- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04757662
Tadalafil to Overcome Immunosuppression During Chemoradiotherapy for IDH-wildtype Grade III-IV Astrocytoma
June 12, 2023 updated by: Washington University School of Medicine
A Phase IB Study to Use Tadalafil to Overcome Immunosuppression During Chemoradiotherapy for IDH-wildtype Grade III-IV Astrocytoma
Increasing preclinical and clinical data have shown that myeloid-derived suppressor cells (MDSCs) may represent a significant driver of immunosuppression in glioblastoma (GBM, grade IV astrocytoma) and a potential mechanism of treatment resistance to chemoradiotherapy.
Tadalafil, an FDA-approved drug with inexpensive cost and excellent safety profile, has been shown to effectively reduce MDSCs and restore T-cell activation in the peripheral blood and in the tumor microenvironment.
The purpose of this study is to investigate the impact of targeting MDSCs in newly diagnosed IDH-wildtype grade III-IV astrocytoma by combining tadalafil with standard of care radiation therapy (RT) and temozolomide (TMZ).
Study Overview
Status
Completed
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
18
Phase
- Phase 1
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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Missouri
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Saint Louis, Missouri, United States, 63110
- Washington University School of Medicine
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
16 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Histologically proven diagnosis of newly diagnosed supratentorial high-grade astrocytoma (WHO grade III-IV), excluding astrocytoma of brainstem and cerebellum. However, supratentorial astrocytoma with extension to the brainstem and cerebellum is allowed at discretion of the PI. Gliosarcoma or other subvariants are allowed, including the newly defined "diffuse astrocytoma, IDH-wildtype, with molecular features of glioblastoma, WHO grade IV" (Brat et al., 2018).
Must have recovered from the effects of surgery, postoperative infection, and other complications sufficiently that they can proceed with RT and TMZ.
-≥ 18 years of age.
- Eligible for and planning to receive standard fractionated RT of 60 Gy with concurrent TMZ.
- Karnofsky performance status ≥ 60.
- Available archival formalin-fixed paraffin-embedded (FFPE) tumor blocks.
Adequate organ and bone marrow function as defined below:
- Absolute neutrophil count (ANC) ≥ 1,500 cells/mm3;
- Platelets ≥ 100,000 cells/mm3;
- Hemoglobin > 9.0 g/dL (Note: the use of transfusion or other intervention to achieve Hgb >9.0 g/dL is acceptable);
- Total bilirubin ≤ 1.5 upper limit of normal (ULN)
- AST (SGOT) and ALT (SGPT) ≤ 3 x ULN
- Creatinine ≤ 1.5 ULN or creatinine clearance ≥ 60 mL/min
- If there is history of human immunodeficiency virus (HIV) infection, patients must be on effective antiretroviral therapy, and HIV viral load must be undetectable within 6 months of study enrollment.
- If there is history of chronic hepatitis B virus (HBV) infection, patients must have either been treated or are on suppressive therapy (as indicated), and HBV viral load must be undetectable.
- If there is history of hepatitis C virus (HCV) infection, patients must have been treated, and HCV viral load must be undetectable.
- Females of childbearing potential (defined as a female who is non-menopausal or surgically sterilized) must be willing to use an acceptable method of birth control (i.e., hormonal contraceptive, intra-uterine device, diaphragm with spermicide, condom with spermicide, or abstinence) for the duration of the study. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately.
- Able to understand and willing to sign an IRB-approved written informed consent document (legally authorized representative permitted).
Exclusion Criteria:
- Prior cranial RT or RT to the head and neck where potential field overlap may exist
- Gliomatosis, leptomeningeal, or metastatic involvement.
- High-grade glioma with known IDH mutation. IDH status could be determined by either immunohistochemistry (IDH1-R132H mutation) or sequencing (including other uncommon variants of IDH1 and IDH2 mutations) as evaluated routinely for clinical diagnosis using a CLIA-approved assay.
- Known severe hypersensitivity to tadalafil or other PDE5 inhibitors, including history of hypotension, priapism (painful erection > 4 hours duration), blindness, or hearing loss during prior treatment with tadalafil or other PDE5 inhibitors.
- Concurrent nitrate, alpha-blocker, guanylate cyclase stimulators (eg, riociguat), or cytochrome P-450 3A4 (CYP3A4) inhibitor use. CYP3A4 inhibitors include ketoconazole, itraconazole, and ritonavir.
