Pilot Study of Mirtazapine for the Dual Tx of Depression and CINV in High-Grade Glioma Pts on TMZ

Research Hypothesis: For glioma patients undergoing TMZ chemotherapy, Mirtazapine will address TMZ-associated nausea and vomiting (CINV) and weight loss in addition to depression. Mirtazapine acts as an antagonist at the 5-HT3 receptor, which may explain its anti-emetic properties. Mirtazapine is also an appetite stimulant, which may help curb the weight loss associated with TMZ chemotherapy.

Specific aim 1: To administer the Beck Depression Inventory to approximately 100 patients meeting the inclusion/exclusion criteria in order to identify at least 36 with clinical depression (defined as total score >= 21).

Specific aim 2: To put at least 36 clinically depressed patients identified in aim one on mirtazapine for eight weeks.

Specific aim 3: To administer the Beck Depression Inventory to patients from aim two at four weeks and at eight weeks of treatment with mirtazapine.

Specific aim 4: To document weight and frequencies of nausea, vomiting, and insomnia among participants over the course of the study.

Specific aim 5: To document adverse events experienced by participants over the course of the study and determine, to the extent possible, if mirtazapine is the cause.

The investigators will:

• Assess changes in the distribution of depression scores as measured by the Beck Depression Inventory (a self-administered instrument extensively used and validated in glioma studies) from baseline to after eight weeks of treatment with mirtazapine.
• Assess changes in nausea, vomiting, Sleeping and body weight between baseline and the eight-week follow-up visit,
• Document the trajectory of changes in depression, nausea, vomiting, and weight over the three study time points (baseline, four-week, and eight-week visit).
• Lastly, collect information on the tolerability of mirtazapine in our patient population.

Main Research Hypothesis: The investigators hypothesize that the mirtazapine regimen will improve depression scores at eight-weeks, compared to baseline scores. Further, the investigators hypothesize that the mirtazapine regimen will limit the reduction of weight and the incidence of nausea/vomiting and insomnia at eight weeks compared to baseline.

Inclusion criteria

• Understand and voluntarily sign and date an informed consent document prior to any study related assessments/procedures are conducted.
• Histologically confirmed diagnosis of glioma
• No prior treatment with temozolomide TMZ
• Patient will receive temozolomide TMZ therapy as part of their standard treatment.
• Males and Females ≥18 years of age at the time of signing the informed consent document. Able to understand consent forms and study materials in English
• Willing to use approved methods of contraception for duration of study
• Karnofsy Performance Score (KPS) of at least 60
• Patients should have stopped any anti-depressant medications by standard of care at least a month before enrolling in the trial
• Willing and able to adhere to the study visit schedule and other protocol requirements.

Exclusion criteria

• Prior treatment with other chemotherapy drugs for glioma
• Known hypersensitivity to Mirtazapine and 5-HT3 receptor antagonists
• Life expectancy of less than three months
• Pregnancy or breastfeeding.