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.
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
Drug | Synonyms | Arms |
---|
vismodegib | | combination of vismodegib with temozolomide |
Temozolomide | temodal | combination 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
Name | Type | Description | Interventions |
---|
combination of vismodegib with temozolomide | Experimental | In 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) | |
temozolomide alone | Active Comparator | In 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). | |
vismodegib alone | Other | Considering 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 | |
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