Combining Temozolomide and M1774 to Treat Advanced Cancer
Official title: A Phase 1/2 Trial Evaluating the Combination of Temozolomide and the Ataxia Telangiectasia and Rad3-Related Inhibitor M1774
Run by National Cancer Institute (NCI) · NCT05691491 · Data updated 2026-11-12
This study is testing a combination of two cancer drugs, temozolomide and M1774, to see if they can help people with advanced metastatic cancers feel better and improve their treatment outcomes.
Quick facts
| Phase | Phase1; Phase2 |
|---|---|
| Study type | Interventional |
| Ages | 18 Years and up |
| Sex | All |
| Enrollment | 42 (estimated) |
| Sponsor | National Cancer Institute (NCI) NIH |
| Locations | 23 sites (Irvine, California and 22 other locations) |
| Status | Recruiting |
| Started | September 28, 2023 |
| Main results expected | March 1, 2027 |
| Study ends | March 1, 2027 |
| Registry record updated | July 31, 2026 |
| Trial ID | NCT05691491 on ClinicalTrials.gov |
Is this trial a fit for you?
✓Likely a good fit
Ideal candidates include patients with histologically confirmed metastatic advanced cancer, particularly those with specific genetic markers like MGMT promoter hypermethylation.
✕Probably not a fit
Patients with cancers that are not advanced or those who do not meet the genetic criteria for eligibility may not benefit from this study.
A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.
What this trial studies
This clinical trial evaluates the safety and effectiveness of a combination of the anti-cancer drugs temozolomide and M1774 in patients with advanced metastatic cancers. It aims to determine the maximum tolerated dose of this combination while observing anti-tumor activity and overall response rates. Patients will receive these medications in a structured regimen, with regular imaging and blood sample collection to monitor progress and side effects. The study includes both dose-escalation and phase II components to assess the treatment's efficacy.
Why it matters
Potential benefit: If successful, this treatment could provide a new effective option for patients with advanced metastatic cancers.
How similar studies have gone: Other studies have shown promise with similar combinations of chemotherapy agents, but this specific combination is being evaluated for the first time.
Who can join: the full rules
Show full inclusion / exclusion criteria
Inclusion Criteria: * Patients must have histologically or cytologically confirmed diagnosis of metastatic advanced cancer. * In dose escalation, any solid tumor patients with either O6-methylguanine DNA methyltransferase (MGMT) promoter hypermethylation positivity on testing / pre-screening of archival tissue OR an extracranial solid tumor where TMZ is considered a standard of care per National Comprehensive Cancer Network (NCCN) guidelines (neuroendocrine tumor, small cell lung cancer, melanoma or soft tissue sarcoma). The tumor lesion must be safely accessible to a mandatory biopsy. Patients with MGMT promoter hypermethylated colorectal cancer must be mismatch repair proficient / microsatellite stable. * In phase 2, only patients with mismatch repair proficient / microsatellite stable colorectal cancer that have MGMT promoter hypermethylation positivity on pre-screening of archival tissue will be eligible. * In dose escalation, patients must have progressed after treatment with all available therapies including immunotherapies for metastatic disease that are known to confer clinical benefit, or are intolerant to treatment, or refuse standard treatment. Patients may not have previously received temozolomide or an ataxia telangiectasia and rad3-related (ATR) inhibitor. * For patients with mismatch repair proficient / microsatellite stable colorectal cancer in the phase 2 portion, patients must have received prior therapy with 1 or more systemic therapies in the metastatic setting that includes 5-fluorouracil, irinotecan, and oxaliplatin. Patients with microsatellite stable colorectal cancer (mCRC) need to have had exposure, unless contraindicated, to all 3 of oxaliplatin, irinotecan, and fluoropyrimidine (FP). The use of 5-fluorouracil and oxaliplatin in the adjuvant setting is acceptable, provided the development of metastatic disease was less than 6 months after the completion of adjuvant therapy. Patients with a prior hypersensitivity reaction to oxaliplatin in the adjuvant setting do not require retreatment in the metastatic setting. * Age \>=18 years. Because no dosing or adverse event data are currently available on the use of M1774 in combination with temozolomide in patients \< 18 years of age, children are excluded from this study. * Measurable disease on CT and/or MRI per Response Evaluation Criteria in Solid Tumors (RECIST) version (v)1.1 criteria. * Eastern Cooperative Oncology Group (ECOG) performance status =\< 2 (or Karnofsky \>= 60%). * Hemoglobin \>=10 g/dL (No blood transfusions are allowed within 14 days of cycle 1 day 1 \[C1D1\]). * White blood cells (WBC) \> 3 x 10\^9/L. * Absolute neutrophil count \>= 1,500/mcL. * Platelets \>= 100,000/mcL. * Total bilirubin =\< 1.5 x institutional upper limit of normal (ULN). * Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase \[SGOT\])/alanine-aminotransferase (ALT) (serum