Phase I/II study of imatinib mesylate for recurrent malignant gliomas: North American Brain Tumor Consortium Study 99-08.

Abstract

PURPOSE:

Phase I: To determine the maximum tolerated doses, toxicities, and pharmacokinetics of imatinib mesylate (Gleevec) in patients with malignant gliomas taking enzyme-inducing antiepileptic drugs (EIAED) or not taking EIAED. Phase II: To determine the therapeutic efficacy of imatinib.

EXPERIMENTAL DESIGN:

Phase I component used an interpatient dose escalation scheme. End points of the phase II component were 6-month progression-free survival and response.

RESULTS:

Fifty patients enrolled in the phase I component (27 EIAED and 23 non-EIAED). The maximum tolerated dose for non-EIAED patients was 800 mg/d. Dose-limiting toxicities were neutropenia, rash, and elevated alanine aminotransferase. EIAED patients received up to 1,200 mg/d imatinib without developing dose-limiting toxicity. Plasma exposure of imatinib was reduced by approximately 68% in EIAED patients compared with non-EIAED patients. Fifty-five non-EIAED patients (34 glioblastoma multiforme and 21 anaplastic glioma) enrolled in the phase II component. Patients initially received 800 mg/d imatinib; 15 anaplastic glioma patients received 600 mg/d after hemorrhages were observed. There were 2 partial response and 6 stable disease among glioblastoma multiforme patients and 0 partial response and 5 stable disease among anaplastic glioma patients. Six-month progression-free survival was 3% for glioblastoma multiforme and 10% for anaplastic glioma patients. Five phase II patients developed intratumoral hemorrhages.

CONCLUSIONS:

Single-agent imatinib has minimal activity in malignant gliomas. CYP3A4 inducers, such as EIAEDs, substantially decreased plasma exposure of imatinib and should be avoided in patients receiving imatinib for chronic myelogenous leukemia and gastrointestinal stromal tumors. The evaluation of the activity of combination regimens incorporating imatinib is under way in phase II trials.

• Authors: Patrick Y Wen, W K Alfred Yung, Kathleen R Lamborn, Patricia L Dahia, Yanfeng Wang, Bin Peng, Lauren E Abrey, Jeffrey Raizer, Timothy F Cloughesy, Karen Fink, Mark Gilbert, Susan Chang, Larry Junck, David Schiff, Frank Lieberman, Howard A Fine, Minesh Mehta, H Ian Robins, Lisa M DeAngelis, Morris D Groves, Vinay K Puduvalli, Victor Levin, Charles Conrad, Elizabeth A Maher, Kenneth Aldape, Michael Hayes, Laurie Letvak, Merrill J Egorin, Renaud Capdeville, Richard Kaplan, Anthony J Murgo, Charles Stiles, Michael D Prados
• Journal: Clinical cancer research : an official journal of the American Association for Cancer Research (Clin Cancer Res) Vol. 12 Issue 16 Pg. 4899-907 (Aug 15 2006) ISSN: 1078-0432 [Print] United States
• PMID: 16914578 (Publication Type: Clinical Trial, Phase I, Clinical Trial, Phase II, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Anticonvulsants
• Antineoplastic Agents
• Benzamides
• Piperazines
• Pyrimidines
• Imatinib Mesylate

Topics

• Adolescent
• Adult
• Aged
• Anticonvulsants (therapeutic use)
• Antineoplastic Agents (adverse effects, pharmacokinetics, therapeutic use)
• Benzamides
• Brain Neoplasms (drug therapy, genetics, metabolism)
• Drug Interactions
• Female
• Genotype
• Glioma (drug therapy, genetics, metabolism)
• Humans
• Imatinib Mesylate
• Male
• Middle Aged
• Piperazines (adverse effects, pharmacokinetics, therapeutic use)
• Pyrimidines (adverse effects, pharmacokinetics, therapeutic use)