Stereotactic Radiosurgery With Nivolumab and Valproate in Patients With Recurrent Glioblastoma

Glioblastoma Clinical Trial

Official title:

A Pilot Study to Evaluate the Feasibility of the Combined Use of Stereotactic Radiosurgery With Nivolumab and Concurrent Valproate in Patients With Recurrent Glioblastoma

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT02648633
• Other study ID #: 18574
• Secondary ID: CA209-378
• Status: Terminated
• Phase: Phase 1
• First received: December 16, 2015
• Last updated: May 26, 2017
• Start date: May 24, 2016
• Est. completion date: February 21, 2017

Study information

• Verified date: May 2017
• Source: University of Virginia
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to evaluate the safety and feasibility of the immunotherapeutic agent nivolumab given in combination with gamma knife therapy and valproate in patients with recurrent glioblastoma, a common and lethal type of brain cancer.

Description:

Immune checkpoint inhibitors have the potential to treat a wide range of diverse cancers. Of particular interest to researchers is the PD-1 receptor-ligand interaction, a major pathway that many cancers hijack in order to suppress immune control. Anti-PD-1 antibodies such as nivolumab show a strong potential to treat many types of cancers including glioblastoma, the most common and most lethal brain cancer.

This study will examine a means of further focusing immune response on glioblastoma by combining stereotactic "gamma knife" radiosurgery with nivolumab. The rationale behind this intervention is that the radiation therapy will enhance immune response rate by providing additional tumor antigens from dying cells. Additionally, a study from investigators at Johns Hopkins indicates that histone deacetylase (HDAC) inhibitors may boost the anti-cancer efficacy of PD-1 antibodies like nivolumab. Valproate, a class I HDAC inhibitor, will be used concurrently with nivolumab with the goal of enhancing the effects of both the nivolumab and the radiotherapy.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 4
• Est. completion date: February 21, 2017
• Est. primary completion date: February 21, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Confirmed malignant, recurrent glioblastoma or gliosarcoma

• Subject must have adequate organ function

• Subject must still be able to care for most of his or her personal needs

Exclusion Criteria:

• Subject is pregnant

• Subject has extracranial metastatic or leptomeningeal disease

• Subject has an additional malignancy that is progressing or requires active treatment, exceptions being basal cell and squamous cell carcinomas of the skin, indolent prostate cancer, chronic lymphocytic leukemia, or in situ cervical cancer

• Subject has received chemotherapy, biological therapy, or had surgery 4 weeks prior to beginning the study

• Subject has had radiation therapy within 10 weeks prior to entering beginning the study

• Subject has had prior therapy with bevacizumab

• Subject has had previous treatment with carmustine wafer except when administered as first-line treatment no less than six months prior to beginning the study

• Subject requires escalating supraphysiologic doses of corticosteroids greater than 2 mg of dexamethasone or an equivalent

• Active autoimmune disease requiring systemic treatment within the past 3 months or any syndrome that requires immunosuppressive agents

• Interstitial lung disease or active, non-infectious pneumonitis

• Evidence of greater than Grade 1 CNS hemorrhage or greater than Grade 3 venous thromboembolism

• History of uncontrolled cardiac disease

• Subject unable or unwilling to have a head contrast enhanced MRI

Related Conditions & MeSH terms

• Glioblastoma

Intervention

Radiation:
• Stereotactic Radiosurgery
Subjects will receive a single large dose of radiation to one or more lesions.

Drug:
• Nivolumab
3 mg/kg of nivolumab will be administered through IV infusion every two weeks following stereotactic radiosurgery.
• Valproate
Subjects will begin regimen of valproate prior to radiosurgery and continue to receive therapy concurrently with nivolumab. Subjects will receive valproate daily with a target serum level of 75-100 µg/ml.

Locations

Country	Name	City	State
United States	University of Virginia	Charlottesville	Virginia

Sponsors (1)

Lead Sponsor	Collaborator
University of Virginia

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Incidence of Pseudoprogressions	Pseudoprogression, the transient increase in apparent tumor size, will be documented.	From the beginning of treatment until documented disease progression or date of death, assessed up to 48 months.
Primary	Feasibility based on number of subjects who complete 4 doses of nivolumab	Feasibility of the radiosurgery and drug combination will be determined based on the number of subjects who complete at least 4 doses of nivolumab.	At 3 months following radiosurgery
Primary	Incidence of adverse events	Safety will be assessed by imaging of necrosis, incidence and severity of adverse events, changes in laboratory findings, physical examinations, vital signs, and the number of discontinuations due to adverse events.	From the beginning of treatment until no sooner than 30 days following the last study treatment
Secondary	Clinical Response Rate	Response to therapy will be evaluated by means of RANO criteria.	From the beginning of treatment until documented disease progression or date of death, assessed up to 48 months.