Back to results

Radiotherapy Planning Using Fluciclovine PET in Patients With Newly Diagnosed Glioblastoma

Primary Purpose

Newly Diagnosed Glioblastoma

Status

Recruiting

Phase

Phase 2

Locations

United States

Study Type

Interventional

Intervention

Fluciclovine PET guided Radiotherapy

About this trial

This is an interventional treatment trial for Newly Diagnosed Glioblastoma

Eligibility Criteria

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

Inclusion Criteria:

Histological diagnosis of primary, newly diagnosed supratentorial, WHO grade IV glioma
Greater than 18 years of age
Karnofsky performance score greater than 70%
Recovered from surgery and on a stable or tapering dose of corticosteroids
Plan to undergo standard therapy with XRT 60Gy/30fx with TMZ followed by 6-12 cycles of maintenance TMZ within 6 weeks of surgery
If woman of child bearing potential, negative serum pregnancy test. Patients must agree to take adequate pregnancy preventions for the length of the study.
Life expectancy of at least 3 months
Written study specific consent

Exclusion Criteria:

Previous treatment of glioma of any grade with bevacizumab or other molecular targeted therapies less than 6 months before MRI (and PET) used for radiotherapy planning
Recurrent of multifocal malignant glioma
Any sites of distant disease (for example drop metastases or leptomeningeal spread)
Prior use of Gliadel wafers or any other intratumal or intracavity treatment
Prior radiotherapy to the cranium, head and neck or other sites resulting in overlapping fields
Molecular targeted therapies planned during radiotherapy
Simultaneous participation in other interventional trials which could interfere with this trial or participation in a clinical trial within the last thirty days before patient's enrollment in current study.
Inability to undergo an MRI or PET (Claustrophobia, non-MRI compatible pacemaker, known allergy to MRI contrast agent or fluciclovine tracer)
Any pregnant or lactating patient
Any prior malignancy within 3 years excluding carcinoma in-situ or early staged,localized basal or squamous cell skin cancers

Sites / Locations

St. Joseph's Hospital and Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

No Intervention

Experimental

Arm Label

MRI-guided radiotherapy

MRI + Fluciclovine PET-guided radiotherapy

Arm Description

Patients will undergo standard of care MRI-guided radiotherapy.

Patients will undergo MRI + Fluciclovine PET-guided radiotherapy

Outcomes

Primary Outcome Measures

Patterns of Failure

To assess whether incorporating fluciclovine PET into radiotherapy planning significantly changes the in-field and out-of-field radiographic progression rates, by comparison to traditional MRI-based radiotherapy

Defining Tumor Volume

2. To determine the effect fluciclovine PET has on definition of the tumor volume, as compared to traditional MRI-based radiotherapy.

Secondary Outcome Measures

Survival using MRI radiotherapy

To quantify overall and progression free survival utilizing MRI cohort.

Overall survival utilizing MRI+PET radiotherapy

To quantify overall survival utilizing MRI+PET-based radiotherapy

Progression free survival utilizing MRI+PET-based radiotherapy

To quantify progression free survival utilizing MRI+PET-based

Full Information

NCT ID

NCT04840069

First Posted

March 16, 2021

Last Updated

January 11, 2023

Sponsor

St. Joseph's Hospital and Medical Center, Phoenix

Collaborators

Barrow Neurological Foundation, Arizona Biomedical Research Commission (ABRC), Blue Earth Diagnostics

1. Study Identification

Unique Protocol Identification Number

NCT04840069

Brief Title

Radiotherapy Planning Using Fluciclovine PET in Patients With Newly Diagnosed Glioblastoma

Official Title

A Phase II Randomized Clinical Trial of Radiotherapy Planning Using Conventional Imaging +/- Fluciclovine PET in Patients With Newly Diagnosed Glioblastoma

Study Type

Interventional

2. Study Status

Record Verification Date

January 2023

Overall Recruitment Status

Recruiting

Study Start Date

June 7, 2021 (Actual)

Primary Completion Date

March 30, 2024 (Anticipated)

Study Completion Date

March 30, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Sponsor

Name of the Sponsor

St. Joseph's Hospital and Medical Center, Phoenix

Collaborators

Barrow Neurological Foundation, Arizona Biomedical Research Commission (ABRC), Blue Earth Diagnostics

4. Oversight

Studies a U.S. FDA-regulated Drug Product

Studies a U.S. FDA-regulated Device Product

Product Manufactured in and Exported from the U.S.

Yes

Data Monitoring Committee

5. Study Description

Brief Summary

The purpose of the this study is to see if the use of a PET scan with 18F-fluciclovine (PET or Fluciclovine PET) in addition to the normal radiation planning imaging procedures (MRI and CT scan) will help determine the areas where the radiation therapy is to be delivered. It is also a goal of the study to determine if subjects live longer when treatment plans for radiation therapy are designed using a Fluciclovine PET scan, as well as MRI and CT scans. We will also collect information on if and where the tumor returns. Information on the side effects from the two different treatment planning imaging methods will also be collected. 18F-Fluciclovine is an FDA-approved radioactive diagnostic agent that is injected into the patient and then taken up by cancer cells, which can then be visualized with a PET/CT scan. 18F-Fluciclovine is FDA approved for the detection of recurrent prostate cancer, but is still investigational for the purposes of this study.

