Clinical Trial Details
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NCT01582152 : Phase I/II Bevacizumab Versus Bevacizumab Plus TPI 287 for Recurrent Glioblastoma
PhasePhase 1/Phase 2
AgesMin: 18 Years Max: N/A
Inclusion Criteria:

1. Patients must have histologically proven glioblastoma or gliosarcoma to be eligible
for this protocol. Patients will be eligible if the original histology was low-grade
glioma or anaplastic glioma (WHO II or III) and a subsequent histological diagnosis
of glioblastoma or gliosarcoma is made. Only patients with histologically proven or
imaging proven recurrent glioblastoma or gliosarcoma will be eligible for this

2. Patients must have shown unequivocal evidence for tumor recurrence or progression by
MRI scan and should have failed radiation and temozolomide therapy. The scan done
prior to study entry documenting progression will be reviewed by the treating
physician to document changes in tumor dimension to confirm recurrence. Patients with
prior therapy that included interstitial brachytherapy or stereotactic radiosurgery
must have confirmation of true progressive disease rather than radiation necrosis.

3. For this study, patients may have had up to 2 prior relapses provided the functional
status and other eligibility criteria for enrollment are met.

4. All patients must sign an informed consent indicating their awareness of the
investigational nature of this study in keeping with the policies of this hospital.

5. The baseline on-study MRI should be performed within 14 days (+/- 3 working days)
prior to registration and on a steroid dosage that has been stable or decreasing for
at least 5 days. If the steroid dose is increased between the date of imaging and the
initiation of therapy (or at that time), a new baseline MRI is required. The same
type of scan, i.e., MRI, must be used throughout the period of protocol treatment for
tumor measurement.

6. Patients having undergone recent resection of recurrent or progressive tumor will be
eligible as long as all of the following conditions apply: a) At least 4 weeks have
elapsed from the date of surgery and the patients have recovered from the effects of
surgery. b) Evaluable or measurable disease following resection of recurrent tumor is
not mandated for eligibility into the study. c) To best assess the extent of residual
measurable disease post-operatively, a MRI should be done no later than 96 hours in
the immediate post-operative period.

7. Patients must be 18 years old or older.

8. Patients must have a Karnofsky performance status (KPS) equal or greater than 60.

9. Patients must have recovered from the toxic effects of prior therapy to < grade 2
toxicity per CTC version 4 (except deep vein thrombosis) prior to Day 1 of Cycle 1:
a) at least 12 weeks from completion of radiation therapy except if there is
unequivocal evidence for tumor recurrence (such as histological confirmation or
advanced imaging data such as PET scan) in which case at least 4 weeks from
completion of radiation therapy will suffice (Note: for patients who have undergone
surgery to confirm recurrence after radiation therapy, guidelines in 5.2.6a should be
followed). b) 4 weeks from prior cytotoxic therapy. c) 4 weeks from prior
experimental drug. d) 2 weeks from vincristine.

10. 9) (continued) e) 6 weeks from nitrosoureas. f) 3 weeks from procarbazine
administration. g) 1 week for non-cytotoxic agents, e.g., interferon, tamoxifen,
cis-retinoic acid, etc. (radiosensitizer does not count). h) Patients who receive
anticancer agents for non-therapeutic purposes unrelated to this study (such as
presurgically for obtaining pharmacology data for the agent) will be eligible to
enter the study provided they have recovered from the toxic effects of the agent if
any. i) Any questions related to the definition of non-cytotoxic agents should be
directed to the Study Chair.

11. Patients must have adequate bone marrow function (ANC> 1,500/mm3 and platelet count
of > 100,000/mm3), adequate liver function (SGPT < 3 times upper limit normal and
alkaline phosphatase < 2 times upper limit normal, total bilirubin <1.5 mg/dl), and
adequate renal function (BUN and creatinine <1.5 times institutional normal) prior to
starting therapy.

12. Male patients on treatment with TPI 287 must agree to use an adequate method of
contraception for the duration of the study, and for 30 days after the last dose of
study medication. Women of childbearing potential must not be pregnant (as evidenced
by a negative pregnancy test prior to study entry), must not be breast-feeding and
must practice adequate contraception for the duration of the study, and for 30 days
after the last dose of study medication. An adequate method of contraception is one
highly effective method or more than one additional methods. Highly effective methods
include intrauterine device (IUD), hormonal (birth control pills, injections,
implants), tubal ligation and partner's vasectomy. Additional effective methods
include latex condom, diaphragm and cervical cap.

