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Stereotactic Brain-directed Radiation With or Without Aguix Gadolinium-Based Nanoparticles in Brain Metastases

Primary Purpose

Brain Cancer, Brain Metastases, Melanoma

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Stereotactic Radiation
AGuIX gadolinium-based nanoparticles
Placebo
Sponsored by
Dana-Farber Cancer Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Brain Cancer focused on measuring Brain Cancer, Brain Metastases, Melanoma, Lung Cancer, Breast Cancer, HER2-positive Breast Cancer, Colorectal Cancer, Gastrointestinal Cancer, SRS, SRT, Whole brain radiation, Stereotactic Radiation, AGuIX, Nanoparticle, Cystic, Brain Tumor

Eligibility Criteria

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

Inclusion Criteria:

  • Participants must have a biopsy proven solid malignancy and at least one intracranial measurable lesion spanning ≥5mm in maximal unidimensional size and radiographically consistent with or pathologically proven to be a brain metastasis AND meet one of the following additional criteria regarding the primary site or nature of the intracranial disease:

    • Melanoma with intracranial growth consistent with tumor progression despite immunotherapy
    • Gastrointestinal primary
    • HER2 positive breast cancer (subtype assessed using most representative tissue available in opinion of enrolling clinician and/or study PI)
    • Cystic metastases
    • Metastases ≥2cm in maximal unidimensional size
    • Locally recurrent metastases after prior stereotactic radiation
    • Locally recurrent metastases after prior whole brain radiation *Patients with metastases from melanoma, GI primaries, or HER2+ breast cancer, as well as those with cystic metastases or metastases ≥2cm in maximal unidimensional size, who have local recurrences after prior brain-directed radiation can only be treated in the strata permitting prior radiation (last two strata above)
  • Age ≥18 years at diagnosis of brain metastases
  • Estimated glomerular filtration rate of ≥ 60 mL/min/1.73m2
  • Karnofsky performance status of at least 70 (i.e. at minimum, "cares for self" but "unable to carry on normal activity or do active work")
  • Estimated survival based on extracranial disease of at least 3 months in the opinion of the enrolling clinician and/or study PI
  • Ability to understand and the willingness to sign a written informed consent document
  • The effects of AGuIX on the developing human fetus are unknown. For this reason, women of child-bearing potential must agree to use adequate contraception prior to study entry and for the duration of the therapeutic component of study participation

Exclusion Criteria:

  • Participants who cannot undergo a brain MRI
  • Participants who cannot receive gadolinium
  • Participants with widespread, definitive leptomeningeal disease
  • Patients requiring radiation to either >10 targets (if naïve to whole brain radiation) or >20 targets (if whole brain radiation has been given previously) per the discretion of the treating clinician and/or study PI
  • Pregnant women are excluded from this study because of the potential deleterious effects of gadolinium on the developing fetus. Because there is an unknown but potential risk for adverse events in nursing infants, women who are breastfeeding are not eligible for this study
  • In cohorts who have received prior brain-directed radiation, patients are not eligible for this study if they have active (at the time of protocol screening) brain metastases that require radiation that are in or within 1.0cm of the brainstem, eyes, optic nerves, or optic chiasm if the juxtaposed organ at risk (i.e. brainstem, eyes, optic nerves, or optic chiasm) has previously received either >6.0 Gy in a single fraction or, if prior radiation was fractionated, a cumulative dose in 2.0 Gy equivalents, using an alpha/beta ratio of 2, of >40.0 Gy. In addition, all patients who have had prior brain-directed radiation, regardless of technique/dose/fractionation, are not eligible for the study until written approval is provided by the study/site PI

Sites / Locations

  • Brigham and Women's HospitalRecruiting
  • Dana Farber Cancer InstituteRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Stereotactic Radiation plus AGuIX gadolinium-based nanoparticles

Stereotactic Radiation plus placebo

Arm Description

Randomly assigned participants will receive: AGuIX gadolinium-based nanoparticles 3-5 days before radiation is initiated AGuIX gadolinium-based up to 2x during radiation, depending on standard of care radiation treatment. If standard of care radiation treatment involves only one day of radiation, participant will receive AGuIX gadolinium-based nanoparticles on the day of radiation. If standard of care radiation treatment involves 5 or 6 days of radiation, participant will receive AGuIX gadolinium-based nanoparticles two-times (2x) in total, on the first and third day of radiation.

