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Imatinib Mesylate and Hydroxyurea in Treating Patients With Recurrent or Progressive Meningioma

Primary Purpose

Glioblastoma, Gliosarcoma

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
hydroxyurea
imatinib mesylate
Sponsored by
Duke University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glioblastoma focused on measuring adult grade I meningioma, adult grade II meningioma, adult grade III meningioma, adult papillary meningioma, adult anaplastic meningioma, recurrent adult brain tumor, glioblastoma multiforme (GBM), Imatinib, Imatinib mesylate, Hydroxyurea, Droxia, Hydrea, Hydroxycarbamide, Gleevec, Meningioma

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically confirmed meningioma Recurrent or progressive disease after prior surgical resection Measurable disease by contrast-enhanced MRI Multifocal disease allowed No evidence of intratumor hemorrhage on pretreatment diagnostic imaging Stable postoperative grade 1 hemorrhage allowed No peripheral edema or central or systemic fluid collections ≥ grade 2 (e.g., pericardial effusion, pulmonary effusion, ascites) PATIENT CHARACTERISTICS: Karnofsky performance status 70-100% Absolute neutrophil count > 1,500/mm³ Hemoglobin > 9 g/dL Platelet count > 100,000/mm³ Potassium normal* Calcium normal* Magnesium normal* Phosphorus normal* alanine aminotransferase (AST) and alanine aminotransferase (ALT) < 2.5 times upper limit of normal (ULN) Bilirubin < 1.5 times ULN Creatinine < 1.5 times ULN OR creatinine clearance > 50 mL/min Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No excessive risk of bleeding, as defined by stroke within the past 6 months No active systemic bleeding (i.e., gastrointestinal bleeding or gross hematuria) No history of central nervous system (CNS) or intraocular bleeding or septic endocarditis No concurrent severe and/or uncontrolled medical disease, including any of the following: Uncontrolled diabetes Congestive cardiac failure Myocardial infarction within the past 6 months Poorly controlled hypertension History of labile hypertension History of poor compliance with antihypertensive regimen Chronic renal disease Active uncontrolled infection requiring intravenous antibiotics No acute or chronic liver disease (i.e., hepatitis, cirrhosis) No HIV positivity No impairment of gastrointestinal function or disease that may significantly alter the absorption of imatinib mesylate, including any of the following: Ulcerative disease Uncontrolled nausea Vomiting Diarrhea Malabsorption syndrome Bowel obstruction Inability to swallow tablets No other malignancy within the past 5 years except basal cell skin cancer or cervical carcinoma in situ NOTE: *Unless correctable with supplements PRIOR CONCURRENT THERAPY: See Disease Characteristics Recovered from prior therapy More than 1 week since prior tumor biopsy More than 2 weeks since prior surgical resection Prior hydroxyurea allowed provided patient has not had progressive disease or toxicity > grade 3 No prior imatinib mesylate or other platelet-derived growth factor-directed therapy At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas)* Chemotherapeutic agents such as etoposide that are normally given at shorter intervals allowed even if < 4 weeks from last prior dose of chemotherapy At least 4 weeks since prior radiotherapy* At least 1 week since prior biological, immunotherapeutic, or cytostatic drugs At least 2 weeks since prior investigational drugs No concurrent warfarin NOTE: *Unless there is unequivocal evidence of tumor progression

Sites / Locations

  • Duke Cancer Institute

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Imatinib mesylate+hydroxyurea

Arm Description

All patients receive imatinib mesylate and hydroxyurea orally on a daily, continuous basis. Dosing of imatinib mesylate is adjusted for patients who are also receiving p450-inducing anti-epileptic drugs.

Outcomes

Primary Outcome Measures

Progression-free Survival at 6 Months
Percentage of participants surviving six months from the start of study treatment without progression of disease. PFS was defined as the time from the date of study treatment initiation to the date of the first documented progression according to the Macdonald criteria, or death due to any cause.

Secondary Outcome Measures

Median Progression-free Survival (PFS)
Time in months from the start of study treatment to the date of first progression according to Macdonald criteria, or to death due to any cause. Patients alive who had not progressed as of the last follow-up had PFS censored at the last follow-up date. Median PFS was estimated using a Kaplan-Meier curve.
Median Overall Survival (OS)
Time in months from the start of study treatment to date of death due to any cause. Patients alive at last follow-up are censored as of that follow-up date. Median OS was estimated using a Kaplan-Meier curve.
Objective Response Rate
Percentage of participants with an objective response (complete response or partial response). Per modified Macdonald criteria and assessed by MRI, complete response (CR) was the disappearance of all target lesions and partial response (PR) was a ≥50% decrease in the sum of the longest diameter of target lesions. Objective response = CR+PR.

