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A Cancer Research UK Phase I Trial of Olaparib (AZD2281), an Oral PARP Inhibitor, in Combination With Extended Low-Dose Oral Temozolomide in Patients With Relapsed Glioblastoma


Phase 1
18 Years
70 Years
Open (Enrolling)
Both
Brain and Central Nervous System Tumors

Thank you

Trial Information

A Cancer Research UK Phase I Trial of Olaparib (AZD2281), an Oral PARP Inhibitor, in Combination With Extended Low-Dose Oral Temozolomide in Patients With Relapsed Glioblastoma


OBJECTIVES:

Primary

- To determine whether olaparib crosses the blood-brain barrier (BBB) and achieves tumor
penetration in patients with relapsed glioblastoma. (Stage 1)

- To determine the safety and tolerability of the combination of olaparib and
temozolomide in patients with relapsed glioblastoma. (Stage 2)

Secondary

- To assess BBB disruption and BBB permeability in patients with relapsed glioblastoma.
(Stage 1 and stage 2 maximum-tolerated dose [MTD] expansion cohort)

- To assess the possible anti-tumor activity of the combination of olaparib and
temozolomide in patients with relapsed glioblastoma. (Stage 2)

Tertiary

- To assess biological markers as possible predictors of olaparib efficacy in patients
with glioblastoma.

- To optimize techniques for measuring DNA damage responses to PARP inhibition in tumor
tissue.

- To determine plasma concentration of olaparib at the time of surgery in patients with
glioblastoma.

- To evaluate the PARP inhibition at the time of surgery in peripheral blood mononuclear
cells (PBMCs).

OUTLINE: This is a multicenter, dose-escalation study.

- Stage 1: Patients receive fixed-dose oral olaparib twice daily for 3 days prior to
resection and then receive a dose of oral olaparib on the morning of the resection.
After the surgical resection, patient receive standard of care treatment. Patients
undergo dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and
diffusion-weighted imaging (DWI) scans to assess the disruption and permeability of the
blood-brain barrier (BBB).

If it is proven that olaparib can cross the BBB and achieve tumor penetration as measured by
liquid chromatography mass spectrometry (LC-MS) in at least one out of six patients, then
new patients are recruited to stage 2 of the study.

- Stage 2: Patients receive escalating doses of oral olaparib once or twice daily for 3
days prior to resection and then receive a dose of oral olaparib on the morning of the
resection. After recovery from surgery, patients receive oral olaparib once or twice
daily and oral temozolomide once daily on days 1-42. Treatment repeats every 8 weeks
for up to 3 courses in the absence of disease progression or unacceptable toxicity.
Patients may receive 3 additional courses of treatment in the absence of disease
progression.

Once the maximum tolerated dose (MTD) is established, 10 more patients are treated at the
MTD as stage 2 MTD expansion cohort. These patients also undergo DCE-MRI and DWI scans.

All patients undergo blood collection periodically for pharmacokinetic and pharmacodynamic
studies.

After completion of study treatment, patients are followed up for 28 days and then monthly
until resolution of study drug-related adverse events.

Peer Reviewed and Funded or Endorsed by Cancer Research UK.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed grade IV glioblastoma

- Radiological diagnosis of recurrent or progressive disease according to Response
Assessment in Neuro-Oncology Working Group (RANO) criteria, which is suitable for
palliative resection

- Must have an adequate amount of tumor tissue available

- Previously received first-line treatment with radical radiotherapy, or chemoradiation
followed by adjuvant chemotherapy

- No prior chemotherapy for recurrent disease

PATIENT CHARACTERISTICS:

- WHO performance status 0-2

- Life expectancy > 12 weeks

- Hemoglobin ≥ 9.0 g/dL

- Absolute neutrophil count ≥ 1.5 x 10^9/L

- Platelet count ≥ 100 x 10^9/L

- Serum bilirubin ≤ 1.5 times upper limit of normal (ULN)

- ALT or AST ≤ 2.5 times ULN

- Calculated creatinine clearance ≥ 50 mL/min OR isotope clearance measurement ≥ 50
mL/min (uncorrected)

