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

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Trial Details

Sponsor: National Cancer Institute (NCI) (federal)

Phase: 1/2

Start date: May 16, 2023

Planned enrollment: 96

Trial ID: NCT05588141
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More trial details at ClinicalTrials.gov More info

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Investigational Drug AI Analysis

chevron Show for: Zotiraciclib (TG02, SB1317, EX 45)

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Goal: Evaluate safety, establish the recommended phase II dose (RP2D), and assess antitumor activity of the oral multi-kinase inhibitor zotiraciclib as a single agent in recurrent IDH1/2-mutant diffuse gliomas, with a primary efficacy focus on 12-month progression-free survival in WHO grade 3 disease versus a matched historical database.

Patients: Adolescents and adults (age >15) with histologically confirmed diffuse glioma (WHO grades 2–4) harboring IDH1 or IDH2 mutations, with recurrent disease after prior radiation and/or chemotherapy, KPS ≥70%, adequate organ function, and no prior bevacizumab for tumor treatment. Phase II limits prior relapses to ≤1 for grades 3–4 or ≤2 for grade 2. Key exclusions include prolonged QTc >470 ms, uncontrolled comorbidities, recent therapies within protocol-defined washouts, pregnancy, and recent invasive malignancy (exceptions apply).

Design: Phase I/II, nonrandomized, multi-cohort, single-arm evaluation of zotiraciclib. Phase I (9–24 patients) uses dose escalation/de-escalation to estimate the RP2D based on DLTs in cycle 1. Phase II enrolls non-surgical and surgical cohorts at RP2D to assess efficacy versus a matched external brain tumor database. Planned enrollment up to 96 with 64 evaluable for Phase II efficacy.

Treatments: Zotiraciclib oral capsules administered intermittently on days 1, 4, 8, 11, 15, and 18 of 28-day cycles for up to 18 cycles; Phase I explores 150–250 mg with a starting dose of 200 mg to define RP2D. The surgical cohort receives a single preoperative RP2D dose (Cycle 0 Day 1) followed by biopsy/resection within 24 hours, then resumes standard dosing after recovery. Zotiraciclib (TG02/SB1317) is an investigational oral multi-kinase inhibitor with prominent CDK9 inhibition, suppressing RNA Pol II phosphorylation, rapidly depleting short‑lived survival proteins (e.g., MCL-1) and inducing metabolic stress; it likely penetrates the blood–brain barrier. Prior trials in high-grade astrocytoma showed manageable safety and signals of greater benefit in IDH-mutant tumors, including longer PFS versus IDH-wildtype when combined with temozolomide; common toxicities include transient neutropenia, diarrhea, transaminase elevation, and fatigue.

Outcomes: Primary: 12-month progression-free survival rate in recurrent IDH1/2-mutant WHO grade 3 gliomas versus a matched historical database; and in Phase I, the number of DLTs in the first 28 days to determine RP2D. Secondary: PFS at 3 years versus database, overall safety profile (type, grade, and frequency of AEs), and overall survival at 5 years versus database.

Burden on patient: Moderate. Patients take an oral agent at home with clinic visits approximately monthly for exams, labs, ECGs, and safety monitoring; brain MRI every 8 weeks is more frequent than some standard practices but typical for early-phase neuro-oncology. Surgical cohort participants have added burden of a mandated biopsy/resection within 24 hours of a preoperative dose. While no intensive pharmacokinetic schedules are specified, early-cycle toxicity monitoring and contraception requirements add logistical demands. Overall, the schedule-intensive intermittent dosing, monthly visits, and q8-week imaging result in a moderate time and travel burden, higher in the surgical cohort due to the operative procedure and perioperative assessments.

Last updated: Oct 2025

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National Institutes of Health Clinical Center

Bethesda, Maryland, 20892, United States

No email / 888-624-1937

Status: Recruiting

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