Introduction: We report the safety, tolerability, pharmacokinetic characteristics and preliminary efficacy of a multi-kinase inhibitor (TG02 capsule) as a new therapy for patients with recurrent high-grade gliomas in China. Methods: This is a single-center, dose-escalation, open-label phase I study, which enrolled patients with recurrent high-grade gliomas who failed to temozolomide. Patients were assigned sequentially into different dose groups and received TG02 every 4 weeks. The dose was increased in a traditional 3 + 3 design. Primary endpoints were the dose-limited toxicity (DLT) and the maximum tolerated dose (MTD). Results: Twelve patients (8 glioblastomas, 4 diffuse astrocytoma) were enrolled between May 2019 and November 2021. Three patients received 100 mg and 9 received 150 mg TG02 twice a week. The plasma concentration of TG02 reached the maximum at 2 h after administration, and the elimination half-life was about 7 h. No DLT occurred and MTD was not defined in this study. Eleven patients had one or more investigator-assessed treatment-related adverse events (TRAEs). The most frequent TRAEs were vomiting (91.7%) and diarrhea (75.0%), and 50% of the patients had grade 3 or 4 adverse events. There were no treatment-related deaths. The median progression-free survival and overall survival were 1.77 (95% confidence interval [CI]: 0.82–4.24) and 9.63 (95% CI: 2.66-not estimated) months, respectively. Conclusions: TG02 capsule 150 mg twice a week is safe and tolerable in Chinese patients with recurrent high-grade gliomas. Patients who failed to temozolomide showed obvious tumor reduction when switching to TG02 capsule. The efficacy of recurrent gliomas warrants further investigation.

1.
Howlader
N
,
Noone
AM
,
Krapcho
M
,
Miller
D
,
Bishop
K
,
Kosary
CL
, et al
, editors.
SEER cancer statistics review, 1975-2014 [Internet]
.
Bethesda, MD
:
National Cancer Institute
;
2016
. [cited 2024 Oct]. Available from: https://seer.cancer.gov/csr/1975_2014/
2.
Chen
Z
,
Li
D
,
Chen
Y
,
Guo
C
,
Zhang
X
,
Sai
K
, et al
.
Real-world management and survival outcomes of patients with newly diagnosed gliomas from a single institution in China: a retrospective cohort study
.
Glioma
.
2019
;
2
(
2
):
96
104
.
3.
Goh
KC
,
Novotny-Diermayr
V
,
Hart
S
,
Ong
LC
,
Loh
YK
,
Cheong
A
, et al
.
TG02, a novel oral multi-kinase inhibitor of CDKs, JAK2 and FLT3 with potent anti-leukemic properties
.
Leukemia
.
2012
;
26
(
2
):
236
43
.
4.
Strik
H
,
Deininger
M
,
Streffer
J
,
Grote
E
,
Wickboldt
J
,
Dichgans
J
, et al
.
BCL-2 family protein expression in initial and recurrent glioblastomas: modulation by radiochemotherapy
.
J Neurol Neurosurg Psychiatry
.
1999
;
67
(
6
):
763
8
.
5.
Annibali
D
,
Whitfield
JR
,
Favuzzi
E
,
Jauset
T
,
Serrano
E
,
Cuartas
I
, et al
.
Myc inhibition is effective against glioma and reveals a role for Myc in proficient mitosis
.
Nat Commun
.
2014
;
5
:
4632
.
6.
Yushan
R
,
Wenjie
C
,
Suning
H
,
Yiwu
D
,
Tengfei
Z
,
Madushi
WM
, et al
.
Insights into the clinical value of cyclin-dependent kinase 5 in glioma: a retrospective study
.
World J Surg Oncol
.
2015
;
13
:
223
.
7.
Shapiro
GI
.
Cyclin-dependent kinase pathways as targets for cancer treatment
.
J Clin Oncol
.
2006
;
24
(
11
):
1770
83
.
8.
Le Rhun
E
,
von Achenbach
C
,
Lohmann
B
,
Silginer
M
,
Schneider
H
,
Meetze
K
, et al
.
Profound, durable and MGMT-independent sensitivity of glioblastoma cells to cyclin-dependent kinase inhibition
.
Int J Cancer
.
2019
;
145
(
1
):
242
53
.
9.
Ponder
KG
,
Matulis
SM
,
Hitosugi
S
,
Gupta
VA
,
Sharp
C
,
Burrows
F
, et al
.
Dual inhibition of Mcl-1 by the combination of carfilzomib and TG02 in multiple myeloma
.
Cancer Biol Ther
.
2016
;
17
(
7
):
769
77
.
10.
William
AD
,
Lee
AC
,
Goh
KC
,
Blanchard
S
,
Poulsen
A
,
Teo
EL
, et al
.
