Bortezomib and Temozolomide in Recurrent Grade-4 Glioma Unmethylated MGMT Promoter (BORTEM-17)

NCT ID: NCT03643549

Last Updated: 2024-02-29

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE1/PHASE2
• Total Enrollment: 63 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-08-30
• Study Completion Date: 2025-12-31

Brief Summary

This phase IB/II trial is designed to investigate the safety and survival benefits for patients with recurrent grade-4 with unmethylated MGMT promoter treated with Bortezomib and Temozolomide in a specific schedule.

Detailed Description

Patients harbouring tumours with functional O6 methylguanine DNA methyltransferase (MGMT) DNA repair enzyme efficiently repair the DNA damage inflicted by Temozolomide and gain limited benefit from this chemotherapy. Bortezomib depletes the MGMT enzyme, restoring the tumour´s susceptibility to Temozolomide, if the chemotherapy is administered in the precise schedule when the MGMT enzyme is depleted. Additionally, Bortezomib inhibits the growth of tumour cells by blocking autophagy flux. Temozolomide causes genotoxic stress in cancer cells that in turn respond by inducing protective processes such as autophagy. If both autophagy and MGMT DNA repair enzyme are blocked a priori, the efficacy of Temozolomide will be enhanced. Thus, pre-treating the tumour with Bortezomib prior to administration of Temozolomide leads to DNA repair enzyme depletion and blockade of autophagy-induced survival signals. The combined effect will sensitize the tumour to therapy, improve chemotherapy efficacy and prolong patient survival outcomes.

Hypothesis: Pretreatment with Bortezomib administered prior to Temozolomide will sensitize recurrent GBM with unmethylated MGMT promoter to standard TMZ in palliative setting.

Objective:

• Assessment of safety and tolerability of Bortezomib administered with Temozolomide.
• Determining the optimal dose of TMZ, when administered as combination therapy
• Estimate the progression free survival (PFS) and overall survival (OS) of patients with recurrent or progressed glioblastoma after pre-treatment with Bortezomib prior to combination with Temozolomide.

Key secondary objectives

• Tumour response to the therapy assessed by RANO and NANO criteria
• Determine physiological, molecular and biochemical changes in blood and tumour tissue that correlate with treatment responses.

Conditions

Glioblastoma

Study Design

• Allocation Method: NA
• Intervention Model: SEQUENTIAL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Bortezomib and Temozolomide

Botezomib 1.3 mg/m2 administered IV on days 1, 4, 7, during each 4-week chemotherapy cycle with per oral Temozolomide at three dose levels: 150 mg/m2, 175 mg/m2 and 200mg/m2 5 days/week every 4 weeks starting on day 3.

Group Type: EXPERIMENTAL

Bortezomib and Temozolomide Phase IB

Intervention Type: DRUG

In the Phase IB of the study the following dose escalation of TMZ will be performed: The first cohort of 3 patients will receive 150 mg/m2 of IMP (TMZ) for 5 days q4w. If one patient in this cohort develops a dose limiting toxicity, another cohort of 3 patients will be treated at the same dose level until 2 or more patients in the group of 3-6 develop DLT.

Bortezomib and Temozolomide Phase II

Intervention Type: DRUG

The patientes will be treated with the maximum recommended starting dose of Temozolomide and Bortezomib established in the IB phase of the study

Interventions

Bortezomib and Temozolomide Phase IB

In the Phase IB of the study the following dose escalation of TMZ will be performed: The first cohort of 3 patients will receive 150 mg/m2 of IMP (TMZ) for 5 days q4w. If one patient in this cohort develops a dose limiting toxicity, another cohort of 3 patients will be treated at the same dose level until 2 or more patients in the group of 3-6 develop DLT.

Intervention Type: DRUG

Bortezomib and Temozolomide Phase II

The patientes will be treated with the maximum recommended starting dose of Temozolomide and Bortezomib established in the IB phase of the study