Full Information

First Posted
July 19, 2006
Last Updated
January 14, 2013
Sponsor
Duke University
Collaborators
National Cancer Institute (NCI), Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT00354913
Brief Title
Imatinib Mesylate and Hydroxyurea in Treating Patients With Recurrent or Progressive Meningioma
Official Title
A Phase II Study of Imatinib Mesylate Plus Hydroxyurea in the Treatment of Patients With Recurrent/Progressive Meningioma
Study Type
Interventional

2. Study Status

Record Verification Date
December 2012
Overall Recruitment Status
Completed
Study Start Date
May 2005 (undefined)
Primary Completion Date
March 2009 (Actual)
Study Completion Date
October 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Duke University
Collaborators
National Cancer Institute (NCI), Novartis Pharmaceuticals

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Imatinib mesylate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as hydroxyurea, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving imatinib mesylate together with hydroxyurea may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving imatinib mesylate together with hydroxyurea works in treating patients with recurrent or progressive meningioma.
Detailed Description
OBJECTIVES: Primary Evaluate the activity of imatinib mesylate and hydroxyurea, as measured by 6-month progression-free survival, in patients with recurrent or progressive meningioma. Secondary Evaluate the progression-free survival (PFS) Overall survival (OS), Objective response rate among patients treated with this regimen. OUTLINE: This is an open-label study. Patients receive oral imatinib mesylate once or twice daily and oral hydroxyurea twice daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. PROJECTED ACCRUAL: A total of 21 patients will be accrued for this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glioblastoma, Gliosarcoma
Keywords
adult grade I meningioma, adult grade II meningioma, adult grade III meningioma, adult papillary meningioma, adult anaplastic meningioma, recurrent adult brain tumor, glioblastoma multiforme (GBM), Imatinib, Imatinib mesylate, Hydroxyurea, Droxia, Hydrea, Hydroxycarbamide, Gleevec, Meningioma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
21 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Imatinib mesylate+hydroxyurea
Arm Type
Experimental
Arm Description
All patients receive imatinib mesylate and hydroxyurea orally on a daily, continuous basis. Dosing of imatinib mesylate is adjusted for patients who are also receiving p450-inducing anti-epileptic drugs.
Intervention Type
Drug
Intervention Name(s)
hydroxyurea
Other Intervention Name(s)
Droxia, Hydrea, Hydroxycarbamide
Intervention Description
Hydroxyurea is administered orally twice a day. The dose will be set at 500 mg twice a day for all patients. If vomiting occurs not additional trial medication should be taken that day in an effort to replace the material that has been vomited. It is recommended that patients take their prescribed hydroxyurea at the same time that they take their prescribed imatinib mesylate, however, a 30-60 minute interval between agents is acceptable, if required for practical or other compliance issues.
Intervention Type
Drug
Intervention Name(s)
imatinib mesylate
Other Intervention Name(s)
Gleevec
Intervention Description
Imatinib administered orally on daily, continuous basis. Imatinib doses of 400mg/600mg administered once daily, whereas daily doses of 800mg/greater administered as equally divided dose taken twice day. Dose for Imatinib: Patients receiving p450-inducing antiepileptic drugs:500mg twice day Patients not receiving p450-inducing antiepileptic drugs:400mg/day. If patients who were not on Cytochrome P450, family 3, subfamily A (CYP3A) enzyme-reducing anti-epileptic drug (EIAED) when originally enrolled must initiate CYP3A enzyme-inducing anti-epileptic drug while on study, study regimen will remain same for minimum of 2 wks before pt transitions to dosing as specified for patients on anti-epileptic drug. If patients originally enrolled must discontinue all EIAEDs while on study, in interest of patient safety, dosing of study regimen will transition to that of patients not on anti-epileptics immediately.
Primary Outcome Measure Information:
Title
Progression-free Survival at 6 Months
Description
Percentage of participants surviving six months from the start of study treatment without progression of disease. PFS was defined as the time from the date of study treatment initiation to the date of the first documented progression according to the Macdonald criteria, or death due to any cause.
Time Frame
From the date of study treatment initiation to the date of the first documented progression or death from any cause, whichever came first, assessed up to 69 months. For each participant, PFS was assessed at 6 months after treatment initiation.
Secondary Outcome Measure Information:
Title
Median Progression-free Survival (PFS)
Description
