Clinical Trials /

Chemotherapy and Radiation Therapy for the Treatment of IDH Wildtype Gliomas or Non-histological (Molecular) Glioblastomas

NCT04623931

Description:

This phase II trial studies how well temozolomide and radiation therapy work in treating patients with IDH wildtype historically lower grade gliomas or non-histological molecular glioblastomas. Radiation therapy uses high-energy x-rays to kill tumor cells and shrink tumors. Giving chemotherapy with radiation therapy may kill more tumor cells. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. The goal of this clinical research study is to compare receiving new radiation therapy doses and volumes to the prior standard treatment for patients with historically grade II or grade III IDH wild-type gliomas, which may now be referred to as IDH wildtype molecular glioblastomas at some institutions. Receiving temozolomide in combination with radiation therapy may also help to control the disease.

Related Conditions:
  • Anaplastic Astrocytoma
  • Anaplastic Oligoastrocytoma
  • Anaplastic Oligodendroglioma
  • Diffuse Astrocytoma
  • Glioblastoma
  • Oligoastrocytoma
  • Oligodendroglioma
Recruiting Status:

Recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Chemotherapy and Radiation Therapy for the Treatment of IDH Wildtype Gliomas or Non-histological (Molecular) Glioblastomas
  • Official Title: Phase II Trial of Treatment Intensification for IDH Wildtype, Non-Histological Glioblastoma, Gliomas (IDH Wildtype Lower Grade Glioma Treatment Intensification)

Clinical Trial IDs

  • ORG STUDY ID: 2019-0715
  • SECONDARY ID: NCI-2019-08264
  • SECONDARY ID: 2019-0715
  • NCT ID: NCT04623931

Conditions

  • Anaplastic Astrocytoma, IDH-Wildtype
  • Anaplastic Oligoastrocytoma
  • Anaplastic Oligodendroglioma
  • Diffuse Astrocytoma, IDH-Wildtype
  • Glioblastoma
  • Oligoastrocytoma
  • Oligodendroglioma
  • WHO Grade II Glioma
  • WHO Grade III Glioma

Interventions

DrugSynonymsArms
TemozolomideCCRG-81045, Imidazo[5,1-d]-1,2,3,5-tetrazine-8-carboxamide, 3, 4-dihydro-3-methyl-4-oxo-, M & B 39831, M and B 39831, Methazolastone, RP-46161, SCH 52365, Temcad, Temodal, Temodar, Temomedac, TMZTreatment (temozolomide, radiation therapy)

Purpose

This phase II trial studies how well temozolomide and radiation therapy work in treating patients with IDH wildtype historically lower grade gliomas or non-histological molecular glioblastomas. Radiation therapy uses high-energy x-rays to kill tumor cells and shrink tumors. Giving chemotherapy with radiation therapy may kill more tumor cells. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. The goal of this clinical research study is to compare receiving new radiation therapy doses and volumes to the prior standard treatment for patients with historically grade II or grade III IDH wild-type gliomas, which may now be referred to as IDH wildtype molecular glioblastomas at some institutions. Receiving temozolomide in combination with radiation therapy may also help to control the disease.

Detailed Description

      PRIMARY OBJECTIVE:

      I. To determine the progression free survival (PFS) based on Response Assessment in
      Neuro-Oncology (RANO) imaging criteria from start of treatment with concurrent chemoradiation
      (CRT) and adjuvant temozolomide (TMZ).

      SECONDARY OBJECTIVE:

      I. To determine the 3-year overall survival (OS) of isocitrate dehydrogenase (IDH) wild-type
      grade II and grade III gliomas with dose escalation radiation with concurrent chemoradiation
      therapy.

      EXPLORATORY OBJECTIVES:

      I. To assess local control patterns (site of 1st progression). II. To evaluate
      neuro-cognitive function by the Neurocognitive Clinical Trial Battery (CTB).

      III. To evaluate the treatment related symptoms, overall symptom impact, and disease related
      factor groupings utilizing the M.D. Anderson Symptom Inventory Brain Tumor (MDASI-BT).

      IV. To assess the quality of life.

      OUTLINE:

      Patients receive temozolomide orally (PO) daily and radiation therapy over 5 days a week
      (weekdays only) for 6 weeks. Beginning 28 days after the last dose of radiation therapy,
      patients receive temozolomide PO for 12 months in the absence of disease progression or
      unacceptable toxicity.

      After completion of study treatment, patients are followed up at 1, 3, 5, 7, 9, 12, 15, 18,
      21, 24, 28, 32, and 36 months.
    

Trial Arms

NameTypeDescriptionInterventions
Treatment (temozolomide, radiation therapy)ExperimentalPatients receive temozolomide PO daily and radiation therapy over 5 days a week (weekdays only) for 6 weeks. Beginning 28 days after the last dose of radiation therapy, patients receive temozolomide PO for 12 months in the absence of disease progression or unacceptable toxicity.
  • Temozolomide

Eligibility Criteria

        Inclusion Criteria:

          -  Historical grade II and III gliomas IDH wildtype gliomas by including; diffuse
             astrocytoma, anaplastic astrocytoma, oligodendroglioma, anaplastic oligodendroglioma,
             oligoastrocytoma, anaplastic oligoastrocytoma

          -  IDH wildtype gliomas (molecularly defined high grade glioma or molecularly defined
             glioblastoma [GBM])

          -  History & physical exam, and Karnofsky performance status (KFS) of >= 70 within 30
             days prior to enrollment

          -  Post-operative magnetic resonance imaging (MRI) with contrast is mandatory and
             necessary for radiation therapy (RT) planning

          -  Thin-slice (< 1.5 mm) three-dimensional (3D) T1 pre and post contrast and axial
             T2/fluid-attenuated inversion recovery (FLAIR) sequences for planning purposes are
             highly encouraged to obtain.