Randomly assigned participants will receive: Placebo 3-5 days before radiation is initiated Placebo up to 2x during radiation, depending on standard of care radiation treatment. If standard of care radiation treatment involves only one day of radiation participant will receive Placebo on the day of radiation. If standard of care radiation treatment involves 5 or 6 days of radiation participant will receive Placebo two-times (2x) in total, on the first and third day of radiation.

Outcomes

Primary Outcome Measures

Local Recurrence
Assessed with Response Assessment in Neuro-Oncology (RANO) - Brain Metastasis Guidelines Time to local failure on a per metastasis basis will be performed using the log-rank test.

Secondary Outcome Measures

Overall Survival (OS)
Assessed with log-rank test
Progression-Free Survival (PFS)
Assessed with log-rank test
Time to Progression (TTP)
Assessed with log-rank test
Death due to neurologic causes
Assessed with Gray's test
Performance status
Karnofsky performance status, assessed longitudinally (longitudinal regression)
Ability to complete activities of daily living
Questionnaire - EQ-5D, assessed longitudinally (longitudinal regression)
Incidence and time to detection of new brain metastases
Assessed with log-rank test
Incidence and time to detection of radiation necrosis
Assessed with log-rank test
Incidence and time to detection of leptomeningeal disease
Assessed with log-rank test
Incidence and time to detection of progressive intracranial disease
Assessed with log-rank test
Incidence and time to detection of salvage craniotomy
Assessed with log-rank test
Incidence and time to additional radiotherapeutic treatments
Assessed with log-rank test
Incidence and time to the development of seizures
Assessed with log-rank test
Steroid use
Assessed longitudinally (longitudinal regression)
Local recurrence at one year in metastases treated radiotherapeutically
Assessed using RECIST (response evaluation criteria in solid tumors) criteria
Neurocognitive function: verbal learning and memory
Hopkins Verbal Learning Test - Revised (HVLT-R)
Neurocognitive function: visual attention and task switching
Trail Making Test Part A and B (TMT)
Neurocognitive function: verbal fluency
Controlled Word Association Test (COWAT)
Neurocognitive function: cognitive impairment
Mini Mental Status Examination (MMSE)

Full Information

First Posted
April 30, 2021
Last Updated
September 21, 2023
Sponsor
Dana-Farber Cancer Institute
Collaborators
NH TherAguix SAS
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1. Study Identification

Unique Protocol Identification Number
NCT04899908
Brief Title
Stereotactic Brain-directed Radiation With or Without Aguix Gadolinium-Based Nanoparticles in Brain Metastases
Official Title
A Double-blind, Phase II Randomized Study of Brain-directed Stereotactic Radiation With or Without AGuIX Gadolinium-based Nanoparticles in the Management of Brain Metastases at Higher Risk of Local Recurrence With Radiation Alone
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 15, 2021 (Actual)
Primary Completion Date
February 2025 (Anticipated)
Study Completion Date
February 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Dana-Farber Cancer Institute
Collaborators
NH TherAguix SAS

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to determine whether AGuIX (Activation and Guidance of Irradiation by X-ray) gadolinium-based nanoparticles make radiation work more effectively in the treatment of patients with brain metastases that are more difficult to control with stereotactic radiation alone.
Detailed Description
This research study is a double-blind, randomized phase II clinical trial of brain-directed stereotactic radiation with or without AGuIX (Activation and Guidance of Irradiation by X-ray) gadolinium-based nanoparticles in the management of brain metastases at higher-risk of local recurrence with radiation alone. The study agent (AGuIX gadolinium-based nanoparticles) has two main parts. The first is gadolinium, also known as "contrast," which is typically injected into a vein during a MRI scan. The second part is a nanoparticle (linked to the gadolinium) that may make focused radiation work more effectively. The AGuIX gadolinium-based nanoparticles are deposited within the brain metastases via the bloodstream and then the brain metastases are radiated. The U.S. Food and Drug Administration (FDA) has not approved AGuIX gadolinium-based nanoparticles as a treatment for any disease. AGuIX gadolinium-based nanoparticles have been tested in other studies for safety and efficacy in patients with brain metastases who are also receiving radiation. This study seeks to determine whether AGuIX gadolinium-based nanoparticles improve outcomes relative to placebo.Participants will be "randomized" into one of the study groups: Group A: Radiation plus AGuIX gadolinium-based nanoparticles Group B: Radiation plus placebo The research study procedures include screening for eligibility and study treatment including evaluations and follow up visits. NH TherAguix, the manufacturer of the AGuIX gadolinium-based nanoparticles, is supporting this research study by providing the AGuIX gadolinium-based nanoparticles that will be evaluated in this study. NH TherAguix is also covering the cost of the study. It is expected that about 134 people will take part in this research study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Brain Cancer, Brain Metastases, Melanoma, Lung Cancer, Breast Cancer, HER2-positive Breast Cancer, Colorectal Cancer, Gastrointestinal Cancer, SRS, SRT, Whole Brain Radiation, Stereotactic Radiation, AGuIX, Nanoparticle, Cystic, Brain Tumor
Keywords
Brain Cancer, Brain Metastases, Melanoma, Lung Cancer, Breast Cancer, HER2-positive Breast Cancer, Colorectal Cancer, Gastrointestinal Cancer, SRS, SRT, Whole brain radiation, Stereotactic Radiation, AGuIX, Nanoparticle, Cystic, Brain Tumor

