Phase II Study of TKI258 (Dovitinib) in Patients With Recurrent or Progressive Glioblastoma Who Have Progressed on Anti-Angiogenic Therapy (Including Anti-VEGF Therapy)
Inclusion Criteria:
- Histologically confirmed glioblastoma, recurrent after standard external-beam
fractionated radiotherapy and temozolomide chemotherapy
- Patients who have received any anti-angiogenic therapy (anti-VEGF, including avastin,
cediranib, or other anti-angiogenic therapies like cilengitide)
- Karnofsky performance status >= 60%
- Absolute neutrophil count (ANC) >= 1.5 x 10^9/L
- Platelets >= 100 x 10^9/L
- Hemoglobin (Hgb) > 9 g/dL
- Serum total bilirubin =< 1.5 x upper limit of normal (ULN)
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3.0 x ULN
- Serum creatinine =< 1.5 x ULN
- Minimum interval since completion of radiation treatment is 12 weeks
- Minimum interval since last drug therapy 2 weeks since last non-cytotoxic therapy 3
weeks must have elapsed since the completion of a non-nitrosourea containing
chemotherapy regimen 6 weeks since the completion of a nitrosourea containing
chemotherapy regimen
- Patients must be able to provide written informed consent
- Patients with the potential for pregnancy or impregnating their partner must agree to
follow acceptable birth control methods to avoid conception; the anti-proliferative
activity of this experimental drug may be harmful to the developing fetus or nursing
infant; female patients of child-bearing potential must have a negative pregnancy
test
- Patients must have no concurrent malignancy except curatively treated basal or
squamous cell carcinoma of the skin or carcinoma in situ of the cervix and breast,
adequately treated stage I or II cancer from which the patient is in complete
remission; patients with other prior malignancies must be disease-free for >= three
years
- Patients must be maintained on a stable corticosteroid regimen from the time of their
baseline scan until the start of treatment and/or for at least 5 days before starting
treatment
- Patients must have a Mini Mental State Exam score >= 15
Exclusion Criteria:
- Patients who have undergone major surgery (e.g. intra-thoracic, intra-abdominal or
intra-pelvic), open biopsy or significant traumatic injury =< 4 weeks prior to
starting study drug, or patients who have had minor procedures, percutaneous biopsies
or placement of vascular access device =< 1 week prior to starting study drug, or who
have not recovered from side effects of such procedure or injury
- Patients with a history of pulmonary embolism (PE), or untreated deep venous
thrombosis (DVT) within the past 6 months
- Patients with any of the following concurrent severe and/or uncontrolled medical
conditions which could compromise participation in the study:
- Impaired cardiac function or clinically significant cardiac diseases, including
any of the following:
- History or presence of serious uncontrolled ventricular arrhythmias
- Clinically significant resting bradycardia
- Left ventricular ejection fraction (LVEF) assessed by 2-dimensional (2-D)
echocardiogram (ECHO) < 50% or lower limit of normal (whichever is higher)
or multi gated acquisition scan (MUGA) < 45% or lower limit of normal
(whichever is higher)
- Any of the following within 6 months prior to starting study drug:
myocardial infarction (MI), severe/unstable angina, coronary artery bypass
graft (CABG), congestive heart failure (CHF), cerebrovascular accident
(CVA), and transient ischemic attack (TIA)
- Uncontrolled hypertension defined by a systolic blood pressure (SBP) >= 160
mm Hg and/or diastolic blood pressure (DBP) >= 100 mm Hg, with or without
anti-hypertensive medication(s)
- Impairment of gastrointestinal (GI) function or GI disease that may
significantly alter the absorption of dovitinib (e.g. ulcerative diseases,
uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel
resection)
- Cirrhosis, chronic active hepatitis or chronic persistent hepatitis
- Known diagnosis of human immunodeficiency virus (HIV) infection (HIV testing is
not mandatory)
- Other concurrent severe and/or uncontrolled concomitant medical conditions (e.g.
active or uncontrolled infection, uncontrolled diabetes) that could cause
unacceptable safety risks or compromise compliance with the protocol
- Women of child-bearing potential, who are biologically able to conceive, not
employing two forms of highly effective contraception; highly effective
contraception (e.g. male condom with spermicide, diaphragm with spermicide,
intra-uterine device) must be used by both sexes during the study and must be
continued for 8 weeks after the end of study treatment; oral, implantable, or
injectable contraceptives may be affected by cytochrome P450 interactions, and
are therefore not considered effective for this study; women of child-bearing
potential, defined as sexually mature women who have not undergone a
hysterectomy or who have not been naturally postmenopausal for at least 12
consecutive months (e.g., who has had menses any time in the preceding 12
consecutive months), must have a negative serum pregnancy test =< 14 days prior
to starting study treatment
- Fertile males not willing to use contraception, as stated above
- Patients who are currently receiving full dose anticoagulation treatment with
therapeutic doses of warfarin or anti-platelet therapy (e.g., Plavix
[clopidogrel bisulfate]); treatment with locally accepted low molecular weight
heparin and low dose of acetylsalicylic acid (i.e., 81mg or 100 mg daily) to
prevent cardiovascular events or strokes is allowed
- Patients unwilling or unable to comply with the protocol