Azoles Targeting Recurrent High Grade Gliomas

Official Title

A Phase 0 Clinical Trial of Two Candidate Azoles (Ketoconazole and Posaconazole) for Patients With Recurrent High Grade Glioma


High grade gliomas (WHO grade III and IV)(HGG) are the most common malignant, and aggressive brain tumour in humans. Current understanding of the mechanisms contributing to their growth and progression remain limited. Furthermore, treatment options have not advanced in recent decades. Recently, it has become evident that these tumours are dependent on glucose metabolism to maintain oncogenic properties. From a preclinical standpoint, targeting hexokinase 2 (HK2), the first committed step of glucose metabolism, with azole class drugs has been shown to display favourable anti-tumour effects in both in vitro and in vivo HGG models. We would like to translate these preclinical findings into the clinical setting by implementing a proof-of biological concept study with two azole drugs: ketoconazole (KCZ) and posaconazole (PCZ). A small cohort of recurrent HGG patients will receive either a single-, or repeated, steady state dose of either KCZ or PCZ and will then go for surgery where drug concentrations will be measured intraoperatively. Study drug selection and dosing details will be selected based on urgency of surgery and patient clinical characteristics Downstream biological effects of drug on tumour tissue, including HK2 activity, will also be assessed. This study will provide a preliminary understanding of azole drug activity in recurrent HGG patients and will help inform future studies of azole drug efficacy in this patient population

Trial Description

Primary Outcome:

  • Intratumoural concentrations of KCZ or PCZ
  • Plasma concentrations of KCZ or PCZ
Secondary Outcome:
  • Assess Hexokinase 2 activity
  • Assess the biological effects of KCZ or PCZ on metabolites within the glycolytic pathway
  • assess the biological effects of KCZ or PCZ on tumour proliferation
  • assess biological effects of KCZ or PCZ on tumour cell death
  • assess biological effects of KCZ or PCZ on tumour angiogenesis

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Canadian Cancer Society

These resources are provided in partnership with the Canadian Cancer Society