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Optune Delivered Electric Field Therapy and Bevacizumab in Treating Patients With Recurrent or Progressive Grade 2 or 3 Meningioma

Primary Purpose

Anaplastic (Malignant) Meningioma, Atypical Meningioma, Grade II Meningioma

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Bevacizumab
Electric Field Therapy
NovoTTF-200A Device
Quality-of-Life Assessment
Sponsored by
Northwestern University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Anaplastic (Malignant) Meningioma

Eligibility Criteria

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

Inclusion Criteria:

  • Patients must have a histologic diagnosis of meningioma, World Health Organization (WHO) grade 2 or 3 (atypical or anaplastic)
  • Patient's tumor must have a supratentorial component
  • Patients must have measurable or non-measurable (evaluable) disease recurrence; recurrence must be documented by magnetic resonance imaging (MRI) or computed tomography (CT) scan
  • All patients must have developed recurrent disease/progression (evidence of recurrence to be established by MRI or CT scan with contrast; there is no limit to the number of relapses) after receiving all standard treatments, which must include the following:

    • Surgical resection, if possible;
    • Definitive radiation therapy for unresectable meningioma, or for recurrent meningioma after resection (Note: At registration, patients must be at least 28 days post-surgery, and must be at least 28 days post-radiation therapy, with resolution of related cytotoxicities down to grade 2)
  • Patients may have had previous systemic treatment regimens with the exception of bevacizumab (no limit to number of prior therapies); a 4 week wash-out period prior to registration is mandatory for all systemic treatments
  • Life expectancy of at least 12 weeks
  • Karnofsky performance status >= 60%
  • Patients must have adequate bone marrow, kidney, and liver function, (within 14 days prior to registration), defined as:
  • Absolute neutrophil count (ANC) >= 1500/uL (with/without growth factor)
  • Hemoglobin (Hgb) >= 9 g/dL (with/without transfusion)
  • Platelets >= 100,000/L
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x institutional upper limit of normal (ULN)
  • Total bilirubin =< 1.5 x institutional ULN
  • Serum creatinine =< 1.5 x institutional ULN
  • Females of child-bearing potential (FOCBP) and males with partners of childbearing potential must agree to use adequate contraception prior to study entry and for the duration of study treatment; should a female patient become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately; likewise, if the female partner of a male patient becomes pregnant or suspect she is pregnant, he should inform his treating physician immediately

NOTE: A FOCBP is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:

  • Has not undergone a hysterectomy or bilateral oophorectomy
  • Has had menses at any time in the preceding 12 consecutive months (and therefore has not been naturally postmenopausal for > 12 months)

    • FOCBP must have a negative serum or urine pregnancy test within 14 days prior to registration on study
    • Patients must have the ability to understand and the willingness to sign a written informed consent prior to registration on study
    • Patients must be able to comply with all protocol requirements

Exclusion Criteria:

  • Patients who have had major surgery or significant traumatic injury within 4 weeks prior to registration, patients who have not recovered from the side effects of any major surgery (defined as requiring general anesthesia), or patients that may require major surgery during the course of the study
  • Patients who have had minor surgical procedures (with the exception of the placement of porta cath or other central venous access) within 7 days prior to registration
  • Patients with infratentorial disease and spinal disease
  • Patients may not be receiving any other investigational agents; (i.e. 28-day washout period from prior investigational drug is required)
  • Patients may not receive any other anti-cancer therapies, within 28 days prior to registration and throughout the duration of this trial
  • Previous treatment with bevacizumab
  • Patients who have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to bevacizumab are not eligible
  • Patients with active implanted medical device, a skull defect (such as, missing bone with no replacement), a shunt or bullet fragments; examples of active electronic devices include deep brain stimulators, spinal cord stimulators, vagus nerve stimulators, pacemakers, defibrillators, and programmable shunts
  • Patients with known sensitivity to conductive hydrogels like the gel used on electrocardiogram (ECG) stickers or transcutaneous electrical nerve stimulation (TENS) electrodes
  • Patients with proteinuria within 14 days of registration as demonstrated by either: urine protein creatinine (UPC) ratio >= 1.0 at screening OR urine dipstick for proteinuria 2+ (patients discovered to have 2+ proteinuria on dipstick urinalysis at baseline should undergo a 24-hour urine collection, and must demonstrate =< 1 g of protein/24 hours to be eligible)
  • Patients with a serious non-healing wound, active ulcer, or untreated bone fracture
  • Patients with evidence of bleeding diathesis or significant coagulopathy (in the absence of therapeutic anticoagulation)
  • Patients with history of hematemesis or hemoptysis (defined as having bright red blood of 1/2 teaspoon or more per episode) within 28 days prior to registration
  • History of myocardial infarction or unstable angina within 6 months of registration
  • Inadequately controlled hypertension (defined as systolic blood pressure > 150 mmHg and /or diastolic blood pressure > 100 mmHg)
  • History of stroke or transient ischemic attack within 6 months prior to registration
  • Any prior history of hypertensive crisis or hypertensive encephalopathy
  • History of abdominal fistula or gastrointestinal perforation within 6 months prior to registration
  • Chronic, systemic treatment with immunosuppressive agents; patients who require a stable dose of corticosteroids for control of cerebral edema are eligible; topical or inhaled steroids are also allowed
  • Patients who have any severe and/or uncontrolled intercurrent medical conditions including, but not limited to any of the following, are not eligible:

