The Toca 5 Trial: Toca 511 & Toca FC Versus Standard of Care in Patients With Recurrent High Grade Glioma

Not Recruiting

Trial ID: NCT02414165


This is a multicenter, randomized, open-label phase 2/3 study of Toca 511 and Toca FC versus standard of care that comprises Investigator's choice of single agent chemotherapy (lomustine or temozolomide) or bevacizumab administered to subjects undergoing resection for first or second recurrence (including this recurrence) of GBM or AA. Subjects meeting all of the inclusion and none of the exclusion criteria will be randomized prior to surgery in a 1:1 ratio to receive either Toca 511 and Toca FC (Experimental arm, Arm T) or control treatment with one option of standard of care (Arm SOC). Stratification will be done by IDH1 mutation status. A second stratification factor is based on the patient's Karnofsky Performance Score (KPS) (70-80 vs 90-100). Further, to account for potential differences in treatment choices for the control arm in regions, the trial will be stratified by geographical region during the randomization process. Funding Source - FDA OOPD

Official Title

A Phase 2/3 Randomized, Open-Label Study of Toca 511, a Retroviral Replicating Vector, Combined With Toca FC Versus Standard of Care in Subjects Undergoing Planned Resection for Recurrent Glioblastoma or Anaplastic Astrocytoma

Stanford Investigator(s)

Seema Nagpal, MD
Seema Nagpal, MD

Clinical Professor, Neurology & Neurological Sciences Clinical Professor (By courtesy), Neurosurgery

Gordon Li, MD
Gordon Li, MD

Professor of Neurosurgery and, by courtesy, of Neurology and of Otolaryngology - Head & Neck Surgery (OHNS)

Reena Thomas, MD PhD
Reena Thomas, MD PhD

Clinical Associate Professor, Neurology & Neurological Sciences Clinical Associate Professor (By courtesy), Neurosurgery


Inclusion Criteria:

   1. Subject has given written informed consent

   2. Subject is between 18 years old and 75 years old, inclusive

   3. Subjects must have histologically proven GBM or AA and:

      1. Must have received first-line multimodal therapy with surgery followed by
      temozolomide (unless MGMT promoter unmethylated) and radiation (subjects with GBM
      must have received temozolomide and radiation concurrently)

      2. Must be in first or second recurrence (including this recurrence)

      3. Recurrence must be confirmed by diagnostic biopsy with local pathology review or
      contrast-enhanced MRI. If first recurrence of GBM is documented by MRI, an
      interval of at least 12 weeks after the end of prior radiation therapy is
      required unless there is either: i) histopathologic confirmation of recurrent
      tumor, or ii) new enhancement on MRI outside of the radiotherapy treatment field

   4. Subjects must have measurable disease preoperatively, defined as at least 1
   contrast-enhancing lesion, with 2 perpendicular measurements of at least 1 cm, as per
   RANO criteria

   5. Subjects must be at least 4 weeks post last dose of temozolomide

   6. Prior gamma knife, stereotactic radiosurgery, or other focal high-dose radiotherapy is
   allowed but the subject must have either histopathologic confirmation of recurrent
   tumor, or new enhancement on MRI outside of the radiotherapy treatment field

   7. Based on the pre-operative evaluation by neurosurgeon, the subject is a candidate for
   ≥ 80% resection of enhancing region

   8. IDH mutation status of the primary tumor must be available or tumor samples must be
   available for pre randomization testing

   9. Laboratory values adequate for patient to undergo surgery, including:

      - Platelet count ≥ 60,000/mm3

      - Hgb ≥ 10 g/dL

      - Absolute neutrophil count (ANC) ≥ 1,500/mm3

      - Absolute lymphocyte count (ALC) ≥ 500/mm3

      - Adequate liver function, including:

         - Total bilirubin ≤ 1.5 x ULN (unless has Gilbert's syndrome)

         - ALT ≤ 2.5 x ULN f. Estimated glomerular filtration rate of at least 50
         mL/min by the Cockcroft Gault formula

10. Women of childbearing potential (≥12 months of non-therapy-induced amenorrhea or
   surgically sterile) must have had a negative serum pregnancy test within the past 21
   days and must use a birth control method in addition to barrier methods (condoms).

11. Subject or subject's partner is willing to use condoms for 12 months after receiving
   Toca 511 or until there is no evidence of the virus in his/her blood, whichever is

12. The subject has a KPS ≥ 70

13. The subject is willing and able to abide by the protocol

Exclusion Criteria:

   1. History of more than 2 prior recurrences (including this recurrence) of GBM or AA

   2. History of other malignancy, unless the patient has been disease free for at least 5
   years. Adequately treated basal cell carcinoma or squamous cell skin cancer is
   acceptable regardless of time, as well as localized prostate carcinoma or cervical
   carcinoma in situ after curative treatment

   3. Histologically confirmed oligodendroglioma or mixed glioma

   4. Known 1p/19q co deletion

   5. A contrast enhancing brain tumor that is any of the following:

      - Multi focal (defined as 2 separate areas of contrast enhancement measuring at
      least 1 cm in 2 planes that are not contiguous on either fluid attenuated
      inversion recovery (FLAIR) or T2 sequences);

      - Associated with either diffuse subependymal or leptomeningeal dissemination; or

      - > 5 cm in any dimension

   6. The subject has or had any active infection requiring systemic antibiotic, antifungal
   or antiviral therapy within the past 4 weeks

   7. The subject has any bleeding diathesis, or must take anticoagulants, or antiplatelet
   agents, including nonsteroidal anti inflammatory drugs (NSAIDs), at the time of the
   scheduled resection that cannot be stopped for surgery

   8. The subject is human immunodeficiency virus (HIV) positive

   9. The subject has a history of allergy or intolerance to flucytosine

10. The subject has a gastrointestinal disease that would prevent him or her from being
   able to swallow or absorb flucytosine

11. The subject received cytotoxic chemotherapy within the past 4 weeks (6 weeks for
   nitrosoureas) of the planned surgery date

12. The subject received any investigational treatment within the past 30 days or prior
   immunotherapy or antibody therapy within the past 45 days.

13. The subject is pregnant or breast feeding

14. The subject intends to undergo treatment with the Gliadel® wafer at the time of this
   surgery or has received the Gliadel® wafer < 30 days from W1D1 (surgery)

15. The subject has received bevacizumab for their disease unless in the context of
   primary therapy for newly diagnosed glioma

16. For subjects planned to potentially receive bevacizumab, they have no evidence of
   uncontrolled hypertension (defined as a blood pressure of ≥ 150 mm Hg systolic and/or
   ≥ 100 mm Hg diastolic on medication) or active GI perforation

17. The subject has received systemic dexamethasone continuously at a dose > 8 mg/day for
   8 weeks prior to the date of the screening assessment

18. Severe pulmonary, cardiac or other systemic disease, specifically:

      - New York Heart Association > Grade 2 congestive heart failure within 6 months
      prior to study entry, unless asymptomatic and well controlled with medication

      - Uncontrolled or significant cardiovascular disease, clinically significant
      ventricular arrhythmia (such as ventricular tachycardia, ventricular
      fibrillation, or Torsades des pointes), clinically significant pulmonary disease
      (such as ≥ Grade 2 dyspnea, according to CTCAE 4.03)

      - Subjects who have any other disease, either metabolic or psychological, which as
      per Investigator assessment may affect the subject's compliance or place the
      subject at higher risk of potential treatment complications


biological: Toca 511

drug: Toca FC

drug: Lomustine

drug: Temozolomide

biological: Bevacizumab

Not Recruiting

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305

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