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Natural Progesterone for the Treatment of Recurrent Glioblastoma

Primary Purpose

Gliosarcoma, Recurrent Glioblastoma

Status
Recruiting
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Quality-of-Life Assessment
Questionnaire Administration
Therapeutic Progesterone
Sponsored by
Emory University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Gliosarcoma

Eligibility Criteria

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

Inclusion Criteria:

  • Patients must have pathologic confirmation of a glioblastoma or gliosarcoma diagnosis at initial surgery or second or later surgery
  • Patients may have had up to two previous salvage agents administered for treatment of recurrent GBM (may be at 1st, 2nd or 3rd recurrence)
  • Patients must be >= 18 years of age
  • Patients must be able to have magnetic resonance imaging (MRI) scans for disease follow up
  • Recurrent GBM must consist of a minimum of 1 cm^3 of contrast enhancing disease on high resolution T1 post-contrast sequence as defined on pre-treatment MRI obtained within 14 days of initiating therapy
  • White blood cell (WBC) >= 3,000/uL (=< 14 days prior to registration)
  • Absolute neutrophil count (ANC) >= 1,500/uL (=< 14 days prior to registration)
  • Platelet count of >= 75,000/uL (=< 14 days prior to registration)
  • Hemoglobin >= 9.0 gm/dl (=< 14 days prior to registration) (transfusion is allowed to reach minimum level)
  • Aspartate aminotransferase (AST) /alanine aminotransferase (ALT) =< 2.0 x upper limit of normal (UNL) (=< 14 days prior to registration)
  • Bilirubin =< 2 x UNL (=< 14 days prior to registration)
  • Creatinine =< 1.5 mg/dL (=< 14 days prior to registration)
  • Patients must have a life expectancy of >= 12 weeks
  • Patients must have a Karnofsky Performance Status (KPS) >= 60
  • Patients who are women of childbearing potential must have a negative pregnancy test documented =< 14 days prior to registration and agree to use adequate barrier contraceptive methods or abstinence for duration of study
  • Patients must be able to understand and provide written informed consent
  • Both men and women, and members of all races and ethnic groups are eligible for this trial. Subjects will be approximately representative of the demographics of the referral base for the participating institutions
  • Patient must not have a known allergy to progesterone
  • In females, no active vaginal bleeding
  • Patients may not be enrolled on any other therapeutic trial for which they are receiving an anti-tumor therapy

Exclusion Criteria:

  • Patients with pacemakers, aneurysm clips, neurostimulators, cochlear implants, metal in ocular structures, history of being a steel worker, or other incompatible implants which makes MRI safety an issue are excluded
  • Patients that have any significant medical illnesses that in the investigator's opinion cannot be adequately controlled with appropriate therapy or would compromise the patient's ability to tolerate this therapy are excluded
  • Patients with a history of severe hepatic dysfunction of disease are excluded
  • Patients with a history of idiopathic jaundice, severe pruritus and pemphigoid gestationis during pregnancy are excluded
  • Patients with a history of breast or genital tract cancer are excluded
  • Patients with a history of any other invasive cancer (except non-melanoma skin cancer and excluding carcinoma in-situ), unless in complete remission and off all therapy for that disease for >= 3 years, are ineligible
  • Patients with an active infection or serious intercurrent medical illness are ineligible
  • Patients who received any other in anti-tumor agents (including investigational ones) must be off therapy for 4 weeks prior to initiating progesterone on study
  • Patient receiving anti-coagulation therapy are excluded
  • Patient with active or recent (within 6 months) thromboembolic disease are excluded
  • Patient with current ongoing therapy with estrogen/progesterone (including hormonal contraceptives) are excluded. Would need to stop this form of birth control at least 7 days prior to initiation of therapy to be eligible

Sites / Locations

  • Emory University Hospital/Winship Cancer InstituteRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (progesterone)

Arm Description

Patients receive progesterone SC QD for up to 24 weeks in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Natural progesterone blood levels
This analysis will be performed to determine what plasma drug levels can be achieved in recurrent glioblastoma (GBM) patients with subcutaneous administration of natural progesterone and whether this is in line with what was previously determined in healthy subjects.
Incidence of adverse events
The safety of this approach will be confirmed by assessing toxicity potentially attributable to the daily progesterone treatment. Toxicity will be determined by Common Terminology Criteria for Adverse Events version 5.0 criteria.
Overall response rate
Will be looking for the fraction of patients that are able to maintain at least stable disease.

