NHMRC CTC, The University of Sydney, Camperdown NSW, Australia
Mustafa Khasraw , Kerrie Leanne McDonald , Mark Rosenthal , Zarnie Lwin , David M. Ashley , Helen Wheeler , Elizabeth Barnes , Eng-Siew Koh , Matthew C Foote , Michael Buckland , Renee Swanson , Merryn Hall , Sonia Yip , Martinus Oostendorp , John Simes
Background: Temozolomide (TMZ) offers minimal benefit in GBM patients (pts) with unmethylated O-6-methylguanine DNA methyltransferase(MGMT), that is the majority of GBMs. Pre-clinical data shows that the addition of the poly ADP ribose polymerase (PARP) inhibitor ABT-888 (veliparib,) to radiotherapy (RT) and TMZ is synergistic. Clinical studies demonstrated that veliparib is safe and tolerable when combined with either RT or TMZ but the triplet was poorly tolerated. VERTU examines using concurrent veliparib and RT (without TMZ) followed by concurrent veliparib and TMZ in newly diagnosed pts with GBM and unmethylated MGMT. Methods: A phase II trial of 120 pts randomized 2:1 to the experimental arm (n = 80) of veliparib 200mg bid concurrently with RT (60Gy in 30 fractions) followed by 6 months of veliparib (40mg bid, D 1-7) concurrently with TMZ (150-200mg/m2D 1-5) every 28 days. The standard treatment arm (n = 40) is concurrent RT and TMZ followed by 6 months of TMZ. MGMT methylation status is tested centrally. Primary endpoint is 6 months Progression Free Survival (6PFS) using RANO criteria with secondary endpoints including overall survival, toxicity and translational endpoints including expression levels of a DNA repair signature of XRCC1, ATM, RAD50, MSH2, PARP1, RAD51, and MRE11 correlated with clinical outcomes. VERTU has 80% power at alpha = 0.1 to detect a large increase in 6PFS from 53% to 65% in the experimental arm, using a Fleming’s one-stage design. An Independent Data Safety Committee is monitoring the study including evaluation of feasibility and safety after completion of RT in the first 60 patients (stage 1) before the remaining patients are accrued (Stage 2). Progress: VERTU commenced 28th Oct 2015. As of Feb 2016, 8 study sites are open in Australia. An additional 4-10 study centres will be activated. To date, 16 patients have been screened and 5 randomized. ANZCTR # ACTRN12615000407594. Clinical trial information: ACTRN12615000407594.
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