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Preoperative Ceritinib (LDK378) in Glioblastoma Multiforme and CNS Metastasis

Primary Purpose

Glioblastoma, Brain Metastases

Status
Completed
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
ceritinib 750mg
Sponsored by
St. Joseph's Hospital and Medical Center, Phoenix
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Glioblastoma

Eligibility Criteria

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

Inclusion Criteria:

  • One prior resection of GBM or MRI evidence of solid tumor CNS metastasis
  • All GBM and NSLC metastases must be ALK+
  • Eastern Cooperative Oncology Group performance status ≤2
  • Archival tumor tissue block available for research use
  • Ability to understand written informed consent
  • Recovery from toxicities related to prior anticancer therapies to ≤ grade 2 (CTCAE v 4.03). Exception: patients with any grade alopecia
  • The following lab criteria are met:

    • Absolute neutrophil count ≥ 1.5 x 10(9th power)/L
    • Hemoglobin ≥ 8 g/dL
    • Platelets ≥ 75 x 10(9th power)/L
    • Serum total bilirubin ≤ 1.5 x upper limit of normal(ULN), except for patients with Gilbert's syndrome who may be included if total bilirubin ≤ 3.0 x ULN and direct bilirubin ≤ 1.5 x ULN
    • Aspartate transaminase (AST) < 3.0 x ULN, except for patients with liver metastasis, who are only included if AST < 5 x ULN; alanine transaminase (ALT) < 3.0 x ULN, except for patients with liver metastasis, who are only included if ALT < 5 x ULN
    • Creatinine clearance ≥ 30 mL/min
  • Patient has following lab values or has lab values corrected with supplements to be within normal limits at screening:

    • Potassium ≥ LLN
    • Magnesium ≥ LLN
    • Phosphorus ≥ LLN
    • Total calcium (corrected for serum albumin) ≥ LLN

Exclusion Criteria:

  • Co-morbid condition(s) that prevent safe surgical treatment
  • Active infection or fever > 38.5°C
  • Patients with known hypersensitivity to any excipients of ceritinib
  • Prior therapy with ceritinib
  • Patients with known history of extensive disseminated bilateral interstitial fibrosis or interstitial lung disease, including a history of pneumonitis, hypersensitivity pneumonitis, interstitial pneumonia, obliterative bronchiolitis, and clinically significant radiation pneumonitis (affecting activities of daily living or requiring therapeutic intervention)
  • Clinically significant uncontrolled heart disease and/or recent cardiac event (within 6 months), such as:

    • history of documented congestive heart failure (New York Heart Association functional classification III-IV);
    • uncontrolled hypertension defined by a Systolic Blood Pressure ≥ 160 mm Hg and/or Diastolic Blood Pressure ≥ 100 mm Hg, with or without antihypertensive medication
    • initiation or adjustment of antihypertensive medication(s) is allowed prior to screening;
    • ventricular arrhythmias; supraventricular and nodal arrhythmias not controlled with medication;
    • other cardiac arrhythmia not controlled with medication;
    • corrected QTc > 450 msec using Fridericia correction on the screening ECG
  • Impaired GI function or GI disease that may alter absorption of ceritinib or inability to swallow up to five ceritinib capsules daily
  • Ongoing GI adverse events > grade 2 (e.g. nausea, vomiting, or diarrhea) at the start of the study
  • Receiving medications that meet 1 of the following criteria and cannot be discontinued at least 1 week prior to start of treatment with ceritinib and for the duration of participation:

    • Medication with a known risk of prolonging the QT interval or inducing Torsades de Pointes
    • Strong inhibitors or strong inducers of CYP3A4/5
    • Medications with a low therapeutic index that are primarily metabolized by CYP3A4/5, CYP2C8 and/or CYP2C9
    • Therapeutic doses of warfarin sodium (Coumadin) or any other coumadin-derived anti-coagulant. Anticoagulants not derived from warfarin are allowed
  • Pregnant or nursing (lactating) women.
  • Women of child-bearing potential, unless they are using highly effective methods of contraception during dosing and for 3 months after the last dose of study treatment.

