Neoadjuvant Chemoradiotherapy with or without Azeliragon for the Treatment of Newly Diagnosed Glioblastoma

Inclusion Criteria

• Histologically proven diagnosis of IDH-wildtype GBM (World Health Organization [WHO] grade 4) according to the 2021 WHO classification (including subtypes such as gliosarcoma)
• Radiographic evidence of residual tumor after initial surgery or biopsy
• Patient is amenable for future surgery (either surgical resection or laser interstitial thermal therapy [LITT]) to sample the residual tumor after completion of chemoradiotherapy
• At least 18 years of age
• Eligible for and planning to receive standard fractionated RT of 60 gray (Gy) with concurrent TMZ
• Recovered from the effects of surgery, postoperative infection, and other complications sufficiently for initiation of chemoradiotherapy, in the opinion of the treating physician
• Karnofsky performance status ≥ 60
• Absolute neutrophil count (ANC) ≥ 1.5 K/cumm
• Platelets ≥ 100 K/cumm
• Hemoglobin > 9.0 g/dL (Note: the use of transfusion or other intervention to achieve hemoglobin [Hgb] > 9.0 g/dL is acceptable)
• Total bilirubin ≤ 1.5 upper limit of normal (ULN)
• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamic pyruvic transaminase [SGPT]) ≤ 3 x ULN
• Creatinine ≤ 1.5 ULN or creatinine clearance ≥ 60 mL/min
• If there is history of human immunodeficiency virus (HIV) infection, patients must be on effective antiretroviral therapy, and HIV viral load must be undetectable within 6 months of study enrollment
• If there is history of chronic hepatitis B virus (HBV) infection, patients must have either been treated or are on suppressive therapy (as indicated), and HBV viral load must be undetectable
• If there is history of hepatitis C virus (HCV) infection, patients must have been treated, and HCV viral load must be undetectable
• Females of childbearing potential (defined as a female who is non-menopausal or surgically sterilized) and sexually active heterosexual males 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) during the trial and for 6 months after the last administration of azeliragon. Should a female trial participant or female partner of a male trial participant become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately
• Able to understand and willingness to sign an institutional review board (IRB)-approved written informed consent document. Legally authorized representatives may sign and give informed consent on behalf of study participants

Exclusion Criteria

• Prior cranial RT or RT to the head and neck where potential field overlap may exist
• Leptomeningeal or metastatic involvement
• Known IDH mutation. IDH status could be determined by either immunohistochemistry or sequencing as evaluated per routine clinical care
• Patients receiving CYP 2C8 inhibitors within 2 weeks or 5 half-lives prior to study entry
• Patients with a gastrointestinal condition that could interfere with swallowing or absorption
• Patients with concurrent participation in another interventional clinical trial or use of another investigational agent within 30 days prior to study entry. Patients who are participating in non-interventional clinical trials (e.g., QOL, imaging, observational, follow-up studies, etc.) are eligible, regardless of the timing of participation
• Medical contraindication to MRI (e.g., unsafe foreign metallic implants, incompatible pacemaker, inability to lie still for long periods, severe to end-stage kidney disease or on hemodialysis)
• Pregnant or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 14 days of the first dose of RT (Arm 1) or azeliragon (Arm 2)
• Patients with psychiatric illness/social situations, including alcohol or drug abuse that in the investigator's opinion will prevent administration or completion of protocol therapy
• Non-English speaking, as the cognitive assessments will only be available in English