Inclusion Criteria Specific for Arm A. 1. All subjects must have histologic evidence of high grade glioma (World Health
Organization [WHO] grade 3 or grade 4) and radiographic evidence of recurrence or
disease progression (defined as either a greater than 25% increase in the largest
bi-dimensional product of enhancement, a new enhancing lesion, or a significant
increase in T2 FLAIR). Subjects must have at least 1 measurable lesion by RANO
criteria (≥ 10 mm in 2 perpendicular diameters).
2. Patients must have previously failed a treatment regimen, including radiation and/or
3. No prior treatment with mTOR inhibitors.
4. No prior treatment with temozolomide for the treatment of recurrent glioma for
patients entering the ABI-009 + temozolomide cohort.
5. No prior treatment with bevacizumab or any other anti-angiogenic agents, including
sorafenib, sunitinib, axitinib, pazopanib, or cilengitide for the ABI-009 +
6. No prior treatment with lomustine for the ABI-009 + lomustine arm.
7. No prior treatment with marizomib or any other proteasome inhibitors, including
bortezomib, carfilzomib, or ixazomib, for patients entering the ABI-009 + marizomib
8. At least 4 weeks from surgical resection and at least 12 weeks from the end of
radiotherapy prior to enrollment in this study, unless relapse is confirmed by tumor
biopsy or new lesion outside of radiation field, or if there are two MRIs confirming
progressive disease that are approximately 4 weeks apart.
Inclusion Criteria Specific for Arm B. 1. Histologically confirmed newly diagnosed glioblastoma.
2. Patients must have had surgery and can have either non-measurable disease or a
measurable post-contrast lesion after surgery detected by MRI.
3. No prior treatment with mTOR inhibitors, and no prior local or systemic therapy for
Exclusion Criteria Common for Both Arms A and B. A patient will not be eligible for inclusion in this study if any of the following criteria
1. Co-medication or concomitant therapy that may interfere with study results, including
anti-coagulants and enzyme-inducing anti-epileptic drugs (EIAEDs).
2. History of thrombotic or hemorrhagic stroke or myocardial infarction within 6 months.
3. Pregnant or breast feeding.
4. Uncontrolled intercurrent illness including, but not limited to, ongoing or active
infection requiring IV antibiotics & psychiatric illness/social situations that would
limit compliance with study requirements, or disorders associated with significant
5. Active gastrointestinal bleeding.
6. Uncontrolled hypertension (systolic blood pressure ≥160 mm Hg and/or diastolic blood
pressure ≥90 mm Hg.
7. Patients with history of intestinal perforations, fistula, hemorrhages and/or
hemoptysis ≤6 months prior to first study treatment.
8. Uncontrolled diabetes mellitus as defined by HbA1c >8% despite adequate therapy.
9. Patients with history of interstitial lung disease and/or pneumonitis, or pulmonary
10. Use of strong inhibitors and inducers of CYP3A4 within the 14 days prior to receiving
the first dose of ABI-009. Additionally, use of any known CYP3A4 substrates with
narrow therapeutic window (such as fentanyl, alfentanil, astemizole, cisapride,
dihydroergotamine, pimozide, quinidine, terfanide) within the 14 days prior to
receiving the first dose of ABI-009.
11. Known other previous/current malignancy requiring treatment within ≤ 3 years except
for limited disease treated with curative intent, such as in situ prostate cancer,
intracapsular renal cancer, cervical carcinoma in situ, squamous or basal cell skin
carcinoma, and superficial bladder carcinoma.
12. Any comorbid condition that restricts the use of study drug and confounds the ability
to interpret data from the study as judged by the Investigator or Medical Monitor.
13. Known Human Immunodeficiency Virus (HIV), or active Hepatitis B or Hepatitis C.