Secondary Outcome Measures

Progression free survival (PFS)
Patients on this study will be followed for PFS. In addition to the 24 weeks PFS, actuarial PFS curves will be assessed and compared to historical controls.
Overall survival (OS)
Patients on this study will be followed for OS. In addition to the 24 weeks OS, actuarial OS curves will be assessed and compared to historical controls.

Full Information

First Posted
September 14, 2021
Last Updated
April 24, 2023
Sponsor
Emory University
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT05091866
Brief Title
Natural Progesterone for the Treatment of Recurrent Glioblastoma
Official Title
Pilot Study of Subcutaneously Administered Natural Progesterone for the Treatment of Recurrent GBM
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
April 11, 2022 (Actual)
Primary Completion Date
August 25, 2024 (Anticipated)
Study Completion Date
August 25, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Emory University
Collaborators
National Cancer Institute (NCI)

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
This early phase I trial identifies the best dose, possible benefits and/or side effects of natural progesterone in treating patients with glioblastoma that has come back (recurrent). Progesterone is a type of hormone made by the body that plays a role in the menstrual cycle and pregnancy. Progesterone may help control tumor growth and spread in patients with glioblastoma.
Detailed Description
PRIMARY OBJECTIVES: I. To determine that the pharmacokinetics of natural progesterone given to recurrent glioblastoma [GBM] patients by subcutaneous injection is consistent with previous determinations made given subcutaneously using the aqueous formulation of progesterone. II. To determine the safety of administering daily subcutaneous natural progesterone for the treatment of patients with recurrent GBMs. III. To determine the rate of stable disease (SD) or better (partial response [PR] or complete response [CR]) at 8 weeks in eligible patients with recurrent GBM treated with daily subcutaneous natural progesterone. SECONDARY OBJECTIVES: I. To determine and compare the progression free survival of eligible patients with recurrent GBM compared with matched historical controls treated with a range of standard therapies. II. To determine and compare the overall survival of eligible patients with recurrent GBM compared with matched historical controls treated with a range of standard therapies. EXPLORATORY OBJECTIVES: I. To determine whether progesterone receptor levels within the tumor correlates with response to daily subcutaneous natural progesterone. II. To determine if other intrinsic tumor factors (mutations and genomic loss/gains) correlates with response to daily subcutaneous natural progesterone. III. To determine if the absolute values or changes in the level of serum biomarkers correlates with response to daily subcutaneous natural progesterone. IV. To determine the quality-of-life (QOL) by validated instruments of eligible patients with recurrent GBM treated with daily subcutaneous natural progesterone and assess whether this differs from historical controls. OUTLINE: Patients receive progesterone subcutaneously (SC) once daily (QD) for up to 24 weeks in the absence of disease progression or unacceptable toxicity.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Treatment
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
32 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Treatment (progesterone)
Arm Type
Experimental
Arm Description
Patients receive progesterone SC QD for up to 24 weeks in the absence of disease progression or unacceptable toxicity.
Intervention Type
Other
Intervention Name(s)
Quality-of-Life Assessment
Other Intervention Name(s)
Quality of Life Assessment
Intervention Description
Ancillary studies
Intervention Type
Other
Intervention Name(s)
Questionnaire Administration
Intervention Description
Ancillary studies
Intervention Type
Biological
Intervention Name(s)
Therapeutic Progesterone
Other Intervention Name(s)
Corlutina, Corluvite, Corpus luteum hormone, Cyclogest, Gestiron, Gestone, Lipo-Lutin, Luteohormone, Lutocyclin, Lutocylin M, Lutogyl, Lutromone, Progestasert, Progesterone, Progestin, Progestogel, Progestol, Progeston, Prolidon, Proluton, Syngesterone, Utrogestan
Intervention Description
Given SC
Primary Outcome Measure Information:
Title
Natural progesterone blood levels
Description
This analysis will be performed to determine what plasma drug levels can be achieved in recurrent glioblastoma (GBM) patients with subcutaneous administration of natural progesterone and whether this is in line with what was previously determined in healthy subjects.
Time Frame
On day 1 (0, 30 minutes, 1, 2, 4, 6, 8 hours from drug injection) as well as at day 4 and day 8 prior to drug injections
Title
Incidence of adverse events
Description
The safety of this approach will be confirmed by assessing toxicity potentially attributable to the daily progesterone treatment. Toxicity will be determined by Common Terminology Criteria for Adverse Events version 5.0 criteria.
Time Frame
Up to 2 years
Title
Overall response rate
Description
Will be looking for the fraction of patients that are able to maintain at least stable disease.
Time Frame
Up to 2 years
Secondary Outcome Measure Information:
Title
Progression free survival (PFS)
Description
Patients on this study will be followed for PFS. In addition to the 24 weeks PFS, actuarial PFS curves will be assessed and compared to historical controls.
Time Frame
From the time of pre-treatment magnetic resonance imaging (MRI) to the time of either radiographic progression or death, whichever occurs first, assessed at 24 weeks
Title
Overall survival (OS)
Description
Patients on this study will be followed for OS. In addition to the 24 weeks OS, actuarial OS curves will be assessed and compared to historical controls.
Time Frame
From the time of pre-treatment MRI to the time of death, assessed at 24 weeks
Other Pre-specified Outcome Measures:
Title
Progesterone receptor expression levels
Description
Original tumor and any recurrent tumor samples will be assessed for progesterone receptor expression levels by immunohistochemistry and these results will be correlated with response assessment to determine whether there is any correlation.
Time Frame
Up to 2 years
Title
Tumor mutational and genomic loss/gain factors
Description
Each of the tumor mutational and genomic loss/gain factors will be scored and these results will be correlated with response assessment to determine whether there is any correlation.
Time Frame
Up to 2 years
Title
EORTC Quality-of-life (QOL) Questionnaire Core 30/Brain Cancer Module-20
Description
Serial QOL assessments will be determined in patients and compared with historical cohorts to determine whether there is any difference in patients treated with subcutaneous progesterone for recurrent GBM.
Time Frame
Up to 2 years
Title
YKL-40 biomarker analysis
Description
YKL-40 will be quantitated at the specific time points (pre-treatment, 4 weeks, 8 weeks) with specific levels and changes in levels recorded. These results will be correlated with response assessment to determine whether there is any correlation.
Time Frame
Up to 8 weeks
Title
Matrix Meteloproteinase-9 (MMP-9)
Description
Matrix Meteloproteinase-9 (MMP-9) will be quantitated at the specific time points (pre-treatment, 4 weeks, 8 weeks) with specific levels and changes in levels recorded. These results will be correlated with response assessment to determine whether there is any correlation.
Time Frame
Up to 8 weeks
Title
Gilal Fibrillary Acidic Protein
Description
Gilal Fibrillary Acidic Protein will be quantitated at the specific time points (pre-treatment, 4 weeks, 8 weeks) with specific levels and changes in levels recorded. These results will be correlated with response assessment to determine whether there is any correlation.
Time Frame
Up to 8 weeks
Title
C-Reactive Protein
Description
C-Reactive Protein will be quantitated at the specific time points (pre-treatment, 4 weeks, 8 weeks) with specific levels and changes in levels recorded. These results will be correlated with response assessment to determine whether there is any correlation.
Time Frame
Up to 8 weeks
Title
Soluble CD14
Description
Soluble CD14 will be quantitated at the specific time points (pre-treatment, 4 weeks, 8 weeks) with specific levels and changes in levels recorded. These results will be correlated with response assessment to determine whether there is any correlation.
Time Frame
Up to 8 weeks
Title
Soluble CD23
Description
Soluble CD23 will be quantitated at the specific time points (pre-treatment, 4 weeks, 8 weeks) with specific levels and changes in levels recorded. These results will be correlated with response assessment to determine whether there is any correlation.
