Phase I Study of Oral ONC206 in Recurrent and Rare Primary Central Nervous System Neoplasms

This is an interventional treatment trial for Central Nervous System Neoplasms focused on measuring Glioblastoma, Anaplastic Astrocytoma, Anaplastic Oligodendroglioma, Diffuse Astrocytoma, Oligodendroglioma Read More

Inclusion Criteria:

• Age ≥ 18 years with a recurrent, primary CNS neoplasm. Primary CNS neoplasms included in this study: glioblastoma and glioblastoma histologic subtypes, gliosarcoma, primary CNS sarcomas, anaplastic glial neoplasms including anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic mixed neuronal-glial tumors, and pilocytic astrocytoma with anaplastic features, diffuse astrocytoma, oligodendroglioma, gliomatosis cerebri, pleomorphic xanthoastrocytoma, anaplastic pleomorphic xanthoastrocytoma, diffuse midline gliomas and histone mutated gliomas, ependymoma, anaplastic ependymoma, and all ependymoma subtypes, medulloblastoma and all medulloblastoma subtypes, atypical teratoid/rhabdoid tumor, primary CNS embryonal/primitive neuroectodermal tumors, atypical and anaplastic meningiomas, choroid plexus tumors, and pineal region tumors.
• Patients must have recurrent and measurable disease as defined by RANO criteria, using either the HGG and/or low-grade glioma (LGG) RANO criteria based on tumor type, after having received established standard of care treatment for their disease and have no standard treatment options available as determined by the investigators.
• There is no limit on the number of total recurrences or prior therapies. However, prior therapies with known clinical benefit (including radiation) for specific tumor types are required. Karnofsky Performance Score (KPS) of greater than or equal to 70.
• Washout for prior investigational or approved cytotoxic chemotherapy is 28 days prior to the first dose of ONC206; 42 days in the case of nitrosoureas; 28 days or 5 half-lives (whichever is less; but not less than 14 days) in case of investigational or approved molecularly targeted agent; 14 days in the case of radiotherapy.
• Patients will be required to enroll on the NCI Neuro-Oncology Branch natural history study (16-C-0151).
• No major surgery in the prior 4 weeks
• Patients must have normal organ and marrow function
• An available tumor specimen (paraffin-embedded block and/or frozen tissue) from prior resection or biopsy, ≥15 unstained slides for IHC analysis.
• Ability to swallow oral capsules.
• Ability to tolerate an MRI study with intravenous gadolinium contrast.
• Patients must be fully vaccinated for coronavirus disease 2019 (COVID-19), as defined by the Center for Disease Control guidance for patients who are immunocompromised. Patients must have received required vaccination(s) by the time of signing consent and be considered fully immunized (typically 2 weeks after final vaccination) by the first dose of study drug (Cycle 1, Day 1).
• Patients must have a negative COVID-19 test within 72 hours of the first dose of study drug (Cycle 1, Day 1).
• Patients must agree to follow study site requirements to limit transmission of COVID-19, such as wearing masks, social distancing, and maintaining good hand hygiene even after vaccination.

Exclusion Criteria:

• Known HIV-positive test on combination antiretroviral therapy
• Active cardiac disease
• Ischemic or hemorrhagic stroke in last 3 months
• Refractory epilepsy and patients with primary or secondarily generalized seizures in the 28 days before enrollment are excluded. Peri-operative seizures occurring within 7 days of surgery with resolution by day 8 after surgery are allowable. Patients must be on stable doses of one or two seizure medications for 14 days prior to study enrollment.
• Impairment of gastrointestinal (GI) function
• Patients who have been treated with any hematopoietic colony-stimulating growth factors (CSFs) (e.g., granulocyte-CSF, granulocyte-macrophage-CSF) ≤2 weeks prior to starting study drug.
• Concurrent use of warfarin sodium or other Coumadin-derivative anti-coagulants.
• Concurrent use of strong inhibitors or inducers of CYP3A4, 2D6, 1A2, 2C9 and 2C19 are excluded at least 14 days prior to and throughout the study.
• Women of childbearing potential, defined as all women physiologically capable of becoming pregnant, or men who do not agree to use highly-effective contraception during treatment and for 16 additional weeks after the final dose of study drug.