Glioblastoma Multiforme Clinical Trial
Official title:
Phase I Trial of Combination of DNX-2401 (Formerly Named Delta-24-RGD) Oncolytic Adenovirus With a Short Course of Temozolomide for Treatment of Glioblastoma at First Recurrent
Phase I trial, unicentric, uncontrolled. Intratumoral injection or intramural (into the
resected tumor cavity) of DNX2401 into brain tissue will be followed by up to two 28 - day
cycles of oral temozolomide (TMZ) in schedule of 7 days on/7 days off to evaluate safety of
the combination. Completion of two full cycles of TMZ will be dependent upon tolerance and
toxicity.
The rationale in using the virus with chemotherapy begins with the lessons learned in many
clinical trials in glioblastoma (GBM) about both the great difficulty of treating this
disease with monotherapy and the limitations of the therapeutic virus. The best clinical
results in recent years have been achieved with combinations of multiple therapeutics
efforts, including, maximum resection and chemotherapy, immunotherapy and targeted therapies.
There are very strong preclinical data about the synergy of DNX-2401 and TMZ proposed in our
trial design. The dose-dense schemes of TMZ like the one we will use, have been developed
with the aim to saturate o6-methylguanine-DNA-methyltransferase (MGMT). The published results
to date have shown reasonable toxicity albeit with modest efficacy' these schemes are now in
phase III trials. In addition, autophagy triggered by TMZ could help viral replication in the
tumor cells 11.
The last argument in favor of this virus + TMZ combination is the proved efficacy in killing
GBM tumor stem cells. In vitro and animals models have shown this combination is much more
effective that any of the treatments alone against GBM stem cells and the tumors derived from
them.
DNX2401 will be injected after stereotactic biopsy reveals intraoperative pathology confirming the presence of recurrent glioblastoma. The injection will be either intratumoral or intramural with injections throughout the post-resection cavity. ;
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