Summary

Eligibility
for people ages 18 years and up (full criteria)
Location
at UC Irvine
Dates
study started
estimated completion
Principal Investigator
Daniela A. Bota, MD, PhD (uci)

Description

Summary

This phase II clinical trial studies how well ERC1671 plus Granulocyte-macrophage colony-stimulating factor (GM-CSF) plus Cyclophosphamide with Bevacizumab works compared to Placebo Injection plus Placebo Pill with Bevacizumab in treating patients with recurrent/progressive, bevacizumab naïve glioblastoma multiforme and gliosarcoma (World Health Organization (WHO) grade IV malignant gliomas, GBM).

Official Title

A Randomized, Double-blinded, Placebo-controlled Study of (ERC1671/GM-CSF/Cyclophosphamide)+Bevacizumab vs. (Placebo Injection/Placebo Pill) +Bevacizumab in the Treatment of Recurrent/Progressive, Bevacizumab naïve Glioblastoma Multiforme and Glioasarcoma Patients (WHO Grade IV Malignant Gliomas, GBM)

Details

PRIMARY OBJECTIVES:

The primary objective of the study is to estimate 12-month overall survival probability of patients with recurrent, bevacizumab naïve glioblastoma treated with ERC1671 in combination with GM-CSF and cyclophosphamide plus bevacizumab as compared with patients receiving bevacizumab plus placebo controls.

SECONDARY OBJECTIVES:

  1. To evaluate radiographic response and progression free survival of patients with recurrent malignant glioma treated with the ERC1671 regimen plus bevacizumab
  2. To evaluate safety and tolerability of ERC1671 plus bevacizumab among patients with recurrent glioblastoma.
  3. To characterize of the immune response to ERC1671 vaccination in adult patients with relapsed glioblastoma. The patient's immune respose evaluation will include cytotoxic T lymphocytes (CTL) (CD3+/CD8+) and Treg (CD3+/CD4+/CD25+/CD127low) populations. Cytokine analyses should initially be limited to IFN-ɣ, TNF and IL-6). Further immune studies should include TGF-B2, IL-12, IL-10.

If this study demonstrates that ERC1671 in combination with bevacizumab is associated with encouraging anti-tumor activity among patients with recurrent glioblastoma, further assessment of this regimen in a phase III study will be considered.

OUTLINE: This is a blinded Phase II study of ERC1671 in combination with bevacizumab in patients with relapsed, bevacizumab naive glioblastoma. The patients who will be randomized (in a 1:1 ratio) to receive either ERC 1671 in combination with GM-CSF and cyclophosphamide or a placebo control, in combination with bevacizumab. The study will be double blinded.

ERC1671/GM-CSF will be intradermally administered, while cyclophosphamide is orally administered. GM-CSF dose is 500mcg fixed dose and cyclophosphamide dose is 50 mg/day. Bevacizumab is administered as standard of care at 10 mg/kg.

The treatment cycles will be 28 days long.

Keywords

Glioblastoma Gliosarcoma ERC1671 GM-CSF Cyclophosphamide Bevacizumab Sargramostim (ERC1671/GM-CSF/Cyclophosphamide)+bevacizumab

Eligibility

You can join if…

Open to people ages 18 years and up

-Patients must have histologically confirmed diagnosis of a recurrent/progressive WHO grade IV malignant gliomas (glioblastoma multiforme and gliosarcoma) and meet the following inclusion criteria:

