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Protein Phosphatase 2A Inhibitor, in Recurrent Glioblastoma

Primary Purpose

Astrocytoma, Grades II, III and IV, Glioblastoma Multiforme, Giant Cell Glioblastoma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
LB-100
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Astrocytoma, Grades II, III and IV focused on measuring Brain Tumor, Blood Brain Barrier, Pharmacokinetics, Pharmacodynamics

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers
  • INCLUSION CRITERIA:
  • Patients must have histologically confirmed glioblastoma/gliosarcoma, grades II-III astrocytoma and oligodendroglioma.
  • Patients must have recurrent disease for which there is a clinical indication for resection.
  • Age greater than or equal to18 years.
  • Karnofsky greater than or equal to 60%.
  • Patients must have adequate bone marrow function (WBC greater than or equal to 3,000/uL ANC greater than or equal to 1,500/mm^3, platelet count of greater than or equal to 100,000/mm^3, and hemoglobin greater than or equal to 10 gm/dL), adequate liver function (SGOT and bilirubin < 2 times ULN). These tests must be performed within 28 days prior to receiving drug. Eligibility level for hemoglobin may be reached by transfusion.
  • Patients must have a serum creatinine of <=1.7 mg/dL. If the serum creatinine is greater than 1.7 mg/dl, a 24-hour urine creatinine clearance will be obtained and if the result of this study is within normal limits*, the patient would be eligible to enroll onto study. This test must be performed within 28 days prior to registrationreceiving drug. (*Normal Creatinine Clearance Range: Male: 90 - 130 ml/min; Female: 80 - 125 ml/min)
  • Patients must be in adequate general medical health to safely tolerate a craniotomy.
  • At the time of registration, all subjects must be removed greater than or equal to 28 days from any investigational agents.
  • The effects of LB100 on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately.
  • Ability of subject to understand and the willingness to sign a written informed consent document indicating that they are aware of the investigational nature of this study, and that this is not a therapeutic clinical trial.

EXCLUSION CRITERIA:

  • Patients who are receiving any other investigational agents.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Patients unwilling to undergo craniotomy.
  • Pregnant women are excluded from this study because the safety of PP2A inhibition on a developing fetus has not been established. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with LB100, breastfeeding should be discontinued if the mother is treated with LB100.
  • Patients may not have had prior chemotherapy or biologic therapy in the 4 weeks prior to study entry. For patients who have been treated with targeted therapy, 5 half-lives of that therapy (or 28 days, whichever is shorter) must have passed prior to enrollment in the study.
  • Known HIV-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with LB100. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated.
  • Patients who are receiving strong CYP450 inducers or inhibitors are ineligible
  • Recruitment Strategies

Patients with recurrent disease will be identified by the Neuro-Oncology Branch, Clinical Center. This study will be posted on NIH websites and on NIH Social media forums.

Sites / Locations

  • National Institutes of Health Clinical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

1/LB100

Arm Description

Treatment with LB100

Outcomes

Primary Outcome Measures

Drug Level in tumor tissue
To determine the pharmacokinetic properties of LB100 in glioblastoma tumor tissues

Secondary Outcome Measures

Relationship between drug concentration at the site of action and the resulting effect and the presence of correlation to identify predictive markers.
Intra-patient PD effect in PBMC and tumor tissue will be evaluated in all subjects for presence of correlation to identify potential predictive markers
Plasma concentration and calculated LB100
determine the plasma concentration and calculated PK parameters of LB100 and LB100M (endothall).
Concentration of LG100 and its major metabolite LB100 in glioblastoma tumor tissue
determine the concentration LB100 and its major metabolite, 7-oxabicyclo [2.2.1] heptanes-2,3-dicarboxylic acid (LB100M) in glioma tumor tissue when a known non-toxic dose of LB100 is delivered intravenously over 2 hours
Changes in phospho-protein expression in circulating PBMC
determine changes in phospho-protein expression in circulating PBMC

Full Information

First Posted
January 18, 2017
Last Updated
July 12, 2023
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT03027388
Brief Title
Protein Phosphatase 2A Inhibitor, in Recurrent Glioblastoma
Official Title
Phase II Trial of LB100, a Protein Phosphatase 2A Inhibitor, in Recurrent Glioblastoma
Study Type
Interventional

