A phase III trial of marizomib in combination with standard temozolomide-based radiochemotherapy versus standard temozolomide-based radiochemotherapy alone in patients with newly diagnosed glioblastoma

The standard of care for newly diagnosed glioblastoma includes surgery, involved-field
radiotherapy, and concomitant and six cycles of maintenance temozolomide chemotherapy,
however the prognosis remains dismal. Marizomib has been tested in patients with newly
diagnosed and recurrent glioblastoma in phase I and phase II studies. In patients with
recurrent glioblastoma, marizomib was administered as a single agent or in combination with
bevacizumab (NCT02330562). Based on encouraging observations, a phase I/II trial of marizomib
in combination with Temozolomide+Radiotherapy(TMZ/RT) followed by Temozolomide (TMZ) in newly
diagnosed glioblastoma has been launched (NCT02903069) which explores safety and tolerability
of this triple combination and which shall help to determine the dose for further clinical
trials in glioblastoma. In this context, given that marizomib has been established as a safe
addition to the standard TMZ/RT -->TMZ, a phase III study is considered essential to
establishing its impact on overall survival.

Inclusion Criteria:

- Histologically confirmed newly diagnosed glioblastoma (WHO grade IV)

- Tumor resection (gross total or partial), or biopsy only

- Availability of formalin-fixed paraffin-embedded (FFPE) tumor block or 24 unstained
slides for o6-methylguanine-DNA-methyltransferase (MGMT) analysis

- Patient must be eligible for standard TMZ/RT + TMZ

- Karnofsky performance score (KPS) ≥ 70

- Recovered from effects of surgery, postoperative infection and other complications of
surgery (if any)

- The patient is at least 18 years of age on day of signing informed consent

- Stable or decreasing dose of steroids for at least 1 week prior to inclusion

- The patient has a life expectancy of at least 3 months

- Patient has undergone a brain MRI within 14 days of randomization but after
intervention (resection or biopsy)

- The patient shows adequate organ functions as assessed by the specified laboratory
values within 2 weeks prior to randomization defined as adequate bone marrow, renal
and hepatic function within the following ranges:

- white blood cell count (WBC) ≥ 3×10*9/L

- absolute neutrophil count (ANC) ≥ 1.5×10*9/L

- Platelet count of ≥ 100×10*9/L independent of transfusion

- Hemoglobin ≥ 10 g/dl

- Total Bilirubin ≤ 1.5 upper limit of normal (ULN)

- Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline
phosphatase (ALP) ≤ 2.5 × ULN

- Serum creatinine < 1.5 x ULN or creatinine clearance (CrCl) > 30 mL/min(using the
Cockcroft-Gault formula)

- Women of child bearing potential (WOCBP) must have a negative urine or serum pregnancy
test within 7 days prior to the first dose of study treatment.

- Patients of childbearing / reproductive potential must agree to use adequate birth
control measures, as defined by the investigator, during the study treatment period
and for at least 6 months after the last study treatment. A highly effective method of
birth control is defined as those which result in low failure rate (i.e. less than 1
percent per year) when used consistently and correctly. Patients must also agree not
to donate sperm during the study and for 6 months after receiving the last dose of
study treatment.

- Women who are breast feeding must agree to discontinue nursing prior to the first dose
of study treatment and until 6 months after the last study treatment.

- Ability to take oral medication

- Ability to understand the requirements of the study, provide written informed consent
and authorization of use and disclosure of protected health information, and agree to
abide by the study restrictions and return for the required assessments.

- Before patient registration/randomization, written informed consent must be given
according to International Council for Harmonisation (ICH) / Good clinical practice
(GCP), and national/local regulations.