    • Ongoing or active wound infection requiring concurrent systemic antibiotic treatment; there is no mandatory duration of time that a patient has to be off antibiotics, but the treating physician has to deem the infection as effectively treated prior to enrollment
    • Symptomatic congestive heart failure
    • Unstable angina pectoris
    • Cardiac arrhythmia (New York Heart Association [NYHA] criteria)
    • Psychiatric illness/social situations that would limit compliance with study requirements, prevent patient comprehension of the nature of, and risk associated with, the study
    • Any other illness or condition that the treating investigator feels would interfere with study compliance or would compromise the patient's safety or study endpoints
  • Female patients who are pregnant or nursing are not eligible

Sites / Locations

  • USC Brain Tumor Center
  • John Wayne Cancer Center at Providence St. John's Health CenterRecruiting
  • Stanford Cancer Center Neuro-Oncology Clinic
  • Miami Cancer InstituteRecruiting
  • Piedmont HealthcareRecruiting
  • Northwestern UniversityRecruiting
  • Northwestern University- Lake Forest Hospital
  • Northwestern Medicine/ Cadence Health - CDHRecruiting
  • Regions Hospital - Cancer Care Center
  • University of PennsylvaniaRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (bevacizumab, electric field therapy)

Arm Description

Patients receive bevacizumab IV over 30-90 minutes on days 1 and 15 of courses 1-4. Beginning on day 1 of course 5, patients may choose to receive bevacizumab IV every 3 weeks or remain on the every 2-week schedule. Patients also undergo electric field therapy using Optune (formerly NovoTTF-200A System) daily over 18 hours. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Progression Free Survival for 6 months (PFS-6)
Determine the efficacy of combination therapy of bevacizumab and Optune (TTF) as assessed by Progression Free Survival at 6 months

Secondary Outcome Measures

Overall Survival (OS)
OS will be defined from the time of registration to death and will be assessed for up to 2 years.
Tumor Response Rate (TRR)
Imaging (MRI or CT scan) will assess radiographic response in terms of complete response, partial response, stable disease, and progressive disease. The iRANO criteria will be used for response assessment.
Quality of Life (QOL) with treatment using FACT-Br questionnaire
To assess QOL with treatment the Functional Assessment of Cancer Therapy-Brain version 4.0 (FACT-Br) questionnaire will be administered.

Full Information

First Posted
July 25, 2016
Last Updated
May 25, 2022
Sponsor
Northwestern University
Collaborators
NovoCure Ltd., National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT02847559
Brief Title
Optune Delivered Electric Field Therapy and Bevacizumab in Treating Patients With Recurrent or Progressive Grade 2 or 3 Meningioma
Official Title
A Phase 2, Single Arm, Multi-center, Open Label Trial Combining Optune With Concurrent Bevacizumab in the Setting of Recurrent or Progressive Meningioma
Study Type
Interventional

