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5 Fraction Stereotactic Radiosurgery With Temozolomide for Glioblastoma Multiforme

Primary Purpose

Glioblastoma Multiforme

Status
Completed
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Temozolomide
Sponsored by
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional other trial for Glioblastoma Multiforme

Eligibility Criteria

18 Years - 100 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients must be at least 18 years of age.
  • Patients must have confirmed glioblastoma multiforme (GBM)
  • Maximum postoperative dimension of cavity plus residual contrast enhancing tumor of < * If a patient is found on the radiation planning scan to have a tumor target larger than this size, the patient will be removed from the study.
  • Patient must be selected for standard temozolomide chemotherapy to be administered with radiotherapy.
  • Patient agrees to have 10 week follow-up visit at a participating Johns Hopkins facility.
  • Patient agrees to allow access to or provide clinical, imaging, and laboratory follow-up information for three years whether or not obtained from Johns Hopkins providers.

3.1.7. Patients must not have received prior radiation therapy, chemotherapy, immunotherapy or therapy with biologic agents (including immunotoxins, immunoconjugates, antisense, peptide receptor antagonists, interferons, interleukins, Tumor-infiltrating lymphocytes (TIL), Lymphokine-Activated Killer Cell (LAK) or gene therapy), or hormonal therapy for their brain tumor. Glucocorticoid therapy is allowed.

  • Patients must have a Karnofsky performance status 60% or higher (i.e. the patient must be able to care for himself/herself with occasional help from others).
  • Patients must be able to provide written informed consent.
  • Patients with the potential for pregnancy or impregnating their partner must agree to follow acceptable birth control methods to avoid conception. Women of childbearing potential must have a negative pregnancy test.
  • Patients must be able to undergo MRI scan with gadolinium contrast for treatment planning.

Exclusion Criteria:

  • Patients may not plan to receive any other approved or investigational agents to treat their glioblastoma besides temozolomide prior to the evaluation visit 10 weeks after the initiation of radiotherapy and temozolomide.
  • No prior malignancy is allowed except for adequately treated basal cell or squamous cell skin cancer, cervical carcinoma in situ, or other cancer from which the patient has been disease free for at least 2 years.
  • Patients with uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements will be excluded.
  • Pregnant and breastfeeding women are excluded. Women of child-bearing potential who are unwilling or unable to use an acceptable method of birth control to avoid pregnancy for the entire study period and up to 12 weeks after the study are excluded. This applies to any woman who has not experienced menarche and who has not undergone successful surgical sterilization or is not postmenopausal (defined as amenorrhea for at least 12 consecutive months). Male subjects must also agree to use effective contraception for the same period as above.

Sites / Locations

  • Sibley Hospital
  • Suburban Hospital
  • SKCCC at Johns Hopkins (East Baltimore)

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

5 fraction radiotherapy with standard temozolomide

Arm Description

5 fraction hypofractionated stereotactic radiosurgery along with standard temozolomide

Outcomes

Primary Outcome Measures

Rate of change of lymphopenia
To measure the incidence of > grade 3ymphopenia resulting from combined stereotactic hypofractionated radiotherapy and standard temozolomide in malignant glioma at the the standard follow-up 10 weeks after the initiation of therapy.

Secondary Outcome Measures

Percentage change in Cluster of differentiation 4 (CD4) count (antigen found on helper T cells)
To describe the percent of patients with CD4 count < 200 mm/m3 at the standard week 10 follow-up
Rate of change of lymphocytes
Describe recovery of lymphocyte counts during routine clinical follow-up.
Rate of survival
To describe clinical/survival outcome based upon routine standard of care.
Rate of change in serious adverse events
To describe treatment related serious adverse effects

Full Information

First Posted
September 15, 2017
Last Updated
November 17, 2021
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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1. Study Identification

Unique Protocol Identification Number
NCT03291990
Brief Title
5 Fraction Stereotactic Radiosurgery With Temozolomide for Glioblastoma Multiforme
Official Title
A Pilot Study to Assess Feasibility of 5 Fraction Hypofractionated Stereotactic Radiosurgery Along With Standard Temozolomide as a Lymphocyte Sparing Therapy for Glioblastoma Multiforme
Study Type
Interventional