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
134 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Stereotactic Radiation plus AGuIX gadolinium-based nanoparticles
Arm Type
Experimental
Arm Description
Randomly assigned participants will receive: AGuIX gadolinium-based nanoparticles 3-5 days before radiation is initiated AGuIX gadolinium-based up to 2x during radiation, depending on standard of care radiation treatment. If standard of care radiation treatment involves only one day of radiation, participant will receive AGuIX gadolinium-based nanoparticles on the day of radiation. If standard of care radiation treatment involves 5 or 6 days of radiation, participant will receive AGuIX gadolinium-based nanoparticles two-times (2x) in total, on the first and third day of radiation.
Arm Title
Stereotactic Radiation plus placebo
Arm Type
Experimental
Arm Description
Randomly assigned participants will receive: Placebo 3-5 days before radiation is initiated Placebo up to 2x during radiation, depending on standard of care radiation treatment. If standard of care radiation treatment involves only one day of radiation participant will receive Placebo on the day of radiation. If standard of care radiation treatment involves 5 or 6 days of radiation participant will receive Placebo two-times (2x) in total, on the first and third day of radiation.
Intervention Type
Radiation
Intervention Name(s)
Stereotactic Radiation
Other Intervention Name(s)
Stereotactic Radiotherapy
Intervention Description
Focused radiation beams to treat tumors
Intervention Type
Drug
Intervention Name(s)
AGuIX gadolinium-based nanoparticles
Intervention Description
Intravenous injection
Intervention Type
Other
Intervention Name(s)
Placebo
Other Intervention Name(s)
Saline
Intervention Description
Intravenous infusion
Primary Outcome Measure Information:
Title
Local Recurrence
Description
Assessed with Response Assessment in Neuro-Oncology (RANO) - Brain Metastasis Guidelines Time to local failure on a per metastasis basis will be performed using the log-rank test.
Time Frame
From enrollment to 6 months
Secondary Outcome Measure Information:
Title
Overall Survival (OS)
Description
Assessed with log-rank test
Time Frame
Time from enrollment to 12 months
Title
Progression-Free Survival (PFS)
Description
Assessed with log-rank test
Time Frame
Time from enrollment to 12 months
Title
Time to Progression (TTP)
Description
Assessed with log-rank test
Time Frame
Time from enrollment to 12 months
Title
Death due to neurologic causes
Description
Assessed with Gray's test
Time Frame
From enrollment to 12 months
Title
Performance status
Description
Karnofsky performance status, assessed longitudinally (longitudinal regression)
Time Frame
From enrollment to 12 months
Title
Ability to complete activities of daily living
Description
Questionnaire - EQ-5D, assessed longitudinally (longitudinal regression)
Time Frame
From enrollment to 12 months
Title
Incidence and time to detection of new brain metastases
Description
Assessed with log-rank test
Time Frame
From enrollment to 12 months
Title
Incidence and time to detection of radiation necrosis
Description
Assessed with log-rank test
Time Frame
From enrollment to 12 months
Title
Incidence and time to detection of leptomeningeal disease
Description
Assessed with log-rank test
Time Frame
From enrollment to 12 months
Title
Incidence and time to detection of progressive intracranial disease
Description
Assessed with log-rank test
Time Frame
From enrollment to 12 months
Title
Incidence and time to detection of salvage craniotomy
Description
Assessed with log-rank test
Time Frame
From enrollment to 12 months
Title
Incidence and time to additional radiotherapeutic treatments
Description
Assessed with log-rank test
Time Frame
From enrollment to 12 months
Title
Incidence and time to the development of seizures
Description
Assessed with log-rank test
Time Frame
From enrollment to 12 months
Title
Steroid use
Description
Assessed longitudinally (longitudinal regression)
Time Frame
From enrollment to 12 months
Title
Local recurrence at one year in metastases treated radiotherapeutically
Description
Assessed using RECIST (response evaluation criteria in solid tumors) criteria
Time Frame
From enrollment to 12 months
Title
Neurocognitive function: verbal learning and memory
Description
Hopkins Verbal Learning Test - Revised (HVLT-R)
Time Frame
From enrollment to 12 months
Title
Neurocognitive function: visual attention and task switching
Description
Trail Making Test Part A and B (TMT)
Time Frame
From enrollment to 12 months
Title
Neurocognitive function: verbal fluency
Description
Controlled Word Association Test (COWAT)
Time Frame
From enrollment to 12 months
Title
