Description:
This study aims to investigate effect of Nivolumab and Temozolomide vs Temozolomide alone on
overall survival in newly diagnosed elderly patients with glioblastoma.
Who is it for? You may be eligible to join this study if you are aged 65 years or above, with
newly diagnosed histologically confirmed GBM (WHO grade IV glioma including gliosarcoma)
following surgery.
The study aims to evaluate whether the combination of adjuvant nivolumab with temozolomide
improves overall survival outcomes for this patient population. The outcome of the study will
help determine the most effective treatment for patients with glioblastoma in the future.
Title
- Brief Title: Nivolumab and Temozolomide Versus Temozolomide Alone in Newly Diagnosed Elderly Patients With GBM
- Official Title: A Randomised Phase II Study of NivolUmab and TeMozolomide vs Temozolomide Alone in Newly Diagnosed Elderly Patients With Glioblastoma (NUTMEG)
Clinical Trial IDs
- ORG STUDY ID:
COGNO 16/01, CTC 0156
- SECONDARY ID:
ACTRN12617000267358
- NCT ID:
NCT04195139
Conditions
Interventions
Drug | Synonyms | Arms |
---|
Nivolumab | Opdivo | Nivolumab and Temozolomide |
Temozolomide | Temodar, Temodal, Temcad | Nivolumab and Temozolomide |
Purpose
This study aims to investigate effect of Nivolumab and Temozolomide vs Temozolomide alone on
overall survival in newly diagnosed elderly patients with glioblastoma.
Who is it for? You may be eligible to join this study if you are aged 65 years or above, with
newly diagnosed histologically confirmed GBM (WHO grade IV glioma including gliosarcoma)
following surgery.
The study aims to evaluate whether the combination of adjuvant nivolumab with temozolomide
improves overall survival outcomes for this patient population. The outcome of the study will
help determine the most effective treatment for patients with glioblastoma in the future.
Detailed Description
Study details:
Participants will be allocated to either experimental or control group in a 2:1 ratio by
chance (randomly). Patients assigned to the experimental group will receive a course of
nivolumab via intravenous infusion (240 mg on days 1 and 15 every 28 days for cycles 1-4;
then 480 mg day 1 every 28 days for cycles 5-6) in addition to the standard regimen of
Temozolomide (TMZ) tablets and radiotherapy. Patients assigned to the control group will
receive the standard treatment of adjuvant temozolomide (150-200mg/m2 days 1-5 every 28 days)
for 6 cycles and standard radiotherapy treatment (40 Gy administered in 15 fractions).
Trial Arms
Name | Type | Description | Interventions |
---|
Nivolumab and Temozolomide | Experimental | After radiotherapy and 4 week break, participants who are assigned to this arm will receive Nivolumab with concurrent adjuvant temozolomide treatment | |
Temozolomide | Active Comparator | After radiotherapy and 4 week break, participants who are assigned to this arm will receive the standard treatment of adjuvant temozolomide treatment | |
Eligibility Criteria
Inclusion Criteria:
1. Adults, aged greater than or equal to 70 years, or aged 65-69 years if long course RT
is inappropriate, with newly diagnosed histologically confirmed GBM (WHO grade IV
glioma including gliosarcoma) following surgery
2. Tissue available for MGMT testing
3. ECOG 0-2
4. Life expectancy of >12 weeks
5. Adequate bone marrow function (platelets > 100 x 10^9/L, ANC > 1.5 x 10^9/L)
6. Adequate liver function (ALT/AST < 1.5 x ULN)
7. Adequate renal function (creatinine clearance > 30 ml/min measured using
Cockroft-Gault
8. Willing and able to comply with all study requirements, including treatment, timing
and/or nature of required assessments including MRI
9. Signed, written informed consent
Exclusion Criteria:
1. Specific comorbidities or conditions (e.g. psychiatric) or concomitant medications
which may impact with the administration of study related treatments or procedures
2. Other co-morbidities or conditions that may compromise assessment of key outcomes
3. Prior chemotherapy or cranial radiation within the last 5 years. Prior or concomitant
therapies for GBM (except surgery).
4. History of another malignancy within 2 years prior to registration. Patients with a
past history of adequately treated carcinoma-in-situ, basal cell carcinoma of the
skin, squamous cell carcinoma of the skin, or superficial transitional cell carcinoma
of the bladder are eligible. Patients with a history of other malignancies are
eligible if they have been continuously disease free for at least 2 years after
definitive primary treatment.
5. Significant infection, including chronic active hepatitis B, hepatitis C, or HIV.
Testing for these is not mandatory unless clinically indicated
6. Active, known or suspected autoimmune disease. Subjects with type I diabetes mellitus,
hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo,
psoriasis or alopecia) not requiring systemic treatment, or conditions not expected to
recur in the absence of an external trigger are permitted to enroll.
