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Arsenic Trioxide, Temozolomide, and Radiation Therapy in Treating Patients With Malignant Glioma That Has Been Removed By Surgery

Primary Purpose

Brain and Central Nervous System Tumors

Status
Unknown status
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
arsenic trioxide
temozolomide
radiation therapy
Sponsored by
Northwestern University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Brain and Central Nervous System Tumors focused on measuring adult anaplastic astrocytoma, adult gliosarcoma, adult anaplastic oligodendroglioma, adult mixed glioma, adult glioblastoma, adult giant cell glioblastoma, recurrent adult brain tumor

Eligibility Criteria

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

DISEASE CHARACTERISTICS: Histologically confirmed supratentorial malignant glioma of 1 of the following types: Glioblastoma multiforme Gliosarcoma Anaplastic astrocytoma Anaplastic oligodendroglioma Anaplastic mixed gliomas Anaplastic gliomas not otherwise specified Has undergone surgical resection of tumor Patients with biopsy only are eligible Evaluable or measurable disease following resection of recurrent tumor is not mandated for entry into the study No brain metastases PATIENT CHARACTERISTICS: Karnofsky performance status 60-100% Life expectancy > 3 months WBC > 3,000/mm^3 Absolute neutrophil count > 2,000/mm^3 Platelet count > 100,000/mm^3 Hemoglobin > 10 g/dL (eligibility level for hemoglobin may be reached by transfusion) Creatinine ≤ 1.5 mg/dL Bilirubin ≤ 2 mg/dL Transaminases ≤ 2 times the upper limit of normal Serum potassium* > 4.0 mEq/dL Serum magnesium* > 1.8 mg/dL NOTE: *If these serum electrolytes are below the specified limits on the baseline laboratory tests, supplemental electrolytes should be administered to bring the serum concentrations to these levels before administering arsenic trioxide Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 3 months after completion of study treatment No second-degree heart block QT interval ≤ 460 msec No other malignancy within the past 3 years except curatively treated carcinoma in situ or basal cell carcinoma of the skin Patients who cannot undergo MRI are not eligible for this study No other serious concurrent infection or other medical illness that would jeopardize the ability of the patient to receive the therapy in this protocol with reasonable safety PRIOR CONCURRENT THERAPY: See Disease Characteristics Patients must have recovered from the effects of surgery prior to the start of treatment (10-14 days minimum) and be maintained on a stable corticosteroid regimen for 5 days Concurrent glucocorticoid therapy allowed at the smallest effective dose Patients must be on non-enzyme-inducing anti-convulsants to minimize any drug reaction No prior radiation therapy, chemotherapy, immunotherapy, therapy with biologic agents (including immunotoxins, immunoconjugates, antisense agents, peptide receptor antagonists, interferons, interleukins, tumor-infiltrating lymphocytes, lymphokine-activated killer cells, or gene therapy), or hormonal therapy for their brain tumor

Sites / Locations

  • Hematology-Oncology Associates of Illinois
  • Robert H. Lurie Comprehensive Cancer Center at Northwestern University
  • Edward Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Radiation + temozolomide and arsenic trioxide

Arm Description

Radiation therapy followed by the combination of temozolomide and arsenic trioxide at the maximum tolerated dose determined in phase 1

Outcomes

Primary Outcome Measures

Maximum tolerated dose of arsenic trioxide and temozolomide in combination with radiotherapy
Escalating doses of study drug until dose limiting toxicities are observed.
Collect data on the toxicity of arsenic and temozolomide during radiation therapy
Toxicity of this drug combination during radiation therapy will be assessed.
Assess serum biomarkers and correlate with tumor tissue
Blood will be drawn at baseline, during radiation therapy, and prior to each cycle of chemotherapy to assess serum biomarkers and correlate with tumor tissue.

Secondary Outcome Measures

Determine progression free survival at 6 and 12 months
Patients will undergo an MRI and neurological evaluation every 6 months while on chemotherapy.
Determine time to disease progression
Disease status will be assessed by MRI and neurological examination every 6 months until disease progression.
To determine overall survival
Survival status will be evaluated every 6 months while on treatment.
To determine radiographic response to study regimen
Radiographic response will be assessed by MRI every 6 months while on treatment
To collect safety data during the radiation therapy phase
EKG's will be done once per week and labs twice per week during radiation therapy phase to evaluate safety data.
To evaluate a potential surrogate marker for outcomes
Blood will be drawn to analyze methylation patterns as a surrogate marker for outcomes at baseline, before and after radiation therapy, and every 2 cycles during chemotherapy.

