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Disulfiram/Copper Combination In The Treatment of Newly Diagnosed Glioblastoma Multiform (GLIODIS)

Primary Purpose

Glioblastoma Multiforme

Status
Unknown status
Phase
Phase 2
Locations
Greece
Study Type
Interventional
Intervention
Temozolomide
Disulfiram
Copper
Sponsored by
Olympion Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glioblastoma Multiforme

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Histopathologically confirmed diagnosis of glioblastoma (World Health Organization [WHO] grade IV astrocytoma). Patients must be newly diagnosed with unifocal supratentorial GBM amenable to gross total resection (< 1 cm. enhancing rim) and not yet received chemoradiation.
  2. Patient must have undergone a gross total surgical resection of the tumor mass with post-surgical MRI (performed within 72 hours after operation) demonstration of adequacy defined as < 1.0 cm of residual enhancement away from resection cavity perimeter.
  3. Ability to start disulfiram on the 5th postoperative day
  4. ≥ 18 years of age
  5. Karnofsky Performance Status (KPS) ≥ 70%
  6. Adequate bone marrow function, defined as:

    Absolute neutrophil count ≥ 1000 cells/mm3 Hemoglobin ≥ 10 g/dL Platelet count ≥ 100,000 cells/mm3

  7. Adequate hepatic function, defined as:

    Bilirubin ≤ 2.0 mg/dL Alkaline phosphatase (ALP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 4x upper limit of normal (ULN)

  8. Adequate renal function, defined blood urea nitrogen (BUN) < 30 mg/dL and creatinine < 2 mg/dL
  9. Prothrombin time (PT) and activated partial thromboplastin time (PTT) ≤ 1.6x control unless therapeutically warranted
  10. Female patients of child-bearing potential must have negative serum or urine pregnancy test
  11. If not surgically sterile, male and female patients of childbearing age must use double barrier contraception (hormonal; intrauterine device; barrier)
  12. Patient must give written informed consent prior to any study-specific procedures being implemented.

Exclusion Criteria:

  1. Recurrent disease
  2. Infratentorial or multifocal tumor.
  3. Placement of Gliadel wafer
  4. No severe, active comorbidity, including any of the following:

    • Unstable angina and/or congestive heart failure requiring hospitalization
    • Transmural myocardial infarction within the last 6 months
    • Chronic obstructive pulmonary disease
    • Known hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
    • Known human immunodeficiency virus (HIV) positivity or acquired immunodeficiency syndrome (AIDS) related illness or other serious medical illness
    • Major medical illnesses or psychiatric impairments that, in the investigator's opinion, will prevent administration or completion of protocol therapy
    • Known history of an autoimmune disorder
    • Presence of any other active malignancy or prior history of malignancy (except for basal cell carcinoma of the skin)
  5. Alcoholism
  6. Breastfeeding
  7. Prior or planned chemotherapy, immunotherapy, biologic therapy, radiation therapy, radioimmunotherapy, hormonal therapy, or experimental therapy for brain tumor
  8. History of severe allergic reaction to contrast media.
  9. Inability to undergo an MRI.
  10. Patients treated on any other therapeutic clinical trial within 30 days prior to study entry or during participation in the study.

Sites / Locations

  • Olympion Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Temozolomide+Disulfiram/copper

Arm Description

Disulfiram/copper combination will be started on the 5th postoperative day and before the initiation of the standard radiochemotherapy (fractionated irradiation with a total dose of 60 Gy with concomitant 75 mg/m2 body surface temozolomide each day, including weekends, during irradiation). After completion of the radiation therapy patients will receive maintenance temozolomide 150-200 mg/m2 body surface on Days 1-5 every 28 days for 6 months. Daily administration of disulfiram and copper will take place for the whole study period. NOTE: Patients may receive additional maintenance temozolomide at the discretion of the treating medical oncologist.