glutamic-pyruvic transaminase \[SGPT\]) =\< 3 x institutional ULN except for when liver metastases are present, in which case they must be =\< 5 x institutional ULN. * Glomerular filtration rate (GFR) \>= 60 mL/min/1.73 m\^2. * Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial. * For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated. * Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load. * Patients with treated brain metastases are eligible if follow-up brain imaging after central nervous system (CNS)-directed therapy shows no evidence of progression for 4 weeks. * Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial. * Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better. * The effects of M1774 on the developing human fetus are unknown. For this reason and because ATR inhibitors agents as well as other therapeutic agents used in this trial are known to be teratogenic, women of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and 6 months after completion of M1774 administration. 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, and 3 months after completion of M1774 administration. * Ability to understand and the willingness to sign a written informed consent document. Exclusion Criteria: * Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities \> grade 1) with the exception of alopecia and neuropathy, which may be =\< grade 2. * History of allergic reactions or hypersensitivity attributed to compounds of similar chemical or biologic composition to M1774 or temozolomide, including dacarbazine. * Patients with uncontrolled intercurrent illness. * Pregnant women are excluded from this study because M1774 is an ATR inhibiting agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with M1774 breastfeeding should be discontinued if the mother is treated with M1774. These potential risks also apply to temozolomide. * Patients with a prior history of ataxia telangiectasia. * Patients who are not able to swallow orally administered medication or have gastrointestinal disorders likely to interfere with absorption of the study medication. * Patients who cannot discontinue proton-pump inhibitors (PPIs) while taking M1774. H-2 receptor antagonists are allowed but should not be taken within 12 hours before or 2 hours after M1774. Antacids are also allowed, but should not be taken 2 hours before 2 hours after M1774. * Extensive RT involving greater than 30% of the bone marrow is not permitted during the study. * A Fridericia's correction formula (QTcF) \> 480 ms is exclusionary given the potential for QT.
Where it's running
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UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
Irvine, California, United States Recruiting -
UC Irvine Health/Chao Family Comprehensive Cancer Center
Orange, California, United States Recruiting -
Yale University
New Haven, Connecticut, United States Recruiting -
Smilow Cancer Hospital Care Center-Trumbull
Trumbull, Connecticut, United States Recruiting -
University of Kansas Clinical Research Center
Fairway, Kansas, United States Recruiting -
University of Kansas Cancer Center
Kansas City, Kansas, United States Recruiting
Show 17 more locations
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University of Kansas Cancer Center-Overland Park
Overland Park, Kansas, United States Recruiting -
University of Kansas Hospital-Indian Creek Campus
Overland Park, Kansas, United States Recruiting -
University of Kansas Hospital-Westwood Cancer Center
Westwood, Kansas, United States Recruiting -
National Cancer Institute Developmental Therapeutics Clinic
Bethesda, Maryland, United States Recruiting -
University of Kansas Cancer Center - North
Kansas City, Missouri, United States Recruiting -
University of Kansas Cancer Center - Lee's Summit
Lee's Summit, Missouri, United States Recruiting -
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, United States Recruiting -
UPMC Hillman Cancer Center
Pittsburgh, Pennsylvania, United States Recruiting -
Vanderbilt University/Ingram Cancer Center
Nashville, Tennessee, United States Recruiting -
UC San Diego Moores Cancer Center
La Jolla, California, United States Active not recruiting -
Memorial Hospital East
Shiloh, Illinois, United States Active not recruiting -
Siteman Cancer Center at Saint Peters Hospital
City of Saint Peters, Missouri, United States Active not recruiting -
Siteman Cancer Center at West County Hospital
Creve Coeur, Missouri, United States Active not recruiting -
University of Kansas Cancer Center at North Kansas City Hospital
North Kansas City, Missouri, United States Suspended -
Washington University School of Medicine
St Louis, Missouri, United States Active not recruiting -
Siteman Cancer Center-South County
St Louis, Missouri, United States Active not recruiting -
Siteman Cancer Center at Christian Hospital
St Louis, Missouri, United States Active not recruiting
Study contacts
- Principal investigator: Michael Cecchini — Yale University Cancer Center LAO
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How to take part
- Review the eligibility criteria above with your treating physician.
- Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
- Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.