          -  Absolute neutrophil count (ANC) >= 1,500 cells/mm^3 (within 60 days prior to
             registration)

          -  Platelets >= 100,000 cells/mm^3 (within 60 days prior to registration)

          -  Hemoglobin >= 10.0 g/dl (within 60 days prior to registration) (Note: The use of
             transfusion or other intervention to achieve hemoglobin [Hgb] >= 10.0 g/dl is
             acceptable)

          -  Bilirubin =< 1.5 upper limit of normal (ULN) (within 60 days prior to registration)

          -  Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 x ULN (within
             60 days prior to registration)

          -  Blood urea nitrogen (BUN) < 30 mg/dl (within 60 days prior to registration)

          -  Serum creatinine < 1.5 mg/dl (within 60 days prior to registration)

        Exclusion Criteria:

          -  Definitive clinical or radiologic evidence of metastatic disease; if applicable

          -  Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free
             for a minimum of 3 years. (For example, carcinoma in situ of the breast, oral cavity
             or cervix are permissible)

          -  Prior cranial radiotherapy or radiotherapy to the head and neck where potential field
             overlaps would exist

          -  Prior chemotherapy or radiotherapy for any brain tumor

          -  Histologic diagnosis of gliosarcoma World Health Organization (WHO grade IV) or
             pilocytic astrocytoma (WHO grade I)

          -  Multicentric glioblastoma

          -  Leptomeningeal disease

          -  Inability to undergo MRI with and without contrast

          -  Severe, active co-morbidity defined as follows:

               -  Unstable angina or congestive heart failure requiring hospitalization within 6
                  months prior to enrollment

               -  Transmural myocardial infarction within the last 6 months prior to registration.
                  Evidence of recent myocardial infarction or ischemia by the findings of S-T
                  elevations of >= 2 mm using the analysis of an electrocardiogram (EKG) performed
                  within 28 days prior to registration. (Note: EKG to be performed only if clinical
                  suspicion of cardiac issue)

                  • New York Heart Association grade II or greater congestive heart failure
                  requiring hospitalization within 12 months prior to registration

               -  Serious and inadequately controlled arrhythmia at step 2 registration

               -  Serious or non-healing wound, ulcer or bone fracture or history of abdominal
                  fistula, intra-abdominal abscess requiring major surgical procedure, open biopsy
                  or significant traumatic injury within 28 days prior to registration, with the
                  exception of the craniotomy for surgical resection

               -  Acute bacterial or fungal infection requiring intravenous antibiotics at the time
                  of registration

               -  Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects;
                  note, however, that laboratory tests for coagulation parameters are not required
                  for entry into this protocol

               -  Chronic obstructive pulmonary disease exacerbation or other respiratory illness
                  requiring hospitalization or precluding study therapy at the time of registration

               -  Human immunodeficiency virus (HIV) positive with CD4 count < 200
                  cells/microliter. Acquired immune deficiency syndrome (AIDS) based upon current
                  Centers for Disease Control and Prevention (CDC) definition; note, however, that
                  HIV testing is not required for entry into this protocol. The need to exclude
                  patients with AIDS from this protocol is because the treatments involved in this
                  protocol may be significantly immunosuppressive with potentially fatal outcomes
                  in patients already immunosuppressed

          -  Any other severe immunocompromised condition

          -  Active connective tissue disorders, such as lupus or scleroderma that in the opinion
             of the treating physician may put the patient at high risk for radiation toxicity

          -  End-stage renal disease (i.e., on dialysis or dialysis has been recommended)

          -  Any other major medical illnesses or psychiatric treatments that in the investigator's
             opinion will prevent administration or completion of protocol therapy
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Progression free survival (PFS)
Time Frame:From start of treatment until objective tumor progression or death, whichever happens first, assessed up to 52 months
Safety Issue:
Description:Tumor progression is defined by the Response Assessment in Neuro-Oncology glioma criteria. PFS time will be estimated using the Kaplan-Meier method. The 1-year PFS rate will be estimated along with a 95% confidence interval. Patient or tumor characteristics (ex. grade, age, etc) will be compared within the single study cohort. Cox regression models will be applied to assess the effect of covariates of interest on PFS.

Secondary Outcome Measures

Measure:Overall survival (OS) rate
Time Frame:From start of treatment until death from any cause, assessed at 3 years
Safety Issue:
Description:The 3-year OS rate is defined as the proportion of participants that are alive at 3-year after the start of treatment, which will be estimated along a 95% confidence interval. OS time will be estimated using the Kaplan-Meier method. Patient or tumor characteristics (ex. grade, age, etc) will be compared within the single study cohort. Cox regression models will be applied to assess the effect of covariates of interest on OS.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Recruiting
Lead Sponsor:M.D. Anderson Cancer Center

Last Updated

November 10, 2020