Dose-Escalation Study of TPI 287 + Avastin Followed by Randomized Study of the Same Versus Avastin for Glioblastoma



Status:Suspended
Conditions:Brain Cancer
Therapuetic Areas:Oncology
Healthy:No
Age Range:18 - Any
Updated:4/17/2018
Start Date:August 2013
End Date:March 2019

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Phase 1/2 Dose-Escalation Study of TPI 287 in Combination With Bevacizumab Followed by Randomized Study of the Maximum Tolerated Dose of TPI 287 in Combination With Bevacizumab Versus Bevacizumab Alone in Adults With Recurrent Glioblastoma

This trial is divided into two parts, a dose-escalation study (phase 1) and a randomized
study (phase 2).

The purpose of the dose-escalation study (phase 1) is to determine the safety, maximum
tolerated dose (MTD), and efficacy of TPI 287 in combination with Avastin (bevacizumab) in
subjects who have glioblastoma multiforme (GBM) that has progressed following prior radiation
therapy and temozolomide (TMZ).

The purpose of the randomized study (phase 2) is to determine the safety and efficacy of the
phase 1 MTD of TPI 287 in combination with bevacizumab versus bevacizumab alone in subjects
who have GBM that has progressed following prior radiation therapy and TMZ.

This multi-center trial is a phase 1/2 study that will be conducted in two sequential phases,
phase 1 and phase 2.

Phase 1 of the trial is a dose-escalation study of the safety, tolerability (MTD), and
efficacy of TPI 287 in combination with bevacizumab in subjects who have GBM that has
progressed following prior radiation therapy and TMZ.

- All subjects will be administered TPI 287 as an intravenous (IV) infusion (target
duration of 1 hour) once every 3 weeks (Days 1 and 22 of a 42-day cycle) and bevacizumab
as a 30 to 90 minute IV infusion once every 2 weeks (Days 1, 15, and 29 of the 42-day
cycle). The subsequent cycle will start 3 weeks after the last TPI 287 infusion and 2
weeks after the last bevacizumab infusion, maintaining the once every 3 week and once
every 2 week schedule, respectively.

- The dose of TPI 287 will be escalated in sequential dose cohorts of 3 to 6 subjects,
while the dose of bevacizumab remains constant (10 mg/kg). The initial cohort of 3
subjects will be treated at a TPI 287 dose of 140 mg/m2. The next four dose levels will
be 150, 160, 170, and 180 mg/m2. Dose levels beyond 180 mg/m2 will be increased in
increments of 20 mg/m2 (i.e., 200, 220, 240 mg/m2, etc.).

- Once a dose level is identified that exceeds the MTD, dose de-escalation will be used to
further refine the MTD. Specifically, 3 subjects will be treated at an intermediate dose
level, halfway between the dose level that exceeded the MTD and the dose level
immediately prior (e.g., 230 mg/m2, if 240 mg/m2 exceeded the MTD).

- Subjects will be assigned to dose cohorts in the order that they are enrolled; there is
no randomization for phase 1. Approximately 20 to 32 subjects are planned for enrollment
in phase 1, depending on the dose level at which dose limiting toxicities (DLTs) are
observed.

- Dose modifications and delays will be required as described in the protocol. Subjects
may continue on treatment unless they meet one or more of the discontinuation criteria
outlined in the protocol. Subjects who are discontinued prior to completing Cycle 1 for
any reason other than toxicity will be replaced.

- Adverse events (AEs) and concomitant medications will be monitored throughout the study.
Subjects will be given a diary to record any AEs or concomitant medications taken
between visits. Additional safety evaluations will include physical examination
(including neurologic examination), Karnofsky performance status (KPS), weight (body
surface area, BSA), vital signs, hematology, serum chemistry, and urinalysis.

- Efficacy evaluations will include magnetic resonance imaging [MRI, including both pre
and post-gadolinium T1-weighted scans and T2/fluid attenuated inversion recovery (FLAIR)
images], corticosteroid usage, and neurologic status (as measured by neurologic exam and
KPS).

Phase 2 of the trial is a randomized study of the safety and efficacy of the phase 1 MTD of
TPI 287 in combination with bevacizumab versus bevacizumab alone in subjects who have GBM
that has progressed following prior radiation therapy and TMZ.