Full Information

First Posted
January 10, 2006
Last Updated
February 24, 2020
Sponsor
Northwestern University
Collaborators
Cephalon, CTI BioPharma
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1. Study Identification

Unique Protocol Identification Number
NCT00275067
Brief Title
Arsenic Trioxide, Temozolomide, and Radiation Therapy in Treating Patients With Malignant Glioma That Has Been Removed By Surgery
Official Title
A Phase I/II Trial of Arsenic Trioxide and Temozolomide in Combination With Radiation Therapy for Patients With Malignant Gliomas
Study Type
Interventional

2. Study Status

Record Verification Date
February 2020
Overall Recruitment Status
Unknown status
Study Start Date
May 2005 (undefined)
Primary Completion Date
May 2021 (Anticipated)
Study Completion Date
May 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Northwestern University
Collaborators
Cephalon, CTI BioPharma

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy, such as arsenic trioxide and temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving arsenic trioxide and temozolomide together with radiation therapy after surgery may kill any remaining tumor cells. PURPOSE: This phase I/II trial is studying the side effects and best dose of arsenic trioxide and temozolomide when given together with radiation therapy and to see how well they work in treating patients with malignant glioma that has been removed by surgery.
Detailed Description
OBJECTIVES: Primary Determine the maximum tolerated dose (MTD) of arsenic trioxide and temozolomide when combined with radiotherapy in patients with resected supratentorial malignant glioma. (Phase I) Determine the toxicity of this regimen in these patients. (Phase I) Secondary Determine the 6- and 12-month progression-free survival of patients treated with this regimen once an MTD is reached. (Phase II) Determine the radiographic response for patients treated with the above regimen. (Phase II) Determine the safety of this regimen in these patients. (Phase II) OUTLINE: This is a phase I, dose-escalation study of arsenic trioxide and temozolomide followed by a phase II study. Phase I: Patients undergo radiotherapy once daily 5 days a week and receive oral temozolomide once daily for approximately 6½ weeks. Patients also receive arsenic trioxide IV over 1-4 hours once daily, 5 days a week in week 1 and then twice a week in weeks 2-7. Beginning within 3-5 weeks after completion of radiotherapy, patients receive oral temozolomide once daily on days 1-5. Treatment with temozolomide repeats every 28 days for up to 1 year in the absence of disease progression and unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of arsenic trioxide and temozolomide until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 1 of 3 or 2 of 6 patients experience dose-limiting toxicity. Phase II: Patients undergo radiotherapy and receive arsenic trioxide and temozolomide as in phase I at the MTD. Patients then receive temozolomide as in phase I for up to 1 year in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed periodically for 1 year. PROJECTED ACCRUAL: A total of 12-18 patients will be accrued for the phase I portion of this study. A total of 25 patients will be accrued for the phase II portion of this study.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Brain and Central Nervous System Tumors
Keywords
adult anaplastic astrocytoma, adult gliosarcoma, adult anaplastic oligodendroglioma, adult mixed glioma, adult glioblastoma, adult giant cell glioblastoma, recurrent adult brain tumor