2. Study Status

Record Verification Date
May 2022
Overall Recruitment Status
Recruiting
Study Start Date
August 2016 (undefined)
Primary Completion Date
September 2023 (Anticipated)
Study Completion Date
August 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Northwestern University
Collaborators
NovoCure Ltd., National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this research study is to determine the effects bevacizumab (the study drug) combined with Optune (the study device) tumor treatment field therapy has on meningiomas. Bevacizumab is considered investigational because the US Food and Drug Administration (FDA) has not approved its use for the treatment of meningiomas. The study drug is a medication that blocks the growth of new blood vessels. It is thought that the study drug may interfere with the growth of new blood vessels and therefore might stop tumor growth, and possibly shrink the tumor by keeping it from receiving nutrients and oxygen supplied by the blood vessels. Optune is also considered investigational because the US FDA has not approved its use for the treatment of meningiomas. Optune is a device that the patient will wear and use for at least 18 hours of each day. It delivers alternating electrical current to the patient's brain tumor and by doing so interrupts a process called mitosis. Mitosis needs to occur in order for cell division to occur and allows tumors to grow. By slowing this process, we hypothesize that meningioma growth may also be slowed.
Detailed Description
PRIMARY OBJECTIVES: I. To determine progression free survival (PFS) for 6 months (PFS-6) in patients with recurrent or progressive meningioma. SECONDARY OBJECTIVES: I. To determine overall survival (OS). II. To determine tumor response rate (TRR). III. To assess quality of life with treatment (QOL) using Functional Assessment of Cancer Therapy-Brain (FACT-Br) questionnaire. OUTLINE: Patients receive bevacizumab intravenously (IV) over 30-90 minutes on days 1 and 15 of courses 1-4. Beginning on day 1 of course 5, patients may choose to receive bevacizumab IV every 3 weeks or remain on the every 2-week schedule. Patients also undergo electric field therapy using Optune (formerly NovoTTF-200A System) daily over 18 hours. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Anaplastic (Malignant) Meningioma, Atypical Meningioma, Grade II Meningioma, Grade III Meningioma, Recurrent Meningioma, Supratentorial 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
27 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment (bevacizumab, electric field therapy)
Arm Type
Experimental
Arm Description
Patients receive bevacizumab IV over 30-90 minutes on days 1 and 15 of courses 1-4. Beginning on day 1 of course 5, patients may choose to receive bevacizumab IV every 3 weeks or remain on the every 2-week schedule. Patients also undergo electric field therapy using Optune (formerly NovoTTF-200A System) daily over 18 hours. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Intervention Type
Biological
Intervention Name(s)
Bevacizumab
Other Intervention Name(s)
Anti-VEGF, Anti-VEGF Humanized Monoclonal Antibody, Anti-VEGF rhuMAb, Avastin, Bevacizumab Biosimilar BEVZ92, Bevacizumab Biosimilar BI 695502, Immunoglobulin G1 (Human-Mouse Monoclonal rhuMab-VEGF Gamma-Chain Anti-Human Vascular Endothelial Growth Factor), Disulfide With Human-Mouse Monoclonal rhuMab-VEGF Light Chain, Dimer, Recombinant Humanized Anti-VEGF Monoclonal Antibody, rhuMab-VEGF
Intervention Description
Given IV
Intervention Type
Procedure
Intervention Name(s)
Electric Field Therapy
Intervention Description
Undergo electric field therapy using Optune device
Intervention Type
Device
Intervention Name(s)
NovoTTF-200A Device
Other Intervention Name(s)
NovoTTF-200A, NovoTTF-200A System, NovoTTFields, NovoTumor Treatment Fields, Optune, Optune Device
Intervention Description
Undergo electric field therapy using Optune device
Intervention Type
Procedure
Intervention Name(s)
Quality-of-Life Assessment
Other Intervention Name(s)
Quality of Life Assessment
Intervention Description
Ancillary studies
Primary Outcome Measure Information:
Title
Progression Free Survival for 6 months (PFS-6)
Description
Determine the efficacy of combination therapy of bevacizumab and Optune (TTF) as assessed by Progression Free Survival at 6 months
Time Frame
At 6 months
Secondary Outcome Measure Information:
Title
Overall Survival (OS)
Description
OS will be defined from the time of registration to death and will be assessed for up to 2 years.
Time Frame
From time of registration to death, assessed up to 2 years
Title
Tumor Response Rate (TRR)
Description
Imaging (MRI or CT scan) will assess radiographic response in terms of complete response, partial response, stable disease, and progressive disease. The iRANO criteria will be used for response assessment.
Time Frame
At baseline and every eight weeks, assessed up to 12 months
Title
Quality of Life (QOL) with treatment using FACT-Br questionnaire
Description
To assess QOL with treatment the Functional Assessment of Cancer Therapy-Brain version 4.0 (FACT-Br) questionnaire will be administered.
Time Frame
At baseline, on Day 1 of every cycle, and 1 month after the last dose of study drug

