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TN-TC11G (THC+CBD) Combination With Temozolomide and Radiotherapy in Patients With Newly-diagnosed Glioblastoma (GEINOCANN)

Primary Purpose

Glioblastoma

Status
Recruiting
Phase
Phase 1
Locations
Spain
Study Type
Interventional
Intervention
TN-TC11G
Temozolomide Oral Product
Radiotherapy
Sponsored by
Grupo Español de Investigación en Neurooncología
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glioblastoma focused on measuring Glioblastoma

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Ability to understand and sign the informed consent document
  • Men or women ≥18 years and ≤70 years
  • Newly-diagnosed GB confirmed by biopsy or by resection in the 4-7 weeks before being registered in the trial.
  • Patients must have at least 15 slides without staining or a tissue block (frozen or paraffin-embedded) available from a previous biopsy or surgery (tumour sample previously archived).
  • Patients must have recovered from previous surgeries (time between surgery and inclusion in the study: 6 weeks).
  • Karnofsky Index ≥60%.
  • Adequate bone marrow reserve: haemoglobin ≥10 g/dL, WBC >3,000/mcL, absolute neutrophil count (ANC) ≥1,500 cells/μL, platelets ≥100,000 cells/μL.
  • Adequate liver function: Bilirubin <1.5 times the upper limit of normal (ULN); AST ≤2.5 x ULN
  • Creatinine clearance >60 ml/min/1.73 m2.
  • The study treatment's effects on the development of the human foetus are not known. For this reason, women of childbearing age and men must agree to use a suitable birth control method (hormonal, barrier, abstinence or surgical sterilisation) before inclusion in the study, for the duration of the study and for at least 3 months after completing the trial treatment. The definition of an effective method of birth control is based on the judgement of the principal investigator or their designee. If a woman is pregnant or there is suspicion that she might be pregnant while participating in the study, she must inform the trial doctor immediately. All women of childbearing age should have a negative pregnancy test (serum/urine) in the 2 weeks prior to the beginning of treatment.

Exclusion Criteria:

  • Presence of extracranial metastatic disease.
  • Any previous treatment for glioblastoma.
  • Patients who have had a Gliadel implant in the surgery.
  • Use of an enzyme-inducing antiepileptic drug. Patients receiving this type of drug must have a washout period of at least 7 days prior to study inclusion.
  • Previous abuse of cannabinoids.
  • Presence of any clinically significant gastrointestinal abnormality that may affect the intake, transit or absorption of the study drug, such as the inability to take medication in the form of oral tablets or solution.
  • Presence of any psychiatric or cognitive impairment that limits understanding or the signing of the informed consent and/or compromises compliance with the requirements of this protocol.
  • Significant or uncontrolled cardiovascular disease, including: 1. Myocardial infarction in the previous 12 months. 2. Uncontrolled angina in the previous 6 months. 3. Congestive heart failure in the previous 6 months. 4. Diagnosed or suspected congenital long QT syndrome. 5. History of ventricular arrhythmias of any clinically significant type (such as ventricular tachycardia, ventricular fibrillation or torsades de pointes). 6. QTc prolongation on an electrocardiogram prior to entry (>470 ms). 7. History of second- or third-degree heart block (these patients may be eligible if they carry pacemakers). 8. Heart rate <50/min on the baseline electrocardiogram. 9. Uncontrolled hypertension
  • Any patient with a history of significant cardiovascular disease, even if it is currently controlled, or who presents signs or symptoms that suggest impaired left ventricular function according to the investigator should have an assessment of left ventricular ejection fraction (LVEF) by ECCO or MUGA. If the LVEF in these circumstances is below the site's lower limit of normality or less than 50%, the patient will not be eligible.
  • History of any cancer, except in the following circumstances: Patients with a history of other malignancies are eligible if they have been disease-free for at least the last 3 years and if, in the investigator's opinion, there is a low risk of disease recurrence. People with the following cancers are eligible, even if they have been diagnosed and treated in the past 3 years: cervical carcinoma in situ and basal cell carcinoma.

Patients will not be eligible if there is evidence of another cancer that required therapy other than surgery in the past 3 years.