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
50 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Radiation + temozolomide and arsenic trioxide
Arm Type
Experimental
Arm Description
Radiation therapy followed by the combination of temozolomide and arsenic trioxide at the maximum tolerated dose determined in phase 1
Intervention Type
Drug
Intervention Name(s)
arsenic trioxide
Other Intervention Name(s)
ATO, TRISENOX
Intervention Description
Arsenic trioxide administered intravenously at a dose of 0.20mg/kg Daily x 5 week then twice per week
Intervention Type
Drug
Intervention Name(s)
temozolomide
Other Intervention Name(s)
TMZ, Temodar
Intervention Description
Temozolomide administered orally once per day 1 hour prior to radiation therapy at a dose of 75 mg/m2 x 42 days; at a dose of 200mg/m2 for 5 days every cycle (1 cycle = 28 days) after radiation therapy
Intervention Type
Radiation
Intervention Name(s)
radiation therapy
Intervention Description
All patients will receive 5940-6120 cGy of radiation therapy as 28-33 treatments/fractions (180-200 cGy/treatment) depending on whether they receive standard 3-D conformal radiation therapy or intensity modulated radiation therapy.
Primary Outcome Measure Information:
Title
Maximum tolerated dose of arsenic trioxide and temozolomide in combination with radiotherapy
Description
Escalating doses of study drug until dose limiting toxicities are observed.
Time Frame
Toxicity evaluated prior to each treatment cycle
Title
Collect data on the toxicity of arsenic and temozolomide during radiation therapy
Description
Toxicity of this drug combination during radiation therapy will be assessed.
Time Frame
Toxicity evaluated prior to each treatment cycle
Title
Assess serum biomarkers and correlate with tumor tissue
Description
Blood will be drawn at baseline, during radiation therapy, and prior to each cycle of chemotherapy to assess serum biomarkers and correlate with tumor tissue.
Time Frame
At baseline, during radiation therapy, and prior to each cycle of chemotherapy
Secondary Outcome Measure Information:
Title
Determine progression free survival at 6 and 12 months
Description
Patients will undergo an MRI and neurological evaluation every 6 months while on chemotherapy.
Time Frame
At 6 and 12 months after beginning chemotherapy
Title
Determine time to disease progression
Description
Disease status will be assessed by MRI and neurological examination every 6 months until disease progression.
Time Frame
At 6 and 12 months after beginning chemotherapy
Title
To determine overall survival
Description
Survival status will be evaluated every 6 months while on treatment.
Time Frame
Every 6 months while on treatment
Title
To determine radiographic response to study regimen
Description
Radiographic response will be assessed by MRI every 6 months while on treatment
Time Frame
Every 6 months while on treatment
Title
To collect safety data during the radiation therapy phase
Description
EKG's will be done once per week and labs twice per week during radiation therapy phase to evaluate safety data.
Time Frame
Weekly during radiation therapy
Title
To evaluate a potential surrogate marker for outcomes
Description
Blood will be drawn to analyze methylation patterns as a surrogate marker for outcomes at baseline, before and after radiation therapy, and every 2 cycles during chemotherapy.
Time Frame
At baseline, before and after radiation therapy, and every 2 cycles during chemotherapy

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed supratentorial malignant glioma of 1 of the following types: Glioblastoma multiforme Gliosarcoma Anaplastic astrocytoma Anaplastic oligodendroglioma Anaplastic mixed gliomas Anaplastic gliomas not otherwise specified Has undergone surgical resection of tumor Patients with biopsy only are eligible Evaluable or measurable disease following resection of recurrent tumor is not mandated for entry into the study No brain metastases PATIENT CHARACTERISTICS: Karnofsky performance status 60-100% Life expectancy > 3 months WBC > 3,000/mm^3 Absolute neutrophil count > 2,000/mm^3 Platelet count > 100,000/mm^3 Hemoglobin > 10 g/dL (eligibility level for hemoglobin may be reached by transfusion) Creatinine ≤ 1.5 mg/dL Bilirubin ≤ 2 mg/dL Transaminases ≤ 2 times the upper limit of normal Serum potassium* > 4.0 mEq/dL Serum magnesium* > 1.8 mg/dL NOTE: *If these serum electrolytes are below the specified limits on the baseline laboratory tests, supplemental electrolytes should be administered to bring the serum concentrations to these levels before administering arsenic trioxide Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 3 months after completion of study treatment No second-degree heart block QT interval ≤ 460 msec No other malignancy within the past 3 years except curatively treated carcinoma in situ or basal cell carcinoma of the skin Patients who cannot undergo MRI are not eligible for this study No other serious concurrent infection or other medical illness that would jeopardize the ability of the patient to receive the therapy in this protocol with reasonable safety PRIOR CONCURRENT THERAPY: See Disease Characteristics Patients must have recovered from the effects of surgery prior to the start of treatment (10-14 days minimum) and be maintained on a stable corticosteroid regimen for 5 days Concurrent glucocorticoid therapy allowed at the smallest effective dose Patients must be on non-enzyme-inducing anti-convulsants to minimize any drug reaction No prior radiation therapy, chemotherapy, immunotherapy, therapy with biologic agents (including immunotoxins, immunoconjugates, antisense agents, peptide receptor antagonists, interferons, interleukins, tumor-infiltrating lymphocytes, lymphokine-activated killer cells, or gene therapy), or hormonal therapy for their brain tumor
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jeffrey Raizer, MD
Organizational Affiliation
Northwestern University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hematology-Oncology Associates of Illinois
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611-2998
Country
United States
Facility Name
Robert H. Lurie Comprehensive Cancer Center at Northwestern University
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611-3013
Country
United States
Facility Name
Edward Cancer Center
City
Naperville
State/Province
Illinois
ZIP/Postal Code
60540
Country
United States

12. IPD Sharing Statement

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Arsenic Trioxide, Temozolomide, and Radiation Therapy in Treating Patients With Malignant Glioma That Has Been Removed By Surgery

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