Sites / Locations

  • Barrow Brain and Spine

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

2-4 hours

4-8 hours

22-26 hours

Arm Description

All patients will be orally-administered 10-14 doses of ceritinib 750mg with the final dose occurring at one of three intervals before brain tumor resection. This arm has the last ceritinib dose 2-4 hours prior to craniotomy for tumor resection.

All patients will be orally-administered 10-14 doses of ceritinib 750mg with the final dose occurring at one of three intervals before brain tumor resection. This arm has the last ceritinib dose 4-8 hours prior to craniotomy for tumor resection.

All patients will be orally-administered 10-14 doses of ceritinib 750mg with the final dose occurring at one of three intervals before brain tumor resection. This arm has the last ceritinib dose 22-26 hours prior to craniotomy for tumor resection.

Outcomes

Primary Outcome Measures

Plasma Concentration
Plasma concentration of Ceritinib after 10-14 oral doses of 750 mg. Will be summarized using descriptive statistics.
Cerebrospinal Concentration
Cerebrospinal concentration of Ceritinib. Will be summarized using descriptive statistics.
Intratumoral Concentration
Intratumoral concentration of Ceritinib. Will be summarized using descriptive statistics.

Secondary Outcome Measures

Tumor Tissue
Tumor tissue quantification of total and phosphorylated forms of ALK, JAK/STAT5B, and Caspase-3. Will be summarized using descriptive statistics.
Tumor Cells in M-Phase
Number of tumor cells in M-phase of cell cycle (PH3). Will be summarized using descriptive statistics.
Double Strand DNA
Presence of double-strand DNA damage (γH2AX). Will be summarized using descriptive statistics.
Tissue Concentration
Tissue concentration of CERITINIB compared to contrast enhancing GBM vs. surrounding nonenhancing FLAIR-hyperintense GBM. Will be summarized using descriptive statistics.

Full Information

First Posted
September 8, 2015
Last Updated
December 10, 2020
Sponsor
St. Joseph's Hospital and Medical Center, Phoenix
Collaborators
Novartis, Wayne State University, Translational Genomics Research Institute
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1. Study Identification

Unique Protocol Identification Number
NCT02605746
Brief Title
Preoperative Ceritinib (LDK378) in Glioblastoma Multiforme and CNS Metastasis
Official Title
A Phase 0/II Study of Ceritinib (LDK378) in Preoperative Glioblastoma Multiforme (GBM) and CNS Metastasis Patients Scheduled for Resection to Evaluate Central Nervous System (CNS) Penetration
Study Type
Interventional

2. Study Status

Record Verification Date
December 2020
Overall Recruitment Status
Completed
Study Start Date
February 17, 2016 (Actual)
Primary Completion Date
November 29, 2018 (Actual)
Study Completion Date
July 12, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
St. Joseph's Hospital and Medical Center, Phoenix
Collaborators
Novartis, Wayne State University, Translational Genomics Research Institute