7. For symptoms related to GBM, the need for >4 mg/day of dexamethasone or >20 mg/day
prednisone (or equivalent) at the time of screening.
8. For a condition other than GBM, the need for >2 mg/day of dexamethasone or >10 mg/day
prednisone (or equivalent) or other immunosuppressive medications within 14 days prior
to randomisation. Exceptions to this include the use of inhaled or topical steriods
>10 mg/day prednisone (or equivalent), which are permitted in the absence of active
autoimmune disease.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 65 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Overall survival outcomes |
Time Frame: | 24 months post randomisation of first participant |
Safety Issue: | |
Description: | Overall survival is defined as the interval from the date of randomisation to date of death from any cause, or date of last known follow-up alive. This will be calculated using the Kaplan-Meier method. |
Secondary Outcome Measures
Measure: | Progression Free Survival |
Time Frame: | 6 months post randomisation |
Safety Issue: | |
Description: | Progression free survival (PFS) is defined as the interval from date of randomisation to the date of first evidence of disease progression or death from any cause, whichever occurs first. The PFS will be calculated using the Kaplan-Meier method and disease progression is defined according to modified Response Assessment in Neuro-Oncology (RANO) criteria. |
Measure: | Number and severity of adverse events |
Time Frame: | Through study completion, up to 24 months |
Safety Issue: | |
Description: | The NCI Common Terminology Criteria for Adverse Events version 4.03 (NCI CTCAE v4.03) will be used to classify and grade the intensity of adverse events. |
Measure: | Health related quality of life of participants |
Time Frame: | Through study completion, up to 24 months |
Safety Issue: | |
Description: | Health related quality of life will be reported directly by the participants using the EORTC core quality of life questionnaire QLQ C-30. The QLQ-C30 is a 30-item questionnaire with 5 functional scales (physical, role, cognitive, emotional, and social), global health status, 3 symptom scales (fatigue, pain, nausea/vomiting), and other (dyspnoea, appetite loss, insomnia, constipation/diarrhea, and financial difficulties). Most questions used 4-point scale (1 'Not at All' to 4 'Very Much'); 2 questions used 7-point scale (1 'Very Poor' to 7 'Excellent'). Scores are averaged and transformed to 0-100 scale; higher score=better level of physical functioning. |
Measure: | Health related quality of life of participants |
Time Frame: | Through study completion, up to 24 months |
Safety Issue: | |
Description: | Health related quality of life will be reported directly by the participants using the EORTC core quality of life questionnaire brain cancer specific module (QLQ-BN20). The QLQ-BN20 consisted of 20 items assessing visual disorders, motor dysfunction, communication deficit, various disease symptoms (e.g. headaches and seizures), treatment toxicities (e.g. hair loss) and future uncertainty. All of the 20 items are rated on a 4 point scale (1=not at all, 4=very much), and were linearly transformed to a 0-100 scale, with higher scores indicating more severe symptoms. |
Measure: | Health related quality of life of participants |
Time Frame: | Through study completion, up to 24 months |
Safety Issue: | |
Description: | Health related quality of life will be reported directly by the participants using the EORTC core quality of life questionnaire EuroQol EQ-5D-5L. The EQ-5D-5L descriptive system comprises the following 5 dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression and as overall health using a "thermometer" visual analog scale with response options ranging from 0 (worst imaginable health) to 100 (best imaginable health). |
Measure: | Neurologic function of participants |
Time Frame: | Through study completion, up to 24 months |
Safety Issue: | |
Description: | Cognitive function will be assessed by the Neurologic Assessment in Neuro-Oncology (NANO) scales. The NANO is a quantifiable evaluation of nine major domains for subjects with brain tumours. The domains include: gait, strength, ataxia, sensation, visual field, facial strength, language, level of consciousness, behaviour and overall. Each domain is rated on a scale of 0 to 3 where 0 represents normal and 3 represents the worst severity. The evaluation is based on direct observation/testing performed during routine office visits. |
Measure: | Correlating modified RANO and immune related RANO in the experimental arm |
Time Frame: | Through study completion, up to 24 months |
Safety Issue: | |
Description: | Site investigators will assess disease progression using modified RANO criteria for clinical decision making. The study team will coordinate image analysis and central review of MRI including modified RANO (both experimental and comparator arms) and iRANO (in the experimental arm). |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Active, not recruiting |
Lead Sponsor: | University of Sydney |
Trial Keywords
- GBM
- Astrocytoma WHO grade IV
- Elderly
- Nivolumab
- Temozolomide
Last Updated
June 29, 2021