Time Frame
Up to 8 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must have pathologic confirmation of a glioblastoma or gliosarcoma diagnosis at initial surgery or second or later surgery Patients may have had up to two previous salvage agents administered for treatment of recurrent GBM (may be at 1st, 2nd or 3rd recurrence) Patients must be >= 18 years of age Patients must be able to have magnetic resonance imaging (MRI) scans for disease follow up Recurrent GBM must consist of a minimum of 1 cm^3 of contrast enhancing disease on high resolution T1 post-contrast sequence as defined on pre-treatment MRI obtained within 14 days of initiating therapy White blood cell (WBC) >= 3,000/uL (=< 14 days prior to registration) Absolute neutrophil count (ANC) >= 1,500/uL (=< 14 days prior to registration) Platelet count of >= 75,000/uL (=< 14 days prior to registration) Hemoglobin >= 9.0 gm/dl (=< 14 days prior to registration) (transfusion is allowed to reach minimum level) Aspartate aminotransferase (AST) /alanine aminotransferase (ALT) =< 2.0 x upper limit of normal (UNL) (=< 14 days prior to registration) Bilirubin =< 2 x UNL (=< 14 days prior to registration) Creatinine =< 1.5 mg/dL (=< 14 days prior to registration) Patients must have a life expectancy of >= 12 weeks Patients must have a Karnofsky Performance Status (KPS) >= 60 Patients who are women of childbearing potential must have a negative pregnancy test documented =< 14 days prior to registration and agree to use adequate barrier contraceptive methods or abstinence for duration of study Patients must be able to understand and provide written informed consent Both men and women, and members of all races and ethnic groups are eligible for this trial. Subjects will be approximately representative of the demographics of the referral base for the participating institutions Patient must not have a known allergy to progesterone In females, no active vaginal bleeding Patients may not be enrolled on any other therapeutic trial for which they are receiving an anti-tumor therapy Exclusion Criteria: Patients with pacemakers, aneurysm clips, neurostimulators, cochlear implants, metal in ocular structures, history of being a steel worker, or other incompatible implants which makes MRI safety an issue are excluded Patients that have any significant medical illnesses that in the investigator's opinion cannot be adequately controlled with appropriate therapy or would compromise the patient's ability to tolerate this therapy are excluded Patients with a history of severe hepatic dysfunction of disease are excluded Patients with a history of idiopathic jaundice, severe pruritus and pemphigoid gestationis during pregnancy are excluded Patients with a history of breast or genital tract cancer are excluded Patients with a history of any other invasive cancer (except non-melanoma skin cancer and excluding carcinoma in-situ), unless in complete remission and off all therapy for that disease for >= 3 years, are ineligible Patients with an active infection or serious intercurrent medical illness are ineligible Patients who received any other in anti-tumor agents (including investigational ones) must be off therapy for 4 weeks prior to initiating progesterone on study Patient receiving anti-coagulation therapy are excluded Patient with active or recent (within 6 months) thromboembolic disease are excluded Patient with current ongoing therapy with estrogen/progesterone (including hormonal contraceptives) are excluded. Would need to stop this form of birth control at least 7 days prior to initiation of therapy to be eligible
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hui-Kuo G Shu, MD, PhD, FASTRO
Organizational Affiliation
Emory University Hospital/Winship Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Emory University Hospital/Winship Cancer Institute
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30322
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Agnes G. Harutyunyan
Phone
404-778-2161
Email
agnieszka.anna.harutyunyan@emory.edu
First Name & Middle Initial & Last Name & Degree
Hui-Kuo G. Shu, MD, PhD, FASTRO

12. IPD Sharing Statement

Learn more about this trial

Natural Progesterone for the Treatment of Recurrent Glioblastoma

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