Sites / Locations

  • Hospital Universitario Virgen del RocíoRecruiting
  • Institut Català d'Oncología L'HospitaletRecruiting
  • Hospital Universitario Son EspasesRecruiting
  • Hospital del MarRecruiting
  • Complejo Hospitalario Regional Virgen de las NievesRecruiting
  • Hospital Universitario 12 de OctubreRecruiting
  • Hospital Regional Universitario de MalagaRecruiting
  • Hospital Clínico Universitario de SalamancaRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

TN-TC11G, radiotherapy and Temozolomide Oral Product

Arm Description

During Phase Ib, Four to seven weeks after surgical diagnosis, concurrent with radiotherapy (STUPP) + temozolomide (75mg/m2/day for 42 days) +TN-TC11G will be evaluated. During radiation therapy, temozolomide and TN-TC11G will be administered. This last, as the dose that have been selected previously, based on dose-titration period. Patient specific dose will remain until progresion of disease, unacceptable toxicity, non-compliance, consent withdrawal up to 2 years.

Outcomes

Primary Outcome Measures

THC-CBD Maximum tolerated dose
After intra-patient dose escalation period, recommended dose of Glasdegib administeres with temozolamide during and after RT.
Incidence of Treatment-Emergent Adverse Events
Type and number or adverse events reported during THC-CBD treatment, based on the CTCAE reference criteria.

Secondary Outcome Measures

Antitumor activity of THC-CBD combination with temozolamide and radiotherapy
Based on the tumor response in patients with measurable disease, after comparison of baseline characteristics and follow-up evaluations
Overall survival
Time between the start of treatment to death
Progression free survival
Time between the start of treatment and progression of disease
Expression of Midkine
Correlation of expression of midkine in peripheral blood and response to the experimental treatment.

Full Information

First Posted
April 23, 2018
Last Updated
September 26, 2023
Sponsor
Grupo Español de Investigación en Neurooncología
Collaborators
Medical Cannabis Bike Tour, Voices Against Brain Cancer, Tilray
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1. Study Identification

Unique Protocol Identification Number
NCT03529448
Brief Title
TN-TC11G (THC+CBD) Combination With Temozolomide and Radiotherapy in Patients With Newly-diagnosed Glioblastoma
Acronym
GEINOCANN
Official Title
Phase Ib, Open-label, Multicenter, Intrapatient Dose-escalation Clinical Trial to Assess the Safety Profile of the TN-TC11G (THC+CBD) Combination With Temozolomide and Radiotherapy in Patients With Newly-diagnosed Glioblastoma
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
August 18, 2023 (Actual)
Primary Completion Date
March 2025 (Anticipated)
Study Completion Date
December 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Grupo Español de Investigación en Neurooncología
Collaborators
Medical Cannabis Bike Tour, Voices Against Brain Cancer, Tilray

