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A Phase I/II Study of GW572016 in Patients With Recurrent Malignant Glioma


Phase 1/Phase 2
18 Years
N/A
Not Enrolling
Both
Brain and Central Nervous System Tumors

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Trial Information

A Phase I/II Study of GW572016 in Patients With Recurrent Malignant Glioma


OBJECTIVES:

Phase I

- Determine the maximum tolerated dose and recommended phase II dose of lapatinib in
patients with recurrent malignant glioblastoma multiforme who are taking CYP3A4
enzyme-inducing anti-epileptic drugs (EIAEDs).

- Determine the toxic effects of this drug in these patients.

- Determine the pharmacokinetics of this drug in these patients.

Phase II

- Determine the efficacy of this drug, in terms of objective tumor response rate, in
patients who are taking EIAEDs and in those who are not taking EIAEDs.

- Correlate immunohistochemical measures of cellular proteins and receptors from tumor
samples with anti-tumor activity of this drug in these patients.

- Determine the pharmacokinetics of this drug in these patients.

OUTLINE: This is a multicenter, open-label, phase I, dose-escalation study followed by a
phase II study.

- Phase I: Patients receive oral lapatinib twice daily on days 1-28. Courses repeat every
28 days in the absence of unacceptable toxicity or disease progression.

Cohorts of 3-6 patients receive escalating doses of lapatinib until the maximum tolerated
dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2
of 6 patients experience dose-limiting toxicity.

- Phase II: Patients receive lapatinib as in phase I at the MTD. Patients are followed at
1 month and then periodically for survival. Patients with stable or responding disease
who go off therapy are followed every 3 months for up to one year and then periodically
thereafter for survival.

PROJECTED ACCRUAL: A total of 3-24 patients will be accrued for the phase I portion of this
study within 18 months. A total of 15-30 patients will be accrued for the phase II portion
of this study within 18 months.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed malignant glioblastoma multiforme

- Recurrent or progressive disease after prior primary treatment with radiotherapy with
or without adjuvant chemotherapy

- Bidimensionally measurable disease on CT scan or MRI with at least one lesion ≥ 1 cm
x 1 cm

- Paraffin embedded tumor sample available

- Concurrent enzyme-inducing anti-epileptic drugs (EIAEDs) required for phase I of the
study

- Patients in phase II of the study may or may not be receiving EIAEDs

PATIENT CHARACTERISTICS:

Age

- 18 and over

Performance status

- ECOG 0-2

Life expectancy

- Not specified

Hematopoietic

- Absolute granulocyte count ≥ 1,500/mm^3

- Platelet count ≥ 100,000/mm^3

Hepatic

- Bilirubin ≤ upper limit of normal (ULN)

- AST and ALT ≤ 2.5 times ULN

Renal

- Creatinine ≤ 1.5 times ULN

Cardiovascular

- LVEF ≥ 50% by echocardiogram or MUGA

- No myocardial infarction within the past 6 months

- No congestive heart failure

- No unstable angina

- No active cardiomyopathy

- No cardiac arrhythmia

- No uncontrolled hypertension

Pulmonary

- No pulmonary disease requiring oxygen

Neurologic

- No preexisting peripheral neuropathy ≥ grade 3

- No history of significant neurologic disorder that would preclude study compliance or
ability to give informed consent

Gastrointestinal

- No upper gastrointestinal or other conditions that would preclude compliance with
oral medication

- No active peptic ulcer disease

Other

- No other malignancy within the past 5 years except adequately treated basal cell or
squamous cell skin cancer, curatively treated carcinoma in situ of the cervix, or
other curatively treated solid tumor

- No immune deficiency

- No history of significant psychiatric disorder (e.g., uncontrolled psychotic
disorders) that would preclude study compliance or ability to give informed consent

- No other serious illness or medical condition that would preclude study participation

- No known hypersensitivity to compounds of similar chemical or biological composition
to lapatinib

- No active uncontrolled or serious infection

- HIV negative

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

- No concurrent prophylactic filgrastim (G-CSF), sargramostim (GM-CSF), or other
hematopoietic growth factors

- Concurrent hematopoietic growth factors allowed for treatment of acute toxicity
(e.g., febrile neutropenia)

Chemotherapy

- See Disease Characteristics

- No prior chemotherapy for recurrent disease

- No more than one prior chemotherapy regimen in the adjuvant setting

- At least 6 months since prior adjuvant chemotherapy

Endocrine therapy

- Concurrent steroids allowed provided the dose is stable for at least 14 days before
study entry

Radiotherapy

- See Disease Characteristics

- At least 6 weeks since prior radiotherapy

Surgery

- At least 2 weeks since prior major surgery

Other

- H2 blockers and proton pump inhibitors allowed, unless they are CYP3A4 inducers or
inhibitors

- At least 7 days since prior and no concurrent administration of any of the following
CYP3A4 inhibitors:

- Clarithromycin

- Erythromycin

- Troleandomycin

- Telithromycin

- Ciprofloxacin

- Norfloxacin

- Itraconazole

- Ketoconazole

- Voriconazole

- Fluconazole (≤150 mg/day allowed)

- Nefazodone

- Fluovoxamine

- Delavirdine

- Nelfinavir

- Amprenavir

- Ritonavir

- Indinavir

- Saquinavir

- Lopinavir

- Verapamil

- Diltiazem

- Aprepitant

- Grapefruit or grapefruit juice

- Bitter orange

- At least 14 days since prior and no concurrent administration of any of the following
CYP3A4 inducers:

- Rifampin

- Rifabutin

- Rifapentine

- Efavirenz

- Nevirapine

- Hypericum perforatum (St. John's wort)

- Modafinil

- At least 6 months since prior and no concurrent administration of amiodarone

- Antacids (e.g., mylanta, maalox, tums, rennies) must be administered ≥ 1 hour before
and ≥ 1 hour after study drug

- At least 2 days since prior and no concurrent cimetidine

- No other concurrent anti-cancer agents

- No other concurrent investigational therapy

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Toxicity for phase I assessed by CTCAE v.3.0 MacDonald criteria

Outcome Time Frame:

7 years

Safety Issue:

Yes

Principal Investigator

Brian A. Thiessen, MD

Investigator Role:

Study Chair

Investigator Affiliation:

British Columbia Cancer Agency

Authority:

United States: Federal Government

Study ID:

I170

NCT ID:

NCT00099060

Start Date:

December 2004

Completion Date:

January 2011

Related Keywords:

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

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