  1. Age ≥18 years of age.
  2. Histologic diagnosis of glioblastoma or gliosarcoma (WHO Grade IV).
  3. KPS of ≥ 70%.
  4. Life expectancy > 12 weeks.
  5. First or second relapse of glioblastoma.
  6. Previous treatment for glioblastoma must include surgery (biopsy, partial resection, or full surgical resection), conventional radiation therapy and temozolomide (TMZ).
  7. MRI record must be obtained showing the MRI was conducted at least 4 weeks after any salvage surgery, and at least 12 weeks after radiation therapy, or at least 4 weeks after radiation for a new lesion outside the prior primary radiation field unless relapse is confirmed by tumor biopsy or new lesion outside of radiation field, or if there are two MRIs confirming progressive disease that are 8 weeks apart
  8. If prior therapy with gamma knife or other focal high-dose radiation, must have subsequent histologic documentation of local relapse, or relapse with new lesion outside the irradiated field.
  9. Resolution of all chemotherapy or radiation-related toxicities ≤ CTCAE Grade 1 severity, except for alopecia and hematologic toxicity. Patients taking temozolomide can start study treatment 23 days from the last temozolamide dose.For all other chemotherapy drugs, study treatment can start as long as all adverse events related to their prior treatment are no higher than Grade 1.
  10. . Systemic corticosteroid therapy must be at a dose of ≤ 4 mg of dexamethasone or equivalent per day during the week prior to Day 1.
  11. . Bi-dimensionally measurable disease (as per iRANO criteria)
  12. . Patients must have normal organ and marrow function as defined below:
  13. hemoglobin (Hbg) > 9g/dL,
  14. leukocytes >1,500/mcL
  15. absolute neutrophil count>1,000/mcL
  16. CD4 count > 450/mcL
  17. platelets>125,000/mcL
  18. Serum bilirubin = 1.5 × upper limit of normal (ULN) or = 3 x ULN if Gilbert's disease is documented AST(SGOT) and ALT(SGPT)<2.5 X institutional upper limit of normal
  19. serum creatinine < 1.5 mg/dl
  20. . Signed informed consent approved by the Institutional Review Board;
  21. . If sexually active, patients must agree to take contraceptive measures for the duration of the treatments.

You CAN'T join if...

  1. Subjects unable to undergo an MRI with contrast.
  2. Presence of diffuse leptomeningeal disease
  3. History, presence, or suspicion of metastatic disease
  4. Administration of immunosuppressive drugs less than 2 weeks prior to first dose of ERC1671, except dexamethasone for cerebral edema as detailed above;
  5. Prior receipt of bevacizumab or other VEGF- or VEGF receptor-targeted agents
  6. Known contraindication or hypersensitivity to any component of bevacizumab.
  7. Evidence of recent hemorrhage on screening MRI of the brain with the following exceptions: presence of hemosiderin; resolving hemorrhagic changes related to surgery; presence of punctate hemorrhage in the tumor.
  8. Significant vascular disease (e.g., aortic aneurysm, aortic dissection) or recent peripheral arterial thrombosis within 6 months prior to Day 1.
  9. Evidence of bleeding diathesis or coagulopathy as documented by an elevated PT, PTT or bleeding time and clinically significant;
  10. . History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to Day 1.
  11. . Urine protein: creatinine ratio ≥ 1.0 at screening;
  12. . Anticipation of need for major surgical procedure during the course of the study.
  13. . Serious non-healing wound, ulcer, or bone fracture.
  14. . Active infection requiring treatment, known immunosuppressive disease, active systemic autoimmune diseases such as lupus, receipt of systemic immunosuppressive therapy, human immunodeficiency virus (HIV) infection, Hepatitis B or Hepatitis C
  15. . Uncontrolled hypertension, blood pressure of > 150 mmHg systolic and > 100 mmHg diastolic, or history of hypertensive encephalopathy. Subjects with any known uncontrolled inter-current illness including ongoing or active infection, symptomatic congestive heart failure (NYHA Gr.2 or >), myocardial infarction, unstable angina pectoris , within the past 12 months
  16. . Stroke, transient ischemic attack, unstable angina, myocardial infarction or congestive heart failure (New York Heart Association Grade II or greater) within the past 12 months.Unstable or severe intercurrent medical conditions chronic renal disease, or uncontrolled diabetes mellitus.
  17. . Women who are pregnant or lactating. All female patients with reproductive potential must have a negative pregnancy test prior to Day 1 and must use a reliable form of contraception during study participation.
  18. . Men refusing to exercise a reliable form of contraception.
  19. . History of any malignancy (other than glioblastoma) during the last three years except non-melanoma skin cancer, in situ cervical cancer, treated superficial bladder cancer or cured, early-stage prostate cancer in a patient with Prostate Surface Antigen (PSA) level <ULN.

Location

  • University of California, Irvine accepting new patients
    Orange California 92868 United States

Lead Scientist at UC Cancer

Details

Status
accepting new patients
Start Date
Completion Date
(estimated)
Sponsor
Daniela A. Bota
ID
NCT01903330
Phase
Phase 2
Study Type
Interventional
Last Updated