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Study of Vismodegib in Combination With Temozolomide Versus Temozolomide Alone in Patients With Medulloblastomas With an Activation of the Sonic Hedgehog Pathway

NCT01601184

Description:

The purpose of this study is to evaluate the safety of vismodegib in combination with temozolomide (primary objective - phase I) and to estimate the efficacy of vismodegib in combination with temozolomide in adult patients with recurrent, progressive, or refractory medulloblastomas to standard therapy measured by the 6-month progression-free rate (phase II). This study is an open-label Phase I/II, international, randomized. 38 patients will be included in the study.

Related Conditions:
  • Medulloblastoma
Recruiting Status:

Terminated

Phase:

Phase 1/Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Study of Vismodegib in Combination With Temozolomide Versus Temozolomide Alone in Patients With Medulloblastomas With an Activation of the Sonic Hedgehog Pathway
  • Official Title: An International, Randomized, Open-label Phase I/II Study of Vismodegib in Combination With Temozolomide Versus Temozolomide Alone in Adult Patients With Recurrent or Refractory Medulloblastomas Presenting an Activation of the Sonic Hedgehog (SHH) Pathway

Clinical Trial IDs

  • ORG STUDY ID: MEVITEM
  • SECONDARY ID: 2011-003372-37
  • NCT ID: NCT01601184

Conditions

  • Histologically Confirmed Medulloblastoma
  • Activation of the Sonic Hedgehog (SHH) Pathway

Interventions

DrugSynonymsArms
vismodegibcombination of vismodegib with temozolomide
Temozolomidetemodalcombination of vismodegib with temozolomide

Purpose

The purpose of this study is to evaluate the safety of vismodegib in combination with temozolomide (primary objective - phase I) and to estimate the efficacy of vismodegib in combination with temozolomide in adult patients with recurrent, progressive, or refractory medulloblastomas to standard therapy measured by the 6-month progression-free rate (phase II). This study is an open-label Phase I/II, international, randomized. 38 patients will be included in the study.

Detailed Description

      Secondary objectives are :

      phase I : to collect preliminary results on the 6-month progression-free rate of the
      combination vismodegib + temozolomide

      PHASE II

      To estimate in the two study arms:

        -  the objective response rate (Complete response + Partial Response according to WHO
           criteria) after 6 months of treatment

        -  the duration of treatment response

        -  the best overall response obtained during the study

        -  the progression-free survival (PFS)

        -  the time to progression (TTP)

        -  the time to treatment failure (TTF)

        -  In the combination arm (vismodegib + temozolomide): to further evaluate the safety of
           the combination.
    

Trial Arms

NameTypeDescriptionInterventions
combination of vismodegib with temozolomideExperimentalIn the first step of the study (Phase I), 9 adult patients with relapsing or refractory medulloblastoma will be randomized (randomization ratio 2:1) to receive - Arm A: the combination of vismodegib (150 mg/day continuously) with temozolomide (150 mg/m2 during Cycle 1 [day 1 to day 5/ 28 day-cycle] and 200 mg/m2 during subsequent cycles) (6 patients)
  • vismodegib
  • Temozolomide
temozolomide aloneActive ComparatorIn the first step of the study (Phase I), 9 adult patients with relapsing or refractory medulloblastoma will be randomized (randomization ratio 2:1) to receive Arm B: temozolomide alone (150 mg/m2 day1 to day 5/ 28 day-cycle during Cycle 1 and 200 mg/m2 day 1 to day 5/ 28 day-cycle during subsequent cycles) (3 patients).
  • Temozolomide
vismodegib aloneOtherConsidering the rarity of the disease, the few therapeutic options available and the promising results reported with vismodegib in adult medulloblastoma : the Sponsor will consider (on case by case basis) the enrolment of patients previously treated by temozolomide in a 3rd independent and parallel study arm
  • vismodegib

Eligibility Criteria

        Inclusion Criteria:

          -  Age ≥ 18 years

          -  Patients must have histologically confirmed medulloblastoma (including posterior fossa
             primitive neuroectodermal tumor) for which no known curative therapy exists

          -  Patients must have recurrent or refractory disease

          -  Patients must have evidence of measurable disease or lesion in pre-inclusion MRI.
             Patients with measurable spinal disease are eligible. NB: Patients with complete
             resection for recurrence are not eligible.

          -  Activation of the SHH pathway validated by IHC.

          -  ECOG performance status 0, 1 or 2

          -  Life expectancy ≥ 12 weeks

          -  Patients must have normal organ and marrow function as defined below:

        Neutrophils ≥ 1. 5 G/L Platelets ≥ 100 G /L Hemoglobin ≥ 10g/dL Creatinine clearance ≥ 50
        mL/min (calculated by Cockcroft-Gault formula or MDRD formula for patients older than 65
        years ) or serum creatinine within normal limits or less than 1.5 x upper limit of normal
        (ULN) Total bilirubin ≤ 1.5 ULN ALAT and ASAT ≤ 2.5 ULN Serum albumin ≥ 25 g/L.

          -  Patients recovered from prior treatment-related toxicity (persistent treatment related
             toxicity <Grade 2 are allowed (NCI-CTCAE v4.0).