Outcomes

Primary Outcome Measures

Progression-free survival

Secondary Outcome Measures

Overall survival

Full Information

First Posted
January 24, 2013
Last Updated
October 14, 2016
Sponsor
Olympion Medical Center
Collaborators
University of Ioannina, University of Eastern Finland, University of Ulm
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1. Study Identification

Unique Protocol Identification Number
NCT01777919
Brief Title
Disulfiram/Copper Combination In The Treatment of Newly Diagnosed Glioblastoma Multiform
Acronym
GLIODIS
Official Title
A PHASE II CLINICAL TRIAL FOR THE EVALUATION OF THE EFFICACY OF DISULFIRAM/COPPER COMBINATION AS AN ADJUVANT AND CONCURRENT CHEMOTHERAPY IN THE TREATMENT OF NEWLY DIAGNOSED GLIOBLASTOMA MULTIFORM
Study Type
Interventional

2. Study Status

Record Verification Date
October 2016
Overall Recruitment Status
Unknown status
Study Start Date
January 2017 (undefined)
Primary Completion Date
January 2019 (Anticipated)
Study Completion Date
January 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Olympion Medical Center
Collaborators
University of Ioannina, University of Eastern Finland, University of Ulm

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Glioblastoma multiform (GBM) is the most common malignant primary brain tumor in adults. Despite maximal treatment tumor relapse occurs regularly accompanied by unfavourable prognosis. Among other reasons, it is believed that this could be in part due to the existence of the so-called tumor stem cells (TSCs), a cellular subfraction within GBM which escape therapy by being highly resistant to irradiation and chemotherapy and thus constituting the source of tumor recurrence. GBM, like many other cancers, show a sub-population of aldehyde dehydrogenase (ALDH) overexpressing TSCs. More specifically, ALDH1A1, a cytoplasmatic isoform of ALDH, proved to be a novel stem cell marker in human GBM. In addition, ALDH1A1 has been shown to be a mediator for resistance of GBM to temozolomide (TMZ) and a reliable predictor of clinical outcome; prognosis of patients with a high level of ALDH1A1 expression was poor compared with that of patients with low levels. Consequently, ALDH1A1 may serve as a potential target to improve treatment of human GBM through inhibition of the enzyme. Disulfiram (DSF) has been used for more than sixty years in the treatment of chronic alcoholism because of the unpleasant symptoms it provokes after ethanol intake. The underlying mechanism is believed to be the accumulation of acetaldehyde in the blood, due to inhibition of the liver ALDHs. Actually, DSF is a strong inhibitor of ALDH1A1 and relatively non-toxic at therapeutic (for chronic alcoholism) doses that can penetrate the blood-brain barrier. In addition, DSF has been shown to be cytotoxic on GBM stem-like cells, inhibiting the growth of TMZ resistant GBM cells and blocking self-renewal by ~100% , while it has been identified as an inhibitor of human GBM stem cells in high-throughput chemical screens. Interestingly, a number of these actions were copper-dependent. In the current Phase II clinical trial, DSF/copper combination will be tested as an adjunctive and concurrent chemotherapy in the treatment of newly diagnosed GBM. According to our hypothesis, initiation of DSF chemotherapy after the resection of the tumor and before the introduction of the standard radio-chemotherapy will inhibit ALDH1A1 of GBM TSCs making them more susceptible to radio-chemotherapy and possibly reducing the recurrence rate of GBM. On the other hand, the addition of copper will probably enhance the cytotoxic effects of DSF possibly through augmentation of its pro-apoptotic and proteasomal inhibitory actions.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glioblastoma Multiforme

