A Study of Bevacizumab (Avastin) in Combination With Temozolomide (TMZ) and Radiotherapy in Paediatric and Adolescent Participants With High-Grade Glioma
High Grade Glioma
About this trial
This is an interventional treatment trial for High Grade Glioma
Eligibility Criteria
Inclusion Criteria - Main cohort :
- Paediatric participants, aged >= 3 years and < 18 years
- Written informed consent obtained from the participant/parents or legally acceptable representative
- Newly diagnosed localised, supratentorial or infratentorial cerebellar or peduncular, WHO Grade III or IV gliomas
- Local histological diagnosis confirmed by a designated central reference neuropathologist
- Availability of the baseline magnetic resonance imaging (MRI) performed according to imaging guidelines
- Able to commence trial treatment not before 4 weeks after cranial surgery and no later than 6 weeks following the last major surgery
- Adequate bone marrow, coagulation, liver, and renal function
Young Participant Cohort
- Written informed consent obtained from parents or legal representative
- Age at enrollment: from >= 6 months to < 3 years of age
- Progressive or relapsed metastatic or localised, supra- or infratentorial, non-brain stem WHO Grade III or IV glioma (local pathology confirmation made either at initial diagnosis or at relapse)
- Availability of a baseline MRI performed according to imaging guidelines
- Adequate organ function (bone marrow, coagulation, liver, kidney)
Exclusion Criteria - Main cohort:
- Metastatic HGG defined as evidence of neuraxis dissemination by MRI or positive cerebrospinal fluid (CSF) cytology
- WHO-defined Gliomatosis cerebri (multifocal HGG)
- Any disease or condition that contraindicates the use of the study medication/treatment or places the patient at an unacceptable risk of experiencing treatment-related complications
- Radiological evidence of surgically related intracranial bleeding
- Prior diagnosis of a malignancy and disease-free for 5 years
- Prior systemic anti-cancer therapy
- Previous cranial irradiation
Young Participant Cohort
- WHO-defined Gliomatosis cerebri (multifocal HGG)
- Newly diagnosed HGG below the age of 3 years
- Relapsed HGG below the age of 6 months or above the age of 3 years regardless of the age at first onset
- Indication for concomitant cranial irradiation, regardless of age
- Any disease or condition that contraindicates the use of the study medication/treatment or places the child at an unacceptable risk of experiencing treatment-related complications
- Any specific contraindication to MRI
Sites / Locations
- The Children's Hospital at Westmead
- Lady Cilento Children's Hospital; Oncology Services Group, Level 12b
- Kepler Universitätskliniken GmbH - Med Campus IV.
- Medizinische Universität Wien
- UZ Leuven Gasthuisberg
- Alberta Children'S Hospital
- Hospital For Sick Children
- Fakultni nemocnice Brno; 2. detska klinika, pracoviste Detska nemocnice
- Fakultni Nemocnice V Motole, S.P.
