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Sorafenib in Newly Diagnosed High Grade Glioma

Primary Purpose

Glioblastoma, Gliosarcoma, Anaplastic Astrocytoma

Status
Completed
Phase
Phase 1
Locations
Switzerland
Study Type
Interventional
Intervention
Sorafenib dose escalation
Sponsored by
University Hospital, Geneva
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glioblastoma focused on measuring high grade glioma, glioblastoma, gliosarcoma, anaplastic astrocytoma, anaplastic oligoastrocytoma, anaplastic oligodendroglioma, phase I, first line treatment, sorafenib, temozolomide, radiation therapy, safety, tolerability, protein kinase inhibitors

Eligibility Criteria

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

Inclusion Criteria:

  • Histological documentation of newly diagnosed malignant glioma
  • ECOG performance status of 0 or 1
  • Age ≥18
  • Life expectancy of at least 12 weeks
  • Hemoglobin ≥ 9.0 g/dl
  • Granulocyte count ≥1.5 X 10^9/L
  • Platelet count ≥100 X 10^9/L
  • SGOT ≤ 2.5X upper limit of normal (ULN)
  • SGPT ≤ 2.5X upper limit of normal (ULN)
  • Alkaline phosphatase ≤4x ULN
  • Serum creatinine ≤1.5X ULN
  • Bilirubin ≤1.5X ULN
  • Spontaneous PT-INR/PTT < 1.5x upper limit of normal (patients on therapeutic anticoagulation will be allowed to participate.
  • Patients must be on a stable or decreasing dose of corticosteroids for at least 2 weeks
  • Patient for whom a first line treatment with temozolomide and radiotherapy is adequate
  • Prophylactic anti-emetic, pentamidine inhalation / co-trimoxazole and anticonvulsants are allowed
  • All patients must sign written informed consent.

Exclusion Criteria:

  • Prior treatment for high grade glioma
  • Previous exposure to Ras pathway inhibitors
  • Other concurrent active malignancy (with the exception of cervical carcinoma in situ or non melanoma carcinoma of the skin, superficial bladder tumor [Ta, Tis & T1] or any cancer curatively treated > 3 years prior to study entry).
  • Serious medical or psychiatric illness that would, in the opinion of the investigator, interfere with the prescribed treatment, including but not limited to: Congestive heart failure > NYHA class 2, active CAD, cardiac arrythmias requiring anti-arrythmic therapy or uncontrolled hypertension within the last 12 months
  • Any condition limiting the patient's judgment capacity
  • History of HIV infection, chronic hepatitis C or B as well as clinically active infections (> grade 2 NCI-CTC version 3.0)
  • History of organ allograft
  • Renal dialysis
  • Evidence or history of bleeding diathesis
  • Major surgery within 4 weeks of start of study treatment, except for neurosurgical resection
  • Autologous bone marrow transplant or stem cell rescue within 4 months of study
  • Substance abuse, medical, psychological or social conditions that may interfere with the patient's participation in the study or evaluation of study results.
  • Medical condition that prevents the patient from swallowing pills
  • Use of biologic response modifiers, such as G-CSF within 3 week of study entry.
  • Pregnant or breast-feeding women.
  • Refusal to use effective contraception. Women of childbearing potential must have a negative pregnancy test performed within 7 days of the start of treatment. Both men and women enrolled in this trial must use adequate barrier birth control measures during the course of the trial and for at least 3 months after administration of study medication.
  • Known or suspected allergy to the investigational agent or any agent given in association with this trial.

Sites / Locations

  • Geneva University Hospital (Hopitaux Universitaires de Geneve), Department of Oncology

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Sorafenib dose titration

Arm Description

Outcomes

Primary Outcome Measures

Safety and tolerability of sorafenib in combination with radiation and temozolomide chemotherapy
Safety and tolerability of sorafenib in combination with radiation and temozolomide chemotherapy in patients with newly diagnosed high grade glioma

Secondary Outcome Measures

Maximum Observed Plasma Concentration (Cmax) and Area under the curve (AUC) of sorafenib and temozolomide
Response rate
Time to treatment failure
6 month progression-free survival
Event free survival
Overall survival

Full Information

First Posted
April 17, 2009
Last Updated
October 31, 2014
Sponsor
University Hospital, Geneva
Collaborators
Bayer
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1. Study Identification

Unique Protocol Identification Number
NCT00884416
Brief Title
Sorafenib in Newly Diagnosed High Grade Glioma
Official Title
Phase I Dose Finding Study of Sorafenib in Combination With Radiation Therapy and Temozolomide as a First Line Treatment of Patients With High Grade Glioma
Study Type
Interventional

2. Study Status

Record Verification Date
October 2014
Overall Recruitment Status
Completed
Study Start Date
March 2009 (undefined)
Primary Completion Date
December 2011 (Actual)
Study Completion Date
March 2012 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University Hospital, Geneva
Collaborators
Bayer

