Erlotinib Hydrochloride and Isotretinoin in Treating Patients With Recurrent Malignant Glioma

Condition(s) targeted: Recurrent Adult Brain Tumor; Adult Anaplastic Astrocytoma; Adult Anaplastic Oligodendroglioma; Adult Diffuse Astrocytoma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Mixed Glioma; Adult Oligodendroglioma

Intervention: erlotinib hydrochloride (Drug); isotretinoin (Drug); laboratory biomarker analysis (Other); protein expression analysis (Genetic)

Phase: Phase 1

Status: Recruiting

Sponsored by: Comprehensive Cancer Center of Wake Forest University

Official(s) and/or principal investigator(s):
Glenn Lesser, Principal Investigator, Affiliation: Wake Forest University

RATIONALE: Erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Isotretinoin may help cells that are involved in the body's immune response to work better. Giving erlotinib hydrochloride together with isotretinoin may kill more tumor cells.

PURPOSE: This phase I trial is studying the side effects and best dose of erlotinib hydrochloride when given with isotretinoin in treating patients with recurrent malignant glioma.

Official title: A Phase I Single Arm Open-Label Study of Erlotinib and 13-cis-Retinoic Acid (CRA) in Patients With Recurrent Malignant Glioma

Study design: Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: Recommended phase II doses of erlotinib hydrochloride and isotretinoin

Secondary outcome:

Toxicity as assessed by NCI CTCAE v3.0

Progression-free survival

Overall survival

Response rates

EGFRvIII, PTEN, cyclin D1, cyclin E, and RARbeta1 expression in tumor samples

Detailed description: PRIMARY OBJECTIVES:

I. To determine the recommended phase II doses of erlotinib and 13-cis-retinoic acid (CRA) when administered to adults with recurrent malignant glioma who are not receiving cytochrome P450 enzyme-inducing antiepileptic drugs (EIAEDs).

SECONDARY OBJECTIVES:

I. To assess dose-related toxicities. II. To measure 6 month progression-free survival and overall survival. III. To estimate response rates in those patients with measurable disease. IV. To evaluate for EGFRvIII, PTEN, cyclin D1, cyclin E, and RARbeta1 expression in tumor samples from enrolled patients as predictors of clinical benefit from this combination.

OUTLINE: Patients receive oral isotretinoin once daily on days 1-21 and oral erlotinib hydrochloride once daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed for up to 2 years.

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Histologically proven malignant glioma (glioblastoma multiforme, anaplastic

astrocytoma, anaplastic oligodendroglioma, or anaplastic mixed oligoastrocytoma) which is progressive or recurrent after radiation therapy +/- chemotherapy; patients with previous low grade glioma who progressed after radiotherapy +/- chemotherapy and are biopsied and found to have a high grade glioma are eligible

- Karnofsky performance status of >= 60%

- Patients - both males and females - with reproductive potential (i. e., premenopausal

or menopausal for less than 1 year and not surgically sterilized) must practice at least 2 contraceptive measures throughout the study

- Patients must be registered and meet all the requirements of iPLEDGE in order to

receive 13-cis-Retinoic Acid (CRA)

- Patients must provide verbal and written informed consent to participate in the study

- Patients must have a Mini Mental Status Exam score >= 15

- Patients must have a 12-lead EKG without evidence of any clinically significant

abnormalities

- ANC >= 1,500/mm^3

- Platelets >= 100,000/mm^3

- AST =< 2. 5 ULN (ULN = 50 U/L)

- ALT =< 2. 5 ULN (ULN = 50 U/L)

- Total Bilirubin =< 1. 5 mg/dL

- Alk. Phos =< 5X ULN (ULN = 125 U/dL)

- Estim. Cr Clearance > 50ml/min

- Fasting total cholesterol < 300 mg/dL

- Fasting triglycerides < 250 mg/dL

- Two separate, laboratory pregnancy tests within 14 days of registration (for women of

childbearing potential)

- Patients must have recovered from the toxicity of prior therapy; specifically, there

must be at least a 3 month interval from the completion of the most recent course of radiation therapy, at least a 3 month interval from the implantation of Gliadel wafer(s), at least a 3 week interval from the completion of a non-nitrosourea-containing chemotherapy regimen, and at least a 6 week interval from the completion of a nitrosourea-containing chemo-regimen

- Uncontrolled intercurrent illness including, but not limited to, ongoing or active

infection, severe cardiovascular disease including recent ( < 6 months) myocardial infarction, severe psychiatric illness that would limit compliance with study requirements, or any other disorder that would be incompatible with the study therapy

Exclusion Criteria:

- Pregnant or breast-feeding women

- Any history of inflammatory bowel disease

- Any history of uncontrolled depression, any history of hospitalization for

depression, or any history of suicidal thoughts or attempt(s)

- Patients receiving concurrent therapy for their tumor (with the exception of

steroids)

- Must have at least a 10 day interval from last dose of vitamin A, tetracyclines,

micro-dosed progesterone preparations, norethindrone/ethinyl estradiol, St. John's Wort, fish oil supplements, or phenytoin or other P450 enzyme inducing antiepileptic drugs

- Current smokers (Smoking >= 11 cigarettes per day), as smoking increases metabolism

and decreases serum levels of erlotinib

- Participants may not have received prior EGFR inhibitors for any disease

- Patients with a history of allergic reactions to 13-cis-retinoic acid (CRA) or

compounds of similar biologic or chemical composition to CRA

- Known allergy to proton pump inhibitors

Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157, United States; Recruiting
Glenn J. Lesser, Phone: 336-716-9527, Email: glesser@wfubmc.edu
Glenn J. Lesser, Principal Investigator

Starting date: May 2010
Last updated: November 29, 2011