Study of TG02 in Elderly Newly Diagnosed or Adult Relapsed Patients With Anaplastic Astrocytoma or Glioblastoma
Study of TG02 in Elderly Newly Diagnosed or Adult Relapsed Patients With Anaplastic Astrocytoma or Glioblastoma
This is a three parallel cohort, open-labeled, non-randomized, multicenter study. All three
 cohorts will enroll independently.
Group A will be composed of newly-diagnosed, elderly patients with IDH1R132H-non mutant and
 MGMT promoter-unmethylated anaplastic astrocytoma or glioblastoma who will receive TG02 and
 RT.

 Group B will be composed of newly-diagnosed, elderly patients with IDH1R132H-non mutant and
 MGMT promoter-methylated anaplastic astrocytoma or glioblastoma who will receive TG02 and
 temozolomide.

 For both Groups A and B, there will be a classical 3+3 dose escalation and an expansion phase
 in the study. Up to a total of 24 evaluable patients in Group A and up to a total of 12
 evaluable patients in Group B (up to 36 evaluable patients for Groups A and B).

 Group C patients will be composed of patients initially diagnosed with IDH1R132H-non-mutant
 anaplastic astrocytoma or glioblastoma at first relapse post TMZ/RT-->TMZ therapy who will
 receive TG02.
Specifics for groups A and B

 -  Newly diagnosed glioblastoma or anaplastic astrocytoma, IDH1R132H-non-mutant by
 immunohistochemistry locally assessed, with FFPE tissue available for central MGMT
 testing and optional biomarker studies (treatment allocation will be performed based
 on centrally assessed MGMT result)

 -  Tumor debulking surgery, including partial resection

 -  Age > 65 and considered non-eligible for combination therapy (TMZ/RT→TMZ) in
 Investigator's opinion

 -  No prior RT with overlap of radiation fields with the planned RT in this study (Group
 A)

 -  No prior therapy for glioblastoma or anaplastic astrocytoma before surgery

 -  Brain MRI within 14 days before the first dose of TG02

 Specifics for group C

 -  IDH1R132H-non-mutant glioblastoma or anaplastic astrocytoma at first relapse with
 tissue available from first surgery. [Per 2016 WHO classification, in patients older
 than 55 years of age at diagnosis with a histological diagnosis of glioblastoma,
 without a pre-existing lower grade glioma and with non-midline tumor location,
 immunohistochemical negativity for IDH1R132H suffices for classification as
 glioblastoma. In all other instances of diffuse gliomas, lack of IDH1R132H
 immunopositivity should be followed by IDH1 and IDH2 sequencing to detect or exclude
 other less common IDH mutations.]

 -  Brain MRI at the time of progression or 14 days before the first dose of TG02 and
 availability of last brain MRI before progression diagnosis for upload to the EORTC
 Imaging Platform for post-hoc central review of progression

 -  Diagnosis of recurrence more than 3 months after the end of RT for initial treatment

 -  Intention to be treated with standard TMZ/RT→TMZ for initial treatment (at least one
 dose of TMZ administered; RT alone or chemotherapy alone as initial treatment are not
 permitted)

 -  No discontinuation of TMZ for toxicity during first-line treatment

 -  No RT or stereotactic radiosurgery is allowed for the treatment of first recurrence
 prior to enrollment in this study

 -  Patient may have been operated for recurrence. If operated:

 -  surgery completed at least 2 weeks before initiation of TG02 and patients should have
 fully recovered as assessed by investigator. Criteria for full recovery include
 absence of active post-operative infection, recovery from medical complications (CTCAE
 grade 0 and 1 acceptable), and capacity for adequate fluid and food intake

 -  residual and measurable disease after surgery is not required but surgery must have
 confirmed the recurrence

 -  a post-surgery MRI should be available within 72 hours; the post-surgery MRI can be
 used as baseline if performed within 2 weeks prior to registration. If not, a baseline
 MRI has to be done within 2 weeks prior to registration

 -  For non-operated patients: recurrent disease must be at least one bi-dimensionally
 measurable contrast-enhancing lesion with clearly defined margins by MRI scan, with
 minimal diameters of 10 mm, visible on 2 or more axial slices 5 mm apart, based on a
 MRI scan done within 2 weeks prior to registration

 -  Age ≥ 18 years

 All groups

 -  Karnofsky Performance Score (KPS) of 60-100

 -  Recovered from effects of debulking surgery, postoperative infection and other
 complications of surgery (if any) (CTCAE grade 0 and 1 acceptable)

 -  Adequate bone marrow, renal and hepatic function within the following ranges within 7
 days before the first dose of TG02:

 -  WBC ≥ 3 x109/L

 -  ANC ≥ 1.5x109/L

 -  Platelet count of ≥ 100 x109/L independent of transfusion

 -  Hemoglobin ≥ 10 g/dl or ≥ 6.2 mmol/L

 -  Bilirubin ≤ 1.5 × ULN

 -  ALT and AST ≤ 2.5 × ULN

 -  Cockcroft-Gault calculated or measured creatinine clearance of ≥ 30 mL/min

 -  No use of enzyme-inducing anti-epileptic drugs (EI-AED) within 7 days prior to the
 first dose of TG02

 -  Life expectancy > 8 weeks

 -  No history of ventricular arrhythmia or symptomatic conduction abnormality in past 12
 months prior to registration

 -  No congestive heart failure (New York Heart Association Class III to IV, see Appendix
 C), symptomatic ischemia, uncontrolled by conventional intervention, or myocardial
 infarction within 6 months prior to enrollment

 -  No 12-lead ECG with a prolonged QTc interval (males: > 450 ms; females: > 470 ms) as
 calculated by the Fridericia correction formula despite balancing of electrolytes at
 registration and/or discontinuing any drugs (for a time period corresponding to 5
 half-lives) known to prolong QTc interval

 -  No known contraindication to imaging tracer or any product of contrast media

 -  No MRI contraindications

 -  No concurrent severe or uncontrolled medical disease (e.g., active systemic infection,
 diabetes, hypertension, coronary artery disease) that, in the opinion of the
 Investigator, would compromise the safety of the patient or compromise the ability of
 the patient to complete the study

 -  No known human immunodeficiency virus infection or acquired immune deficiency syndrome

 -  No previous other malignancies, except for any previous malignancy which was treated
 with curative intent more than 3 years prior to enrollment, or adequately controlled
 limited basal cell carcinoma of the skin, squamous carcinoma of the skin or carcinoma
 in situ of the cervix

 -  No pregnant women. Negative serum or urine pregnancy test within 72 hours prior to the
 first dose for women of childbearing potential (WOCBP). Nursing must be discontinued
 at least 1 hour before first dose.

 -  For men of reproductive potential and WOCBP, adequate contraception must be used
 throughout the study and for 6 months thereafter. For this study, acceptable methods
 of contraception include a reliable intrauterine device or a spermicide in combination
 with a barrier method. Hormonal forms of birth control (oral, implantable, or
 injectable) may only be used if combined with another highly effective form of birth
 control such as a spermicide combined with a barrier method

 -  Ability to understand the requirements of the study, provide written informed consent
 and authorization of use and disclosure of protected health information, and agree to
 abide by the study restrictions and return for the required assessments

 -  Ability to take oral medication

 -  Absence of any psychological, familial, sociological or geographical condition
 potentially hampering compliance with the study protocol and follow-up schedule; those
 conditions should be discussed with the patient before registration in the trial

 -  Before patient registration, written informed consent must be given according to
 ICH/GCP, and national/local regulations.