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Life expectancy > 8 weeks
• Histologically confirmed intracranial glioblastoma (GBM), with MGMT unmethylated promoter
• Must submit an unstained paraffin block and/ or cryopreserved tumour tissue from surgical procedure
• Radiologically (MRI) confirmed tumour relapse/progression ≥ 12 weeks since completed radiotherapy
• Measurable recurrent tumor
• Tumor not available for radio-surgery
• If previously treated with gammaknife, at least one evaluable lesion outside the irradiated area is required, unless the time after the radiosurgery is 12 weeks or more
• Written informed consent for study participation and tumour, blood sample collection obtained before performance of any study related procedure.
• Karnofsky performance status ≥ 70
• WBC ≥ 3,000/mm^3
• ANC ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3
• Hemoglobin ≥ 10 g/dL (transfusion allowed)
• Bilirubin < 2.5 times upper limit of normal (ULN)
• serum aspartate aminotransferase (AST) < 2.5 times ULN
• Estimated GFR ≥ 60 mL/minute
• Serum sodium > 130 mmol/L
• Serum potassium level within normal limit
• Stable or reduced doses of corticosteroids for at least 1 week prior to enrolment
• Negative pregnancy test no longer than 14 days prior to enrollment
• Fertile patients and female partners with child bearing potential of male patients must use adequate contraception
• Patients on EIAED must be transitioned to non-EAIED for ≥ 2 weeks
• Unfractionated and/or low molecular weight heparin allowed
• Patients previously treated with neurosurgery er eligible for the study

Exclusion Criteria

• Hypersensitivity to Bortezomib, boron, or mannitol
• Any contraindications for use of temozolomide
• Peripheral neuropathy ≥ grade 2
• Previous treatment with bevacizumab or lomustine alone or as a combination therapy for ralapsed glioblastoma (PCV as primary treatment of low grade glioma, before development of glioblastoma, is allowed)
• Myocardial infarction within the past 6 months
• NYHA class III or IV heart failure
• Uncontrolled angina
• Severe uncontrolled ventricular arrhythmias
• Electrocardiographic evidence of acute ischemia or active conduction system abnormalities
• Known heart failure
• Serious medical or psychiatric illness that would interfere with the study participation including, but not limited to, any of the following:
• Ongoing or active infection requiring IV antibiotics
• Psychiatric illness and/or social situations that would limit compliance with study requirements
• Disorders associated with a significant immunocompromised state (e.g., HIV, systemic lupus erythematosus)
• History of stroke within the past 6 months
• Other malignancy within the past 3 years except completely resected basal cell carcinoma or squamous cell carcinoma of the skin, an in situ malignancy (i.e., cervical cancer), or low-risk prostate cancer after curative therapy
• Significant medical illness that, in the investigator's opinion, cannot be adequately controlled with appropriate therapy or would compromise the patient's ability to tolerate this therapy
• Disease that will obscure toxicity or dangerously alter the drug metabolism
• Viral hepatitis (HBV surface antigen positive) or active hepatitis C infection
• Other investigational drugs must be stopped at least 12 weeks prior to therapy or treatment failure under other experimental therapy must be confirmed before study entry. If progression during other experimental therapy is confirmed, the time interval between previous treatment and BORTEM-17 may be reduced to 4 weeks
• Concurrent inducers of CYP450 3A4 (e.g., enzyme-inducing anti-epileptic drugs [EIAED])

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Oslo University Hospital

OTHER

Sponsor Role: collaborator

St. Olavs Hospital

OTHER

Sponsor Role: collaborator

University Hospital of North Norway

OTHER

Sponsor Role: collaborator

University of Bergen

OTHER

Sponsor Role: collaborator

University of Bonn

OTHER

Sponsor Role: collaborator

University of Oslo

OTHER

Sponsor Role: collaborator

Haukeland University Hospital

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Dorota Goplen, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Haukeland University Hospital

Locations

Haukeland University Hospital

Bergen, , Norway

Site Status: RECRUITING

Oslo University Hospital

Oslo, , Norway

Site Status: RECRUITING

Countries

Norway

Central Contacts

Dorota Goplen, MD, PhD

Role: CONTACT

dgop@helse-bergen.no

+47 55974019

Martha E Chekenya, PhD, Dr. Philos

Role: CONTACT

martha.enger@uib.no

+47 55586380

Facility Contacts

Dorota Goplen, MD, PhD

Role: primary

dgop@helse-bergen.no

+4755974019

Jorunn Brekke, MD

Role: backup

joub@helse-bergen.no

+4755970986

Petter Brandal, MD

Role: primary

pebra@ous-hf.no

References

Rahman MA, Brekke J, Arnesen V, Hannisdal MH, Navarro AG, Waha A, Herfindal L, Rygh CB, Bratland E, Brandal P, Haasz J, Oltedal L, Miletic H, Lundervold A, Lie SA, Goplen D, Chekenya M. Sequential bortezomib and temozolomide treatment promotes immunological responses in glioblastoma patients with positive clinical outcomes: A phase 1B study. Immun Inflamm Dis. 2020 Sep;8(3):342-359. doi: 10.1002/iid3.315. Epub 2020 Jun 24.

Reference Type: DERIVED

PMID: 32578964 (View on PubMed)

Other Identifiers

2017/2084

Identifier Type: -

Identifier Source: org_study_id