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have a histologic diagnosis of meningioma, World Health Organization (WHO) grade 2 or 3 (atypical or anaplastic) Patient's tumor must have a supratentorial component Patients must have measurable or non-measurable (evaluable) disease recurrence; recurrence must be documented by magnetic resonance imaging (MRI) or computed tomography (CT) scan All patients must have developed recurrent disease/progression (evidence of recurrence to be established by MRI or CT scan with contrast; there is no limit to the number of relapses) after receiving all standard treatments, which must include the following: Surgical resection, if possible; Definitive radiation therapy for unresectable meningioma, or for recurrent meningioma after resection (Note: At registration, patients must be at least 28 days post-surgery, and must be at least 28 days post-radiation therapy, with resolution of related cytotoxicities down to grade 2) Patients may have had previous systemic treatment regimens with the exception of bevacizumab (no limit to number of prior therapies); a 4 week wash-out period prior to registration is mandatory for all systemic treatments Life expectancy of at least 12 weeks Karnofsky performance status >= 60% Patients must have adequate bone marrow, kidney, and liver function, (within 14 days prior to registration), defined as: Absolute neutrophil count (ANC) >= 1500/uL (with/without growth factor) Hemoglobin (Hgb) >= 9 g/dL (with/without transfusion) Platelets >= 100,000/L Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x institutional upper limit of normal (ULN) Total bilirubin =< 1.5 x institutional ULN Serum creatinine =< 1.5 x institutional ULN Females of child-bearing potential (FOCBP) and males with partners of childbearing potential must agree to use adequate contraception prior to study entry and for the duration of study treatment; should a female patient become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately; likewise, if the female partner of a male patient becomes pregnant or suspect she is pregnant, he should inform his treating physician immediately NOTE: A FOCBP is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria: Has not undergone a hysterectomy or bilateral oophorectomy Has had menses at any time in the preceding 12 consecutive months (and therefore has not been naturally postmenopausal for > 12 months) FOCBP must have a negative serum or urine pregnancy test within 14 days prior to registration on study Patients must have the ability to understand and the willingness to sign a written informed consent prior to registration on study Patients must be able to comply with all protocol requirements Exclusion Criteria: Patients who have had major surgery or significant traumatic injury within 4 weeks prior to registration, patients who have not recovered from the side effects of any major surgery (defined as requiring general anesthesia), or patients that may require major surgery during the course of the study Patients who have had minor surgical procedures (with the exception of the placement of porta cath or other central venous access) within 7 days prior to registration Patients with infratentorial disease and spinal disease Patients may not be receiving any other investigational agents; (i.e. 28-day washout period from prior investigational drug is required) Patients may not receive any other anti-cancer therapies, within 28 days prior to registration and throughout the duration of this trial Previous treatment with bevacizumab Patients who have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to bevacizumab are not eligible Patients with active implanted medical device, a skull defect (such as, missing bone with no replacement), a shunt or bullet fragments; examples of active electronic devices include deep brain stimulators, spinal cord stimulators, vagus nerve stimulators, pacemakers, defibrillators, and programmable shunts Patients with known sensitivity to conductive hydrogels like the gel used on electrocardiogram (ECG) stickers or transcutaneous electrical nerve stimulation (TENS) electrodes Patients with proteinuria within 14 days of registration as demonstrated by either: urine protein creatinine (UPC) ratio >= 1.0 at screening OR urine dipstick for proteinuria 2+ (patients discovered to have 2+ proteinuria on dipstick urinalysis at baseline should undergo a 24-hour urine collection, and must demonstrate =< 1 g of protein/24 hours to be eligible) Patients with a serious non-healing wound, active ulcer, or untreated bone fracture Patients with evidence of bleeding diathesis or significant coagulopathy (in the absence of therapeutic anticoagulation) Patients with history of hematemesis or hemoptysis (defined as having bright red blood of 1/2 teaspoon or more per episode) within 