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
32 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Temozolomide+Disulfiram/copper
Arm Type
Experimental
Arm Description
Disulfiram/copper combination will be started on the 5th postoperative day and before the initiation of the standard radiochemotherapy (fractionated irradiation with a total dose of 60 Gy with concomitant 75 mg/m2 body surface temozolomide each day, including weekends, during irradiation). After completion of the radiation therapy patients will receive maintenance temozolomide 150-200 mg/m2 body surface on Days 1-5 every 28 days for 6 months. Daily administration of disulfiram and copper will take place for the whole study period. NOTE: Patients may receive additional maintenance temozolomide at the discretion of the treating medical oncologist.
Intervention Type
Drug
Intervention Name(s)
Temozolomide
Other Intervention Name(s)
Temodar
Intervention Type
Drug
Intervention Name(s)
Disulfiram
Other Intervention Name(s)
Antabuse
Intervention Type
Drug
Intervention Name(s)
Copper
Primary Outcome Measure Information:
Title
Progression-free survival
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Overall survival
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histopathologically confirmed diagnosis of glioblastoma (World Health Organization [WHO] grade IV astrocytoma). Patients must be newly diagnosed with unifocal supratentorial GBM amenable to gross total resection (< 1 cm. enhancing rim) and not yet received chemoradiation. Patient must have undergone a gross total surgical resection of the tumor mass with post-surgical MRI (performed within 72 hours after operation) demonstration of adequacy defined as < 1.0 cm of residual enhancement away from resection cavity perimeter. Ability to start disulfiram on the 5th postoperative day ≥ 18 years of age Karnofsky Performance Status (KPS) ≥ 70% Adequate bone marrow function, defined as: Absolute neutrophil count ≥ 1000 cells/mm3 Hemoglobin ≥ 10 g/dL Platelet count ≥ 100,000 cells/mm3 Adequate hepatic function, defined as: Bilirubin ≤ 2.0 mg/dL Alkaline phosphatase (ALP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 4x upper limit of normal (ULN) Adequate renal function, defined blood urea nitrogen (BUN) < 30 mg/dL and creatinine < 2 mg/dL Prothrombin time (PT) and activated partial thromboplastin time (PTT) ≤ 1.6x control unless therapeutically warranted Female patients of child-bearing potential must have negative serum or urine pregnancy test If not surgically sterile, male and female patients of childbearing age must use double barrier contraception (hormonal; intrauterine device; barrier) Patient must give written informed consent prior to any study-specific procedures being implemented. Exclusion Criteria: Recurrent disease Infratentorial or multifocal tumor. Placement of Gliadel wafer No severe, active comorbidity, including any of the following: Unstable angina and/or congestive heart failure requiring hospitalization Transmural myocardial infarction within the last 6 months Chronic obstructive pulmonary disease Known hepatic insufficiency resulting in clinical jaundice and/or coagulation defects Known human immunodeficiency virus (HIV) positivity or acquired immunodeficiency syndrome (AIDS) related illness or other serious medical illness Major medical illnesses or psychiatric impairments that, in the investigator's opinion, will prevent administration or completion of protocol therapy Known history of an autoimmune disorder Presence of any other active malignancy or prior history of malignancy (except for basal cell carcinoma of the skin) Alcoholism Breastfeeding Prior or planned chemotherapy, immunotherapy, biologic therapy, radiation therapy, radioimmunotherapy, hormonal therapy, or experimental therapy for brain tumor History of severe allergic reaction to contrast media. Inability to undergo an MRI. Patients treated on any other therapeutic clinical trial within 30 days prior to study entry or during participation in the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Petros N Karamanakos, MD, PhD
Phone
+30 6945 548463
Email
pkaramanakos@olympion-sa.gr
First Name & Middle Initial & Last Name or Official Title & Degree
Marios S Marselos, MD, PhD
Phone
+30 6976 119554
Email
mmarsel@cc.uoi.gr
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Petros N Karamanakos, MD, PhD
Organizational Affiliation
Department of Neurosurgery, Olympion Medical Center, 26443, Patras, GREECE
Official's Role
Principal Investigator
Facility Information:
Facility Name
Olympion Medical Center
City
Patras
ZIP/Postal Code
26443
Country
Greece
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Petros N Karamanakos, MD, PhD
First Name & Middle Initial & Last Name & Degree
Petros N Karamanakos, MD, PhD

12. IPD Sharing Statement

Citations:
PubMed Identifier
24344045
Citation
Karamanakos PN. Possible role for furazolidone in the treatment of glioblastoma multiforme. J BUON. 2013 Oct-Dec;18(4):1097. No abstract available.
Results Reference
derived

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Disulfiram/Copper Combination In The Treatment of Newly Diagnosed Glioblastoma Multiform

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