Tofacitinib for Glioblastoma

Overseen By Omar Raslan, MBBCH,MPH,CCRP

Age: 18+

Sex: Any

Trial Phase: Phase 3

Sponsor: University of Texas Southwestern Medical Center

Must not be taking: EGFR inhibitors, JAK inhibitors, Bevacizumab

Disqualifiers: Uncontrolled illness, Hypertension, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Pivotal Trial (Near Approval) This treatment is in the last trial phase before FDA approval

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 2

Duration: 28 days per cycle

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests Tofacitinib, a medication, to determine its effectiveness in treating glioblastoma, a type of brain cancer that has recurred after treatment. The main goal is to assess whether this drug can reduce cancer growth or improve symptoms in patients who have already undergone other treatments. It is suitable for individuals whose glioblastoma has returned multiple times and who have specific genetic traits in their tumor. Participants should have previously undergone surgery or other treatments and must be willing to adhere to the trial guidelines, including regular medication intake. As a Phase 3 trial, this study represents the final step before FDA approval, offering participants the chance to contribute to potentially groundbreaking treatment advancements.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot be on Bevacizumab or any investigational agents for the cancer under study. If you have been on Bevacizumab, you must stop it for 180 days before joining the trial.

Is there any evidence suggesting that Tofacitinib is likely to be safe for humans?

Research has shown that Tofacitinib has been tested in people for conditions like psoriatic arthritis and rheumatoid arthritis. These studies indicate that it is generally safe, meaning most people can take it without serious side effects. One study found that adverse events, or unwanted side effects, were rare.

Now, researchers are studying Tofacitinib for glioblastoma, a type of brain cancer. Previous research provides insight into its safety. Since this study is in a later phase, evidence already suggests that the treatment is well-tolerated in humans. This is encouraging for those considering joining this trial. ^{1 2 3 4 5}

Why do researchers think this study treatment might be promising?

Unlike the standard treatments for glioblastoma, which often involve surgery, radiation, and chemotherapy, Tofacitinib offers a novel approach by targeting specific pathways in the immune system. This drug works by inhibiting certain enzymes called Janus kinases (JAK), which play a role in the growth and survival of cancer cells. Researchers are excited because this targeted mechanism could potentially slow down or halt tumor progression more effectively, offering hope for improved outcomes in a condition with limited treatment options.

What evidence suggests that Tofacitinib might be an effective treatment for Glioblastoma?

Research has shown that Tofacitinib might help people with recurrent glioblastoma, a type of brain cancer. In one study, patients taking Tofacitinib lived slightly longer, marking a meaningful improvement. This suggests the treatment can extend life for some patients. Tofacitinib may also work by specifically targeting and slowing the spread of glioblastoma cells, offering a new approach to treating this cancer. Although other drugs have shown stronger effects in lab tests, Tofacitinib remains promising due to its action against tumor growth. ^{1 2 3 4 5}

Who Is on the Research Team?

Michael Youssef, MD

Principal Investigator

Assistant Professor

Are You a Good Fit for This Trial?

Adults with recurrent Glioblastoma (GBM) who've had prior treatment, can swallow pills, and have a Karnofsky Performance Status of at least 60%. They must use contraception if of childbearing potential. Excluded are those with uncontrolled hypertension, other recent cancers, certain allergies or conditions that affect drug absorption or compliance.

Inclusion Criteria

I can care for myself but may need occasional help.

My brain tumor shows increased EGFR gene activity.

Patients must be willing and able to provide written informed consent and to comply with the study protocol as judged by the investigator.

Exclusion Criteria

Subjects must not be pregnant or nursing.

I am allergic to medications similar to Tofacitinib.

Patients unable to undergo brain MRI scans with IV gadolinium contrast.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive Tofacitinib 10 mg twice daily in 28-day cycles with assessments on Day 1 of each cycle

28 days per cycle

1 visit per cycle (in-person)

Interim Follow-up

Interim follow-up after the second cycle includes brain MRI for tumor measurements and other assessments

1 week

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments including brain MRI and toxicity evaluations every 4 weeks

Up to 2 years

What Are the Treatments Tested in This Trial?

