned to a group. If you are
enrolled after the first 20 participants, you will be more likely to be enrolled in the
group that is showing better results.

- If you are in Group 1, you will take bevacizumab.

- If you are in Group 2, you will take bevacizumab and vorinostat.

Study Drug Administration:

If you are in Group 1:

-On Days 1 and 15 of every 28-day cycle, you will receive bevacizumab by vein over 30-90
minutes.

If you are in Group 2:

- On Days 1-7 and 15-21 of every 28-day cycle, you will take vorinostat by mouth 1 time a
day.

- On Days 1 and 15 of every cycle, you will receive bevacizumab by vein over 30-90
minutes.

Vorinostat capsules should be swallowed whole and should not be opened. If a capsule is
damaged or broken, spills of powder from vorinostat capsules should be cleaned up carefully.
If you come in contact with the powder, you should wash your hands thoroughly. If the
spill is on a surface, the area must be washed at least 3 times with rubbing alcohol,
followed by water. Vorinostat capsules should be stored at room temperature (59°-86°F
[15°-30°C]) in a dry area. You should take vorinostat with food, but not a high fat meal.

Study Visits:

At Week 2 of Cycle 1:

- Your blood pressure will be recorded.

- Blood (about 3 teaspoons) will be drawn for routine tests.

- Urine will be collected to check kidney function.

At Week 4 of Cycles 1-2 and then every other cycle after that (Cycles 4, 6, 8, and so on):

- You will be asked about any drugs you may be taking and if you have had any side
effects.

- You will have a physical exam, including measurement of your vital signs.

- You will have a neurological exam.

- Your performance status will be recorded.

- Blood (about 3 teaspoons) will be drawn for routine tests.

- If you are able to become pregnant, you will have a blood (about 1 teaspoon) pregnancy
test.

- Urine will be collected to check kidney function.

At Week 2 of every cycle:

- Your blood pressure will be recorded.

- Blood (about 1 teaspoon) will be drawn for routine tests.

At Week 4 of Cycles 3, 5, 7, and so on:

- Your blood pressure will be measured.

- Blood (about 3 teaspoons) will be drawn for routine tests.

- If you are able to become pregnant, you will have a blood (about 1 teaspoon) pregnancy
test.

- Urine will be collected to check kidney function.

At Week 4 of Cycles 2, and every other cycle after that (Cycles 4, 6, 8, and so on), you
will have a brain MRI scan to check the status of the disease.

In addition, if you are having surgery to remove a tumor that has come back before you
receive the study drugs, leftover tumor tissue from the surgery will be used for biomarker
testing.

At any time during the study, extra tests may be performed if the doctor thinks they are
needed for your safety. The study doctor will tell you more about any extra tests.

Length of Study:

You may take the study drug(s) for up to 1 year. You may continue to receive the study
drug(s) beyond 1 year if your doctor decides that it is in your best interest. You will be
taken off study early if the disease gets worse or you have intolerable side effects.

Your participation on this study will end once you complete the end-of-dosing visit and
long-term follow-up.

End-of-Dosing Visit:

After you are no longer taking the study drugs, you will have an end-of-dosing visit. At
this visit, the following tests and procedures will be performed:

- You will be asked about any drugs you may be taking and if you have had any side
effects.

- You will have a physical exam, including measurement of your vital signs.

- You will have a neurological exam.

- Your performance status will be recorded.

- Blood (about 2 teaspoons) will be drawn for routine tests.

- You will have a brain MRI scan to check the status of the disease.

- If you are able to become pregnant, you will have a blood (about 1 teaspoon) pregnancy
test.

Long-Term Follow-Up:

After you are no longer taking part in the study, every 3 months after that, you may be
called and asked how you are feeling. This phone call should take about 5-10 minutes.

This is an investigational study. Bevacizumab is FDA approved and commercially available
for treatment of some types of brain cancer. Vorinostat is FDA approved and commercially
available for some types of lymphoma. The use of these drugs in this combination is
investigational.

Up to 108 participants will take part in this study. Up to 90 patients will be enrolled in
the Phase 2 portion of this study. Up to 20 will be enrolled at MD Anderson.


Inclusion Criteria:



1. Patients must have histologically proven glioblastoma, gliosarcoma or anaplastic
glioma to be eligible for the Phase I component of this protocol. Anaplastic gliomas
include anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO), anaplastic
mixed oligoastrocytoma (AMO), or malignant glioma NOS (not otherwise specified).
Patients will be eligible if the original histology was low-grade glioma and a
subsequent histological diagnosis of a malignant glioma is made. Only patients with
histologically proven or imaging proven recurrent glioblastoma or gliosarcoma will be
eligible for the Phase II component. Wafer acceptable if recurrence is confirmed.

