Sponsor: National Cancer Institute (NCI) (federal)
Phase: 1/2
Start date: May 16, 2023
Planned enrollment: 96
Zotiraciclib (also known as TG02, SB1317; sometimes referenced as ZTR) is an oral, macrocyclic multi‑kinase inhibitor with predominant activity against cyclin‑dependent kinases (notably CDK9) and additional activity against JAK2 and FLT3. It has been evaluated in malignant gliomas (alone and with temozolomide or radiotherapy) and previously in hematologic malignancies. (nature.com)
Gliomas - Recurrent high‑grade astrocytoma/glioblastoma (NCI, Phase I; NCT02942264): zotiraciclib plus temozolomide (TMZ) identified an MTD of 250 mg for zotiraciclib on an intermittent schedule. In the randomized cohort expansion, dose‑dense TMZ + zotiraciclib achieved a 4‑month progression‑free survival rate (PFS4) of 40% versus 25% with metronomic TMZ + zotiraciclib. Objective response rates were not highlighted in the abstract; imaging was assessed per RANO. (pubmed.ncbi.nlm.nih.gov)
Newly diagnosed elderly GBM or first‑relapse GBM (EORTC 1608 STEAM, Phase 1b; NCT03224104):
• With radiotherapy alone or TMZ alone in elderly: MTD for zotiraciclib was 150 mg.
• Single‑agent zotiraciclib at first relapse: PFS at 6 months was 6.7%, indicating low monotherapy activity in this setting. (ascopubs.org)
Ongoing/recent trial in IDH‑mutant recurrent diffuse gliomas (Phase I/II; NCT05588141): single‑agent zotiraciclib using days 1, 4, 8, 11, 15, 18 every 28 days design is recruiting; no efficacy results posted as of July–October 2025. Rationale is preclinical selective vulnerability of IDH‑mutant gliomas. (trial.medpath.com)
Hematologic malignancies (early development) - Preclinical AML/MPN work showed activity via combined CDK and JAK2/FLT3 inhibition; early phase studies in leukemias and CLL/SLL were conducted (e.g., NCT01204164, NCT01699152), but peer‑reviewed clinical efficacy readouts are limited in the public domain. (nature.com)
Notes: Zotiraciclib remains investigational. As of October 2025, randomized Phase II/III efficacy data in gliomas have not been published; current signals suggest limited monotherapy activity and potential for combination benefit, warranting further controlled studies. (ascopubs.org)
Last updated: Oct 2025
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
* 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 TSO500 performed in LP, NCI or prior documentation of IDH1 or IDH2 mutation status
* Participants must have received prior treatment (e.g., radiation, conventional chemotherapy) 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 prior disease relapse (WHO grade 3-4) or more than two prior disease relapses (WHO grade 2) for Phase II only. 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
Bethesda, Maryland, 20892, United States
No email / 888-624-1937
Status: Recruiting