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use one (male) or two (female) highly effective forms of
contraception 4 weeks prior to, during, and for 6 months after completion of study
therapy

- Able to swallow and retain oral medications

- Not at high medical risk due to non-malignant systemic disease, including active
uncontrolled infection

- No known hepatitis B, hepatitis C, or HIV seropositivity

- No concurrent congestive heart failure, prior history of NYHA class III-IV cardiac
disease, prior history of cardiac ischemia, or prior history of cardiac arrhythmia
within the past 12 months

- No grand mal seizures occurring ≥ 3 times per week over the past month

- No gastrointestinal disorders likely to interfere with absorption of the study
medication

- No known hypersensitivity to any of the components of olaparib

- No known hypersensitivity to temozolomide (TMZ) or any of its components, or to
dacarbazine (DTIC) (for patients enrolled in stage 2 study only)

- No known lactose intolerance (for patients enrolled in the stage 2 study only)

- No metal fragments in the eyes (shrapnel or bullet injuries are excluded on the basis
of their unsuitability to undergo MRI scans)

- No other condition which, in the Investigator's opinion, would not make the patient a
good candidate for the clinical trial

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No ongoing toxic manifestations from previous treatments except for alopecia or grade
1 toxicities which, in the opinion of the Investigator and the Drug Development
Office (DDO), should not exclude the patient

- At least 12 weeks since prior radiotherapy, endocrine therapy, or immunotherapy

- At least 6 weeks since prior major surgery

- At least 4 weeks since prior chemotherapy

- At least 4 weeks since prior immunizations with live vaccines (or expected to receive
vaccines during the trial and up to at least 6 months after receiving last study
treatment), including BCG and yellow fever vaccines

- No prior PARP inhibitors, including olaparib

- No prior major thoracic or abdominal surgery from which the patient has not yet
recovered

- No prior heart surgery

- No pacemakers

- No change to systemic steroids dose within 5 days prior to enrollment (i.e., must be
on a stable dose at time of enrollment and remain on a stable dose throughout the
treatment period)

- No herbal supplements and/or ingestion of foods known to modulate CYP3A4 enzyme
activity from time entered on screening period until 28 days after the last dose of
study medication

- No concurrent drugs known to be potent inducers of CYP3A4, including phenytoin,
carbamazepine, phenobarbital, rifampicin, rifapentine, rifabutin, nevirapine,
modafinil, or St. John wort (wash-out period for phenobarbital is 5 weeks, 3 weeks
for all others)

- No concurrent drugs known to be potent inhibitors of CYP3A4, including ketoconazole,
itraconazole, ritonavir, indinavir, saquinavir, telithromycin, clarithromycin, or
nelfinavir (wash-out period is 1 week)

- No concurrent or planned participation in another interventional clinical study

- Participation in an observational study is acceptable

- No concurrent warfarin (patients requiring anticoagulation should be given
subcutaneous low molecular weight heparin)

- No other concurrent anticancer therapy (including radiotherapy) or investigational
drugs

- Patients in stage 1 of the study only may receive additional anticancer
therapies as soon as the resection has been performed

Type of Study:

Interventional

Study Design:

Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Detection of olaparib in tumor tissue using liquid chromatography mass spectrometry (LC-MS) seen in at least 1 out of the 6 patients treated in stage 1 of the study

Safety Issue:

No

Principal Investigator

Anthony Chalmers, Prof

Investigator Role:

Principal Investigator

Investigator Affiliation:

Beatson West of Scotland Cancer Centre

Authority:

United Kingdom: Medicines and Healthcare Products Regulatory Agency

Study ID:

CDR0000702605

NCT ID:

NCT01390571

Start Date:

July 2011

Completion Date:

Related Keywords:

  • Brain and Central Nervous System Tumors
  • adult glioblastoma
  • adult giant cell glioblastoma
  • adult gliosarcoma
  • recurrent adult brain tumor
  • Glioblastoma
  • Nervous System Neoplasms
  • Central Nervous System Neoplasms

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