Discovery of kinase spectrum selective macrocycle (16E)-14-methyl-20-oxa-5,7,14,26-tetraazatetracyclo[19.3.1.1(2,6).1(8,12)]heptacosa-1(25),2(26),3,5,8(27),9,11,16,21,23-decaene (SB1317/TG02), a potent inhibitor of cyclin dependent kinases (CDKs), Janus kinase 2 (JAK2), and fms-like tyrosine kinase-3 (FLT3) for the treatment of cancer
.
J Med Chem
.
2012
;
55
(
1
):
169
96
.
11.
Su
YT
,
Chen
R
,
Wang
H
,
Song
H
,
Zhang
Q
,
Chen
LY
, et al
.
Novel targeting of transcription and metabolism in glioblastoma
.
Clin Cancer Res
.
2018
;
24
(
5
):
1124
37
.
12.
NCCN clinical practice guidelines in oncology-central nervous system cancers [Internet]
.
Natl Compr Cancer Netw
.
2022
[cited 2024 Oct]. Available from: http://www.nccn.org
13.
Davies
MA
,
Saiag
P
,
Robert
C
,
Grob
JJ
,
Flaherty
KT
,
Arance
A
, et al
.
Dabrafenib plus trametinib in patients with BRAF(V600)-mutant melanoma brain metastases (COMBI-MB): a multicentre, multicohort, open-label, phase 2 trial
.
Lancet Oncol
.
2017
;
18
(
7
):
863
73
.
14.
Doebele
RC
,
Drilon
A
,
Paz-Ares
L
,
Siena
S
,
Shaw
AT
,
Farago
AF
, et al
.
Entrectinib in patients with advanced or metastatic NTRK fusion-positive solid tumours: integrated analysis of three phase 1-2 trials
.
Lancet Oncol
.
2020
;
21
(
2
):
271
82
.
15.
Hofmeister
CC
,
Berdeja
JG
,
Vesole
DH
,
Suvannasankha
A
,
Parrott
T
,
Abonour
R
.
TG02, an oral CDK9-inhibitor, in combination with carfilzomib demonstrated objective responses in carfilzomib refractory multiple myeloma patients
.
Blood
.
2015
;
126
(
23
):
3052
.
16.
Patel
JN
.
Cancer pharmacogenomics: implications on ethnic diversity and drug response
.
Pharmacogenet Genomics
.
2015
;
25
(
5
):
223
30
.
17.
O’Donnell
PH
,
Dolan
ME
.
Cancer pharmacoethnicity: ethnic differences in susceptibility to the effects of chemotherapy
.
Clin Cancer Res
.
2009
;
15
(
15
):
4806
14
.
18.
Wu
J
,
Yuan
Y
,
Long Priel
DA
,
Fink
D
,
Peer
CJ
,
Sissung
TM
, et al
.
Phase I study of zotiraciclib in combination with temozolomide for patients with recurrent high-grade astrocytomas
.
Clin Cancer Res
.
2021
;
27
(
12
):
3298
306
.
19.
Wick
W
,
Puduvalli
VK
,
Chamberlain
MC
,
van den Bent
MJ
,
Carpentier
AF
,
Cher
LM
, et al
.
Phase III study of enzastaurin compared with lomustine in the treatment of recurrent intracranial glioblastoma
.
J Clin Oncol
.
2010
;
28
(
7
):
1168
74
.
20.
Nabors
LB
,
Portnow
J
,
Ammirati
M
,
Baehring
J
,
Brem
H
,
Brown
P
, et al
.
Central nervous system cancers, version 1.2015
.
J Natl Compr Canc Netw
.
2015
;
13
(
10
):
1191
202
.
21.
Han
SJ
,
Rolston
JD
,
Molinaro
AM
,
Clarke
JL
,
Prados
MD
,
Chang
SM
, et al
.
Phase II trial of 7 days on/7 days off temozolmide for recurrent high-grade glioma
.
Neuro Oncol
.
2014
;
16
(
9
):
1255
62
.
22.
Tosoni
A
,
Franceschi
E
,
Poggi
R
,
Brandes
AA
.
Relapsed glioblastoma: treatment strategies for initial and subsequent recurrences
.
Curr Treat Options Oncol
.
2016
;
17
(
9
):
49
.
23.
Wu
J
,
Yuan
Y
,
Long Priel
DA
,
Fink
D
,
Peer
CJ
,
Sissung
TM
, et al
.
Phase I study of zotiraciclib in combination with temozolomide for patients with recurrent high-grade astrocytomas
.
Clin Cancer Res
.
2021
;
27
(
12
):
3298
306
.
24.
Le Rhun
E
,
Gorlia
T
,
Felsberg
J
,
Jongen
J
,
Maurage
CA
,
Ducray
F
, et al
.
Zotiraciclib (TG02) for newly diagnosed glioblastoma in the elderly or for recurrent glioblastoma: the EORTC 1608 STEAM trial
.
Eur J Cancer
.
2024
;
198
:
113475
.
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