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a phase I study to evaluate the safety and tolerability of Sorafenib in combination with Temodar and radiation therapy in patients with newly diagnosed high grade glioma (glioblastoma, gliosarcoma, anaplastic astrocytoma and anaplastic oligodendroglioma or oligoastrocytoma). The mechanism of action of sorafenib, an oral multikinase inhibitor, makes it an interesting drug to investigate in the treatment of patients with high grade glioma as this agent has anti-angiogenic activity and inhibits other pathways such as Ras, Platelet-derived growth factor (PDGF) and fms-like tyrosine kinase receptor-3 (Flt-3), which are potential targets against gliomas.
Detailed Description
Up to 18 patients will be included in this phase I study. The primary goal of this study will be to establish the maximum tolerated dose of sorafenib when used in combination with temozolomide and radiation therapy. Secondary goals of this study include: response rate, time to treatment failure, 6 month progression-free survival, event free survival and overall survival. A correlative study will investigate the pharmacokinetics of sorafenib used in combination with radiation therapy and temozolomide.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glioblastoma, Gliosarcoma, Anaplastic Astrocytoma, Anaplastic Oligoastrocytoma, Anaplastic Oligodendroglioma
Keywords
high grade glioma, glioblastoma, gliosarcoma, anaplastic astrocytoma, anaplastic oligoastrocytoma, anaplastic oligodendroglioma, phase I, first line treatment, sorafenib, temozolomide, radiation therapy, safety, tolerability, protein kinase inhibitors

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
17 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Sorafenib dose titration
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Sorafenib dose escalation
Intervention Description
Sorafenib dose escalation scheme: 3 first patients: 200 mg/d, if dose limiting toxicities (DLT) not reached: 3 patients at 200 mg BID, if no DLT reached: 3 patients at 400 mg bid
Primary Outcome Measure Information:
Title
Safety and tolerability of sorafenib in combination with radiation and temozolomide chemotherapy
Description
Safety and tolerability of sorafenib in combination with radiation and temozolomide chemotherapy in patients with newly diagnosed high grade glioma
Time Frame
35 weeks
Secondary Outcome Measure Information:
Title
Maximum Observed Plasma Concentration (Cmax) and Area under the curve (AUC) of sorafenib and temozolomide
Time Frame
0.25, 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, 8, 12 and 24 hours post dose
Title
Response rate
Time Frame
35 weeks
Title
Time to treatment failure
Time Frame
20 months
Title
6 month progression-free survival
Time Frame
6 months
Title
Event free survival
Time Frame
20 months
Title
Overall survival
Time Frame
20 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histological documentation of newly diagnosed malignant glioma ECOG performance status of 0 or 1 Age ≥18 Life expectancy of at least 12 weeks Hemoglobin ≥ 9.0 g/dl Granulocyte count ≥1.5 X 10^9/L Platelet count ≥100 X 10^9/L SGOT ≤ 2.5X upper limit of normal (ULN) SGPT ≤ 2.5X upper limit of normal (ULN) Alkaline phosphatase ≤4x ULN Serum creatinine ≤1.5X ULN Bilirubin ≤1.5X ULN Spontaneous PT-INR/PTT < 1.5x upper limit of normal (patients on therapeutic anticoagulation will be allowed to participate. Patients must be on a stable or decreasing dose of corticosteroids for at least 2 weeks Patient for whom a first line treatment with temozolomide and radiotherapy is adequate Prophylactic anti-emetic, pentamidine inhalation / co-trimoxazole and anticonvulsants are allowed All patients must sign written informed consent. Exclusion Criteria: Prior treatment for high grade glioma Previous exposure to Ras pathway inhibitors Other concurrent active malignancy (with the exception of cervical carcinoma in situ or non melanoma carcinoma of the skin, superficial bladder tumor [Ta, Tis & T1] or any cancer curatively treated > 3 years prior to study entry). Serious medical or psychiatric illness that would, in the opinion of the investigator, interfere with the prescribed treatment, including but not limited to: Congestive heart failure > NYHA class 2, active CAD, cardiac arrythmias requiring anti-arrythmic therapy or uncontrolled hypertension within the last 12 months Any condition limiting the patient's judgment capacity History of HIV infection, chronic hepatitis C or B as well as clinically active infections (> grade 2 NCI-CTC version 3.0) History of organ allograft Renal dialysis Evidence or history of bleeding diathesis Major surgery within 4 weeks of start of study treatment, except for neurosurgical resection Autologous bone marrow transplant or stem cell rescue within 4 months of study Substance abuse, medical, psychological or social conditions that may interfere with the patient's participation in the study or evaluation of study results. Medical condition that prevents the patient from swallowing pills Use of biologic response modifiers, such as G-CSF within 3 week of study entry. Pregnant or breast-feeding women. Refusal to use effective contraception. Women of childbearing potential must have a negative pregnancy test performed within 7 days of the start of treatment. Both men and women enrolled in this trial must use adequate barrier birth control measures during the course of the trial and for at least 3 months after administration of study medication. Known or suspected allergy to the investigational agent or any agent given in association with this trial.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Pierre-Yves Dietrich, MD
Organizational Affiliation
Department of oncology, Geneva University hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Geneva University Hospital (Hopitaux Universitaires de Geneve), Department of Oncology
City
Geneva
State/Province
GE
ZIP/Postal Code
1211
Country
Switzerland

12. IPD Sharing Statement

Citations:
PubMed Identifier
24786603
Citation
Hottinger AF, Ben Aissa A, Espeli V, Squiban D, Dunkel N, Vargas MI, Hundsberger T, Mach N, Schaller K, Weber DC, Bodmer A, Dietrich PY. Phase I study of sorafenib combined with radiation therapy and temozolomide as first-line treatment of high-grade glioma. Br J Cancer. 2014 May 27;110(11):2655-61. doi: 10.1038/bjc.2014.209. Epub 2014 May 1. Erratum In: Br J Cancer. 2018 Jan 09;:
Results Reference
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Sorafenib in Newly Diagnosed High Grade Glioma

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