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This is two parallel studies to examine pharmacokinetic (PK), pharmacodynamic (PD), and pharmacogenetic (PG) endpoints following short-interval therapy (10-14) daily doses without dose reduction and interruption) with the ALK (anaplastic lymphoma kinase) small-molecule inhibitor, ceritinib. The Phase 0 study will investigate: first recurrence GBM patients and patients with CNS metastases from solid tumors such as, but not limited to, NSCLC (non-small cell lung cancer) and melanoma. The CNS (central nervous system) metastases Phase 0 is designed to identify PK effects (in addition to PD, and PG effects on ALK-positive NSCLC metastases), while the GBM Phase 0 is designed to identify PK, PD, and PG effects in all patients.
Detailed Description
This study is being done to learn about a new drug, Ceritinib (LKD378). The results of the study may reveal how the drug works for cancer that spreads to the brain (metastases) and for a type of brain cancer called glioblastoma (GBM). Subjects are persons scheduled to have surgery to remove the tumor.This study would test how much of the new drug is present in the tumor, blood, and cerebrospinal fluid (CSF) after taking the drug orally for 10-14 days before surgery. It is only given to patients who are already scheduled to have surgery to remove a tumor that has returned. If the drug seems to be working for a subject's tumor, subject will have the option to continue to receive it as part of a continuation study looking at the drug effect on preventing the tumor from recurring. Small samples of blood, tumor tissue, and CSF will be taken. These samples will be sent to and analyzed at the Barbara Ann Karmanos Cancer Institute (KCI) and to the Translational Genomics Research Institute (TGen). Subject involvement will be for 10-14 days before surgery and for 30 days following surgery. Patients with ALK+ solid tumors will be provided the option of continuing therapy until tumor progression. ALK positivity will be assessed by approved FISH test (Abbott Molecular Inc) using Vysis break apart probes (defined as 15% or more positive tumor cells), the Ventana IHC (immunohistochemistry) test, and/or NGS (next generation sequencing).

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Other
Study Phase
Early Phase 1
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
10 (Actual)

8. Arms, Groups, and Interventions

Arm Title
2-4 hours
Arm Type
Experimental
Arm Description
All patients will be orally-administered 10-14 doses of ceritinib 750mg with the final dose occurring at one of three intervals before brain tumor resection. This arm has the last ceritinib dose 2-4 hours prior to craniotomy for tumor resection.
Arm Title
4-8 hours
Arm Type
Experimental
Arm Description
All patients will be orally-administered 10-14 doses of ceritinib 750mg with the final dose occurring at one of three intervals before brain tumor resection. This arm has the last ceritinib dose 4-8 hours prior to craniotomy for tumor resection.
Arm Title
22-26 hours
Arm Type
Experimental
Arm Description
All patients will be orally-administered 10-14 doses of ceritinib 750mg with the final dose occurring at one of three intervals before brain tumor resection. This arm has the last ceritinib dose 22-26 hours prior to craniotomy for tumor resection.
Intervention Type
Drug
Intervention Name(s)
ceritinib 750mg
Primary Outcome Measure Information:
Title
Plasma Concentration
Description
Plasma concentration of Ceritinib after 10-14 oral doses of 750 mg. Will be summarized using descriptive statistics.
Time Frame
at pre-dose on day 10-14(Day 0), 0.5, 1, 2, 4, 6, 8, and 24 hours following single dose of CERITINIB
Title
Cerebrospinal Concentration
Description
Cerebrospinal concentration of Ceritinib. Will be summarized using descriptive statistics.
Time Frame
collected intraoperatively at 2-4, 4-8, and 22-26 hours following single dose of CERITINIB relative to the final dose on day 10-14
Title
Intratumoral Concentration
Description
Intratumoral concentration of Ceritinib. Will be summarized using descriptive statistics.
Time Frame
collected intraoperatively at 2-4, 4-8, and 22-26 hours following single dose of CERITINIB relative to the final dose on day 10-14
Secondary Outcome Measure Information:
Title
Tumor Tissue
Description
Tumor tissue quantification of total and phosphorylated forms of ALK, JAK/STAT5B, and Caspase-3. Will be summarized using descriptive statistics.
Time Frame
at baseline(archival) and up to 26 hours post dosing
Title
Tumor Cells in M-Phase
Description
Number of tumor cells in M-phase of cell cycle (PH3). Will be summarized using descriptive statistics.
Time Frame
at baseline and up to 26 hours post dose CERITINIB
Title
Double Strand DNA
Description
Presence of double-strand DNA damage (γH2AX). Will be summarized using descriptive statistics.
Time Frame
at baseline and up to 26 hours post dose CERITINIB
Title
Tissue Concentration
Description
Tissue concentration of CERITINIB compared to contrast enhancing GBM vs. surrounding nonenhancing FLAIR-hyperintense GBM. Will be summarized using descriptive statistics.
Time Frame
2-4, 4-8, and 22-26 hours post dosing relative to the final Day 10 dose, as compared to the immediate pre-operative MRI scan

