Abstract
Background Vorinostat, a histone deacetylase (HDAC) inhibitor, has shown radiosensitizing properties in preclinical studies. This open-label, single-arm trial evaluated the maximum tolerated dose (MTD; phase I) and efficacy (phase II) of vorinostat combined with standard chemoradiation in newly diagnosed glioblastoma. Methods Patients received oral vorinostat (300 or 400 mg/day) on days 1-5 weekly during temozolomide chemoradiation. Following a 4-to 6-week rest, patients received up to 12 cycles of standard adjuvant temozolomide and vorinostat (400 mg/day) on days 1-7 and 15-21 of each 28-day cycle. Association between vorinostat response signatures and progression-free survival (PFS) and overall survival (OS) was assessed based on RNA sequencing of baseline tumor tissue. Results Phase I and phase II enrolled 15 and 107 patients, respectively. The combination therapy MTD was vorinostat 300 mg/day and temozolomide 75 mg/m 2/day. Dose-limiting toxicities were grade 4 neutropenia and thrombocytopenia and grade 3 aspartate aminotransferase elevation, hyperglycemia, fatigue, and wound dehiscence. The primary efficacy endpoint in the phase II cohort, OS rate at 15 months, was 55.1% (median OS 16.1 mo), and consequently, the study did not meet its efficacy objective. Most common treatment-related grade 3/4 toxicities in the phase II component were lymphopenia (32.7%), thrombocytopenia (28.0%), and neutropenia (21.5%). RNA expression profiling of baseline tumors (N = 76) demonstrated that vorinostat resistance (sig-79) and sensitivity (sig-139) signatures had a reverse and positive association with OS/PFS, respectively. Conclusions Vorinostat combined with standard chemoradiation had acceptable tolerability in newly diagnosed glioblastoma. Although the primary efficacy endpoint was not met, vorinostat sensitivity and resistance signatures could facilitate patient selection in future trials.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 546-556 |
| Number of pages | 11 |
| Journal | Neuro-Oncology |
| Volume | 20 |
| Issue number | 4 |
| DOIs | |
| State | Published - Mar 27 2018 |
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Keywords
- glioblastoma
- histone deacetylase inhibitors
- phase I/II trial
- temozolomide
- vorinostat
ASJC Scopus subject areas
- Oncology
- Clinical Neurology
- Cancer Research
Cite this
Phase I/II trial of vorinostat combined with temozolomide and radiation therapy for newly diagnosed glioblastoma : Results of Alliance N0874/ABTC 02. / Galanis, Evanthia; Keith Anderson, S.; Miller, C. Ryan; Sarkaria, Jann N; Jaeckle, Kurt; Buckner, Jan Craig; Ligon, Keith L.; Ballman, Karla V.; Moore, Dennis F.; Nebozhyn, Michael; Loboda, Andrey; Schiff, David; Ahluwalia, Manmeet Singh; Lee, Eudocia Q.; Gerstner, Elizabeth R.; Lesser, Glenn J.; Prados, Michael; Grossman, Stuart A.; Cerhan, Jane H; Giannini, Caterina; Wen, Patrick Y.
In: Neuro-Oncology, Vol. 20, No. 4, 27.03.2018, p. 546-556.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Phase I/II trial of vorinostat combined with temozolomide and radiation therapy for newly diagnosed glioblastoma
T2 - Results of Alliance N0874/ABTC 02
AU - Galanis, Evanthia
AU - Keith Anderson, S.
AU - Miller, C. Ryan
AU - Sarkaria, Jann N
AU - Jaeckle, Kurt
AU - Buckner, Jan Craig
AU - Ligon, Keith L.
AU - Ballman, Karla V.
AU - Moore, Dennis F.
AU - Nebozhyn, Michael
AU - Loboda, Andrey
AU - Schiff, David
AU - Ahluwalia, Manmeet Singh
AU - Lee, Eudocia Q.
AU - Gerstner, Elizabeth R.
AU - Lesser, Glenn J.
AU - Prados, Michael
AU - Grossman, Stuart A.
AU - Cerhan, Jane H
AU - Giannini, Caterina
AU - Wen, Patrick Y.