- Sixty subjects will be randomized 1:1 to receive either TPI 287 in combination with
bevacizumab or bevacizumab alone.

- For the combination arm, the subjects will be administered TPI 287 as an IV infusion
(target duration of 1 hour) once every 3 weeks (Days 1 and 22 of a 42-day cycle) and
bevacizumab as a 30 to 90 minute IV infusion once every 2 weeks (Days 1, 15, and 29 of
the 42-day cycle). The dose of TPI 287 will be the MTD determined in phase 1, and the
dose of bevacizumab will be the same as phase 1 (10 mg/kg).

- Subjects randomized to the bevacizumab alone arm will be administered 10 mg/kg
bevacizumab as a 30 to 90 minute IV infusion once every 2 weeks (Days 1, 15, and 29 of
the 42-day cycle).

- The same dose modifications and delays required in phase 1 will apply to phase 2.
Subjects may continue on treatment unless they meet one or more of the discontinuation
criteria outlined in the protocol. There will be no subject replacement for phase 2 of
the trial.

- The safety and efficacy evaluations during phase 2 will be the same as those in phase 1.
In addition, subjects participating in phase 2 will be telephoned every two months
following the final study visit (4 weeks after the last dose of study drug) for up to
two years after randomization to follow survival.

- Subjects that participate in phase 1 of the trial will not be eligible to participate in
phase 2 of the trial.

Inclusion Criteria:

1. Histologically proven GBM

2. Disease progression following radiation and TMZ

3. Up to 2 prior relapses allowed

4. Baseline MRI within 17 days of Day 1 & on steroid dosage that has been stable or
decreasing for at least 5 days

5. Recent resection of recurrent or progressive tumor allowed as long as at least 4 weeks
have elapsed from date of surgery and the subject has recovered from surgery

6. Life expectancy >12 weeks

7. Eighteen years old or older

8. KPS equal to or greater than 70

9. Recovered from toxic effects of prior therapy to < Grade 2 per National Cancer
Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) prior to Day 1.
Minimum duration required between prior therapy and Day 1 is:

1. At least 12 weeks from completion of radiation therapy except if there is
unequivocal evidence for tumor recurrence in which case at least 4 weeks

2. 4 weeks from prior cytotoxic therapy

3. 4 weeks from prior experimental drug

4. 6 weeks from nitrosoureas

5. 3 weeks from procarbazine

6. 1 week for non-cytotoxic agents, such as interferon, tamoxifen, & cis-retinoic
acid

10. Adequate bone marrow function (absolute neutrophil count > 1,500/mm3 and platelet
count of > 100,000/mm3), adequate liver function [ALT and AST <3 x upper limit normal
(ULN), alkaline phosphatase <2 x ULN, and total bilirubin <1.5 mg/dL], & adequate
renal function (BUN and creatinine <1.5 x ULN)

11. Minimum hemoglobin of 9 g/dL

12. Males & women of childbearing potential must agree to abstain from sex or use an
adequate method of contraception for the duration of study, & for 6 months after last
dose of study drug

13. Signed & dated informed consent prior to Screening evaluations

Exclusion Criteria:

1. Radiographic evidence of contrast-enhancing tumor crossing midline, leptomeningeal
dissemination, gliomatosis cerebri or infratentorial tumor

2. Evidence or suspicion of disease metastatic to sites remote from the supratentorial
brain

3. Prior treatment with bevacizumab or other anti-vascular endothelial growth factor
(VEGF) drugs

4. Prior treatment with tyrosine-kinase inhibitors targeting VEGF, platelet-derived
growth factor, fibroblast growth factor, tyrosine kinase with immunoglobulin-like and
epidermal growth factor-like domains 2 (TIE-2), or angiopoietin (or their receptors)

5. Prior treatment with histone deacetylase inhibitors or mammalian target of rapamycin
(mTOR) inhibitors

6. Prior treatment with TPI 287

7. Treatment with Enzyme-Inducing Anti-Epileptic Drugs within 2 weeks prior to Day 1

8. Treatment with drugs or herbal supplements known to be strong inhibitors/inducers of
cytochrome P450 3A4 or cytochrome P450 2C8 within 2 weeks prior to Day 1

9. Received more than one course of radiation therapy or more than a total dose of 65 Gy.
May have received radiosurgery as part of initial therapy; however, the dose counts
against the total dose limit.

