Overview
The objective of this study is to assess the tolerability, safety, and efficacy of Liposomal Curcumin (LC) in combination with radiotherapy (RT) and Temozolomide (TMZ) in patients with newly diagnosed High-Grade Gliomas (HGG).
Description
This study is a Phase 1/2, single-center, single-institution, open-label, dose-escalation study in patients with newly diagnosed high-grade malignant gliomas. Dose finding will be performed using a time-to-event Bayesian optimal interval (TITE-BOIN) rule-based schema.
The primary objectives of the study are to determine the maximum tolerated dose /recommended phase 2 dose of Liposomal Curcumin (LC) in combination with radiotherapy (RT), and TMZ and adjuvant TMZ in newly diagnosed High-Grade Gliomas, and to determine the safety and tolerability of LC IV infused over 3-hours.
The secondary objectives are to estimate the safety and tolerability of LC in combination with standard RT and TMZ and adjuvant TMZ, to determine the feasibility of weekly LC infusion, defined as the number of patients being able to complete 80% of the planned doses of LC, 80% of RT, and 60% of TMZ within the first 10 weeks of treatment, and to assess efficacy as defined by overall survival (OS) and progression free survival (PFS) observed for each dose level.
This study is an unblinded, sequential treatment intervention employing 3 dose levels.
Approximately 50 patients will be screened to achieve up to 30 patients assigned to study intervention.
The duration of treatment for each patient will be up to 34 weeks. Treatment starts with the beginning of infusion and ends, if tolerated, at the end of Cycle 6 of adjuvant TMZ.
Eligibility
Inclusion Criteria:
- ≥18 years of age
- Histologically confirmed HGG (WHO grade III or IV, including GBM, astrocytoma, gliosarcoma, H3K27M mutant diffuse midline glioma). Patients with methylated or unmethylated O(6)-methylguanine-DNA methyltransferase (MGMT) promoter are eligible, as are IDH WT and mutant patients as long as the treatment plan is for combined RT/TMZ. The neuropathologic diagnosis of HGG will be made at the respective institution. If any question arises regarding the accuracy of the neuropathologic diagnosis, slides (and pathological blocks, if necessary) will be centrally reviewed
- Planning standard therapy with TMZ and RT for 6 weeks
- Karnofsky Performance Scale (KPS) ≥ 60%
Adequate organ and marrow function defined as:
- Hgb > 9 g/dL
- ANC ≥ 1500/µL
- Platelet count ≥ 100,000/µL
- Total bilirubin ≤ 1.5 * institutional ULN
- AST and ALT ≤ 3 * institutional ULN
- Creatinine ≤ 1.5 * institutional ULN OR
- Estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 unless data exist supporting safe use at lower values of renal function, but eGFR must be ≥ 30 mL/min/1.73 m2
- Patients with human immunodeficiency virus (HIV) who are on effective antiretroviral
therapy are eligible if the viral load was assessed as undetectable within 6 months prior to baseline
- Women: WOCBP must agree to use adequate contraception (hormonal or barrier method of birth control or abstinence) prior to study entry and for the duration of study participation
- Men: must agree to use adequate contraception prior to study entry, for the duration of study participation, and for 4 months after completion of LC administration
Exclusion Criteria:
- Any concurrent cancer diagnosis that is untreated, actively treated, or has undergone any therapy (RT, cytotoxic, targeted, immunotherapeutic, etc) within 2 years of study enrollment, with the exception of squamous or basal cell skin cancer
- Patient has not recovered from AEs due to prior anticancer therapy (ie, residual toxicities > Grade 1), with the exception of alopecia
- Receiving any other investigational agent
- Active infection requiring systemic antibiotics
- History of allergic reaction to compounds that are chemically or biologically similar to LC (see Protocol Section 5.5.1.2 and Section 5.5.1.3 of protocol)
- Patient is taking a medication that may potentiate hemolysis
- Unstable angina or myocardial infarction within the past 6 months
- Prolonged QTc interval, Bazett formula (QTcB) (> 450 msec for males or > 460 msec for females)
- Psychiatric illness or social situation that could limit compliance with study r requirements
- Pregnant or breastfeeding