          -  Prior therapy:

        No prior hedgehog antagonist vismodegib or other antagonists of the hedgehog pathway, and
        no prior temozolomide treatment for patients to be randomized in Arm A or B. Patients
        previously treated with temozolomide are eligible for enrollment in study arm C on a case
        by case basis and following sponsor agreement More than 4 weeks since prior
        myelosuppressive chemotherapy (6 weeks for nitrosoureas, 6 months after high dose therapy)
        or immunotherapy At least 3 months since prior craniospinal irradiation (≥ 23 Gy) At least
        8 weeks since prior local irradiation to primary tumor At least 2 weeks since prior focal
        irradiation for symptomatic metastatic sites.

        At least 1 week since prior colony-stimulating factors (e.g., G-CSF, GM-CSF, or
        erythropoietin)

          -  Women of childbearing potential* are required to have a negative serum pregnancy test
             within 72 hours prior to study treatment initiation (i.e. Cycle 1 Day 1).

             *: Female patients who meet at least one of the following criteria are defined as
             women of non-childbearing potential:

             ≥50 years old and naturally amenorrheic for ≥ 1 year Permanent premature ovarian
             failure confirmed by a specialist gynaecologist Previous bilateral
             salpingo-oophorectomy XY genotype, Turner's syndrome, or uterine agenesis Female
             patient who do not meet at least of the above criteria are defined as women of
             childbearing potential.

          -  An embryo-fetal development study in rats has confirmed the teratogenic potential of
             vismodegib. Therefore, women of child-bearing potential and men must use two forms of
             effective contraception (including one barrier method- refer to Appendix 4 for
             acceptable method of contraception) at least 4 weeks prior to study entry, during the
             study period and for at least 24 months post-treatment for women and 2 months
             post-treatment for men. Prior to dispensing vismodegib, the investigator must confirm
             and document the patient's use of two contraceptive methods, dates of negative
             pregnancy test, and confirm the patient's understanding of the teratogenic potential
             of vismodegib.

          -  Ability to understand and willingness to comply to follow-up visits.

          -  Covered by a medical insurance (in countries where applicable)

        Exclusion Criteria:

          -  Tumor tissue sample not available for biological studies (from the initial diagnosis
             and/or relapse)

          -  Pregnant or breastfeeding women are not eligible.

          -  History of allergic reactions attributed to compounds of similar chemical composition
             to vismodegib.

          -  Any contraindications to temozolomide treatment as per Temodal® SPC (see Appendix 5).

          -  Patients with malabsorption syndrome or other condition that would interfere with
             intestinal absorption. Patients must be able to swallow capsules.

          -  Uncontrolled hypocalcemia, hypomagnesemia, hyponatremia, or hypokalemia, defined as
             less than the lower limit of normal despite adequate electrolyte supplementation.

          -  History of congestive heart failure.

          -  History of ventricular arrhythmia requiring medication.

          -  Congenital long QT syndrome.

          -  Clinically significant unrelated systemic illness (e.g., serious infection or
             significant cardiac, pulmonary, hepatic, or other organ dysfunction) that would
             compromise the patient's ability to tolerate study treatment or would likely interfere
             with study procedures or results.

          -  Patients using prohibited concomitant and/or concurrent medications (see section
             "Prohibited concomitant/concurrent treatments.)
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:To evaluate the safety of a fixed dose of vismodegib in combination with (phase I)temozolomide in adult patients with recurrent, progressive, or refractory to standard therapy medulloblastoma
Time Frame:during the first three months follow up
Safety Issue:
Description:number of severe toxicities occurring during the first 3 months of follow-up : Toxic death Grade 4 toxicity Any grade 3 AE leading to study treatment interruption for more than 7 days or discontinuation.

Secondary Outcome Measures

Measure:To collect preliminary results on the 6-month progression-free rate of the combination vismodegib + temozolomide (phase I)
Time Frame:6 months after start of treatment
Safety Issue:
Description:measurement of progression free rate
Measure:To estimate in the two study arms the objective response rate after 6 months of treatment (phase II)
Time Frame:after 6 months of treatment
Safety Issue:
Description:measure by objective response rate
Measure:To estimate in the two study arms the duration of treatment response (phase II)
Time Frame:one year
Safety Issue:
Description:treatment response
Measure:To estimate in the two study arms the best overall response obtained during the study (phase II)
Time Frame:one year
Safety Issue:
Description:
Measure:To estimate in the two study arms the progression-free survival (PFS)(phase II)
Time Frame:one year
Safety Issue:
Description:measure of progression free rate
Measure:To estimate in the two study arms the time to treatment failure (phase II)
Time Frame:one year
Safety Issue:
Description:
Measure:frequency of adverse events based on the common toxicity criteria (CTC-AE-V4.0) grade
Time Frame:one year
Safety Issue:
Description:In the combination arm (vismodegib + temozolomide): to further evaluate the safety of the combination

Details

Phase:Phase 1/Phase 2
Primary Purpose:Interventional
Overall Status:Terminated
Lead Sponsor:Centre Leon Berard

Trial Keywords

  • medulloblastoma
  • sonic hedgehog pathway
  • vismodegib

Last Updated

May 21, 2019