PY - 2018/3/27
Y1 - 2018/3/27
N2 - Background Vorinostat, a histone deacetylase (HDAC) inhibitor, has shown radiosensitizing properties in preclinical studies. This open-label, single-arm trial evaluated the maximum tolerated dose (MTD; phase I) and efficacy (phase II) of vorinostat combined with standard chemoradiation in newly diagnosed glioblastoma. Methods Patients received oral vorinostat (300 or 400 mg/day) on days 1-5 weekly during temozolomide chemoradiation. Following a 4-to 6-week rest, patients received up to 12 cycles of standard adjuvant temozolomide and vorinostat (400 mg/day) on days 1-7 and 15-21 of each 28-day cycle. Association between vorinostat response signatures and progression-free survival (PFS) and overall survival (OS) was assessed based on RNA sequencing of baseline tumor tissue. Results Phase I and phase II enrolled 15 and 107 patients, respectively. The combination therapy MTD was vorinostat 300 mg/day and temozolomide 75 mg/m 2/day. Dose-limiting toxicities were grade 4 neutropenia and thrombocytopenia and grade 3 aspartate aminotransferase elevation, hyperglycemia, fatigue, and wound dehiscence. The primary efficacy endpoint in the phase II cohort, OS rate at 15 months, was 55.1% (median OS 16.1 mo), and consequently, the study did not meet its efficacy objective. Most common treatment-related grade 3/4 toxicities in the phase II component were lymphopenia (32.7%), thrombocytopenia (28.0%), and neutropenia (21.5%). RNA expression profiling of baseline tumors (N = 76) demonstrated that vorinostat resistance (sig-79) and sensitivity (sig-139) signatures had a reverse and positive association with OS/PFS, respectively. Conclusions Vorinostat combined with standard chemoradiation had acceptable tolerability in newly diagnosed glioblastoma. Although the primary efficacy endpoint was not met, vorinostat sensitivity and resistance signatures could facilitate patient selection in future trials.
AB - Background Vorinostat, a histone deacetylase (HDAC) inhibitor, has shown radiosensitizing properties in preclinical studies. This open-label, single-arm trial evaluated the maximum tolerated dose (MTD; phase I) and efficacy (phase II) of vorinostat combined with standard chemoradiation in newly diagnosed glioblastoma. Methods Patients received oral vorinostat (300 or 400 mg/day) on days 1-5 weekly during temozolomide chemoradiation. Following a 4-to 6-week rest, patients received up to 12 cycles of standard adjuvant temozolomide and vorinostat (400 mg/day) on days 1-7 and 15-21 of each 28-day cycle. Association between vorinostat response signatures and progression-free survival (PFS) and overall survival (OS) was assessed based on RNA sequencing of baseline tumor tissue. Results Phase I and phase II enrolled 15 and 107 patients, respectively. The combination therapy MTD was vorinostat 300 mg/day and temozolomide 75 mg/m 2/day. Dose-limiting toxicities were grade 4 neutropenia and thrombocytopenia and grade 3 aspartate aminotransferase elevation, hyperglycemia, fatigue, and wound dehiscence. The primary efficacy endpoint in the phase II cohort, OS rate at 15 months, was 55.1% (median OS 16.1 mo), and consequently, the study did not meet its efficacy objective. Most common treatment-related grade 3/4 toxicities in the phase II component were lymphopenia (32.7%), thrombocytopenia (28.0%), and neutropenia (21.5%). RNA expression profiling of baseline tumors (N = 76) demonstrated that vorinostat resistance (sig-79) and sensitivity (sig-139) signatures had a reverse and positive association with OS/PFS, respectively. Conclusions Vorinostat combined with standard chemoradiation had acceptable tolerability in newly diagnosed glioblastoma. Although the primary efficacy endpoint was not met, vorinostat sensitivity and resistance signatures could facilitate patient selection in future trials.
KW - glioblastoma
KW - histone deacetylase inhibitors
KW - phase I/II trial
KW - temozolomide
KW - vorinostat
UR - http://www.scopus.com/inward/record.url?scp=85045223336&partnerID=8YFLogxK
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U2 - 10.1093/neuonc/nox161
DO - 10.1093/neuonc/nox161
M3 - Article
VL - 20
SP - 546
EP - 556
JO - Neuro-Oncology
JF - Neuro-Oncology
SN - 1522-8517
IS - 4
ER -