2. Patients must have shown unequivocal evidence for tumor progression by MRI scan. The
scan done prior to study entry documenting progression will be reviewed by the
treating physician to document changes in tumor dimension to confirm recurrence.
Patients with prior therapy that included interstitial brachytherapy or stereotactic
radiosurgery must have confirmation of true progressive disease rather than radiation
necrosis.

3. For the phase II portion of the study, patients may have had treatment for no more
than 2 prior relapses. There is no limit to the number of relapses for the phase I
portion of the study provided the functional status and other eligibility criteria
for enrollment are met. Relapse is defined as progression following initial therapy
(i.e. radiation+/- chemo if that was used as initial therapy). The intent therefore
is that patients had no more than 3 prior therapies (initial and treatment for 2
relapses). If the patient had a surgical resection for relapsed disease and no
anti-cancer therapy was instituted for up to 12 weeks, and the patient undergoes
another surgical resection, this is considered as 1 relapse. For patients who had
prior therapy for a low-grade glioma, the surgical diagnosis of a high-grade glioma
will be considered the first relapse

4. All patients must sign an informed consent indicating their awareness of the
investigational nature of this study. Patients must have signed an authorization for
the release of their protected health information.

5. The baseline on-study MRI should be performed within 14 days (+ 3 working days) prior
to registration but before starting treatment and on a steroid dosage that has been
stable or decreasing for at least 5 days. If the steroid dose is increased between
the date of imaging and registration (or at that time), a new baseline MRI is
required. The same type of scan, i.e., MRI, must be used throughout the period of
protocol treatment for tumor measurement.

6. Patients having undergone recent resection of recurrent or progressive tumor will be
eligible as long as all of the following conditions apply: a) At least 4 weeks(28
days) have elapsed from the date of surgery and the patients have recovered from the
effects of surgery. b) Evaluable or measurable disease following resection of
recurrent Malignant Glioma is not mandated for eligibility into the study. c) To best
assess the extent of residual measurable disease post-operatively, a MRI should be
done no later than 96 hours in the immediate post-operative period or at least 4
weeks post-operatively, within 14 days prior to registration. If the 96-hour scan is
more than 14 days before registration, the scan needs to be repeated. If the steroid
dose is increased between the date of imaging and registration, a new baseline MRI is
required on a stable steroid dosage for at least 5 days.

7. Patients must be 18 years old or older.

8. Patients must have a Karnofsky performance status (KPS) equal or greater than 60.

9. At the time of registration: (1) Patients must have recovered from the toxic effects
of prior therapy to < grade 2 toxicity per CTC version 4 (except deep vein
thrombosis): 28 days from any investigational agent; 4 weeks (28 days) from prior
cytotoxic therapy; 2 weeks (14 days) from vincristine; 6 weeks (42 days) from
nitrosoureas; 3 weeks (21 days) from procarbazine administration; >1 week (7 days)
for non-cytotoxic agents, e.g., interferon, tamoxifen, thalidomide, cis-retinoic
acid, etc. (radiosensitizer does not count). (2) Patients who receive anticancer
agents for non-therapeutic purposes unrelated to this study (such as presurgically
for obtaining pharmacology data for the agent) will be eligible to enter the study
provided they have recovered from the toxic effects of the agent if any. Any
questions related to the definition of non-cytotoxic agents should be directed to the
Study Chair.

10. Patients must have adequate bone marrow function (ANC>/= 1,500/mm^3 and platelet
count of >/= 100,000/mm^3), adequate liver function (SGPT normal and alkaline phosphatase 1.5 mg/dl), and adequate renal function (BUN Creatinine < 1.5 mg/dl) prior to registration. These tests must be performed within
14 days prior to registration.

11. Patients receiving treatment with any antiepileptic medications except valproic acid
(because of its HDAC inhibitory activity) can be included in the study. Vorinostat is
not metabolized by cytochrome P450 3A4 (CYP 3A4); however, vorinostat may potentially
suppress CYP 3A4 activity. Therefore, patients should preferably be treated with
non-enzyme inducing anti-epileptic medications although this is not mandatory. If
enzyme-inducing antiepileptic drugs are used, monitoring of these drug levels should
be considered, as considered clinically appropriate by the treating physician.

12. Women of childbearing potential must have a negative B-HCG pregnancy test documented
within 14 days prior to registration. Women of childbearing potential must not be
pregnant, must not be breast-feeding and must practice adequate contraception for the
duration of the study, and for 30 days after the last dose of study medication.
Patients must not be pregnant because animal studies show that bevacizumab and
Vorinostat are teratogenic.

13. Patient must be able to tolerate the procedures required in this study including
periodic blood sampling, study related assessments, and management at the treating
institution for the duration of the study.

14. Patients must have failed prior radiation therapy and must have an interval of
greater than or equal to 12 weeks (84 days) from the completion of radiation therapy
to study entry except if there is unequivocal evidence for tumor recurrence (such as
histological confirmation or advanced imaging data such as PET scan) in which case at
least 4 weeks (28 days) from completion of radiation therapy will suffice (Note: for
patients who have undergone surgery to confirm recurrence after radiation therapy,
guidelines in 4.9a should be followed).