2. Study Status

Record Verification Date
February 2021
Overall Recruitment Status
Completed
Study Start Date
October 18, 2017 (Actual)
Primary Completion Date
August 19, 2020 (Actual)
Study Completion Date
August 19, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This investigation is not only to develop an improved radiation/temozolomide approach, but also develop a regimen with potential to form the basis of better combined therapy with immune based treatments.
Detailed Description
Glioblastoma has a poor prognosis with median survival is 14-16 months for patients enrolling in clinical trials, and across the United States one year survival is reported in the Surveillance, Epidemiology, and End Results (SEER) registry to be only 35%. Radiation treatment related lymphopenia has been associated with poor tumor outcome in Glioblastoma and a variety of other tumor types. As this lymphopenias is prolonged, it may also reduce efficacy of the checkpoint inhibitor lymphocyte mediated immune therapies now approved by the FDA for an increasing number of indications. Modeling and clinical studies suggest that administering radiation over 5 or fewer days (rather than standard 30 days of treatment) may reduce the incidence of lymphopenia.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Other
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Model Description
5 fraction hypofractionated stereotacic radiosurgery along with standard temozolomide
Masking
None (Open Label)
Allocation
N/A
Enrollment
3 (Actual)

8. Arms, Groups, and Interventions

Arm Title
5 fraction radiotherapy with standard temozolomide
Arm Type
Experimental
Arm Description
5 fraction hypofractionated stereotactic radiosurgery along with standard temozolomide
Intervention Type
Drug
Intervention Name(s)
Temozolomide
Other Intervention Name(s)
5 fraction radiosurgery with temozolomide
Intervention Description
5 fraction hypofractionated stereotactic radiosurgery along with standard temozolomide
Primary Outcome Measure Information:
Title
Rate of change of lymphopenia
Description
To measure the incidence of > grade 3ymphopenia resulting from combined stereotactic hypofractionated radiotherapy and standard temozolomide in malignant glioma at the the standard follow-up 10 weeks after the initiation of therapy.
Time Frame
10 weeks
Secondary Outcome Measure Information:
Title
Percentage change in Cluster of differentiation 4 (CD4) count (antigen found on helper T cells)
Description
To describe the percent of patients with CD4 count < 200 mm/m3 at the standard week 10 follow-up
Time Frame
10 weeks
Title
Rate of change of lymphocytes
Description
Describe recovery of lymphocyte counts during routine clinical follow-up.
Time Frame
10 weeks
Title
Rate of survival
Description
To describe clinical/survival outcome based upon routine standard of care.
Time Frame
10 weeks
Title
Rate of change in serious adverse events
Description
To describe treatment related serious adverse effects
Time Frame
10 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
100 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must be at least 18 years of age. Patients must have confirmed glioblastoma multiforme (GBM) Maximum postoperative dimension of cavity plus residual contrast enhancing tumor of < * If a patient is found on the radiation planning scan to have a tumor target larger than this size, the patient will be removed from the study. Patient must be selected for standard temozolomide chemotherapy to be administered with radiotherapy. Patient agrees to have 10 week follow-up visit at a participating Johns Hopkins facility. Patient agrees to allow access to or provide clinical, imaging, and laboratory follow-up information for three years whether or not obtained from Johns Hopkins providers. 3.1.7. Patients must not have received prior radiation therapy, chemotherapy, immunotherapy or therapy with biologic agents (including immunotoxins, immunoconjugates, antisense, peptide receptor antagonists, interferons, interleukins, Tumor-infiltrating lymphocytes (TIL), Lymphokine-Activated Killer Cell (LAK) or gene therapy), or hormonal therapy for their brain tumor. Glucocorticoid therapy is allowed. Patients must have a Karnofsky performance status 60% or higher (i.e. the patient must be able to care for himself/herself with occasional help from others). Patients must be able to provide written informed consent. Patients with the potential for pregnancy or impregnating their partner must agree to follow acceptable birth control methods to avoid conception. Women of childbearing potential must have a negative pregnancy test. Patients must be able to undergo MRI scan with gadolinium contrast for treatment planning. Exclusion Criteria: Patients may not plan to receive any other approved or investigational agents to treat their glioblastoma besides temozolomide prior to the evaluation visit 10 weeks after the initiation of radiotherapy and temozolomide. No prior malignancy is allowed except for adequately treated basal cell or squamous cell skin cancer, cervical carcinoma in situ, or other cancer from which the patient has been disease free for at least 2 years. Patients with uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements will be excluded. Pregnant and breastfeeding women are excluded. Women of child-bearing potential who are unwilling or unable to use an acceptable method of birth control to avoid pregnancy for the entire study period and up to 12 weeks after the study are excluded. This applies to any woman who has not experienced menarche and who has not undergone successful surgical sterilization or is not postmenopausal (defined as amenorrhea for at least 12 consecutive months). Male subjects must also agree to use effective contraception for the same period as above.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lawrence Kleinberg, MD
Organizational Affiliation
SKCCC at Johns Hopkins (East Baltimore)
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sibley Hospital
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20016
Country
United States
Facility Name
Suburban Hospital
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20818
Country
United States
Facility Name
SKCCC at Johns Hopkins (East Baltimore)
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

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5 Fraction Stereotactic Radiosurgery With Temozolomide for Glioblastoma Multiforme

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