Efficacy Study of CYT997 in Combination With Carboplatin in Glioblastoma

Inclusion Criteria:

• Patients must have histologically-confirmed glioblastoma multiforme that has progressed after initial surgery, radiation therapy and temozolomide chemotherapy.
• Measurable tumour must be present on gadolinium-enhanced MRI
• At least 3 months must have elapsed from completing radiation to minimize the possibility of pseudo-progression.
• At least 4 weeks since prior chemotherapy (6 weeks if the last regimen included bischloroethylnitrosourea (BCNU) or Chloroethyl-Cyclohexyl-NitrosoUrea (CCNU)).
• Age ≥ 18 years.
• If patients are taking steroids, the dose must be stable for = 7 days.
• Eastern Cooperative Oncology Group (ECOG) performance status = 2.
• Life expectancy of greater than 2 months.

• Patients must have adequate organ and marrow function as defined below:

  • Absolute neutrophil count = 1.5 × 109/L
  • Platelet count = 100 × 109/L
  • Total bilirubin within normal limits
  • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) < 5 × upper limit of normal (ULN)
  • Creatinine within normal limits OR creatinine clearance = 60 mL/min/1.73 m2 for patients with creatinine levels above normal
  • Normal left ventricular ejection fraction on a gated blood pool scan or echocardiogram
• Must agree to use adequate contraceptive measures if indicated
• Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria:

• Patients who have received any other investigational agent in the preceding four weeks prior to commencing therapy in this study.
• Patients who have been previously treated with carboplatin.
• Patients who have been previously treated with bevacizumab or other anti-angiogenesis or vascular-disrupting agents
• Patients who are receiving enzyme-inducing anticonvulsant drugs (EIACD) such as phenytoin or carbamazepine.
• Patients with a history of allergic reactions attributed to compounds of similar chemical composition to CYT997 or other agents used in the study.
• Patients with uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, cardiac arrhythmia or psychiatric illness/social situations that would limit compliance with study requirements.
• Pregnant or lactating women.
• Patients with immune deficiency, including HIV-positive patients.
• Patients with uncontrolled diarrhoea despite optimal medication and those with any history of acute gastrointestinal bleeding.
• Patients who are unable or unwilling to undergo MRI scanning

• Patients with the following conditions/treatments will be excluded:

  • Myocardial infarction (MI) or stroke within 6 months
  • History of stroke or transient ischemic attacks (TIAs)
  • Unstable angina pectoris or acute ischemic changes on ECG
  • History of diabetic retinopathy
  • Symptomatic peripheral arterial disease o Major surgery in the last 4 weeks
  • Evidence of intra-tumoural haemorrhage on imaging, except for stable grade-1 post-operative haemorrhage.
  • Current therapeutic anti-coagulation with warfarin or a heparin (excludes lowdose prophylactic heparin).
  • Uncontrolled hypertension
  • The need for any anti-arrhythmic drugs
• Presence of luminal stenosis of 50% or more in any of the extracranial or intracranial arteries supplying the brain, as measured by magnetic resonance angiography (MRA) at baseline.
• Patients with a baseline prolongation of the QTc interval of Common Terminology Criteria (CTC) grade 1 (QTc > 0.45- 0.47 sec) or greater.

• Patients with impaired cardiac function or clinically significant cardiac diseases, including any one of the following:

  • Left ventricular ejection fraction (LVEF) < 45% as determined by multigated acquisition (MUGA) scan or echocardiogram;
  • complete left bundle branch block;
  • obligate use of a cardiac pacemaker;
  • congenital long QT syndrome;
  • history or presence of ventricular tachyarrhythmia;
  • presence of unstable atrial fibrillation (ventricular response > 100 bpm) Patients with stable atrial fibrillation are eligible, provided they do not meet any of the other cardiac exclusion criteria;
  • clinically significant resting bradycardia (< 50 bpm);
  • right bundle branch block + left anterior hemiblock (bifascicular block);
  • angina pectoris = 3 months prior to starting study drug;
  • acute MI = 3 months prior to starting study drug; or
  • other clinically significant heart disease (e.g., congestive heart failure (CHF), uncontrolled hypertension, history of labile hypertension, or history of poor compliance with an antihypertensive regimen).
• Patients currently receiving treatment with medications known to prolong the QTc interval and/or to induce Torsades de Pointes arrhythmia.