Randomized Phase II Study of Cilengitide, an Integrin-Targeting Arginine-Glycine-Aspartic Acid Peptide, in Recurrent Glioblastoma Multiforme

27 October 2008

Reardon DA, Fink KL, Mikkelsen T, Cloughesy TF, O'Neill A, Plotkin S, Glantz M, Ravin P, Raizer JJ, Rich KM, Schiff D, Shapiro WR, Burdette-Radoux S, Dropcho EJ, Wittemer SM, Nippgen J, Picard M, Nabors LB.

Duke University Medical Center, Durham, NC; Baylor University Medical Center, Dallas, TX; Henry Ford Hospital, Detroit, MI; University of California, Los Angeles Medical Center, Los Angeles, CA; TransMolecular, Inc, Cambridge; Massachusetts General Hospital, Boston; University of Massachusetts Medical Center, Worcester, MA; Northwestern University Medical Center, Chicago, IL; Washington University, St Louis, MO; University of Virginia Health Science Center, Charlottesville, VA; Barrow Neurological Institute, Phoenix, AZ; University of Vermont, Burlington, VT; Indiana University Medical Center, Indianapolis, IN; University of Alabama at Birmingham, Birmingham, AL; and Merck KGaA Pharmaceuticals, Darmstadt, Germany.

PURPOSE: Cilengitide, an inhibitor of alphavbeta3 and alphavbeta5 integrin receptors, demonstrated minimal toxicity and durable activity across a wide range of doses administered to adults with recurrent glioblastoma multiforme (GBM) in a prior phase I study. The current multicenter phase II study was conducted to evaluate the activity and safety of cilengitide in GBM patients at first recurrence. PATIENTS AND METHODS: Eligible patients were randomly assigned to receive either 500 or 2,000 mg of cilengitide twice weekly on a continuous basis. Patients were assessed every 4 weeks. The primary end point was 6-month progression-free survival (PFS) rate. Secondary end points included PFS, overall survival (OS), and radiographic response, as well as quality-of-life and pharmacokinetic assessments. RESULTS: Eighty-one patients were enrolled, including 41 on the 500-mg arm and 40 on the 2,000-mg arm. The safety profile of cilengitide was excellent, with no significant reproducible toxicities observed on either arm. Antitumor activity was observed in both treatment cohorts but trended more favorably among patients treated with 2,000 mg, including a 6-month PFS of 15% and a median OS of 9.9 months. CONCLUSION: Cilengitide monotherapy is well tolerated and exhibits modest antitumor activity among recurrent GBM patients. Additional studies integrating cilengitide into combinatorial regimens for GBM are warranted.

PMID: 18981465 [PubMed - as supplied by publisher]

Commento Personale: Il farmaco in questione sebbene dimostri una buona mediana di sopravvivenza (“garantisce” circa 3/e mesi in più di sopravvivenza) non offre però una risposta adeguata di riduzione del tumore con una PFS di solo il 15%. Il farmaco, quindi, appare interessante (specialmente per la sua eccellente tossicitià) solo se utilizzato combinato ad un altro, magari un agiogenetico.

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