Severe, active co-morbidity, defined as follows:
- Unstable angina, angina requiring treatment with nitrates, positive cardiac stress test without evidence of subsequent effective cardiac intervention within 90 days of planned tadalafil administration
- Myocardial infarction, coronary artery bypass graft surgery, or percutaneous coronary angioplasty or stent within the 90 days of planned tadalafil administration
- New York Heart Association grade II or greater congestive heart failure within 6 months
- Serious and inadequately controlled arrhythmia
- Hypotension (<90/50 mm Hg) or uncontrolled hypertension (>170/100 mm Hg)
- Left ventricular outflow obstructions, such as aortic stenosis
- Stroke within the last 6 months
- Acute bacterial or fungal infection requiring intravenous antibiotics.
- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects; note, however, that laboratory tests for coagulation parameters are not required for entry into this protocol.
- Active peptic ulcer disease.
- End-stage renal disease (ie, on dialysis or dialysis has been recommended).
- Unilateral blindness, hereditary retinal disorder, including retinitis pigmentosa.
- Patients treated on any other therapeutic clinical protocols within 30 days prior to registration.
- Inability to undergo contrast-enhanced MRI (e.g., due to safety reasons, such as presence of a pacemaker, or severe claustrophobia).
- Pregnant or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 14 days of study entry.
- Patients with psychiatric illness/social situations, including alcohol or drug abuse that in the investigator's opinion will prevent administration or completion of protocol therapy.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Tadalafil
|
Tadalafil is commercially available and will be purchased by the Siteman Cancer Center and distributed to participants free of charge.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Relative change of MDSCs in peripheral blood
Time Frame: Baseline, week 6 of RT, before the start of adjuvant TMZ (approximately 4-6 weeks after the end of RT), before the 3rd cycle of adjuvant TMZ (or approximately 3 months after the end of RT if no planned 3rd cycle of adjuvant TMZ), time of progression
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Baseline, week 6 of RT, before the start of adjuvant TMZ (approximately 4-6 weeks after the end of RT), before the 3rd cycle of adjuvant TMZ (or approximately 3 months after the end of RT if no planned 3rd cycle of adjuvant TMZ), time of progression
|
Frequency of adverse events as measured by CTCAE v5.0
Time Frame: Baseline through 30 days after last dose of tadalafil (estimated to be 90 days)
|
Baseline through 30 days after last dose of tadalafil (estimated to be 90 days)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of severe lymphopenia
Time Frame: Within 12 weeks from start of radiation therapy
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-Defined as grade 3-4 lymphopenia per CTCAE v5.0 (absolute lymphocyte count < 500)
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Within 12 weeks from start of radiation therapy
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Progression-free survival (PFS)
Time Frame: 12 months after completion of radiation therapy (estimated to be 14 months)
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12 months after completion of radiation therapy (estimated to be 14 months)
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Overall survival (OS)
Time Frame: 12 months after completion of radiation therapy (estimated to be 14 months)
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-OS is defined as the time from enrollment in the trial until the date of death due to any cause.
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12 months after completion of radiation therapy (estimated to be 14 months)
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Number of imaging changes on heterogeneity diffusion imaging (HDI)
Time Frame: Baseline and 4-6 weeks after end of radiation therapy (estimated to be 12 weeks)
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Baseline and 4-6 weeks after end of radiation therapy (estimated to be 12 weeks)
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Investigators
- Principal Investigator: Jiayi Huang, M.D., Washington University School of Medicine
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 14, 2021
Primary Completion (Actual)
June 7, 2023
Study Completion (Actual)
June 7, 2023
Study Registration Dates
First Submitted
February 12, 2021
First Submitted That Met QC Criteria
February 12, 2021
First Posted (Actual)
February 17, 2021
Study Record Updates
Last Update Posted (Estimated)
June 13, 2023
Last Update Submitted That Met QC Criteria
June 12, 2023
Last Verified
June 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms, Glandular and Epithelial
- Glioma
- Neoplasms, Neuroepithelial
- Neuroectodermal Tumors
- Neoplasms, Germ Cell and Embryonal
- Neoplasms, Nerve Tissue
- Glioblastoma
- Astrocytoma
- Molecular Mechanisms of Pharmacological Action
- Vasodilator Agents
- Urological Agents
- Enzyme Inhibitors
- Phosphodiesterase Inhibitors
- Phosphodiesterase 5 Inhibitors
- Tadalafil
Other Study ID Numbers
- 202103257
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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