10. Prior taxane, vincristine, or other microtubule inhibitor chemotherapies for treatment
of GBM or other malignancy

11. Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
prior to Day 1 or anticipation of need for major surgical procedure during the course
of the study

12. Core biopsy or other minor surgical procedure, excluding placement of a vascular
access device, within 7 days prior to Day 1

13. Any condition, including the presence of clinically significant laboratory
abnormalities, which places subject at unacceptable risk if he/she were to participate
in the study or confounds the ability to interpret data from the study, including:

1. Active infection including known AIDS or Hepatitis C or with a fever ≥38.5°C
within 3 days prior to enrollment

2. Diseases or conditions that obscure toxicity or dangerously alter drug metabolism

3. Serious intercurrent medical illness (e.g., symptomatic congestive heart failure)

14. Any serious medical condition, laboratory abnormality, or psychiatric illness that
would prevent the subject from providing informed consent

15. Inadequately controlled hypertension (defined as systolic blood pressure >140 mmHg
and/or diastolic blood pressure > 90 mmHg)

16. Prior history of hypertensive crisis or hypertensive encephalopathy

17. New York Heart Association Grade II or greater congestive heart failure

18. History of myocardial infarction or unstable angina within 6 months prior to Day 1

19. History of stroke or transient ischemic attack within 6 months prior to Day1

20. Significant vascular disease (e.g., aortic aneurysm, requiring surgical repair or
recent peripheral arterial thrombosis) within 6 months prior to Day 1

21. History of hemoptysis (≥ 1/2 teaspoon of bright red blood per episode) within 1 month
prior to Day 1

22. Evidence of bleeding diathesis or significant coagulopathy (in the absence of
therapeutic anticoagulation)

23. Grade 2 or higher peripheral neuropathy per NCI CTCAE

24. History of abdominal fistula or gastrointestinal perforation within 6 months prior to
Day 1

25. Serious, non-healing wound, active ulcer, or untreated bone fracture

26. Proteinuria at Screening. Subjects with a urine dipstick protein ≥2+ at Screening
should undergo a 24-hour urine collection and must demonstrate ≤1g of protein in 24
hours to be eligible

27. Known hypersensitivity to inactive ingredient of bevacizumab

28. Known hypersensitivity to inactive ingredient of TPI 287

29. Pregnancy or lactation

30. Inability to comply with protocol
We found this trial at
9
sites
1720 2nd Ave S
Birmingham, Alabama 35233
(205) 934-4011 
Principal Investigator: Louis B. Nabors, III, M.D.
Phone: 205-934-1842
University of Alabama at Birmingham The University of Alabama at Birmingham (UAB) traces its roots...
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Birmingham, AL
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601 Elmwood Avenue
Rochester, New York 14642
(585) 275-2100
Principal Investigator: Nimish Mohile, M.D.
Phone: 585-276-3971
Univ of Rochester Medical Center One of the nation's top academic medical centers, the University...
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Rochester, NY
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410 W 10th Ave
Columbus, Ohio 43210
(614) 293-8652
Principal Investigator: Pierre Giglio, M.D.
Phone: 614-293-5554
The Ohio State University, Wexner Medical Center Located in Columbus, The Ohio State University Wexner...
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Columbus, OH
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Commack, NY
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92 2nd St
Hackensack, New Jersey 07601
(201) 996-5900
Principal Investigator: Samuel A. Goldlust, M.D.
Phone: 551-996-5098
John Theurer Cancer Center at the Hackensack University Medical Center The mission of the John...
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Houston, Texas 77030
Principal Investigator: Sigmund Hsu, M.D.
Phone: 713-704-2359
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Houston, TX
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Lake Success, NY
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660 S Euclid Ave
Saint Louis, Missouri 63110
(314) 362-5000
Washington University School of Medicine Washington University Physicians is the clinical practice of the School...
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Saint Louis, MO
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Seattle, Washington 98122
Principal Investigator: Tara L. Benkers, M.D.
Phone: 206-320-3542
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Seattle, WA
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