Clinical Study on the Safety and Tolerability of Macitentan in Combination With Dose-dense Temozolomide in Patients With Recurrent Glioblastoma

A Phase 1/1b, Open-label Study in Patients With Recurrent Glioblastoma to Assess the Safety and Tolerability of Macitentan in Combination With Dose-dense Temozolomide

This is an open-label, single arm, Phase 1 study to assess the safety and tolerability of macitentan in combination with dose-dense temozolomide in adult patients with recurrent glioblastoma or gliosarcoma. The study is composed of three parts. A Phase 1 Dose Escalation Period with a traditional 3+3 design will determine the maximum tolerated dose of macitentan in combination with dose-dense temozolomide. A Phase 1b Period will expand the safety and tolerability data of two doses of macitentan and dose-dense temozolomide selected from the Dose Escalation Period and explore efficacy. An Ancillary Study will further evaluate the effects of macitentan on biomarkers in brain tumor tissue.

The study is planned to have a minimum duration of 12 months. The study will end when all patients (excluding those prematurely withdrawn or lost to follow-up) in each part of the study have completed a visit at month 12 and 30 days of safety follow-up.

Study Overview

• Status: Terminated
• Conditions: Glioblastoma
• Intervention / Treatment: Drug: Phase 1 Dose Escalation; Drug: Phase 1b; Drug: Ancillary Study

• Study Type: Interventional
• Enrollment (Anticipated): 75
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • MD Anderson Cancer Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria

• Histologically confirmed glioblastoma multiforme or gliosarcoma

• Recurrent disease with an:

  • interval of at least 3 months following initial radiotherapy and temozolomide
  • interval of at least 3 weeks between end of surgery for recurrent disease and start of protocol therapy for patients who have undergone surgery for recurrent disease
• KPS 60% or higher
• Adequate bone marrow function Women of childbearing potential must have a negative serum beta-HCG pregnancy test documented within 14 days prior to study initiation.
• Women of childbearing potential must agree to use two reliable methods of contraception from screening and up to 30 days after discontinuation of study treatment.
• Males not naturally or surgically sterile, who have a female partner of childbearing potential, must agree to use two reliable methods of contraception from screening and up to 30 days after discontinuation of study treatment.

Exclusion Criteria

• Histology other than astrocytoma grade IV (GBM or gliosarcoma)
• Tumor foci below the tentorium or or beyond the cranial vault
• Glioblastoma or gliosarcoma disease with leptomeningeal spread
• Patients with a history of any other cancer, unless in complete remission, and off all therapy for that disease for a minimum of 5 years
• Elevated serum aspartate aminotransferase, alanine aminotransferase, or bilirubin (unless there is medical justification for bilirubin elevation, and aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase are normal)
• Moderate to severe hepatic impairment
• Confirmed systolic blood pressure < 100 mmHg or diastolic blood pressure < 50 mmHg
• History of orthostatic hypotension
• Renal insufficiency or serum creatinine above the normal reference range
• Prior chemotherapy for recurrent glioblastoma with nitrosourea compounds or bevacizumab
• Prior focal radiotherapy
• Severe, active co-morbidity (e.g. cardiac disease; respiratory disease; chronic hepatitis; hematological and bone marrow diseases; severe malabsorption)
• No other active cancer
• No concurrent cytochrome P450 3A4 inducers
• No concurrent strong cytochrome P450 3A4 inhibitors
• No other concurrent investigational agents

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: NA
• Interventional Model: SINGLE_GROUP
• Masking: NONE

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

EXPERIMENTAL: Macitentan; Macitentan in combination with dose-dense temozolomide

Drug: Phase 1 Dose Escalation; Macitentan 30, 60, 90 mg or higher in 30 mg dose increments, given orally, up to 150 mg, then 225 mg, 300 mg and 375 mg, unless otherwise decided by the Safety Monitoring Committee. Dose-dense temozolomide 150 mg/m2 body surface area alternating 1 week on 1 week off.; Other Names: Macitentan; dose-dense temozolomide; Drug: Phase 1b; Macitentan given orally and daily at doses/schedule determined from the dose escalation period. Dose-dense temozolomide 150mg/m2 body surface area alternating 1 week on 1 week off.; Other Names: Macitentan; dose-dense temozolomide; Drug: Ancillary Study; Macitentan dosed initially for 8-14 days prior to craniotomy, then treatment interrupted from time of craniotomy until 7 days before start of dose dense temozolomide therapy. dose-dense temozolomide 150 mg/m2 body surface area alternating 1 week on 1 week off.; Other Names: Macitentan; dose-dense temozolomide

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
To determine the maximum tolerated dose of macitentan in combination with dose-dense temozolomide	Phase I Dose Escalation period (Dose-Limiting Toxicity from Baseline to 28 days for each dose level)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of patients with treatment-emergent adverse events (AEs) and serious AEs	for all study periods	Participants will be followed up for the duration of combination treatment, an expected average of 9-12 months.
Number of patients with AEs leading to premature discontinuation of study treatment	for all study periods	Participants will be followed up for the duration of combination treatment, an expected average of 9-12 months.
Incidence of treatment-emergent* marked laboratory abnormalities	for all study periods	Participants will be followed up for the duration of combination treatment, an expected average of 9-12 months.
Number of patients with treatment-emergent ECG abnormalities	for all study periods	Up to 30 days after discontinuation of macitentan
Change from baseline in vital signs	for all study periods: systolic and diastolic blood pressure [supine and standing], average of the two measurements and pulse rate.	Up to 30 days after discontinuation of macitentan
Occurrence of at least grade 2 ALT and/or AST elevation	for all study periods	Participants will be followed up for the duration of combination treatment, an expected average of 9-12 months.

Collaborators and Investigators

• Sponsor: Actelion

Publications and helpful links

General Publications

• Weathers SP, Rood-Breithaupt J, de Groot J, Thomas G, Manfrini M, Penas-Prado M, Puduvalli VK, Zwingelstein C, Yung WKA. Results of a phase I trial to assess the safety of macitentan in combination with temozolomide for the treatment of recurrent glioblastoma. Neurooncol Adv. 2021 Oct 2;3(1):vdab141. doi: 10.1093/noajnl/vdab141. eCollection 2021 Jan-Dec.

Study record dates

Study Major Dates

• Study Start: January 1, 2012
• Primary Completion (ACTUAL): January 1, 2016
• Study Completion (ACTUAL): April 1, 2016

Study Registration Dates

• First Submitted: December 20, 2011
• First Submitted That Met QC Criteria: December 22, 2011
• First Posted (ESTIMATE): December 26, 2011

Study Record Updates

• Last Update Posted (ESTIMATE): May 5, 2016
• Last Update Submitted That Met QC Criteria: May 4, 2016
• Last Verified: May 1, 2016

More Information

Terms related to this study

• Keywords: glioblastoma
• Additional Relevant MeSH Terms: Neoplasms by Histologic Type; Neoplasms; Neoplasms, Glandular and Epithelial; Astrocytoma; Glioma; Neoplasms, Neuroepithelial; Neuroectodermal Tumors; Neoplasms, Germ Cell and Embryonal; Neoplasms, Nerve Tissue; Glioblastoma; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Antineoplastic Agents, Alkylating; Alkylating Agents; Endothelin Receptor Antagonists; Endothelin A Receptor Antagonists; Endothelin B Receptor Antagonists; Temozolomide; Macitentan
• Other Study ID Numbers: AC-055-115