Time in months from the start of study treatment to the date of first progression according to Macdonald criteria, or to death due to any cause. Patients alive who had not progressed as of the last follow-up had PFS censored at the last follow-up date. Median PFS was estimated using a Kaplan-Meier curve.
Time Frame
From the date of study treatment initiation to the date of the first documented progression or death from any cause, whichever came first, assessed up to 69 months.
Title
Median Overall Survival (OS)
Description
Time in months from the start of study treatment to date of death due to any cause. Patients alive at last follow-up are censored as of that follow-up date. Median OS was estimated using a Kaplan-Meier curve.
Time Frame
From the date of study treatment initiation to the date of death from any cause, assessed up to 69 months.
Title
Objective Response Rate
Description
Percentage of participants with an objective response (complete response or partial response). Per modified Macdonald criteria and assessed by MRI, complete response (CR) was the disappearance of all target lesions and partial response (PR) was a ≥50% decrease in the sum of the longest diameter of target lesions. Objective response = CR+PR.
Time Frame
69 Months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed meningioma Recurrent or progressive disease after prior surgical resection Measurable disease by contrast-enhanced MRI Multifocal disease allowed No evidence of intratumor hemorrhage on pretreatment diagnostic imaging Stable postoperative grade 1 hemorrhage allowed No peripheral edema or central or systemic fluid collections ≥ grade 2 (e.g., pericardial effusion, pulmonary effusion, ascites) PATIENT CHARACTERISTICS: Karnofsky performance status 70-100% Absolute neutrophil count > 1,500/mm³ Hemoglobin > 9 g/dL Platelet count > 100,000/mm³ Potassium normal* Calcium normal* Magnesium normal* Phosphorus normal* alanine aminotransferase (AST) and alanine aminotransferase (ALT) < 2.5 times upper limit of normal (ULN) Bilirubin < 1.5 times ULN Creatinine < 1.5 times ULN OR creatinine clearance > 50 mL/min Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No excessive risk of bleeding, as defined by stroke within the past 6 months No active systemic bleeding (i.e., gastrointestinal bleeding or gross hematuria) No history of central nervous system (CNS) or intraocular bleeding or septic endocarditis No concurrent severe and/or uncontrolled medical disease, including any of the following: Uncontrolled diabetes Congestive cardiac failure Myocardial infarction within the past 6 months Poorly controlled hypertension History of labile hypertension History of poor compliance with antihypertensive regimen Chronic renal disease Active uncontrolled infection requiring intravenous antibiotics No acute or chronic liver disease (i.e., hepatitis, cirrhosis) No HIV positivity No impairment of gastrointestinal function or disease that may significantly alter the absorption of imatinib mesylate, including any of the following: Ulcerative disease Uncontrolled nausea Vomiting Diarrhea Malabsorption syndrome Bowel obstruction Inability to swallow tablets No other malignancy within the past 5 years except basal cell skin cancer or cervical carcinoma in situ NOTE: *Unless correctable with supplements PRIOR CONCURRENT THERAPY: See Disease Characteristics Recovered from prior therapy More than 1 week since prior tumor biopsy More than 2 weeks since prior surgical resection Prior hydroxyurea allowed provided patient has not had progressive disease or toxicity > grade 3 No prior imatinib mesylate or other platelet-derived growth factor-directed therapy At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas)* Chemotherapeutic agents such as etoposide that are normally given at shorter intervals allowed even if < 4 weeks from last prior dose of chemotherapy At least 4 weeks since prior radiotherapy* At least 1 week since prior biological, immunotherapeutic, or cytostatic drugs At least 2 weeks since prior investigational drugs No concurrent warfarin NOTE: *Unless there is unequivocal evidence of tumor progression
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David A. Reardon, MD
Organizational Affiliation
Duke Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Duke Cancer Institute
City
Durham
State/Province
North Carolina
ZIP/Postal Code
27710
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
21938530
Citation
Reardon DA, Norden AD, Desjardins A, Vredenburgh JJ, Herndon JE 2nd, Coan A, Sampson JH, Gururangan S, Peters KB, McLendon RE, Norfleet JA, Lipp ES, Drappatz J, Wen PY, Friedman HS. Phase II study of Gleevec(R) plus hydroxyurea (HU) in adults with progressive or recurrent meningioma. J Neurooncol. 2012 Jan;106(2):409-15. doi: 10.1007/s11060-011-0687-1. Epub 2011 Sep 22.
Results Reference
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Imatinib Mesylate and Hydroxyurea in Treating Patients With Recurrent or Progressive Meningioma

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