28 days prior to registration History of myocardial infarction or unstable angina within 6 months of registration Inadequately controlled hypertension (defined as systolic blood pressure > 150 mmHg and /or diastolic blood pressure > 100 mmHg) History of stroke or transient ischemic attack within 6 months prior to registration Any prior history of hypertensive crisis or hypertensive encephalopathy History of abdominal fistula or gastrointestinal perforation within 6 months prior to registration Chronic, systemic treatment with immunosuppressive agents; patients who require a stable dose of corticosteroids for control of cerebral edema are eligible; topical or inhaled steroids are also allowed Patients who have any severe and/or uncontrolled intercurrent medical conditions including, but not limited to any of the following, are not eligible: Ongoing or active wound infection requiring concurrent systemic antibiotic treatment; there is no mandatory duration of time that a patient has to be off antibiotics, but the treating physician has to deem the infection as effectively treated prior to enrollment Symptomatic congestive heart failure Unstable angina pectoris Cardiac arrhythmia (New York Heart Association [NYHA] criteria) Psychiatric illness/social situations that would limit compliance with study requirements, prevent patient comprehension of the nature of, and risk associated with, the study Any other illness or condition that the treating investigator feels would interfere with study compliance or would compromise the patient's safety or study endpoints Female patients who are pregnant or nursing are not eligible
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Study Coordinator
Phone
(312)695-1301
Email
cancertrials@northwestern.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Priya Kumthekar, MD
Organizational Affiliation
Northwestern University
Official's Role
Principal Investigator
Facility Information:
Facility Name
USC Brain Tumor Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Individual Site Status
Suspended
Facility Name
John Wayne Cancer Center at Providence St. John's Health Center
City
Santa Monica
State/Province
California
ZIP/Postal Code
90404
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Santosh Kesari, MD, PhD
Phone
310-829-8265
First Name & Middle Initial & Last Name & Degree
Santosh Kesari, MD, PhD
Facility Name
Stanford Cancer Center Neuro-Oncology Clinic
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Seema Nagpal, MD
Phone
650-498-6000
Email
snagpal@stanford.edu
First Name & Middle Initial & Last Name & Degree
Seema Nagpal, MD
Facility Name
Miami Cancer Institute
City
Miami
State/Province
Florida
ZIP/Postal Code
33176
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Minesh P. Mehta, MD
Phone
786-596-2000
First Name & Middle Initial & Last Name & Degree
Minesh P. Mehta, MD
Facility Name
Piedmont Healthcare
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30309
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Erin Dunbar, MD
Phone
404-605-2050
First Name & Middle Initial & Last Name & Degree
Erin Dunbar, MD
Facility Name
Northwestern University
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Priya Kumthekar, MD
Phone
312-503-1818
Email
p-kumthekar@northwestern.edu
First Name & Middle Initial & Last Name & Degree
Priya Kumthekar, MD
First Name & Middle Initial & Last Name & Degree
Jeffrey Raizer, MD
First Name & Middle Initial & Last Name & Degree
Karan Dixit, MD
First Name & Middle Initial & Last Name & Degree
Orin Bloch, MD
First Name & Middle Initial & Last Name & Degree
James P. Chandler, MD
Facility Name
Northwestern University- Lake Forest Hospital
City
Lake Forest
State/Province
Illinois
ZIP/Postal Code
60045
Country
United States
Individual Site Status
Active, not recruiting
Facility Name
Northwestern Medicine/ Cadence Health - CDH
City
Winfield
State/Province
Illinois
ZIP/Postal Code
60190
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Sean Grimm, MD
Phone
630-352-5450
First Name & Middle Initial & Last Name & Degree
Sean Grimm, MD
Facility Name
Regions Hospital - Cancer Care Center
City
Saint Paul
State/Province
Minnesota
ZIP/Postal Code
55101
Country
United States
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Richard A. Peterson, MD
Phone
651-254-3572
Email
Richard.A.Peterson@HealthPartners.Com
First Name & Middle Initial & Last Name & Degree
Richard A. Peterson, MD
Facility Name
University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Arati S. Desai, MD
Phone
215-615-5858
First Name & Middle Initial & Last Name & Degree
Arati S. Desai, MD

12. IPD Sharing Statement

Learn more about this trial

Optune Delivered Electric Field Therapy and Bevacizumab in Treating Patients With Recurrent or Progressive Grade 2 or 3 Meningioma

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