Ensayos clínicos

Inclusion Criteria: 

• Patients must have histopathologic or molecular confirmation of either IDH-mutant DA or IDH-mutant AA. Acceptable IDH mutations for study eligibility include any IDH1 mutation at codon 132 or any IDH2 mutation at codon 172. 
• Age ≥ 16 years. The intended neurocognitive tests have not been validated in children below the age of 16. 
• Eastern Cooperative Oncology Group (ECOG) performance status =< 1 (Karnofsky >= 70%). 
• Hemoglobin > 9.0 g/dL. 
• Leukocytes >= 3.0 x 10^9/L.
• Absolute neutrophil count >= 1.5 x 10^9/L.
• Platelets >= 100 x 10^9/L.
• International normalized ratio (INR) =< 1.5 x upper limit of normal (ULN).
• Partial thromboplastin time (PTT) or activated partial thromboplastin time (APTT) =< 1.5 x ULN. 
• Patients on a stable dose of anti-coagulation therapy will be allowed to participate if they have no signs of bleeding or clotting and the INR/PT and PTT/aPTT results are compatible with an acceptable risk-benefit ratio as per the investigator's discretion.
• Total bilirubin =< 1.5 x institutional ULN and < 3 mg/dL for patients with Gilbert's disease.
• Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) & alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3 x institutional ULN. 
• Creatinine =< 1.5 x institutional ULN or creatinine clearance >= 60 mL/minute.
• 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. 
• Patient must have measurable disease by RANO criteria (dose expansion cohort only). 
• Patient must be at least 7 days beyond stereotactic biopsy and/or at least 14 days beyond open craniotomy.
• Patients must have been on a stable or decreasing dose of corticosteroids over the last 7 days.
• Patients must have been on a stable or decreasing dose of antiepileptic therapy over the last 14 days. 
• Females of childbearing potential must have a negative pregnancy test (=<14 days) prior to start of trial treatment. The effects of CB-839 HCl on the developing human fetus are unknown. For this reason and because alkylating agents as well as TMZ are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 4 months after completion of CB-839 HCl administration.
• Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

• Patients must not have received prior chemotherapy to treat the glioma. 
• Patients who are receiving any other investigational agents. 
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to CB-839 HCl or TMZ. 
• Patient must not have received prior radiation therapy to the brain. Prior radiation therapy to the head and neck is also excluded if radiation fields overlap. 
• No prior use of Gliadel wafers. 
• Patient must have no evidence of either infratentorial or spinal involvement with tumor. 
• Patients who are unable to swallow tablets.
• Patients who are at risk for impaired absorption of oral medication including, but not limited to, refractory vomiting, gastric resection/bypass, and duodenal/jejunal resection. 
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. 
• Patients with a "currently active" second malignancy other than non-melanoma skin cancers. Patients are not considered to have a "currently active" malignancy if they have completed therapy and are free of disease for more than 3 years. 
• Pregnant women are excluded from this study because CB-839 HCl is an agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for AEs in nursing infants secondary to treatment of the mother with CB-839 HCl, breastfeeding should be discontinued if the mother is treated with CB-839 HCl. These potential risks may also apply to TMZ.