2. Study Status

Record Verification Date
July 6, 2023
Overall Recruitment Status
Completed
Study Start Date
January 9, 2019 (Actual)
Primary Completion Date
August 15, 2022 (Actual)
Study Completion Date
August 31, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Background: The brain is separated from the rest of the blood stream by the blood-brain barrier. This is like a filter that protects the brain. But is also a challenge when medicines need to get into the brain. Researchers want to give the new drug LB100 to people before brain tumor surgery. They will measure how much LB100 is in the blood and how much gets into the brain. This may help with the use of LB100 to treat brain tumors in the future. Objective: To see if LB100 can pass into the brain. Eligibility: People at least 18 years old with a brain tumor that requires surgery Design: Participants will be screened with: Physical exam Medical history Blood tests Neurosurgery evaluation Scans Heart tests Tumor sample. This can be from a previous procedure. Participants will have their brain surgery at the Clinical Center. Participants will get a dose of the study drug through a plastic tube in a vein for 2 hours during surgery. Participants will have blood taken 7 times in the 8 hours after getting the study drug. Tumor samples will be taken during surgery. Participants will have a heart test after getting the study drug. Sticky pads on the skin will measure electrical activity of the heart. Two-three weeks after leaving the hospital, participants will have a follow-up visit. They will have a physical exam and blood tests. One month after surgery, they will be contacted in person or by phone to see how they are doing.
Detailed Description
Background: Primary gliomas are an incurable disease in spite of aggressive multimodality therapy consisting of craniotomy, irradiation, and chemotherapy. Therapeutic options for patients with recurrent glioma are limited, and there is an unmet need to identify more effective agents. LB100, a water soluble small molecule novel protein phosphatase 2A (PP2A) inhibitor, was commercially developed through a CRADA based on our previous intramural research. This compound has shown to be effective in a variety of cancer types in both in vitro and in vivo models. Preclinical studies indicate LB100 has in vitro and in vivo activity as a single agent as well as potentiating the effect of cytotoxic agents including temozolomide, docetaxel, doxorubicin, and ionizing radiation. LB100 is active in combination with temozolomide or doxorubicin against xenografts of glioblastoma, neuroblastoma, pheochromocytoma, breast cancer, fibrosarcoma, and melanoma. A complete phase I study of LB100 has established its safety and the recommended phase II dose (2.33 mg/m^2, daily for three days every 3 weeks). Although it is a polar compound, rodent studies suggest LB100 has activity in the brain. Whether LB100 can across the human blood brain barrier (BBB), and at what concentration relative to the plasma level is not known. Characterizing these parameters is important because: 1) Our ongoing in vitro studies indicate that LB100 has distinct mechanisms of action at different drug concentrations (e.g. nM versus uM); 2) There are other brain tumors lacking effective medical therapies but without a BBB. Characterizing the LB100 BBB penetration profile will assist in defining its optimal clinical indication. Objective: -To determine the pharmacokinetic (PK) properties of LB100 in glioma tumor tissues. Eligibility: Patients with histologically proven glioblastoma and grades II-III astrocytomas and oligodendrogliomas. A clear clinical indication for another surgical resection must be present. Subjects must be greater than or equal to 18 years old. Karnofsky performance status of greater than or equal to 60%. Patients must have adequate organ function. Design: This is a two stage Phase II, open label, single institution study to determine the PK and PD profile of LB100. The dose (established from a Phase I study) will be 2.33 mg/m^2 delivered intravenously over 2 hours. PK and PD effect of LB100 treated tissues will only be evaluated with pathologic confirmation of recurrent tumor. Resected material demonstrating chemoradiation treatment effect or inflammatory response will not be included in the analysis. PK will be determined by quantitating LB100 in tumor tissues removed at various time points. The primary endpoint is PK response, defined as a binary variable indicating the presence/absence of LB100 in tumor tissues. PD effect is defined as statistically significant elevation of phospho-proteins in treated tumor tissues compared to untreated glioma specimens. Untreated inter-patient baseline variance and standard deviation (SD) will be calculated. Post-treatment PD effect difference greater than 2.5 times the baseline SD is statistically significant at the .05 significance level. Due to relatively small sample size, t-distribution is to be used to calculate the cutoff defining the PD response. Up to 25 patients may be enrolled to obtain 8 evaluable subjects. A two-stage design will be used. Five patients will be initially treated. If at least one of five demonstrates PK activity, 3 additional subjects will be enrolled. PK effect will be declared to be significant if at least 2 of the 8 patients demonstrate a PK response (presence of LB100 in tumor tissue).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Astrocytoma, Grades II, III and IV, Glioblastoma Multiforme, Giant Cell Glioblastoma, Glioma, Oligodendrogliomas
Keywords
Brain Tumor, Blood Brain Barrier, Pharmacokinetics, Pharmacodynamics

