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Treatment Name: BIBW 2992 with or without daily temozolomide in the treatment of patients with recurrent malignant glioma
Keywords: BIBW 2992
Phase: Phase 1/2
Treatment ID#s: VT1889        
Age Group: Adults Only
Min Karnofsky Score: 60: Requires occasional assistance but is able to care for most of own needs
Conditions: Newly Diagnosed: N
Recurrent: Y
Prior Surgery is Allowed
Prior Radiation is Allowed
Prior Chemotherapy is Allowed
Exclusions: 1.Less than 12 weeks between radiotherapy and start of study treatment, unless new enhancing lesion outside of radiation field or radiologically progressive on two consecutive MRI scans at least four weeks apart or biopsy-proven recurrence. 2. Less than two weeks from surgical resection (one week from prior stereotactic biopsy) or major surgical procedure. 3. Less than two weeks after previous chemotherapy (6 weeks from nitrosureas). 4. Less than four weeks from prior treatment with bevacizumab. 5. Treatment with other investigational drugs; participation in another clinical study within the past 2 weeks before start of therapy or concomitantly with this study. 6. Progressive disease or toxicity =CTCAEv3 Grade 3 to protracted temozolomide dosing (defined as temozolomide administered more than 5 days/28 day cycle). 7. Active infectious disease requiring intravenous therapy. 8. Known human immunodeficiency virus (HIV) infection or chronic Hepatitis B or C. 9. Gastrointestinal disorders that may interfere with the absorption of the study drug or chronic diarrhea. 10. Serious illness or concomitant non-oncological disease considered by the investigator to be incompatible with the protocol. 11. Patient is <3 years free of another primary malignancy except: if the other primary malignancy is either not currently clinically significant or does not require active intervention (such as a basal cell skin cancer or a cervical carcinoma in situ). Existence of any other malignant disease is not allowed. 12. Cardiac left ventricular function with resting ejection fraction <50%. 13. Absolute neutrophil count (ANC) less than 1500/mm3. 14. Platelet count less than 100,000/mm3. 15. Bilirubin greater than 1.5 x upper limit of institutional norm. 16. Aspartate amino transferase (AST) greater than 3 x upper limit of institutional norm. 17. Serum creatinine greater than 1.5 x upper limit of institutional norm. 18. Patients who are sexually active and unwilling to use a medically acceptable method of contraception. 19. Pregnancy or breast-feeding.
Last Updated: 10/20/2008
Tumor Types: Anaplastic Astrocytoma
Glioblastoma Multiforme
Oligodendroglioma High Grade
Comments: BIBW 2992 is a highly potent and irreversible inhibitor of the EGFR and HER2 tyrosine kinases. BIBW 2992 inhibits EGFR/HER2 tyrosine kinases both in vitro and in vivo. The in vitro potency of BIBW 2992 has been determined in enzymatic assays using the human EGFR and HER2 protein kinase domains as well as in cellular assays measuring the inhibition of either receptor phosphorylation or proliferation. The potency of BIBW 2992 on the EGFR and HER2 kinases revealed IC50 values of 0.5 nM and 14 nM, respectively. BIBW 2992 is highly selective for these kinases and no additional inhibition of other kinases has been observed. The inhibitory activity of BIBW 2992 on EGFR and HER2 was confirmed at the cellular level. This compound prevents EGF-stimulated transphosphorylation and induces the dephosphorylation of constitutively activated HER2, in different cell lines, in the nanomolar range. In summary, BIBW 2992 is effective in mechanism and disease-related in vitro and in vivo models. Tumor regression was achieved in all models upon treatment with BIBW 2992. The necessary maximum plasma concentration in nude mice to reach this effect was 300 nM. Thus, BIBW 2992 is a potent, irreversible, orally available EGFR/HER2 tyrosine kinase inhibitor displaying significant anti-tumor activity in a once daily dosing schedule. BIBW 2992 did not show relevant inhibition of cytochrome P450 isoenzymes. However, BIBW 2992 is a CYP3A4 substrate (U05-1723-01), although this metabolic pathway is not the dominant one. Therefore, drug-drug interactions with CYP3A4 inducers or inhibitors are not expected.
Treatment Type: Less-Toxics.
Contact: University of Virginia Health System
David Schiff, MD
Co-Director, Division of Neuro-Oncology
Department of Neurology
Box 800432
Charlottesville, VA 22908-0432
Phone:434-982-4415
Fax: 434-982-4467
Click here to send an email
Website: www.uvabraintumor.com



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