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Dexamethasone and Azeliragon for Management of Post-Resection Cerebral Edema in Patients With Glioblastoma

Primary Purpose

Glioblastoma, Malignant Glioma

Status
Not yet recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Azeliragon
Biospecimen Collection
Computed Tomography
Dexamethasone
Magnetic Resonance Imaging of the Brain with and without Contrast
Sponsored by
City of Hope Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glioblastoma

Eligibility Criteria

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

Inclusion Criteria: Documented informed consent of the participant and/or legally authorized representative Age: >= 18 years Karnofsky performance status of >= 60% Histologically confirmed glioblastoma or radiographic findings consistent with a high grade glioma in patients undergoing surgery for initial diagnosis If midline shift is present on the pre-op brain MRI, it must be less than 10 mm The patient is planning to undergo a standard of care craniotomy, and the neurosurgeon anticipates being able to perform a gross total resection of tumor If a patient is taking more than 3 mg twice daily (bid) of dexamethasone at the time of signing the consent form, it is anticipated by the neurosurgeon that the participant will be able to decrease their dose of dexamethasone to 3 mg bid by 6 days before the surgery Note: If the patient is not able to decrease their dose of dexamethasone to 3 mg BID 6 days before surgery, then the patient will not be allowed to participate in the study The patient is not planning to participate in another clinical trial during the study period The patient has recovered from any acute toxic effects (except alopecia) to =< grade 1 of prior anti-cancer therapy Absolute neutrophil count (ANC) >= 1,000/mm^3 Platelets >= 100,000/mm^3 Total bilirubin =< 1.5 X upper limit of normal (ULN) (unless has Gilbert's disease) Aspartate aminotransferase (AST) =< 1.5 x ULN Alanine aminotransferase (ALT) =< 1.5 x ULN Creatinine clearance of >= 60 mL/min by the Cockcroft-Gault formula International normalized ratio (INR) OR prothrombin (PT) =< 1.5 x ULN Activated partial thromboplastin time (aPTT) =< 1.5 x ULN Corrected QT (QTc) =< 480 ms Note: To be performed within 28 days prior to day 1 of protocol therapy People of childbearing potential: negative urine or serum pregnancy test Agreement by people of childbearing potential to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 3 months after the last dose of protocol therapy Childbearing potential defined as not being surgically sterilized (regardless of gender) or not being free from menses for > 1 year (people with uteri only) Exclusion Criteria: Less than 6 weeks since taking a nitrosourea-containing chemotherapy regimen; less than 4 weeks since completing a non-nitrosourea-containing cytotoxic chemotherapy regimen (except temozolomide: only patients with an interval of less than 23 days from the last dose administered when treated with the temozolomide regimen of daily for 5 days, repeated every 28 days are excluded); less than 2 weeks from taking the last dose of a targeted agent; less than 4 weeks from the last dose of bevacizumab Less than 3 months since focal brain radiation unless recurrent disease has been confirmed surgically or the area of recurrent tumor is outside of the radiation field The patient is taking a medication that is a strong CYP3A4 inducers/ inhibitors within 14 days prior to day -6 of protocol therapy The patient is unwilling to stop taking herbal medications prior to the start of study treatment The patient is taking a hepatic enzyme-inducing anticonvulsant within 14 days prior to day -6 of protocol therapy Clinically significant uncontrolled illness Active infection requiring antibiotics Human immunodeficiency virus (HIV)-positive Undergoing treatment for another cancer Issues with tolerating oral medication (e.g. inability to swallow pills, malabsorption issues, ongoing nausea or vomiting) Chronic or active viral infection of the central nervous system (CNS) Pregnant or breastfeeding Coagulopathy or bleeding disorder Inability to undergo a brain MRI Inability to tolerate dexamethasone Any other condition that would, in the investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)

Sites / Locations

  • City of Hope Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Arm I (azeliragon, dexamethasone)

Arm II (dexamethasone)

Arm Description

Patients receive azeliragon PO and dexamethasone PO or IV throughout the study. Patients also undergo collection of cavity fluid and blood samples, CT scan, and brain MRI with or without contrast throughout the study.