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
7 (Actual)

8. Arms, Groups, and Interventions

Arm Title
1/LB100
Arm Type
Experimental
Arm Description
Treatment with LB100
Intervention Type
Drug
Intervention Name(s)
LB-100
Intervention Description
LB-100 will be infused over 2 hours via IV infusion 2 to 4 hours before surgery. The dose established from a Phase I study will be 2.33 mg/m2.
Primary Outcome Measure Information:
Title
Drug Level in tumor tissue
Description
To determine the pharmacokinetic properties of LB100 in glioblastoma tumor tissues
Time Frame
Post Surgery
Secondary Outcome Measure Information:
Title
Relationship between drug concentration at the site of action and the resulting effect and the presence of correlation to identify predictive markers.
Description
Intra-patient PD effect in PBMC and tumor tissue will be evaluated in all subjects for presence of correlation to identify potential predictive markers
Time Frame
8 hours post infusion
Title
Plasma concentration and calculated LB100
Description
determine the plasma concentration and calculated PK parameters of LB100 and LB100M (endothall).
Time Frame
8 hours post infusion
Title
Concentration of LG100 and its major metabolite LB100 in glioblastoma tumor tissue
Description
determine the concentration LB100 and its major metabolite, 7-oxabicyclo [2.2.1] heptanes-2,3-dicarboxylic acid (LB100M) in glioma tumor tissue when a known non-toxic dose of LB100 is delivered intravenously over 2 hours
Time Frame
8 hours post infusion
Title
Changes in phospho-protein expression in circulating PBMC
Description
determine changes in phospho-protein expression in circulating PBMC
Time Frame
8 hours post infusion

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Patients must have histologically confirmed glioblastoma/gliosarcoma, grades II-III astrocytoma and oligodendroglioma. Patients must have recurrent disease for which there is a clinical indication for resection. Age greater than or equal to18 years. Karnofsky greater than or equal to 60%. Patients must have adequate bone marrow function (WBC greater than or equal to 3,000/uL ANC greater than or equal to 1,500/mm^3, platelet count of greater than or equal to 100,000/mm^3, and hemoglobin greater than or equal to 10 gm/dL), adequate liver function (SGOT and bilirubin < 2 times ULN). These tests must be performed within 28 days prior to receiving drug. Eligibility level for hemoglobin may be reached by transfusion. Patients must have a serum creatinine of <=1.7 mg/dL. If the serum creatinine is greater than 1.7 mg/dl, a 24-hour urine creatinine clearance will be obtained and if the result of this study is within normal limits*, the patient would be eligible to enroll onto study. This test must be performed within 28 days prior to registrationreceiving drug. (*Normal Creatinine Clearance Range: Male: 90 - 130 ml/min; Female: 80 - 125 ml/min) Patients must be in adequate general medical health to safely tolerate a craniotomy. At the time of registration, all subjects must be removed greater than or equal to 28 days from any investigational agents. The effects of LB100 on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Ability of subject to understand and the willingness to sign a written informed consent document indicating that they are aware of the investigational nature of this study, and that this is not a therapeutic clinical trial. EXCLUSION CRITERIA: Patients who are receiving any other investigational agents. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Patients unwilling to undergo craniotomy. Pregnant women are excluded from this study because the safety of PP2A inhibition on a developing fetus has not been established. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with LB100, breastfeeding should be discontinued if the mother is treated with LB100. Patients may not have had prior chemotherapy or biologic therapy in the 4 weeks prior to study entry. For patients who have been treated with targeted therapy, 5 half-lives of that therapy (or 28 days, whichever is shorter) must have passed prior to enrollment in the study. Known HIV-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with LB100. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated. Patients who are receiving strong CYP450 inducers or inhibitors are ineligible Recruitment Strategies Patients with recurrent disease will be identified by the Neuro-Oncology Branch, Clinical Center. This study will be posted on NIH websites and on NIH Social media forums.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Eric C Burton, M.D.
Organizational Affiliation
National Cancer Institute (NCI)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
.BTRIS: All IPD recorded in the medical record will be shared with intramural investigators upon request.
IPD Sharing Time Frame
BTRIS: Clinical data available during the study and indefinitely.
IPD Sharing Access Criteria
BTRIS: Clinical data will be made available via subscription to BTRIS and with the permission of the study PI.
Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?B_2017-C-0037.html
Description
NIH Clinical Center Detailed Web Page

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Protein Phosphatase 2A Inhibitor, in Recurrent Glioblastoma

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