A Phase I/II Study of Zotiraciclib for Recurrent Malignant Gliomas With Isocitrate Dehydrogenase 1 or 2 (IDH1 or IDH2) Mutations

Inclusion criteria

• Participants must have diffuse glioma, WHO grades 2-4, histologically confirmed by Laboratory of Pathology, NCI.
• IDH1 or IDH2 mutation status confirmed by TruSight(TM) Oncology 500 performed in LP, NCI or prior documentation of IDH1 or IDH2 mutation status
• Participants must have received prior treatment (e.g., radiation, conventional chemotherapy, or vorasidenib) prior to disease progression.
• Participants must have recurrent disease, proven histologically or by imaging studies
• Participants who have undergone prior surgical resection are eligible for enrollment to cohorts 1-4.
• Age \>15 years
• Karnofsky \>70%
• Participants must have adequate organ and marrow function as defined below:
• leukocytes \>=3,000/microliter
• absolute neutrophil count (ANC) \>=1,500/microliter
• platelets \>100,000/microliter
• total bilirubin \<=2x ULN (ULN 1.3 mg/dl) except for participants with Gilbert Syndrome
• AST \< 3x ULN (ULN 34U/L)
• ALT \< 3x ULN (ULN 55U/L)
• serum creatinine \< 1.5 mg/dL
• calculated creatinine clearance by CKD-EPI equation \> 60 cc/min
• Participants must have recovered from the adverse effects of prior therapy to grade 2 or less (per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0)
• Individuals of child-bearing potential (IOCBP) and men must agree to use highly effective contraception (hormonal, intrauterine device (IUD), abstinence, tube ligation, partner has had a previous vasectomy) at the study entry, for the duration of study treatment, and up to 3 months after the last dose of zotiraciclib
• Breastfeeding participants must be willing to discontinue breastfeeding from study treatment initiation through 3 months after study treatment discontinuation
• Participants must be scheduled for brain tumor biopsy or surgical resection at NIH (Cohort 5 only)
• The ability of a participant, parent or legal guardian of minor participant to understand and the willingness to sign a written informed consent document. No Legally Authorized Representative can provide initial consent.

Exclusion criteria

• More than one disease relapse in those with initial diagnosis of WHO grade 3-4, or more than two disease relapses in those with initial diagnosis of WHO grade 2 for Phase II. For Phase I enrollment, there are no limits on the number of prior recurrences.
• Prior therapy with:
• any investigational agent (including IDH mutant inhibitor) and/or standard of care cytotoxic therapy within 28 days prior to treatment initiation
• vincristine within 14 days prior to treatment initiation
• nitrosoureas within 42 days prior to treatment initiation
• procarbazine within 21 days prior to treatment initiation
• non-cytotoxic agents, e.g., interferon, tamoxifen, thalidomide, cis-retinoic acid, within 7 days prior to treatment initiation
• surgery within 14 days prior to treatment initiation
• radiation therapy within 30 days prior to treatment initiation
• bevacizumab for tumor treatment. Note: participants who received bevacizumab for symptom management, including but not limited to cerebral edema, or pseudo progression can be enrolled
• Prolonged QTc \>470ms as calculated by correction formula on screening electrocardiogram (ECG) (QTCf can be used; QTCb can be used for participants with sinus bradycardia)
• Prior invasive malignancies within the past 3 years prior to study treatment initiation (with the exception of non-melanoma skin cancers, carcinoma in situ of the cervix, melanoma in situ, or any localized cancer for whom the systemic standard of care therapy is not required)
• History of allergic reactions attributed to compounds of similar chemical composition to zotiraciclib, such as flavopiridol
• Pregnancy (confirmed with beta-HCG serum or urine pregnancy test performed at screening)
• Uncontrolled intercurrent illness or social situations that would limit compliance with study requirements
• Uncontrolled primary diabetes mellitus