Patients receive dexamethasone PO or IV throughout the study. Patients also undergo collection of cavity fluid and blood samples, CT scan, and brain MRI with or without contrast throughout the study.

Outcomes

Primary Outcome Measures

Lack of feasibility
Defined by exceeding the planned total dose of dexamethasone (per dose level) during post-operative days 1 to 8 by approximately 50%.
Incidence of adverse events
Azeliragon related adverse events and dose limiting toxicity rate assessed per Common Terminology Criteria for Adverse Events version 5.0.

Secondary Outcome Measures

Cytokines/chemokines
Will assess cytokines/chemokines in brain interstitium and peripheral blood. The cytokine and chemokine levels will be measured as concentrations (pg/mL) and reported as a median with range.
Volume of cerebral edema
Will assess volume of cerebral edema for each post-surgery brain magnetic resonance imaging (MRI) as measured qualitatively and quantitatively by manual segmentation and computer assisted techniques.
Azeliragon concentrations
Will assess azeliragon concentrations in tumor samples compared to azeliragon concentrations in blood.

Full Information

First Posted
January 30, 2023
Last Updated
July 3, 2023
Sponsor
City of Hope Medical Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT05773664
Brief Title
Dexamethasone and Azeliragon for Management of Post-Resection Cerebral Edema in Patients With Glioblastoma
Official Title
A Phase I De-Escalation Study of Dexamethasone With Azeliragon for Management of Post-Resection Cerebral Edema in Patients With Glioblastoma
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
October 1, 2023 (Anticipated)
Primary Completion Date
November 29, 2024 (Anticipated)
Study Completion Date
November 29, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
City of Hope Medical Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

