Azoles Targeting Recurrent High Grade Gliomas

Launched by UNIVERSITY HEALTH NETWORK, TORONTO · Nov 30, 2018

Keywords

ClinConnect Summary

This clinical trial is studying two medications, ketoconazole and posaconazole, to see if they can help patients with recurrent high-grade gliomas, which are aggressive brain tumors. Researchers believe that these tumors use a lot of glucose (a type of sugar) to grow, and these medications might help stop that process. The trial will involve a small group of patients who will receive one or more doses of these drugs before surgery. During the surgery, doctors will check how much of the medication is in the brain and how it impacts the tumor’s ability to process glucose.

To be eligible for this trial, participants must be at least 18 years old and have a confirmed diagnosis of a recurrent high-grade glioma that needs to be surgically removed. They should also be in reasonably good health, meaning they can perform daily activities with some assistance and have a life expectancy of at least 12 weeks. Participants will need to be able to take the medication by mouth and agree to use birth control if they are capable of becoming pregnant. It’s important to note that there are several medical conditions and medications that might prevent someone from joining the study, so potential participants would need to discuss their health history with the research team. This trial aims to gather important information that could help improve future treatments for this type of brain cancer.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Age ≥18 years
• • Evidence of recurrent HGG that in the opinion of the treating team does not represent pseudoprogression and would require surgical resection
• • Karnofsky Performance Score (KPS) ≥ 60%
• • ECOG ≤ 2
• • Life expectancy greater than 12 weeks
• • Adequate liver function defined as ALT, AST, ALP, GGT, bilirubin within 1.5x institutional upper limit of normal
• • Potassium, calcium, and magnesium within normal limits (PCZ cohort)
• • Adequate renal function defined as eGFR levels within 1.5x the institutional upper limit of normal (only for KCZ cohort)
• • Ability to swallow medication
• • Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) for the duration of study participation.
• • Ability to understand and willingness to sign a written informed consent document
• • Be able to comply with treatment plan, study procedures and follow-up examinations
• Exclusion Criteria:
• • 1. Patients may not be receiving any other investigational agents while on study
• • Patients who have known allergy to KCZ, PCZ, or other azoles
• • Patients who have previously had a severe side effect, such as agranulocytosis and neutropenia, in conjunction with previous azole class drugs for a parasitic infection
• • Patients with a history of acute or chronic hepatitis
• • Patients with liver enzymes (ALT, AST, ALP, GGT, Bilirubin) \>1.5x above normal range for the laboratory performing the test
• • ECG with QT \> 450 msec (PCZ cohort)
• • Patients taking drugs known to prolong the QT interval (PCZ cohort)
• • Patients who are taking metronidazole and cannot be safely moved to a different antibiotic greater than 7 days prior to starting KCZ therapy
• • Patients who have taken any azoles within the last 3 months
• • Patients who are taking any anti-convulsant medication that interferes with the cytochrome P450 pathway (e.g. phenytoin, phenobarbital, carbamazepine, etc.) and who cannot be switched to alternative medications such as keppra (levetiracetam)
• • Uncontrolled intercurrent illness such as chronic hepatitis, acute hepatitis, or psychiatric illness/social situation that would limit compliance with study requirements
• • Patients with a history of Addison's disease or other forms of adrenal insufficiency
• • Patient with little or no stomach acid production (achlorhydria) are excluded from the KCZ cohort
• • Pregnant and breast feeding women
• • Patients with a history of any medical or psychiatric condition or laboratory abnormality that in the opinion of the investigator may increase the risks associated with the study participation or investigational product administration or may interfere with the interpretation of the results.
• • Patients who are not available for follow-up assessments or unable to comply with study requirements.
• • Patients who are currently taking medications that induce the metabolism of KCZ or PCZ, such as isoniazid, nevirapine, rifamycins (such as rifabutin, rifampin), St. John's wort, among others (see section 5.3 for full details).
• • Patients who are currently taking medications for which the metabolism may be affected by KCZ or PCZ, which include but are not limited to: benzodiazepines (such as alprazolam, midazolam, triazolam), domperidone, eletriptan, eplerenone, ergot drugs (such as ergotamine), nisoldipine, drugs used to treat erectile dysfunction-ED or pulmonary hypertension (such as sildenafil, tadalafil), some drugs used to treat seizures (such as carbamazepine, phenytoin), some statin drugs (such as atorvastatin, lovastatin, simvastatin)