13. Patient must be able to tolerate the procedures required in this study including
periodic blood sampling, study related assessments, and management at the treating
institution for the duration of the study.

14. Exploratory, Cross-Over Trial Arm: Patients with evidence of clinical or radiographic
progression on the bevacizumab alone arm are eligible for cross-over into the
exploratory arm of the trial if KPS is 50 or greater and all other criteria for
initial enrollment in the trial are still met at time of progression. Patients will
be excluded if the investigators feel the patient will not tolerate TPI 287 or if an
alternative treatment approach is deemed necessary by the treating physician.

Exclusion Criteria:

1. Inability to comply with protocol or study procedures.

2. Prior treatment with bevacizumab or TPI 287.

3. Patients who are receiving concurrent Enzyme-Inducing Anti-Epileptic Drugs (EIAEDs)
(e.g., carbamazepine, oxcarbazepine, phenytoin, fosphenytoin, phenobarbital and
primidone, or who received EIAEDs within 2 weeks prior to the first dose of study

4. Patients who have received more than one course of radiation therapy or more than a
total dose of 65 Gy. Patients may have received radiosurgery as part of the initial
therapy (i.e., in addition to one course of radiation therapy); however, the dose
used for the radiosurgery counts against the total dose limit listed above.

5. Patient who have received prior taxane chemotherapy for treatment of GBM or other
malignancy. GliadelTM as part of the initial therapy is permitted. Patients who have
received prior biologic therapy other than bevacizumab will be eligible.

6. Any condition, including the presence of clinically significant laboratory
abnormalities, which places the patient at unacceptable risk if he/she were to
participate in the study or confounds the ability to interpret data from the study.
These would include: a) Active infection including known AIDS or Hepatitis C or with
a fever >/= 38.5°C within 3 days prior to the study enrollment. b) Diseases or
conditions that obscure toxicity or dangerously alter drug metabolism. c) Serious
intercurrent medical illness (e.g. symptomatic congestive heart failure).

7. Any serious medical condition, laboratory abnormality, or psychiatric illness that
would prevent the subject from providing informed consent.

8. Inadequately controlled hypertension (defined as systolic blood pressure >140 mmHg
and/or diastolic blood pressure > 90 mmHg)

9. Prior history of hypertensive crisis or hypertensive encephalopathy

10. New York Heart Association (NYHA) Grade II or greater congestive heart failure.

11. History of myocardial infarction or unstable angina within 6 months prior to Day 1

12. History of stroke or transient ischemic attack within 6 months prior to Day1

13. Significant vascular disease (e.g., aortic aneurysm, requiring surgical repair or
recent peripheral arterial thrombosis) within 6 months prior to Day 1

14. History of hemoptysis (>/= 1/2 teaspoon of bright red blood per episode) within 1
month prior to Day 1

15. Evidence of bleeding diathesis or significant coagulopathy (in the absence of
therapeutic anticoagulation)

16. Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
prior to Day 1 or anticipation of need for major surgical procedure during the course
of the study.

17. Core biopsy or other minor surgical procedure, excluding placement of a vascular
access device, within 7 days prior to Day 1

18. History of abdominal fistula or gastrointestinal perforation within 6 months prior to
Day 1

19. Serious, non-healing wound, active ulcer, or untreated bone fracture.

20. Proteinuria as demonstrated by: (1) Urine protein:creatinine (UPC) ratio >/= 1.0 at
screening; OR (2) Urine dipstick for proteinuria >/= 2+ (patients discovered to have
>/= 2+ proteinuria on dipstick urinalysis at baseline should undergo a 24 hour urine
collection and must demonstrate
21. Known hypersensitivity to any component of bevacizumab

22. Pregnancy (positive pregnancy test) or lactation. Not able to use of effective means
of contraception (men and women) in subjects of child-bearing potential.

23. Patients with Grade 2 or higher peripheral neuropathy.
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