Identification of Treatment Concentrations of Defactinib or Avutometinib for the Treatment of Patients with Glioblastoma

Inclusion Criteria

• New or recurrent glioblastoma diagnosed by neuroimaging techniques for which surgical resection is indicated
• Age older than 21 years
• An Eastern Cooperative Group (ECOG) performance status =< 1
• Hemoglobin (Hb) >= 9.0 g/dL. If a red blood cell transfusion has been administered the Hb must remain stable and >= 9.0 g/dL for at least 1 week prior to first dose of study therapy.
• Platelets >= 100,000/mm^3
• Absolute neutrophil count (ANC) >= 1500/mm^3
• Total bilirubin =< 1.5 × upper limit of normal (ULN) per the institution; patients with Gilbert syndrome may enroll if total bilirubin < 3.0 mg/dL (51 umole/L)
• Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 × ULN (or < 5x ULN in patients with liver metastases)
• Creatinine clearance rate of >= 50 mL/min as calculated by the Cockcroft-Gault formula or serum creatinine of =< 1.5 x ULN
• International normalized ratio (INR) ≤ 1.5 and partial thromboplastin time (PTT) ≤ 1.5 x ULN in the absence of anticoagulation or therapeutic levels in the presence of anticoagulation
• Albumin >= 3.0 g/dL (451 umole/L)
• Creatine phosphokinase (CPK) =< 2.5 x ULN
• Left ventricular ejection fraction >= 50% by echocardiography (ECHO) or multiple-gated acquisition (MUGA) scan
• Baseline QTc interval < 460 ms for women and =< 450 ms for men (average of triplicate readings) (Common Terminology Criteria for Adverse Events [CTCAE] Grade 1) using Fredericia’s QT correction formula. NOTE: This criterion does not apply to subjects with a right or left bundle branch block
• Adequate recovery from toxicities related to prior treatments to at least Grade 1 by CTCAE v 5.0. Exceptions include alopecia and peripheral neuropathy grade =< 2
• Male and female patients with reproductive potential agree to use highly effective method of contraceptive (per Clinical Trial Facilitation Group [CFTG] recommendations) during the trial and for 3 months following the last dose of VS-6766 for male patients, and 1 month following the last dose of VS-6766 for female patients.

Exclusion Criteria

• Clinically significant active gastrointestinal abnormalities, requirement for systemic anticoagulation or potent CYP 2C8 inhibitors, and history of clinically significant cardiac or pulmonary disorders
• Minors will be excluded from the investigation. Glioblastoma is the major form of brain cancer in people over 50 years old. Pediatric cases of glioblastoma are relatively rare. Besides this, there are crucial molecular differences between adult and pediatric gliomas. Our preliminary data for proposed investigation were obtained on GBM specimens and cultures developed from GBM tissues donated by adult subjects. Results of investigation of adult glioma tissue cannot simply be extrapolated to children. Therefore, our primary research focus is the investigation of GBM in adults. If appropriate, a separate, age-specific study in children will be performed
• Pregnant women will be excluded from the study as altered hormonal and immunological status can affect the study results
• Prisoners will be excluded from the study
• Systemic anti-cancer therapy within 4 weeks of the first dose of study therapy
• History of prior malignancy, with the exception of curatively treated malignancies or malignancies with very low potential for recurrence or progression
• Major surgery within 4 weeks (excluding placement of vascular of the investigational agent (defactinib or avutometinib)
• Exposure to medications (with or without prescription), supplements, herbal remedies, or foods with potential for drug-drug interactions with the investigational agent (defactinib or avutometinib) within 14 days prior to the first dose of the investigational agent (defactinib or avutometinib) and during the course of therapy, including: * Avutometinib: strong CYP3A4, inhibitors or inducers, due to potential drug-drug interactions with avutometinib *Defactinib: strong CYP3A4, CYP2C9, and P-glycoprotein (P-gp) inhibitors or inducers, due to potential drug-drug interactions with VS-6766 and/or defactinib
• Known hepatitis B, hepatitis C or human immunodeficiency virus (HIV) infection that is active and/or requires therapy
• Active skin disorder that has required systemic therapy within the past 1 year
• History of rhabdomyolysis
• Concurrent ocular disorders: *Patients with activly treated glaucoma, retinal vein occlusion (RVO), including predisposing factors for RVO, including uncontrolled hypertension, and uncontrolled diabetes *Patients with current evidence of visible retinal pathology that is considered a risk factor for RVO, intraocular pressure > 21 mm Hg as measured by tonometry, or other significant ocular pathology, and anatomical abnormalities that increase the risk for RVO *Patients with active corneal erosion (instability of corneal epithelium), corneal degeneration, active or recurrent keratitis, and other forms of serious ocular surface inflammatory conditions
• Concurrent congestive heart failure, prior history of class III/ IV cardiac disease (New York Heart Association [NYHA]), myocardial infarction within the last 6 months, unstable arrhythmias, unstable angina, or severe obstructive pulmonary disease
• Patients with the inability to swallow oral medications or impaired gastrointestinal absorption due to gastrectomy or active inflammatory bowel disease
• Patients with a history of hypersensitivity to any of the inactive ingredients (hydroxypropylmethylcellulose, mannitol, magnesium stearate) of the investigational product