- Skejby Sygehus - Aarhus University Hospital; CF Center, Børneafdeling A
- Rigshospitalet; Onkologisk Klinik
- Centre Hospitalier d'Angers; Service de cancérologie pédiatrique
- CHU ESTAING; Centre Regional de Cancérologie et Thérapie Cellulaire Pédiatrique (CRCTCP)
- Centre Oscar Lambret; Service de Pediatrie
- Centre Leon Berard
- Hopital Timone Enfants; Onco Pediatrie
- Hopital Lenval; Service Hématologie Infantile
- Institut Curie - Centre de Lutte Contre le Cancer (CLCC) de Paris; Service d Oncologie Pediatrique
- CHRU de Rennes - Hôpital Sud- Service d'Hématologie Pédiatrique
- Hopital Nord;Consult Pediatrie
- Hôpital Hautepierre
- Hopital Des Enfants; Service d Hemato-Oncologie
- CHRU de Tours - Centre de Pédiatrie Clocheville; Service d'Oncopédiatrie
- Hopital Brabois Enfants
- Institut Gustave Roussy; Service Pediatrique
- Semmelweis University, 2nd Dept of Pediatrics Neurooncology Unit
- Azienda Ospedaliera Universitaria Policlinico Sant'Orsola Malpigh
- Istituto Giannina Gaslini-Ospedale Pediatrico IRCCS; U.O.S. Neuroncologia
- Fondazione IRCCS Istituto Nazionale dei Tumori
- Azienda Ospedaliera di Padova
- UMC St Radboud
- Erasmus Mc/Sophia's Childrens Hospital; Dept. of Pediatric Oncology
- Instytut Pomnik-Centrum Zdrowia Dziecka; Klinika Onkologii
- Hospital Sant Joan De Deu
- Hospital Universitari Vall d'Hebron
- Hospital Universitario La Fe
- Sahlgrenska Universitetssjukhuset, Östra Sjukhus; Drottning Silvias Barnsjukhus
- Universitetssjukhuset Linköping; Barn och Ungdomskliniken
- Skånes Universitetssjukhus
- Karolinska Universitetssjukhuset, Solna; Astrid Lindgrens Barnsjukhus, Barcanceravdelningen
- Birmingham Childrens Hospital; Oncology Dept
- Bristol Royal Hospital for Children; Paediatric Haematology, Oncology, BMT
- Addenbrookes Hospital; Paediatric Oncology Ward C2
- Royal Hospital for Sick Children
- Leeds General Infirmary; Ward 35
- Alder Hey Children's NHS Foundation Trust
- University College London NHS Foundation Trust
- Great Ormond Street Hospital; Dept. Of Pediatric Oncology
- Royal Manchester Childrens Hospital
- Newcastle University & The Newcastle upon Tyne Hospitals NHS Foundation Trust
- Queens Medical Centre
- Southampton General Hospital
- Royal Marsden Hospital; Pediatric Unit
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Experimental
Active Comparator
Bevacizumab + TMZ Young Patient Cohort (YPC)
Main Cohort: Chemoradiation + Bevacizumab + TMZ
Main Cohort: Chemoradiation + TMZ
Participants aged greater than or equal to (>/=) 6 months and less than (<) 3 years will receive 10 milligrams per kilogram (mg/kg) Bevacizumab every 2 weeks and 150 to 200 milligrams per meter squared (mg/m^2) of TMZ daily on Days 1-5 of each cycle. TMZ will be given at a dose of 150 mg/m^2 on Days 1-5 of cycle 1 and then escalated to 200 mg/m^2 on days 1-5 from cycle 2 onwards depending on the tolerance during the 1st cycle.
Participants will receive a total dose of 54 Grey (Gy) units delivered in 30 daily fractions of 1.8 Gy over 6 weeks with 75 mg/m^2 TMZ daily for up to 49 days followed by a treatment break of approximately 4 weeks. The treatment break will be followed by an adjuvant treatment phase where participants will receive 150 to 200 mg/m^2 of TMZ daily on Days 1-5 of each cycle. TMZ will be given at a dose of 150 mg/m^2 on Days 1-5 of cycle 1 and then escalated to 200 mg/m^2 on days 1-5 from cycle 2 onwards depending on the tolerance during the 1st cycle. Bevacizumab will be given concomitantly at a dose of 10 mg/kg every 2 weeks throughout the entire treatment period.
Participants will receive a total dose of 54 Gy units delivered in 30 daily fractions of 1.8 Gy over 6 weeks with 75 mg/m^2 TMZ daily for up to 49 days followed by a treatment break of approximately 4 weeks. The treatment break will be followed by an adjuvant treatment phase where participants will receive 150 to 200 mg/m^2 of TMZ daily on Days 1-5 of each cycle. TMZ will be given at a dose of 150 mg/m^2 on Days 1-5 of cycle 1 and then escalated to 200 mg/m^2 on days 1-5 from cycle 2 onwards depending on the tolerance during the 1st cycle.