Evaluation of Fluoxetine and Cytotoxic Lysosomal Stress in Glioma (FLIRT)

The purpose of this research study is to determine if fluoxetine increases lysosomal stress in patients with recurrent IDHwt glioma by evaluating LAMP1 expression in tumor samples obtained pre-resection via biopsy and during surgery. Lysosomes are organelles (structures in cells) that contain digestive enzymes (substances that break down chemicals) that help keep the cells free of extra or worn out cell parts. Fluoxetine, a drug approved by the FDA to treat problems like depression and anxiety, can cause changes to structures in cells called lysosomes that then improve how well the chemotherapy drug temozolomide (TMZ) kills cancer cells in the brain.

Inclusion Criteria:Age ≥ 24 years of age Note: Fluoxetine has a warning about suicidal thoughts in children, adolescents, and young adults. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24.Patients with recurrent gliomaTumor volume ≥ 1 cm3Clinical indication for craniotomy for biopsy and resection of the lesionClinical indication for repeat treatment with TemozolomideKarnofsky Performance Status (KPS) > 70%Adequate organ function: platelets > 100,000/µL, hemoglobin >9 gm/dL, ANC > 1000/µL; creatinine < 1.5x upper limit of normal (ULN), total bilirubin < 1.5x ULN, AST/ALT < 2.5x ULN within 72 hours prior to first administration of FluoxetineAble to undergo MRI brain with and without contrastIf the patient is a sexually active female of childbearing potential, whose partner is male, or if the patient is a sexually active male, whose partner is a female of childbearing potential, the patient must use appropriate contraceptive measures for the duration of the treatment and for 6 months afterwards. Female patients of childbearing potential must have a negative serum pregnancy test at the time of screening and within 48 hours of starting the infusion of the study drug.Signed informed consent approved by the Institutional Review BoardExclusion Criteria:Patients currently taking or who have taken any other anti-depressant medication within the past yearPatients currently taking psychotropic agents or who have taken other psychotropic agents within the past 7 daysPatients with any history of mood/psychotic/substance use disordersPrior, unrelated malignancy requiring current active treatment except for cervical carcinoma in situ and adequately treated basal cell or squamous cell carcinoma of the skinPatients who are pregnant or breastfeedingPatients with contrast-enhancing tumor crossing the midline, multifocal tumor, infratentorial tumor, tumor in eloquent brain regions, extensive tumor dissemination (subependymal or leptomeningeal), or in unsafe brain regions per the opinion of the treating neurosurgeonPatients with worsening neurologic deficits, clinically significant increased intracranial pressure (e.g., impending herniation), uncontrolled seizures, or requirement for immediate palliative treatmentUnstable systemic disease in the opinion of the treating physicianLess than 12 weeks from radiation therapy, unless progressive disease outside of the radiation field or 2 progressive scans at least 4 weeks apart or histopathologic confirmation of recurrent tumorTreated with immunotherapeutic agents within 4 weeks, alkylating agents within 4 weeks, nitrosoureas within 6 weeks, or non-alkylating chemotherapy within 2 weeks before enrollment, unless the patient has recovered from the expected toxic effects of such therapyTreated with antiangiogenic agents (i.e., bevacizumab) within 4 weeks before biopsyPatients who have developed disease progression while receiving temozolomide treatment are not eligiblePatients with allergy to fluoxetinePatients with known cardiac disease, predisposing to long QT syndromePatients with diabetes mellitus, epilepsy, history of bleeding disorders, history of mania or susceptibility to angle-closure glaucomaPatients with a history or who develop significant hyponatremia (serum sodium less than 130mmol/L)Patients with a history of bipolar disorder or schizoaffective disorderPatients with a history of seizure disorder prior to onset of their primary gliomaPatients who are currently taking or have taken in the past 2 months: Monoamine Oxidase Inhibitors (MAOI), Pimozide, Thioridazine, Drugs metabolized by the CYP2D6 pathway, Tricyclic Antidepressants, Antipsychotics, Serotonergic Drugs, Triptans, Tryptophan, Anticoagulant drugs (e.g., NSAIDs, aspirin, warfarin), OlanzapinePatients who demonstrated thrombocytopenia following prior treatment with TMZ (platelets < 50,000/µL)