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: One prior resection of GBM or MRI evidence of solid tumor CNS metastasis All GBM and NSLC metastases must be ALK+ Eastern Cooperative Oncology Group performance status ≤2 Archival tumor tissue block available for research use Ability to understand written informed consent Recovery from toxicities related to prior anticancer therapies to ≤ grade 2 (CTCAE v 4.03). Exception: patients with any grade alopecia The following lab criteria are met: Absolute neutrophil count ≥ 1.5 x 10(9th power)/L Hemoglobin ≥ 8 g/dL Platelets ≥ 75 x 10(9th power)/L Serum total bilirubin ≤ 1.5 x upper limit of normal(ULN), except for patients with Gilbert's syndrome who may be included if total bilirubin ≤ 3.0 x ULN and direct bilirubin ≤ 1.5 x ULN Aspartate transaminase (AST) < 3.0 x ULN, except for patients with liver metastasis, who are only included if AST < 5 x ULN; alanine transaminase (ALT) < 3.0 x ULN, except for patients with liver metastasis, who are only included if ALT < 5 x ULN Creatinine clearance ≥ 30 mL/min Patient has following lab values or has lab values corrected with supplements to be within normal limits at screening: Potassium ≥ LLN Magnesium ≥ LLN Phosphorus ≥ LLN Total calcium (corrected for serum albumin) ≥ LLN Exclusion Criteria: Co-morbid condition(s) that prevent safe surgical treatment Active infection or fever > 38.5°C Patients with known hypersensitivity to any excipients of ceritinib Prior therapy with ceritinib Patients with known history of extensive disseminated bilateral interstitial fibrosis or interstitial lung disease, including a history of pneumonitis, hypersensitivity pneumonitis, interstitial pneumonia, obliterative bronchiolitis, and clinically significant radiation pneumonitis (affecting activities of daily living or requiring therapeutic intervention) Clinically significant uncontrolled heart disease and/or recent cardiac event (within 6 months), such as: history of documented congestive heart failure (New York Heart Association functional classification III-IV); uncontrolled hypertension defined by a Systolic Blood Pressure ≥ 160 mm Hg and/or Diastolic Blood Pressure ≥ 100 mm Hg, with or without antihypertensive medication initiation or adjustment of antihypertensive medication(s) is allowed prior to screening; ventricular arrhythmias; supraventricular and nodal arrhythmias not controlled with medication; other cardiac arrhythmia not controlled with medication; corrected QTc > 450 msec using Fridericia correction on the screening ECG Impaired GI function or GI disease that may alter absorption of ceritinib or inability to swallow up to five ceritinib capsules daily Ongoing GI adverse events > grade 2 (e.g. nausea, vomiting, or diarrhea) at the start of the study Receiving medications that meet 1 of the following criteria and cannot be discontinued at least 1 week prior to start of treatment with ceritinib and for the duration of participation: Medication with a known risk of prolonging the QT interval or inducing Torsades de Pointes Strong inhibitors or strong inducers of CYP3A4/5 Medications with a low therapeutic index that are primarily metabolized by CYP3A4/5, CYP2C8 and/or CYP2C9 Therapeutic doses of warfarin sodium (Coumadin) or any other coumadin-derived anti-coagulant. Anticoagulants not derived from warfarin are allowed Pregnant or nursing (lactating) women. Women of child-bearing potential, unless they are using highly effective methods of contraception during dosing and for 3 months after the last dose of study treatment.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nader Sanai, MD
Organizational Affiliation
Barrow Brain and Spine, Phoenix AZ
Official's Role
Principal Investigator
Facility Information:
Facility Name
Barrow Brain and Spine
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85013
Country
United States

12. IPD Sharing Statement

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Preoperative Ceritinib (LDK378) in Glioblastoma Multiforme and CNS Metastasis

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