Cilengitide (EMD 121974) for Recurrent Glioblastoma Multiforme (Brain Tumor)

Angiogenesis (growth of new blood vessels) is important for tumor growth. Cilengitide (EMD
121974) inhibits two receptor proteins (proteins on cell surface), called integrins αvβ3 and
αvβ5, which appear to be important in the process of angiogenesis. Cilengitide has been shown
to inhibit angiogenesis and growth of several different experimental tumors in animals. Some
tumors themselves express integrin αvβ3 and use it as a survival factor (e.g. glioblastoma
multiforme), so cilengitide might target both endothelial cells (cells of blood vessels) and
the tumor itself triggering tumor cell apoptosis (programmed cell death).

Inclusion Criteria:

- Written informed consent obtained before undergoing any study-related activities.

- Males or females 18 years of age or older who can be treated in an outpatient setting.

- Histologically proven GBM, which is recurrent or progressive following surgery or
biopsy, external beam radiation therapy, and 1 previous regimen of systemic
chemotherapy (Gliadel wafer therapy is not considered systemic chemotherapy).
Malignancy is to be documented with a previous histopathological report.

- Subjects initially diagnosed with other conditions similar to GBM (such as anaplastic
astrocytoma [AA] or low grade glioma) that subsequently progressed to histologically
proven GBM and have had surgery or biopsy, external beam radiation therapy, and 1
previous regimen of systemic chemotherapy for the original diagnosis are eligible if
they meet all inclusion criteria.

- GBM recurring only in the contralateral hemisphere must be histologically confirmed by
biopsy. GBM recurring bilaterally does not need to be histologically confirmed by
biopsy (i.e., if recurrence is ipsilateral and contralateral).

- Archived tumor tissue specimens from the GBM surgery or biopsy must be available for
central pathology review and exploratory analysis of angiogenic markers (e.g. avb3 and
avb5 integrins).

- Measurable disease (solid contrast-enhancing lesion ~1 cm in any dimension) evaluated
by Gd MRI within 2 weeks prior to the first dose of EMD 121974.

- At least 12 weeks have elapsed since the last radiation treatment, and at least 4
weeks have elapsed since the last chemotherapy dose (at least 6 weeks for
nitrosourea-containing chemotherapy) prior to the first dose of EMD 121974.

- If the subject underwent recent surgery, status must be ~2 weeks post surgery or ~1
week post biopsy, in stable condition, and maintained on a stable corticosteroid
regimen for ~5 days prior to first dose of EMD 121974.

- Karnofsky Performance Score (KPS) of ≥ 70%.

- Subjects with the potential for pregnancy or impregnating their partner must agree to
follow acceptable methods of birth control to avoid conception during the study and
for at least 6 months after receiving the last dose of study drug.

- Women of childbearing potential must have a negative pregnancy test at screening.

- Laboratory values (within 1 week prior to the first dose of EMD 121974, except for
blood count and PT/PTT, which are to be within 72 hours of the first dose): * Absolute
neutrophil count ≥1500/mm 3. * Platelets ≥ 100,000/mm 3. * Creatinine ≤ 1.5 mg/dL or
creatinine clearance ≥ 60 mL/min. * Hematocrit ≥ 30%. * Prothrombin time (PT) and
partial thromboplastin time (PTT) within normal limits. * Hemoglobin ≥ 10 mg/dL. *
Total bilirubin ≤ 1.5 times the upper limit of normal. * Aspartate aminotransferase
and alanine aminotransferase ≤ 2.5 times above upper limit of normal.

- No more than 8 weeks have elapsed since recurrence was detected

Exclusion Criteria:

- Prior radiation therapy >66 Gray.

- Subject anticipates undergoing elective surgery, dental extraction, or invasive dental
procedures.

- History of recent peptic ulcer disease (endoscopically proven gastric ulcer, duodenal
ulcer, or esophageal ulcer) within 6 months of enrollment.

- History of prior malignancy. Subjects with curatively treated cervical carcinoma in
situ or basal cell carcinoma of the skin, or subjects who have been free of other
malignancies for ≥5 years are eligible for this study.

- History of coagulation disorder associated with bleeding or recurrent thrombotic
events.

- Concurrent illness, including severe infection, which may jeopardize the ability of
the subject to receive the procedures outlined in this protocol with reasonable
safety.

- Subject is pregnant, anticipates becoming pregnant within 6 months after study
participation, or is currently breast-feeding.

- Receiving concurrent investigational agents or has received an investigational agent
within the past 30 days prior to the first dose of EMD 121974.

- Prior antiangiogenic therapy.

- Placement of Gliadel wafer at surgery for recurrence.

- Unable to undergo Gd MRI.

- Current known alcohol dependence or drug abuse.

- Requiring concomitant chemotherapy.

- Treatment with a prohibited concomitant medication.

- Known hypersensitivity to the study treatment.

- Legal incapacity or limited legal capacity.