15. Patients with prior therapy that included interstitial brachytherapy or stereotactic
radiosurgery must have confirmation of true progressive disease rather than radiation
necrosis based upon either PET or Thallium scanning, MR spectroscopy or
surgical/pathological documentation of disease.

16. Male patients on treatment with Vorinostat must agree to use an adequate method of
contraception for the duration of the study, and for 30 days after the last dose of
study medication .

Exclusion Criteria:

1. Inability to comply with protocol or study procedures (for example, an inability to
swallow tablets).

2. Prior treatment with bevacizumab or vorinostat.

3. Patients receiving valproic acid (VPA), an anticonvulsant drug with HDAC inhibitor
properties, will be excluded, unless they are switched to an alternative agent prior
to treatment initiation. A 5-day wash out period is required. Patients who have
failed prior treatment with other histone deacetylase inhibitors will be excluded.

4. Any serious medical condition, laboratory abnormality, or psychiatric illness that
would prevent the subject from providing informed consent.

5. Any condition, including the presence of clinically significant laboratory
abnormalities, which places the patient at unacceptable risk if he/she were to
participate in the study or confounds the ability to interpret data from the study.
These would include, a) Active infection (including persistent fever) including known
AIDS or Hepatitis C infection, b) Diseases or conditions that obscure toxicity or
dangerously alter drug metabolism, c) Serious intercurrent medical illness (e.g.
symptomatic congestive heart failure).

6. Current, recent (within 4 weeks (28 days) of the first infusion of this study), or
planned participation in an experimental antitumor drug study(other than the current
one).

7. Patients with a history of any other cancer (except non-melanoma skin cancer or
carcinoma in-situ of the cervix or bladder), unless in complete remission and off of
all therapy for that disease for a minimum of 3 years are ineligible.

8. Inadequately controlled hypertension (defined as systolic blood pressure > 140 mmHg
and/or diastolic blood pressure > 90 mmHg).

9. Prior history of hypertensive crisis or hypertensive encephalopathy.

10. New York Heart Association (NYHA) Grade II or greater congestive heart failure.

11. History of myocardial infarction or unstable angina within 6 months prior to Day 1.

12. History of stroke or transient ischemic attack within 6 months prior to Day 1

13. Significant vascular disease (e.g., aortic aneurysm, requiring surgical repair or
recent peripheral arterial thrombosis) within 6 months prior to Day 1.

14. History of hemoptysis (>/= 1/2 teaspoon of bright red blood per episode) within 1
month prior to Day 1.

15. Evidence of bleeding diathesis or significant coagulopathy (in the absence of
therapeutic anticoagulation).

16. Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
prior to Day 1 or anticipation of need for major surgical procedure during the course
of the study.

17. Core biopsy or other minor surgical procedure, excluding placement of a vascular
access device, within 7 days prior to Day 1.

18. History of abdominal fistula or gastrointestinal perforation within 6 months prior to
Day 1.

19. Serious, non-healing wound, active ulcer, or untreated bone fracture.

20. Proteinuria as demonstrated by: (a) Urine protein:creatinine (UPC) ratio >/= 1.0 at
screening OR (b) Urine dipstick for proteinuria >/= 2+ (patients discovered to have
>/= 2+ proteinuria on dipstick urinalysis at baseline should undergo a 24 hour urine
collection and must demonstrate
21. Known hypersensitivity to any component of bevacizumab

22. Pregnancy (positive pregnancy test) or lactation. Use of effective means of
contraception (men and women) in subjects of child-bearing potential is required for
study treatment.

23. Patients with spinal disease (metastasis) and/or leptomeningeal disease will not be
allowed in the study.

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Progression Free Survival (PFS)

Outcome Time Frame:

4 months

Safety Issue:

Yes

Principal Investigator

Marta Penas-Prado, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

UT MD Anderson Cancer Center

Authority:

United States: Food and Drug Administration

Study ID:

2010-0429

NCT ID:

NCT01266031

Start Date:

July 2011

Completion Date:

Related Keywords:

  • Brain Cancer
  • Malignant glioma
  • Recurrent Glioblastoma
  • Glioblastoma multiforme
  • Gliosarcoma
  • Anaplastic astrocytoma
  • Anaplastic oligodendroglioma
  • Anaplastic oligoastrocytoma
  • Vorinostat
  • SAHA
  • Suberoylanilide Hydroxamic Acid
  • MSK-390
  • Zolinza
  • Bevacizumab
  • Avastin
  • Anti-VEGF monoclonal antibody
  • rhuMAb-VEGF
  • Brain Neoplasms
  • Glioblastoma

Name

Location

UT MD Anderson Cancer Center Houston, Texas  77030