Disulfiram in Treating Patients with Glioblastoma Multiforme after Radiation Therapy with Temozolomide
This phase I trial studies disulfiram in treating patients with glioblastoma multiforme (GBM) who have completed radiation therapy with temozolomide. Disulfiram may block some of the enzymes needed for tumor cell growth and improve clinical outcome in GBM patients.
Inclusion Criteria
- Diagnosis of histologically confirmed GBM (World Health Organization [WHO] grade IV)
- Eastern Cooperative Oncology Group (ECOG) performance status of at least 2
- Has received or is in the process of completing a course of definitive radiotherapy of at least 45 Gray (Gy) with concurrent temozolomide (patient may be registered before completing radiotherapy as long as it is anticipated that s/he will complete at least 45 Gy)
- Eligible for and planning to receive maintenance temozolomide after completion of definitive radiotherapy plus temozolomide
- Willing to remain abstinent from consuming alcohol while on disulfiram
- Absolute neutrophil count >= 1,500/mcL
- Platelets >= 100,000/mcL
- Hemoglobin > 9.0 g/dL (transfusion and/or erythropoiesis stimulating agents [ESA] allowed)
- Total bilirubin =< 2 x institutional upper limit of normal (ULN)
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 3 x ULN
- Calculated creatinine clearance must be > 60 mL/min (by Cockcroft-Gault)
- Females of childbearing potential (defined as a female who is non-menopausal or surgically sterilized) must be willing to use an acceptable method of birth control (i.e., hormonal contraceptive, intra-uterine device, diaphragm with spermicide, condom with spermicide, or abstinence) for the duration of the study; should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately
- Able to take oral medication
- Able to understand and willing to sign an Institutional Review Board (IRB)-approved written informed consent document (legally authorized representative permitted)
Exclusion Criteria
- Receipt of any other investigational agents within 14 days prior to study enrollment
- Enrolled on another clinical trial testing a novel therapy or drug
- History of allergic reaction to disulfiram
- Treatment with clinically significant cytochromes P450 enzyme inducers, such as phenytoin, phenobarbital, chlordiazepoxide, diazepam, isoniazid, metronidazole, warfarin, amitriptyline within 14 days prior to the first dose of disulfiram; of note, lorazepam and oxazepam are not affected by the P450 system and are not contraindicated with disulfiram
- Active or severe hepatic, cardiovascular, or cerebrovascular disease, including myocardial infarction within 6 months prior to enrollment, have New York Heart Association (NYHA) class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or active conduction system abnormalities
- History of idiopathic seizure disorder, psychosis or schizophrenia
- Pregnant and/or breastfeeding; women of childbearing potential must have a negative pregnancy test within 14 days of initiation of treatment
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT01907165.
PRIMARY OBJECTIVES:
I. To determine the pharmacological effect of disulfiram on proteasome inhibition in GBM patients after chemoradiotherapy.
SECONDARY OBJECTIVES:
I. To determine the tolerability of disulfiram with concurrent maintenance temozolomide after definitive chemoradiotherapy.
II. To determine preliminary clinical effects of disulfiram as measured by tumor response rate (complete response [CR] + partial response [PR]), local control (within the radiotherapy field), and time to tumor progression (within or outside the radiotherapy field).
OUTLINE: This is a dose-escalation study of disulfiram followed by an expansion cohort.
Approximately 4-6 weeks after completion of radiation therapy with temozolomide, patients receive maintenance temozolomide orally (PO) once daily (QD) on days 1-5 and disulfiram PO QD on days 1-28. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity.
Patients in the expansion cohort also receive a copper gluconate supplement PO thrice daily (TID) on days 1-28.
After completion of study treatment, patients are followed up at 30 days, and then periodically for up to 2 years.
Trial PhasePhase O
Trial Typetreatment
Lead OrganizationSiteman Cancer Center at Washington University
Principal InvestigatorJiayi Huang
- Primary ID201308038
- Secondary IDsNCI-2013-01331, 13-X181
- ClinicalTrials.gov IDNCT01907165