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Glioblastoma is the primary brain tumour with the worst prognosis: median survival is only 12 months despite the use of the most advanced treatments. In the past 10 years, survival in the treatment of this disease has not advanced significantly, with the postoperative standard being the administration of chemoradiotherapy with temozolomide, followed by 6 cycles of sequential chemotherapy with temozolomide. Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have shown a clear synergistic antitumour effect with temozolomide and radiotherapy in preclinical glioma models. THC and CBD have a wide variety of biological effects by binding with and activating the type 1 and type 2 cannabinoid receptors (CB1 expressed in certain neuronal areas of the brain and CB2 expressed in the immune system and in glial cells). The activation of these receptors initiates a signalling pathway, called the endoplasmic reticulum stress response, which generates tumour cell autophagy by activating TRB3. Given these data, the Spanish Group for Neuro-oncology (GEINO) proposes developing a phase Ib, open-label, multicenter, intrapatient dose-escalation clinical trial to assess the safety profile of the THC+CBD combination at a 1:1 ratio, adding temozolomide and radiotherapy in patients with newly-diagnosed glioblastoma. The number of patients to be recruited is 30 over 6 months at 8 sites specialising in neuro-oncology.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glioblastoma
Keywords
Glioblastoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
Phase Ib, intra-patient dose escalation trial.
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
TN-TC11G, radiotherapy and Temozolomide Oral Product
Arm Type
Experimental
Arm Description
During Phase Ib, Four to seven weeks after surgical diagnosis, concurrent with radiotherapy (STUPP) + temozolomide (75mg/m2/day for 42 days) +TN-TC11G will be evaluated. During radiation therapy, temozolomide and TN-TC11G will be administered. This last, as the dose that have been selected previously, based on dose-titration period. Patient specific dose will remain until progresion of disease, unacceptable toxicity, non-compliance, consent withdrawal up to 2 years.
Intervention Type
Drug
Intervention Name(s)
TN-TC11G
Intervention Description
TN-TC11G dose will be gradually increased as follows: Week 1: TN-TC11G: 0-0-5 mg (THC 5 mg + CBD 5 mg; in the mornings, 90 minutes after breakfast; in the afternoons, 90 minutes after lunch; in the evenings, 90 minutes after dinner). Week 2: TN-TC11G: 5-0-5 mg Week 3: TN-TC11G: 5-5-5 mg Week 4: TN-TC11G: 5-5-10 mg Week 5: TN-TC11G: 5-5-15 mg Week 6: TN-TC11G: 10-10-15 mg Week 7: TN-TC11G: 10-10-20 mg. Week 8: TN-TC11G: 15-15-30 mg Week 9: TN-TC11G: 20-20-40 mg TN-TC11G will be administered daily at the relevant dose level according to the individual titration performed in the first 9 weeks of treatment. If there is any dose reduction, the reduced dose must be administered.
Intervention Type
Drug
Intervention Name(s)
Temozolomide Oral Product
Other Intervention Name(s)
Temozolomide
Intervention Description
During RT, patients will receive Temozolomide (TMZ). All patients will be given TMZ at 75 mg/m2/d concurrently with RT for a maximum of 42 days. At 4 weeks after RT completion, patients will start taking TMZ at 150 mg/m2/d for the first 5 days of a 28-day cycle. If first cycle is well tolerated, patients will receive TMZ at 200 mg/m2/d for the first 5 days of every subsequent 28-day cycle for another 5 cycles.
Intervention Type
Radiation
Intervention Name(s)
Radiotherapy
Other Intervention Name(s)
STUPP
Intervention Description
All the patients will receive the Stupp regimen. The radiotherapy (RT) treatment will be administered in fractions of 1.8-2.0 Gy/day delivered 5 days/week to a total dose of 58-60 Gy. Radiotherapy will be delivered to the gross tumor volume with a 2-3 cm margin for the clinical target volume.
Primary Outcome Measure Information:
Title
THC-CBD Maximum tolerated dose
Description
After intra-patient dose escalation period, recommended dose of Glasdegib administeres with temozolamide during and after RT.
Time Frame
9 weeks
Title
Incidence of Treatment-Emergent Adverse Events
Description
Type and number or adverse events reported during THC-CBD treatment, based on the CTCAE reference criteria.
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Antitumor activity of THC-CBD combination with temozolamide and radiotherapy
Description
Based on the tumor response in patients with measurable disease, after comparison of baseline characteristics and follow-up evaluations
Time Frame
12 months
Title
Overall survival
Description
Time between the start of treatment to death
Time Frame
12 months
Title
Progression free survival
Description
Time between the start of treatment and progression of disease
Time Frame
12 months
Title
Expression of Midkine
Description
Correlation of expression of midkine in peripheral blood and response to the experimental treatment.
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Ability to understand and sign the informed consent document Men or women ≥18 years and ≤70 years Newly-diagnosed GB confirmed by biopsy or by resection in the 4-7 weeks before being registered in the trial. Patients must have at least 15 slides without staining or a tissue block (frozen or paraffin-embedded) available from a previous biopsy or surgery (tumour sample previously archived). Patients must have recovered from previous surgeries (time between surgery and inclusion in the study: 6 weeks). Karnofsky Index ≥60%. Adequate bone marrow reserve: haemoglobin ≥10 g/dL, WBC >3,000/mcL, absolute neutrophil count (ANC) ≥1,500 cells/μL, platelets ≥100,000 cells/μL. Adequate liver function: Bilirubin <1.5 times the upper limit of normal (ULN); AST ≤2.5 x ULN Creatinine clearance >60 ml/min/1.73 m2. The study treatment's effects on the development of the human foetus are not known. For this reason, women of childbearing age and men must agree to use a suitable birth control method (hormonal, barrier, abstinence or