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

5. Study Description

Brief Summary
This phase I trial tests the safety, side effects, and best dose of dexamethasone when given with azeliragon in managing cerebral edema after surgery (post-resection) in patients with glioblastoma. Cerebral edema is a pathological increase in the water mass contained within the brain interstitial space. Dexamethasone is in a class of medications called corticosteroids. It is used to reduce inflammation and lower the body's immune response to help lessen the side effects of chemotherapy drugs. Azeliragon is an oral RAGE inhibitor. Blocking the RAGE pathway at the time of surgery (peri-operatively) may decrease cerebral edema. Giving dexamethasone with azeliragon may help control post-operative cerebral edema in decreasing doses of concurrently administered dexamethasone.
Detailed Description
PRIMARY OBJECTIVES: I. Determine the lowest dose of dexamethasone that needs to be co-administered with azeliragon for treatment of post-resection cerebral edema in patients with glioblastoma. II. Assess the safety of administering azeliragon peri-operatively to patients with glioblastoma. SECONDARY OBJECTIVES: I. Describe post-operative changes in levels of cytokines and chemokines in brain interstitium and peripheral blood in study participants. II. Quantitatively assess changes in the volume of cerebral edema post-operatively in study participants. III. Determine brain concentrations of azeliragon in resected tumor tissue from Arm 1 participants. EXPLORATORY OBJECTIVES: I. Describe post-operative changes in levels of RAGE ligands in brain interstitium, peripheral blood, and resection cavity fluid (when possible to obtain) in study participants. II. Describe changes in levels of cytokines, chemokines, and immune cell populations in resection cavity fluid (when possible to obtain). III. Describe differences in levels of cytokines, chemokines and RAGE ligands between patients in Arm 1 and Arm 2. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I: Patients receive azeliragon orally (PO) and dexamethasone PO or intravenously (IV) throughout the study. Patients also undergo collection of cavity fluid and blood samples, computed tomography (CT) scan, and brain magnetic resonance imaging (MRI) with or without contrast throughout the study. ARM II: Patients receive dexamethasone PO or IV throughout the study. Patients also undergo collection of cavity fluid and blood samples, CT scan, and brain MRI with or without contrast throughout the study.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
21 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm I (azeliragon, dexamethasone)
Arm Type
Experimental
Arm Description
Patients receive azeliragon PO and dexamethasone PO or IV throughout the study. Patients also undergo collection of cavity fluid and blood samples, CT scan, and brain MRI with or without contrast throughout the study.
Arm Title
Arm II (dexamethasone)
Arm Type
Active Comparator
Arm Description
Patients receive dexamethasone PO or IV throughout the study. Patients also undergo collection of cavity fluid and blood samples, CT scan, and brain MRI with or without contrast throughout the study.
Intervention Type
Drug
Intervention Name(s)
Azeliragon
Intervention Description
Given PO
Intervention Type
Procedure
Intervention Name(s)
Biospecimen Collection
Other Intervention Name(s)
Biological Sample Collection, Biospecimen Collected, Specimen Collection
Intervention Description
Undergo collection of cavity fluid and blood samples
Intervention Type
Procedure
Intervention Name(s)
Computed Tomography
Other Intervention Name(s)
CAT, CAT Scan, Computed Axial Tomography, Computerized Axial Tomography, Computerized Tomography, CT, CT Scan, tomography
Intervention Description
Undergo CT scan
Intervention Type
Drug
Intervention Name(s)
Dexamethasone
Other Intervention Name(s)
Aacidexam, Adexone, Aknichthol Dexa, Alba-Dex, Alin, Alin Depot, Alin Oftalmico, Amplidermis, Anemul mono, Auricularum, Auxiloson, Baycadron, Baycuten, Baycuten N, Cortidexason, Cortisumman, Decacort, Decadrol, Decadron, Decadron DP, Decalix, Decameth, Decasone R.p., Dectancyl, Dekacort, Deltafluorene, Deronil, Desamethasone, Desameton, Dexa-Mamallet, Dexa-Rhinosan, Dexa-Scheroson, Dexa-sine, Dexacortal, Dexacortin, Dexafarma, Dexafluorene, Dexalocal, Dexamecortin, Dexameth, Dexamethasone Intensol, Dexamethasonum, Dexamonozon, Dexapos, Dexinoral, Dexone, Dinormon, Dxevo, Fluorodelta, Fortecortin, Gammacorten, Hemady, Hexadecadrol, Hexadrol, Lokalison-F, Loverine, Methylfluorprednisolone, Millicorten, Mymethasone, Orgadrone, Spersadex, TaperDex, Visumetazone, ZoDex
Intervention Description
Given PO or IV
Intervention Type
Procedure
Intervention Name(s)
Magnetic Resonance Imaging of the Brain with and without Contrast
Other Intervention Name(s)
Brain Magnetic Resonance Imaging with and without Contrast, Brain MRI, Brain MRI with and without Contrast, Head MRI with and without Contrast
Intervention Description
Undergo MRI with or without contrast
Primary Outcome Measure Information:
Title
Lack of feasibility
Description
Defined by exceeding the planned total dose of dexamethasone (per dose level) during post-operative days 1 to 8 by approximately 50%.
Time Frame
Up to 8 days after surgery
Title
Incidence of adverse events
Description
Azeliragon related adverse events and dose limiting toxicity rate assessed per Common Terminology Criteria for Adverse Events version 5.0.
Time Frame
Up to 30 days post-last dose of protocol therapy
Secondary Outcome Measure Information:
Title
Cytokines/chemokines
Description
Will assess cytokines/chemokines in brain interstitium and peripheral blood. The cytokine and chemokine levels will be measured as concentrations (pg/mL) and reported as a median with range.
Time Frame
Up to 3 days after surgery
Title
Volume of cerebral edema
Description
Will assess volume of cerebral edema for each post-surgery brain magnetic resonance imaging (MRI) as measured qualitatively and quantitatively by manual segmentation and computer assisted techniques.
Time Frame
Up to 8 days after surgery
Title
Azeliragon concentrations
Description
Will assess azeliragon concentrations in tumor samples compared to azeliragon concentrations in blood.
Time Frame
Up to 8 days after surgery