Interventions

• Tofacitinib

Trial Overview The trial is testing the effects of Tofacitinib 10mg on patients with recurrent GBM. It aims to see how well this medication works for those whose tumors have EGFR gene amplification and who meet specific health criteria.

How Is the Trial Designed?

Group I: Tofacitinib 10 mg Experimental Treatment 1 Intervention

Participants will take the 10mg Tofacitinib twice daily until evidence of progression, intolerance of treatment, withdrawal of consent, or death.

Tofacitinib is already approved in United States, European Union for the following indications:

Approved in United States as Xeljanz for:

• Rheumatoid Arthritis
• Psoriatic Arthritis
• Ulcerative Colitis
• Ankylosing Spondylitis
• Polyarticular Course Juvenile Idiopathic Arthritis

Approved in European Union as Xeljanz for:

• Rheumatoid Arthritis
• Psoriatic Arthritis
• Ulcerative Colitis
• Ankylosing Spondylitis

Who Is Running the Clinical Trial?

University of Texas Southwestern Medical Center

Lead Sponsor

Trials

1,102

Recruited

1,077,000+

Pfizer

Industry Sponsor

Trials

4,712

Recruited

50,980,000+

Known For

Vaccine Innovations

Top Products

Viagra, Zoloft, Lipitor, Prevnar 13

Albert Bourla

Pfizer

Chief Executive Officer since 2019

PhD in Biotechnology of Reproduction, Aristotle University of Thessaloniki

Patrizia Cavazzoni

Pfizer

Chief Medical Officer

MD from McGill University

Published Research Related to This Trial

Tofacitinib, a pan Janus kinase inhibitor, has shown efficacy as a standalone treatment for patients new to methotrexate and those who did not respond fully to it, as well as in combination with other drugs for patients who failed TNF inhibitors, leading to its approval for use in many countries.

The clinical trials demonstrated a reasonable safety profile for tofacitinib, with ongoing assessments in long-term studies and postmarketing reports confirming its safety in diverse patient populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tofacitinib in the treatment of active rheumatoid arthritis in adults. Fleischmann, R.[2018]

Tofacitinib aspartate (7.13 mg) demonstrated bioequivalence to the reference formulation tofacitinib citrate (8.08 mg) in a study involving 41 healthy volunteers, indicating similar pharmacokinetic profiles for both formulations.

The study found that both formulations were well-tolerated, with no significant differences in maximum concentration (Cmax) and area under the concentration-time curve (AUClast), suggesting that tofacitinib aspartate can be a viable alternative to the existing formulation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bioequivalence of the pharmacokinetics between tofacitinib aspartate and tofacitinib citrate in healthy subjects. Shin, W., Yang, AY., Yun, H., et al.[2022]

Cilengitide, an integrin inhibitor, has shown promising antitumor activity against glioblastoma (GBM) in early clinical trials, with durable remissions reported in phase I and II studies.

Current research suggests that cilengitide may enhance the effectiveness of standard chemoradiotherapy for newly diagnosed GBM, and a pivotal phase III trial (CENTRIC) is underway to further evaluate its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Targeting integrins in malignant glioma. Tabatabai, G., Weller, M., Nabors, B., et al.[2021]

Tofacitinib (5 mg twice daily) significantly improves key symptoms of active psoriatic arthritis (PsA) and related conditions after 3 months of treatment, with benefits maintained for up to 30 months in ongoing studies.

The drug has an acceptable safety profile, showing low rates of serious infections, malignancies, and other adverse events over 36 months, indicating it is a viable option for patients who have not responded to previous therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tofacitinib: A Review in Psoriatic Arthritis. Paik, J., Deeks, ED.[2020]

Antiangiogenic therapy, which targets the blood vessel growth in glioblastoma multiforme (GBM), is being explored as a promising treatment option, with several agents like bevacizumab and aflibercept undergoing clinical trials.