surgical sterilisation) before inclusion in the study, for the duration of the study and for at least 3 months after completing the trial treatment. The definition of an effective method of birth control is based on the judgement of the principal investigator or their designee. If a woman is pregnant or there is suspicion that she might be pregnant while participating in the study, she must inform the trial doctor immediately. All women of childbearing age should have a negative pregnancy test (serum/urine) in the 2 weeks prior to the beginning of treatment. Exclusion Criteria: Presence of extracranial metastatic disease. Any previous treatment for glioblastoma. Patients who have had a Gliadel implant in the surgery. Use of an enzyme-inducing antiepileptic drug. Patients receiving this type of drug must have a washout period of at least 7 days prior to study inclusion. Previous abuse of cannabinoids. Presence of any clinically significant gastrointestinal abnormality that may affect the intake, transit or absorption of the study drug, such as the inability to take medication in the form of oral tablets or solution. Presence of any psychiatric or cognitive impairment that limits understanding or the signing of the informed consent and/or compromises compliance with the requirements of this protocol. Significant or uncontrolled cardiovascular disease, including: 1. Myocardial infarction in the previous 12 months. 2. Uncontrolled angina in the previous 6 months. 3. Congestive heart failure in the previous 6 months. 4. Diagnosed or suspected congenital long QT syndrome. 5. History of ventricular arrhythmias of any clinically significant type (such as ventricular tachycardia, ventricular fibrillation or torsades de pointes). 6. QTc prolongation on an electrocardiogram prior to entry (>470 ms). 7. History of second- or third-degree heart block (these patients may be eligible if they carry pacemakers). 8. Heart rate <50/min on the baseline electrocardiogram. 9. Uncontrolled hypertension Any patient with a history of significant cardiovascular disease, even if it is currently controlled, or who presents signs or symptoms that suggest impaired left ventricular function according to the investigator should have an assessment of left ventricular ejection fraction (LVEF) by ECCO or MUGA. If the LVEF in these circumstances is below the site's lower limit of normality or less than 50%, the patient will not be eligible. History of any cancer, except in the following circumstances: Patients with a history of other malignancies are eligible if they have been disease-free for at least the last 3 years and if, in the investigator's opinion, there is a low risk of disease recurrence. People with the following cancers are eligible, even if they have been diagnosed and treated in the past 3 years: cervical carcinoma in situ and basal cell carcinoma. Patients will not be eligible if there is evidence of another cancer that required therapy other than surgery in the past 3 years.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Federico Nepote
Phone
+34 93 434 44 12
Email
investigacion@mfar.net
First Name & Middle Initial & Last Name or Official Title & Degree
Verónica Roca
Phone
+34 93 434 44 12
Email
investigacion@mfar.net
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Manuel Benavides, M.D., Ph.D.
Organizational Affiliation
Hospital Universitario y Regional de Málaga y Virgen de la Victoria
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital Universitario Virgen del Rocío
City
Sevilla
State/Province
Andalucia
ZIP/Postal Code
41013
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Investigator Selected by Sponsor
Email
investigacion@mfar.net
First Name & Middle Initial & Last Name & Degree
Principal Investigator Selected by Sponsor
Facility Name
Institut Català d'Oncología L'Hospitalet
City
L'Hospitalet de Llobregat
State/Province
Barcelona
ZIP/Postal Code
08908
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Investigator Selected by Sponsor
Email
investigacion@mfar.net
First Name & Middle Initial & Last Name & Degree
Principal Investigator Selected by Sponsor
Facility Name
Hospital Universitario Son Espases
City
Palma de Mallorca
State/Province
Mallorca
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Investigator Selected by Sponsor
Email
investigacion@mfar.net
First Name & Middle Initial & Last Name & Degree
Principal Investigator Selected by Sponsor
Facility Name
Hospital del Mar
City
Barcelona
ZIP/Postal Code
08003
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Investigator Selected by Sponsor
Email
investigacion@mfar.net
First Name & Middle Initial & Last Name & Degree
Principal Investigator Selected by Sponsor
Facility Name
Complejo Hospitalario Regional Virgen de las Nieves
City
Granada
ZIP/Postal Code
18004
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Investigator Selected by Sponsor
Email
investigacion@mfar.net
First Name & Middle Initial & Last Name & Degree
Principal Investigator Selected by Sponsor
Facility Name
Hospital Universitario 12 de Octubre
City
Madrid
ZIP/Postal Code
28041
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Investigator Selected by Sponsor
Email
investigacion@mfar.net
First Name & Middle Initial & Last Name & Degree
Principal Investigator Selected by Sponsor
Facility Name
Hospital Regional Universitario de Malaga
City
Malaga
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Investigator Selected by Sponsor
Email
investigacion@mfar.net
First Name & Middle Initial & Last Name & Degree
Principal Investigator Selected by Sponsor
Facility Name
Hospital Clínico Universitario de Salamanca
City
Salamanca
ZIP/Postal Code
37007
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Investigator Selected by Sponsor
Email
investigacion@mfar.net
First Name & Middle Initial & Last Name & Degree
Principal Investigator Selected by Sponsor

12. IPD Sharing Statement

Plan to Share IPD
Undecided

Learn more about this trial

TN-TC11G (THC+CBD) Combination With Temozolomide and Radiotherapy in Patients With Newly-diagnosed Glioblastoma

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