Summary

This phase I/II trial studies the side effects and best dose of Verteporfin and to see how well it works in treating patients with high grade EGFR-mutated glioblastoma that has come back (recurrent). Verteporfin may increase body's sensitivity to light, which may help to kill cancer cells.

Objectives

PRIMARY OBJECTIVES:
I. To evaluate the safety and tolerability of successively higher doses of liposomal verteporfin and determine the maximum tolerated dose (MTD) in study participants with recurrent EGFR positive (+) glioblastoma (GBM). (Phase I)
II. To evaluate the anti-tumor activity of liposomal verteporfin by assessing progression-free survival (PFS) and overall survival (OS). (Phase II)
III. To describe the response rate of EGFR+ GBM in study participants treated with liposomal verteporfin. (Phase II)

SECONDARY OBJECTIVES:
I. To evaluate the anti-tumor activity of liposomal verteporfin by assessing progression-free survival (PFS) and overall survival (OS). (Phase I)
II. To describe the response rate of EGFR+ GBM in study participants treated with liposomal verteporfin. (Phase I)
III. To describe pharmacokinetics of liposomal verteporfin administered on a weekly schedule. (Phase I)
IV. To evaluate the safety and tolerability of successively higher doses of liposomal verteporfin in study participants with recurrent EGFR+ GBM. (Phase II)

OUTLINE: This is a dose-escalation study.

Patients receive verteporfin intravenously (IV) over 63 minutes weekly for 6 weeks in cycle 1, then weekly for 5 weeks in subsequent cycles. Cycles repeat every 6 weeks in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for 30 days and then every 12 weeks.

Eligibility

1. Persons with recurrent or progressive grade 4 glioma (glioblastoma) are eligible for this study. Participants should have received standard first line therapy including radiation and temozolomide
2. Eligible participants have tumors that show mutant or amplified EGFR. This determination can be made using standard of care mutation analysis panels (e.g. Snapshot). It is often assessed at diagnosis as part of standard of care
3. Eligible participants must have evidence on magnetic resonance imaging (MRI) of progression. This may be as new or increased enhancement, or growth / increase in nonenhancing abnormality. Care should be taken to distinguish those with true progression from those with radiation related changes. Persons with changes in enhancement possibly due in part or in whole to late radiation effect should receive bevacizumab as standard of care, and defer study participation
4. Participants may be receiving bevacizumab, and show progression while on bevacizumab. These participants may continue bevacizumab while on study. Persons not on bevacizumab but who would benefit from the anti-edema effect of bevacizumab should not enroll on this study but should proceed with bevacizumab alone, and defer enrollment until such time as they progress
5. liposomal verteporfin is a vesicant. Participants will likely have poor veins, and will require repeated intravenous treatments. Participants must be willing to have placed a central venous access, such as a portacath
6. Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-3. Participants who are ECOG 2 or 3 should ideally have been in that situation for some time, and not be in the midst of rapid clinical decline
7. Medical comorbidities (excepting neurological) must be grade 2 or less if graded as toxicity. Examples: * Hemoglobin > 8 * Platelets > 50,000 * Creatinine < 3 x upper limit of normal * Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 5 x upper limit of normal
8. Eligible participants may have grade 3 neurologic comorbidities (for example aphasia, ataxia) arising as a consequence of brain pathology
9. Participants should be reasonably expected to be able to complete 6 weeks (1 cycle) of treatment on study before death or worsening of PS to 4 or 5
10. Other anti-cancer medical treatments. Treatments in this category include chemotherapy and non-bevacizumab therapies. 7 days must have elapsed since discontinuation of prior chemotherapeutic treatments for glioma and study treatment. Participants may have had any number of prior treatments
11. All participants on this study must have had prior radiation to the brain. Radiation must have been completed 90 days prior to first study treatment
12. 21 days must have elapsed since prior major surgery
13. Participants already using a Novo-tumor treating fields therapy (TTF) (Optune) device and who wish to continue may do so
14. All participants must sign a written informed consent
15. The effects of study drugs used in this study on the developing human fetus are unknown. For this reason, female of child-bearing potential (FCBP) must have a negative serum or urine pregnancy test prior to starting therapy
16. FCBP and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation and 8 weeks after. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation. A female of childbearing potential (FCBP) is a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months