Detailed Description

The goal of this study is to see if the use of PET in planning radiotherapy can reduce these local failures. Glioblastoma (GBM) is the most common primary malignant brain tumor. Newly diagnosed glioblastoma management includes maximum safe resection followed by radiotherapy with concurrent temozolomide, followed by maintenance temozolomide for 6 - 12 cycles. This postoperative chemoradiotherapy approach has resulted in a significant increase in median PFS (5.0 vs. 6.9 months) and OS (12.1 vs. 14.6 months) compared to radiotherapy alone (Stupp 2005). However, despite such multi-modality therapy, the median survival for GBM remains poor at approximately 15-16 months in contemporary series (Grossman, Ye et al. 2010, Gilbert, Wang et al. 2013 vs 2010). Recently, a randomized trial of tumor-treating fields (TTF or Optune) plus temozolomide demonstrated the benefit of this treatment in newly diagnosed glioblastoma that led to FDA approval of the device (Stupp 2015, Stupp 2017). However despite these advances, most patients still have a poor prognosis with median survival of 16-21 months. Although adjuvant chemoradiotherapy has been shown to increase survival, a predominant pattern of failure remains local (Chan, Lee et al. 2002, Milano, Okunieff et al. 2010). Therefore, better therapeutic options are needed for this disease.

6. Conditions and Keywords

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

Newly Diagnosed Glioblastoma

7. Study Design

Primary Purpose

Treatment

Study Phase

Phase 2

Interventional Study Model

Parallel Assignment

Masking

None (Open Label)

Allocation

Randomized

Enrollment

100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title

MRI-guided radiotherapy

Arm Type

No Intervention

Arm Description

Patients will undergo standard of care MRI-guided radiotherapy.

Arm Title

MRI + Fluciclovine PET-guided radiotherapy

Arm Type

Experimental

Arm Description

Patients will undergo MRI + Fluciclovine PET-guided radiotherapy

Intervention Type

Drug

Intervention Name(s)

Fluciclovine PET guided Radiotherapy

Intervention Description

PET+MRI Based There is no GTV_5400. The GTV_6000 will be defined as the surgical cavity inclusive of any remaining tumor enhancement and the hypermetabolic volume. CTV_5400 will include the GTV_6000 plus a margin of 1.0 cm which may be reduced around natural barriers to tumor growth such as the skull, ventricles, falx, etc. CTV_5400 must also include the entirety of the GTV_6000. There is no CTV_6000. PTV_5400 is the CTV_5400 plus a geometric 3 mm expansion in all dimensions; PTV_6000 is GTV_6000 plus a geometric 3 mm expansion in all dimensions. PTV may extend beyond bony margins and the skin surface. The PTV_5400 must contain the PTV_6000. In the setting of multi-focal disease, the primary target volumes will be defined as above, but for satellite lesions, the GTV_6000 will be defined as any tumor enhancement and hypermetabolic volume. There will be no CTV_6000. PTV_6000 will be defined as GTV_6000 plus a geometric 3 mm expansion in all dimensions.

Primary Outcome Measure Information:

Title

Patterns of Failure

Description

Time Frame

36 months

Title

Defining Tumor Volume

Description

2. To determine the effect fluciclovine PET has on definition of the tumor volume, as compared to traditional MRI-based radiotherapy.

Time Frame

36 months

Secondary Outcome Measure Information:

Title

Survival using MRI radiotherapy

Description

To quantify overall and progression free survival utilizing MRI cohort.

Time Frame

36 months

Title

Overall survival utilizing MRI+PET radiotherapy

Description

To quantify overall survival utilizing MRI+PET-based radiotherapy

Time Frame

36 months

Title

Progression free survival utilizing MRI+PET-based radiotherapy

Description

To quantify progression free survival utilizing MRI+PET-based

Time Frame

36 months

10. Eligibility

Sex

All

Minimum Age & Unit of Time

18 Years

Accepts Healthy Volunteers

Eligibility Criteria

Inclusion Criteria: Histological diagnosis of primary, newly diagnosed supratentorial, WHO grade IV glioma Greater than 18 years of age Karnofsky performance score greater than 70% Recovered from surgery and on a stable or tapering dose of corticosteroids Plan to undergo standard therapy with XRT 60Gy/30fx with TMZ followed by 6-12 cycles of maintenance TMZ within 6 weeks of surgery If woman of child bearing potential, negative serum pregnancy test. Patients must agree to take adequate pregnancy preventions for the length of the study. Life expectancy of at least 3 months Written study specific consent Exclusion Criteria: Previous treatment of glioma of any grade with bevacizumab or other molecular targeted therapies less than 6 months before MRI (and PET) used for radiotherapy planning Recurrent of multifocal malignant glioma Any sites of distant disease (for example drop metastases or leptomeningeal spread) Prior use of Gliadel wafers or any other intratumal or intracavity treatment Prior radiotherapy to the cranium, head and neck or other sites resulting in overlapping fields Molecular targeted therapies planned during radiotherapy Simultaneous participation in other interventional trials which could interfere with this trial or participation in a clinical trial within the last thirty days before patient's enrollment in current study. Inability to undergo an MRI or PET (Claustrophobia, non-MRI compatible pacemaker, known allergy to MRI contrast agent or fluciclovine tracer) Any pregnant or lactating patient Any prior malignancy within 3 years excluding carcinoma in-situ or early staged,localized basal or squamous cell skin cancers

Central Contact Person:

First Name & Middle Initial & Last Name or Official Title & Degree

Phase 0 Navigator

Phone

602-406-8605

research@ivybraintumorcenter.org

Facility Information:

Facility Name

St. Joseph's Hospital and Medical Center

City

Phoenix

State/Province

Arizona

ZIP/Postal Code

85013

Country

United States

Individual Site Status

Recruiting

Facility Contact:

First Name & Middle Initial & Last Name & Degree

Phase 0 Navigator

Phone

602-406-8605

research@ivybraintumorcenter.org

First Name & Middle Initial & Last Name & Degree

Igor Barani, MD

12. IPD Sharing Statement

Learn more about this trial

Radiotherapy Planning Using Fluciclovine PET in Patients With Newly Diagnosed Glioblastoma

We'll reach out to this number within 24 hrs