Symptoms and General Pathology

All Conditions

Neoplasms

Rare Diseases

Recurrence

Glioblastoma

Disease Progression

Astrocytoma

Glioma

Neoplasms, Neuroepithelial

Neuroectodermal Tumors

Neuroectodermal Tumors, Primitive

Neoplasms, Germ Cell and Embryonal

Neoplasms by Histologic Type

Neoplasms, Glandular and Epithelial

Neoplasms, Nerve Tissue

Disease Attributes

Neuroepithelioma

Antineoplastic Agents

All Drugs and Chemicals

Lomustine

Antineoplastic Agents, Alkylating

Alkylating Agents

Patients will be treated with L19TNF on Days 1, 3 and 5, and on Days 22, 24 and 26 and Lomustine on Day 1 (in the evening after L19TNF infusion) of a 42-day cycle for up to a maximum of 6 cycles.

Patients will be treated with on Days 1, 3 and 5, and on Days 22, 24 and 26 and Lomustine on Day 1 (in the evening after L19TNF infusion) of a 42-day cycle for up to a maximum of 6 cycles

L19TNF

Teresa Hemmerle, PhD

Marco Taras

The trial aims to collect safety, efficacy, exposure, dose- response, pharmacokinetic and pharmacodynamic information of the combination of L19TNF and lomustine at different dose levels in patients with Glioblastoma at progression or recurrence

The present study is a randomized, open-label, non-controlled phase II study in patients with glioblastoma at any progression/recurrence (first and later).

Overall, 90 subjects will be enrolled and parallel assigned in a 1:1 fashion to one of six treatment arms (from A to F) of 15 patients each.

Each arm has a different combination of L19TNF (7 μg/kg or 10 μg/kg or 13 μg/kg) and lomustine at different dose levels (90 or 110 mg/m2).

Treatment is based on a 42-day cycle for up to a maximum of 6 cycles.

This is an open-label study, so there is no blinding.

Patients who successfully complete the screening evaluations and are eligible for participation in the study will be enrolled and randomly assigned (1:1:1:1:1:1) to either of the six parallel treatment arms.

To maintain an appropriate balance between the six treatment arms and avoid undesired confounding effect of different factors, patients will be randomized in accordance with the following strata:

* MGMT status
* Steroid administration
* Previous systemic therapy treatment for progression

A randomization list will be prepared for each stratum using permuted block, the block sizes will be chosen randomly from different, pre-specified sizes with an equal treatment allocation ratio. The labels for the arms are assigned randomly within each block (fixed seed). The obtained final list is sorted by block together with the progressive enrollment number for the patients.

The primary objective of this study is to select the optimal regimen of L19TNF in combination with lomustine, that maximizes effects on clinical parameters and minimizes the probability of moderate to severe adverse events, among six (three L19TNF doses x two lomustine doses) combination schedules for the treatment of patient with progressing or recurrent glioblastoma.

Primary endpoints include Safety (Incidence of adverse Events (AEs), Serious Adverse Events (SAEs) and Drug-Induced Liver Injury (DILI), standard laboratory assessments, ECG, ECHO and physical examination according to CTCAE v.5.0) and Efficacy (Survival rate at 12 months).

The secondary objective of this study is to further evaluate safety, efficacy, exposure, dose-response, pharmacokinetic and pharmacodynamic information of the combination of L19TNF and lomustine at different dose levels to determine the best dose regimen for further studies.

During the conduct of the study the safety information collected will be routinely reviewed by the Data and Safety Monitoring Board (DSMB) in order to identify possible safety concerns.

If the probability in a treatment arm that the development of unacceptable toxicity rate exceeds 33 % is equal or higher than 80%, the recruitment to this treatment arm will be interrupted and the DSMB will be informed to assess the events and relationship to the study treatment. The DSMB may then recommend to re-start recruitment again for the treatment arm or permanently suspend it.

In case of a treatment-related death, recruitment will be suspended for all treatment arms until the Data and Safety Monitoring Board (DSMB) has reviewed the event and recommended to restart

A Study With L19TNF in Combination With Lomustine in Patients With Glioblastoma at Progression or Recurrence

A Dose Optimization Study for L19TNF in Combination With Lomustine in Patients With Glioblastoma at Progression or Recurrence

Occurence of AEs according to CTCAE v.5.0

Occurence of SAEs according to CTCAE v.5.0

Occurence of Unacceptable Toxicity according to CTCAE v.5.0

Occurence of DILI according to CTCAE v.5.0

The rate of patients achieving Complete Response (CR) or Partial Response (PR) defined according to RANO criteria

The rate of patients achieving complete (CR), partial (PR) and stable response (SD)

Pharmacokinetics assessment of L19TNF through blood sampling

Determination of the formation of Human Anti-Fusion protein Antibodies (HAFA) against L19TNF

Spots Global Cancer Trial Database for glioblastoma at progression