Individualized screening trial of innovative glioblastoma therapy (INSIGhT).

Authors

Brian Alexander

Brian Michael Alexander

Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA

Brian Michael Alexander , Lorenzo Trippa , Sarah C. Gaffey , Isabel Arrillaga , Eudocia Quant Lee , Shyam Kumar Tanguturi , Manmeet Singh Ahluwalia , Howard Colman , Evanthia Galanis , John Frederick De Groot , Jan Drappatz , Andrew B. Lassman , Louis B. Nabors , David A. Reardon , David Schiff , Mary Roberta Welch , Keith L. Ligon , Patrick Y. Wen

Organizations

Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, Dana-Farber Cancer Institute, Boston, MA, MGH, Boston, MA, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Bayport, NY, Cleveland Clinic, Cleveland, OH, Hunstman Cancer Institute, Salt Lake City, UT, Mayo Clinic, Rochester, MN, The University of Texas MD Anderson Cancer Center, Houston, TX, University of Pittsburgh Cancer Institute, Pittsburgh, PA, Columbia University Medical Center, New York, NY, University of Alabama at Birmingham, Birmingham, AL, Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA, University of Virginia Health System, Charlottesville, VA, Montefiore Medical Center, New York, NY

Research Funding

Other

Background: Patient with glioblastoma (GBM) with unmethylated MGMT promoters derive limited benefit from temozolomide (TMZ) and have dismal outcome. Prioritizing the numerous available therapies and biomarkers for late stage testing requires an efficient clinical testing platform. INSIGhT (NCT02977780) is a biomarker-based, Bayesian adaptively randomized, multi-arm phase II platform screening trial for patients with newly diagnosed GBM and unmethylated MGMT promoters. Methods: INSIGhT compares experimental arms to a common control of standard concurrent TMZ and radiation therapy (RT) followed by adjuvant TMZ. The primary endpoint is overall survival (OS). Patients with newly diagnosed, unmethylated GBM that are IDH R132H mutation negative, and with genomic data available or who consent to whole exome sequencing through the ALLELE companion study for biomarker grouping are eligible. Two experimental arms consist of concurrent RT/TMZ followed by adjuvant neratinib (EGFR, HER2, and HER4 inhibitor) or abemaciclib CDK 4/6 inhibitor), respectively, in place of TMZ. The other experimental arm is CC-115 (TORC1/2 and DNA PK inhibitor), which replaces TMZ in both the concurrent and adjuvant phases. Biomarker groups include: EGFR + patients with EGFR amplification/mutation; PI3K + patients with PIK3CA mutation/amplification, PIK3R1 mutation, AKT3amplification, PIK3C2B > 1 copy gain, or PTEN dual loss; CDK: + patients with wild-type RB1 and CDK4 amplification, CDK6 amplification, or CDKN2A > 1 copy loss. Given the lack of pretrial biomarker data and the anticipated overlap of the groups, randomization will initially be equal. As the trial progresses, randomization probabilities will be adapted based on the Bayesian estimation of the probability of treatment impact on progression-free survival (PFS). These randomization probabilities can vary among the biomarker groups so predictive biomarkers will be identified and utilized if present. Treatment arms may drop due to low probability of treatment impact on OS, and new arms may be added. Experimental arms are compared only with control and should be thought of as discrete experimental questions, with INSIGhT being open to new investigators with proposed therapeutic hypotheses. Clinical trial information: NCT02977780

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Abstract Details

Meeting

2017 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Central Nervous System Tumors

Track

Central Nervous System Tumors

Sub Track

Central Nervous System Tumors

Clinical Trial Registration Number

NCT02977780

Citation

J Clin Oncol 35, 2017 (suppl; abstr TPS2079)

DOI

10.1200/JCO.2017.35.15_suppl.TPS2079

Abstract #

TPS2079

Poster Bd #

321a

Abstract Disclosures