Neurocognitive function: cognitive impairment
Description
Mini Mental Status Examination (MMSE)
Time Frame
From enrollment to 12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants must have a biopsy proven solid malignancy and at least one intracranial measurable lesion spanning ≥5mm in maximal unidimensional size and radiographically consistent with or pathologically proven to be a brain metastasis AND meet one of the following additional criteria regarding the primary site or nature of the intracranial disease: Melanoma with intracranial growth consistent with tumor progression despite immunotherapy Gastrointestinal primary HER2 positive breast cancer (subtype assessed using most representative tissue available in opinion of enrolling clinician and/or study PI) Cystic metastases Metastases ≥2cm in maximal unidimensional size Locally recurrent metastases after prior stereotactic radiation Locally recurrent metastases after prior whole brain radiation *Patients with metastases from melanoma, GI primaries, or HER2+ breast cancer, as well as those with cystic metastases or metastases ≥2cm in maximal unidimensional size, who have local recurrences after prior brain-directed radiation can only be treated in the strata permitting prior radiation (last two strata above) Age ≥18 years at diagnosis of brain metastases Estimated glomerular filtration rate of ≥ 60 mL/min/1.73m2 Karnofsky performance status of at least 70 (i.e. at minimum, "cares for self" but "unable to carry on normal activity or do active work") Estimated survival based on extracranial disease of at least 3 months in the opinion of the enrolling clinician and/or study PI Ability to understand and the willingness to sign a written informed consent document The effects of AGuIX on the developing human fetus are unknown. For this reason, women of child-bearing potential must agree to use adequate contraception prior to study entry and for the duration of the therapeutic component of study participation Exclusion Criteria: Participants who cannot undergo a brain MRI Participants who cannot receive gadolinium Participants with widespread, definitive leptomeningeal disease Patients requiring radiation to either >10 targets (if naïve to whole brain radiation) or >20 targets (if whole brain radiation has been given previously) per the discretion of the treating clinician and/or study PI Pregnant women are excluded from this study because of the potential deleterious effects of gadolinium on the developing fetus. Because there is an unknown but potential risk for adverse events in nursing infants, women who are breastfeeding are not eligible for this study In cohorts who have received prior brain-directed radiation, patients are not eligible for this study if they have active (at the time of protocol screening) brain metastases that require radiation that are in or within 1.0cm of the brainstem, eyes, optic nerves, or optic chiasm if the juxtaposed organ at risk (i.e. brainstem, eyes, optic nerves, or optic chiasm) has previously received either >6.0 Gy in a single fraction or, if prior radiation was fractionated, a cumulative dose in 2.0 Gy equivalents, using an alpha/beta ratio of 2, of >40.0 Gy. In addition, all patients who have had prior brain-directed radiation, regardless of technique/dose/fractionation, are not eligible for the study until written approval is provided by the study/site PI
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Ayal Aizer, MD, MHS
Phone
(617) 732-7560
Email
aaaizer@partners.org
First Name & Middle Initial & Last Name or Official Title & Degree
Ivy Ricca, BA
Phone
6175828927
Email
iricca@mgb.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ayal Aizer, MD, MHS
Organizational Affiliation
Brigham and Women's Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Brigham and Women's Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ayal Aizer
Phone
617-732-7560
Email
aaaizer@partners.org
First Name & Middle Initial & Last Name & Degree
Ayal Aizer, MD, MHS
Facility Name
Dana Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02115
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ayal Aizer, MD, MPH
Phone
617-732-7560
Email
aaaizer@partners.org
First Name & Middle Initial & Last Name & Degree
Ayal Aizer, MD, MPH

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.
IPD Sharing Time Frame
Data can be shared no earlier than 1 year following the date of publication
IPD Sharing Access Criteria
Contact the Belfer Office for Dana-Farber Innovations (BODFI) at innovation@dfci.harvard.edu

Learn more about this trial

Stereotactic Brain-directed Radiation With or Without Aguix Gadolinium-Based Nanoparticles in Brain Metastases

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