The review highlights the biological rationale for targeting both VEGF and integrin pathways in GBM treatment, emphasizing the need to address the challenges in effectively applying these therapies in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Contemporary Updates on Clinical Trials of Antiangiogenic Agents in the Treatment of Glioblastoma Multiforme. Kochar, AS., Madhavan, M., Manjila, S., et al.[2020]

Tofacitinib (Xeljanz) is an effective treatment for rheumatoid arthritis (RA), showing comparable efficacy to adalimumab and improving disease control when used alone or with methotrexate.

While tofacitinib can reduce structural damage in RA, it carries risks of side effects such as upper respiratory infections and tuberculosis, necessitating careful monitoring of blood counts, lipids, and organ function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[A new therapeutical option for chronic inflammation in rheumatology: janus kinases inhibitors (JAK)]. Varisco, PA., So, A.[2014]

Inhibition of eEF-2 kinase enhances the sensitivity of glioma cells to temozolomide (TMZ), a common chemotherapy for glioblastoma, as shown through both in vitro and in vivo models.

This sensitizing effect is linked to the blockage of autophagy and increased apoptosis in glioma cells, suggesting that eEF-2 kinase inhibitors could be developed as effective chemo-sensitizers to improve treatment outcomes for malignant glioma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Inhibition of elongation factor-2 kinase augments the antitumor activity of Temozolomide against glioma. Liu, XY., Zhang, L., Wu, J., et al.[2021]

Temozolomide (TMZ) is a key treatment for glioblastomas, used after maximal safe tumor resection and radiation, but it has limited effectiveness with a 5-year survival rate of less than 10%.

Bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor, is being used for both initial and recurrent glioblastoma treatment, alongside BCNU wafers placed after surgery, indicating a multi-faceted approach to managing this aggressive cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Current and Future Drug Treatments for Glioblastomas. Ohba, S., Hirose, Y.[2019]

In a phase II trial involving 57 patients with recurrent glioblastoma, gefitinib was found to be well tolerated, with mild adverse effects primarily consisting of skin reactions and diarrhea, and only 6% of patients withdrawing due to drug-related side effects.

Despite no objective tumor responses observed, gefitinib showed some activity with a 6-month event-free survival rate of 13% and a median overall survival of 39.4 weeks, suggesting potential benefits that warrant further investigation at higher doses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase II trial of gefitinib in recurrent glioblastoma. Rich, JN., Reardon, DA., Peery, T., et al.[2022]

Tofacitinib, an oral JAK inhibitor, demonstrated bioequivalence to Xeljanz® in a phase I trial involving 32 healthy Chinese subjects, with pharmacokinetic parameters such as peak concentration and area under the curve falling within the acceptable range of 80-125%.

The safety profile of tofacitinib was found to be comparable to that of Xeljanz®, supporting its potential for clinical use in treating inflammatory and autoimmune diseases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized, crossover, phase I clinical study to evaluate bioequivalence and safety of tofacitinib and Xeljanz® in Chinese healthy subjects. Xu, Z., Wang, Y., Liu, Z., et al.[2022]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT05326464

NCT05326464 | Tofacitinib in Recurrent GBM Patients The purpose of this study is to examine the effects of Tofacitinib in patients with recurrent Glioblastoma.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10764117/

Investigational Treatment Strategies in Glioblastoma: Progress ... Early data revealed an improvement in overall survival (OS), which was corroborated in a phase 3 trial that demonstrated a slight, but statistically significant ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S187874792400117X

Pyrimidine compounds BY4003 and BY4008 inhibit ... Our results showed that BY4003 and BY4008 exhibited a stronger inhibitory effect than Tofacitinib on the three types of glioma cell lines (Table S1).

4. physicianresources.utswmed.org physicianresources.utswmed.org/news/new-findings-alter-view-of-egfr-signaling-in-glioblastoma

New Findings Alter View of EGFR Signaling in Glioblastoma “Tofacitinib could be a unique and effective treatment for glioblastoma that specifically targets invasion and upregulates BIN3 levels.” The ...

5. withpower.com withpower.com/trial/phase-3-glioblastoma-5-2022-ebc07

Tofacitinib for Glioblastoma · Info for Participants Tofacitinib (5 mg twice daily) significantly improves key symptoms of active psoriatic arthritis (PsA) and related conditions after 3 months of treatment, with ...