A Phase I/II Combination Study of NMS-03305293 and Temozolomide in Adult Patients with Recurrent Glioblastoma
- Conditions
- Recurrent GlioblastomaMedDRA version: 20.0Level: SOCClassification code: 10029104Term: Neoplasms benign malignant and unspecified (incl cysts and polyps) Class: 2Therapeutic area: Diseases [C] - Neoplasms [C04]
- Registration Number
- CTIS2023-508318-41-00
- Lead Sponsor
- erviano Medical Sciences S.r.l.
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Recruiting
- Sex
- All
- Target Recruitment
- 75
Phase I - 1. Histologically confirmed diagnosis of an intracranial diffuse glioma (i.e. diffuse astrocytoma, oligodendroglioma or glioblastoma)., Phase I and Phase II - 7. Able to undergo brain MRI scans with IV gadolinium., Phase I and Phase II - 8. No evidence of symptomatic and acute intratumoral hemorrhage on MRI. Patients with MRI demonstrating old hemorrhage or subacute blood after a neurosurgical procedure (biopsy or resection) are eligible., Phase I and Phase II - 9. Sufficient tissue representative of the disease available for central MGMT promoter methylation status (Phase I and II) and IDH status evaluation (Phase I)., Phase I and Phase II - 10. Male or female patients with age = 18 years., Phase I and Phase II - 11. ECOG performance status <2., Phase I and Phase II - 12. Signed and dated IEC or IRB-approved Informed Consent., Phase I and Phase II - 13. Resolution of all acute toxic effects (excluding alopecia) of any prior anticancer therapy to NCI CTCAE (Version 5.0) Grade = 1 or to the baseline laboratory values as stated in the protocol, Phase I and Phase II - 14. Baseline laboratory values fulfilling defined requirements as stated in the protocol, Phase I and Phase II - 15. Patients must use effective contraception or abstinence. Female patients of childbearing potential must agree to use effective contraception or abstinence during the period of therapy and in the following 6 months after discontinuation of study treatment. Being NMS-03305293 a potential CYP3A perpetrator, hormonal contraception may lose efficacy while on treatment with NMS-03305293, therefore this should be taken into account. Male patients must be surgically sterile or must agree to use effective contraception or abstinence during the period of therapy and in the following 6 months after discontinuation of study treatment., Phase I and Phase II - 16. Ability to swallow capsules intact (without chewing, crushing, or opening)., Phase I - 2. Patients at first relapse after chemotherapy including temozolomide as long as no more than 12 cycles of temozolomide were administered., Phase I and Phase II - 17. Willingness and ability to comply with scheduled visits, treatment plan, laboratory tests and other study indications or procedures., Phase I - 3. Patients may have been operated for recurrence. If operated: - residual and measurable disease after surgery is not required but pathology must have confirmed tumor recurrence. - a post-surgery MRI should be available within 48 hours following surgery. - surgery completed at least 2 weeks before enrolment and patient clinical status should not be worsened respect to pre-surgery condition, Phase II - 1. Histologically confirmed diagnosis of Glioblastoma, IDH wildtype as per WHO 2021 classification including IDH-wildtype diffuse and astrocytic glioma in adults if there is microvascular proliferation or necrosis or TERT promoter mutation or EGFR gene amplification or +7/- 10 chromosome copy number changes or c-IMPACT-NOW 3 definition including diffuse astrocytic glioma, IDH-wildtype, with molecular features of glioblastoma, WHO Grade 4., Phase II - 2. Patients at first relapse after initial standard therapy including temozolomide as long as no more than 6 cycles of temozolomide were administered and provided that patient completed standard of care concurrent temozolomide and the radiation therapy., Phase II - 3. Patients may have been operated for recurrence. If operated: • residual and measurable disease after s
1. Current enrollment in another interventional clinical trial., 10. Treatment with enzyme-inducing anti-epileptic drugs (EIAED). Patients may be on non-EIAED or not be taking any anti-epileptic drugs. Patients previously on EIAED must be fully switched to non-EIAED at least 2 weeks prior to enrolment., 11. Pregnant or breast-feeding women., 12. Known hypersensitivity to any component of NMS-03305293 or TMZ drug formulations., 13. Known active infections (bacterial, fungal, viral including HIV positivity) requiring systemic treatment., 14. Patients with QTc interval =460 milliseconds for women, =450 milliseconds for men or with risk factors for torsade de pointes (e.g.,uncontrolled heart failure, uncontrolled hypokalemia, history of prolonged QTc interval or family history of long QT syndrome). For patients receiving treatment with concomitant medications known to prolong the QTc interval, replacement with another treatment prior to enrollment is mandatory., 15. Active gastrointestinal disease (e.g., documented gastrointestinal ulcer, Crohn's disease, ulcerative colitis, or short gut syndrome) or other syndromes that would impact on drug absorption., 16. Any of the following in the past 6 months: myocardial infarction, unstable angina, coronary/peripheral artery bypass graft, symptomatic congestive heart failure, cerebrovascular accident or transient ischemic attack, active bleeding disorder., 17. Prior invasive malignancy (except for non melanoma skin cancer, carcinoma in situ or localized cancer) unless the patient has been disease-free and off therapy for that disease for = 3 years., 18. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study drug administration or may interfere with the interpretation of study results and, in the judgment of the Investigator, would make the patient inappropriate for entry into this study or could compromise protocol objectives in the opinion of the Investigator and/or the Sponsor., 2. Current treatment with other anticancer agents, or treatment at recurrence with carmustine wafer implants and proteasome inhibitors., 3. Previous treatment with PCV (procarbazine, lomustine and vincristine) or any of its components, carmustine wafer implants, or bevacizumab., 4. Previous treatment with PARP inhibitors., 5. Major surgery, other than surgery for recurrent diffuse glioma, within 4 weeks prior to treatment., 6. Standard radiotherapy within the three months (12 weeks) prior to the diagnosis of progression unless the progression is clearly outside the radiation field (eg, beyond the high-dose region or 80% isodose line) or unless the recurrence is histologically proven., 7. Prior radiotherapy with a dose over 65 Gy, stereotactic radiosurgery or brachytherapy, unless the recurrence is histologically proven., 8. Use of full-dose anticoagulants unless the INR or aPTT is within therapeutic limits (according to the medical standard in the institution) and the patient has been on a stable dose of anticoagulants for at least two weeks before enrollment., 9. Treatment with concomitant medications known to be sensitive substrates of CYP2D6 and CYP2C19 that cannot be replaced with another treatment
Study & Design
- Study Type
- Interventional clinical trial of medicinal product
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Main Objective: To determine the Maximum Tolerated Dose (MTD) and the Recommended Phase 2 Dose (RP2D) of NMS-03305293 in combination with temozolomide (TMZ) in patients with diffuse gliomas at first relapse (Phase I).<br>To assess the antitumor efficacy of the combination of NMS-03305293 and TMZ in patients with isocitrate dehydrogenase (IDH) wild type glioblastoma (Phase II) at first relapse.;Secondary Objective: To characterize the safety profile of NMS-03305293 in combination with TMZ, To evaluate the pharmacokinetics of NMS-03305293 in combination with TMZ, To evaluate additional measures of antitumor efficacy of NMS-03305293 in combination with TMZ;Primary end point(s): First cycle Dose Limiting Toxicities (DLTs) (Phase I), Objective Response Rate (ORR), calculated as the proportion of evaluable patients who have achieved, as best overall response (BOR), confirmed complete response (CR) or partial response (PR) through central retrospective assessment of RANO criteria (Phase II)
- Secondary Outcome Measures
Name Time Method