Brain and Central Nervous System Tumors
Conditions
Keywords
adult giant cell glioblastoma, adult gliosarcoma, recurrent adult brain tumor
Brief summary
RATIONALE: Lapatinib may stop the growth of tumor cells by blocking the enzymes necessary for their growth. PURPOSE: This phase I/II trial is studying the side effects and best dose of lapatinib and to see how well it works in treating patients with recurrent glioblastoma multiforme.
Detailed description
OBJECTIVES: Phase I * Determine the maximum tolerated dose and recommended phase II dose of lapatinib in patients with recurrent malignant glioblastoma multiforme who are taking CYP3A4 enzyme-inducing anti-epileptic drugs (EIAEDs). * Determine the toxic effects of this drug in these patients. * Determine the pharmacokinetics of this drug in these patients. Phase II * Determine the efficacy of this drug, in terms of objective tumor response rate, in patients who are taking EIAEDs and in those who are not taking EIAEDs. * Correlate immunohistochemical measures of cellular proteins and receptors from tumor samples with anti-tumor activity of this drug in these patients. * Determine the pharmacokinetics of this drug in these patients. OUTLINE: This is a multicenter, open-label, phase I, dose-escalation study followed by a phase II study. * Phase I: Patients receive oral lapatinib twice daily on days 1-28. Courses repeat every 28 days in the absence of unacceptable toxicity or disease progression. Cohorts of 3-6 patients receive escalating doses of lapatinib until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. * Phase II: Patients receive lapatinib as in phase I at the MTD. Patients are followed at 1 month and then periodically for survival. Patients with stable or responding disease who go off therapy are followed every 3 months for up to one year and then periodically thereafter for survival. PROJECTED ACCRUAL: A total of 3-24 patients will be accrued for the phase I portion of this study within 18 months. A total of 15-30 patients will be accrued for the phase II portion of this study within 18 months.
Interventions
For patients receiving enzyme inducing anti-epileptic drugs (EIAEDs): * Phase I: starting dose for first cohort: 1000 mg GW572016 po b.i.d.; actual dose assigned at registration; intra patient dose escalation permitted ONCE in phase I patients ONLY if specified criteria met (see section 8.6). * Phase II: Recommended phase II dose from phase I portion of the study, given po b.i.d. For patients NOT receiving enzyme inducing anti-epileptic drugs (NON-EIAEDs): • Phase II: 750 mg GW572016 po b.i.d. For all patients: • Dose reductions as required based on adverse events.
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically confirmed malignant glioblastoma multiforme * Recurrent or progressive disease after prior primary treatment with radiotherapy with or without adjuvant chemotherapy * Bidimensionally measurable disease on CT scan or MRI with at least one lesion ≥ 1 cm x 1 cm * Paraffin embedded tumor sample available * Concurrent enzyme-inducing anti-epileptic drugs (EIAEDs) required for phase I of the study * Patients in phase II of the study may or may not be receiving EIAEDs PATIENT CHARACTERISTICS: Age * 18 and over Performance status * ECOG 0-2 Life expectancy * Not specified Hematopoietic * Absolute granulocyte count ≥ 1,500/mm\^3 * Platelet count ≥ 100,000/mm\^3 Hepatic * Bilirubin ≤ upper limit of normal (ULN) * AST and ALT ≤ 2.5 times ULN Renal * Creatinine ≤ 1.5 times ULN Cardiovascular * LVEF ≥ 50% by echocardiogram or MUGA * No myocardial infarction within the past 6 months * No congestive heart failure * No unstable angina * No active cardiomyopathy * No cardiac arrhythmia * No uncontrolled hypertension Pulmonary * No pulmonary disease requiring oxygen Neurologic * No preexisting peripheral neuropathy ≥ grade 3 * No history of significant neurologic disorder that would preclude study compliance or ability to give informed consent Gastrointestinal * No upper gastrointestinal or other conditions that would preclude compliance with oral medication * No active peptic ulcer disease Other * No other malignancy within the past 5 years except adequately treated basal cell or squamous cell skin cancer, curatively treated carcinoma in situ of the cervix, or other curatively treated solid tumor * No immune deficiency * No history of significant psychiatric disorder (e.g., uncontrolled psychotic disorders) that would preclude study compliance or ability to give informed consent * No other serious illness or medical condition that would preclude study participation * No known hypersensitivity to compounds of similar chemical or biological composition to lapatinib * No active uncontrolled or serious infection * HIV negative * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: Biologic therapy * No concurrent prophylactic filgrastim (G-CSF), sargramostim (GM-CSF), or other hematopoietic growth factors * Concurrent hematopoietic growth factors allowed for treatment of acute toxicity (e.g., febrile neutropenia) Chemotherapy * See Disease Characteristics * No prior chemotherapy for recurrent disease * No more than one prior chemotherapy regimen in the adjuvant setting * At least 6 months since prior adjuvant chemotherapy Endocrine therapy * Concurrent steroids allowed provided the dose is stable for at least 14 days before study entry Radiotherapy * See Disease Characteristics * At least 6 weeks since prior radiotherapy Surgery * At least 2 weeks since prior major surgery Other * H2 blockers and proton pump inhibitors allowed, unless they are CYP3A4 inducers or inhibitors * At least 7 days since prior and no concurrent administration of any of the following CYP3A4 inhibitors: * Clarithromycin * Erythromycin * Troleandomycin * Telithromycin * Ciprofloxacin * Norfloxacin * Itraconazole * Ketoconazole * Voriconazole * Fluconazole (≤150 mg/day allowed) * Nefazodone * Fluovoxamine * Delavirdine * Nelfinavir * Amprenavir * Ritonavir * Indinavir * Saquinavir * Lopinavir * Verapamil * Diltiazem * Aprepitant * Grapefruit or grapefruit juice * Bitter orange * At least 14 days since prior and no concurrent administration of any of the following CYP3A4 inducers: * Rifampin * Rifabutin * Rifapentine * Efavirenz * Nevirapine * Hypericum perforatum (St. John's wort) * Modafinil * At least 6 months since prior and no concurrent administration of amiodarone * Antacids (e.g., mylanta, maalox, tums, rennies) must be administered ≥ 1 hour before and ≥ 1 hour after study drug * At least 2 days since prior and no concurrent cimetidine * No other concurrent anti-cancer agents * No other concurrent investigational therapy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Toxicity for phase I assessed by CTCAE v.3.0 MacDonald criteria | 7 years |
| Response for phase II | 7 years |
Secondary
| Measure | Time frame |
|---|---|
| Correlative studies on archival tissue | 7 years |
| Pharmacokinetics | 7 years |
Countries
Canada