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Documented informed consent of the participant and/or legally authorized representative Age: >= 18 years Karnofsky performance status of >= 60% Histologically confirmed glioblastoma or radiographic findings consistent with a high grade glioma in patients undergoing surgery for initial diagnosis If midline shift is present on the pre-op brain MRI, it must be less than 10 mm The patient is planning to undergo a standard of care craniotomy, and the neurosurgeon anticipates being able to perform a gross total resection of tumor If a patient is taking more than 3 mg twice daily (bid) of dexamethasone at the time of signing the consent form, it is anticipated by the neurosurgeon that the participant will be able to decrease their dose of dexamethasone to 3 mg bid by 6 days before the surgery Note: If the patient is not able to decrease their dose of dexamethasone to 3 mg BID 6 days before surgery, then the patient will not be allowed to participate in the study The patient is not planning to participate in another clinical trial during the study period The patient has recovered from any acute toxic effects (except alopecia) to =< grade 1 of prior anti-cancer therapy Absolute neutrophil count (ANC) >= 1,000/mm^3 Platelets >= 100,000/mm^3 Total bilirubin =< 1.5 X upper limit of normal (ULN) (unless has Gilbert's disease) Aspartate aminotransferase (AST) =< 1.5 x ULN Alanine aminotransferase (ALT) =< 1.5 x ULN Creatinine clearance of >= 60 mL/min by the Cockcroft-Gault formula International normalized ratio (INR) OR prothrombin (PT) =< 1.5 x ULN Activated partial thromboplastin time (aPTT) =< 1.5 x ULN Corrected QT (QTc) =< 480 ms Note: To be performed within 28 days prior to day 1 of protocol therapy People of childbearing potential: negative urine or serum pregnancy test Agreement by people of childbearing potential to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 3 months after the last dose of protocol therapy Childbearing potential defined as not being surgically sterilized (regardless of gender) or not being free from menses for > 1 year (people with uteri only) Exclusion Criteria: Less than 6 weeks since taking a nitrosourea-containing chemotherapy regimen; less than 4 weeks since completing a non-nitrosourea-containing cytotoxic chemotherapy regimen (except temozolomide: only patients with an interval of less than 23 days from the last dose administered when treated with the temozolomide regimen of daily for 5 days, repeated every 28 days are excluded); less than 2 weeks from taking the last dose of a targeted agent; less than 4 weeks from the last dose of bevacizumab Less than 3 months since focal brain radiation unless recurrent disease has been confirmed surgically or the area of recurrent tumor is outside of the radiation field The patient is taking a medication that is a strong CYP3A4 inducers/ inhibitors within 14 days prior to day -6 of protocol therapy The patient is unwilling to stop taking herbal medications prior to the start of study treatment The patient is taking a hepatic enzyme-inducing anticonvulsant within 14 days prior to day -6 of protocol therapy Clinically significant uncontrolled illness Active infection requiring antibiotics Human immunodeficiency virus (HIV)-positive Undergoing treatment for another cancer Issues with tolerating oral medication (e.g. inability to swallow pills, malabsorption issues, ongoing nausea or vomiting) Chronic or active viral infection of the central nervous system (CNS) Pregnant or breastfeeding Coagulopathy or bleeding disorder Inability to undergo a brain MRI Inability to tolerate dexamethasone Any other condition that would, in the investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jana L Portnow
Organizational Affiliation
City of Hope Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
City of Hope Medical Center
City
Duarte
State/Province
California
ZIP/Postal Code
91010
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Jana L. Portnow
Phone
626-218-9200
Email
jportnow@coh.org
First Name & Middle Initial & Last Name & Degree
Jana L. Portnow

12. IPD Sharing Statement

Learn more about this trial

Dexamethasone and Azeliragon for Management of Post-Resection Cerebral Edema in Patients With Glioblastoma

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