NovoTTF-100A With Bevacizumab (Avastin) in Patients With Recurrent Glioblastoma
Primary Purpose
Adult Giant Cell Glioblastoma, Adult Glioblastoma, Adult Gliosarcoma
Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Bevacizumab
NovoTTF-l00A
Quality of Life Assessment
Sponsored by
About this trial
This is an interventional treatment trial for Adult Giant Cell Glioblastoma focused on measuring adult giant cell glioblastoma, adult glioblastoma, adult gliosarcoma, recurrent adult brain tumor, Bevacizumab-naive, NovoTTF-100A
Eligibility Criteria
Inclusion Criteria:
- Patients with histologically confirmed glioblastoma or other grade IV malignant glioma (i.e. gliosarcoma, small cell glioblastoma, etc.), recurrent after prior external-beam fractionated radiotherapy and temozolomide chemotherapy.
- Patients with up to two prior recurrences are allowed.
- Karnofsky performance status ≥70.
Patients must have the following laboratory values:
- Absolute neutrophil count (ANC) ≥1.5 x 10^9/L
- Platelets ≥ 100 x 10^9/L
- Hemoglobin (Hgb) > 9 g/dL
- Serum total bilirubin: ≤ 1.5 x ULN
- ALT and AST ≤ 3.0 x ULN
- Serum creatinine ≤ 1.5 x ULN
- Blood coagulation parameters: INR ≤ 1.5
- Minimum interval since completion of radiation treatment is 12 weeks
Minimum interval since last drug therapy:
- 3 weeks since last non-cytotoxic therapy
- 3 weeks must have elapsed since the completion of a non-nitrosourea-containing chemotherapy regimen
- 6 weeks since the completion of a nitrosourea-containing chemotherapy regimen.
- Patients must have signed an approved informed consent and authorization permitting release of personal health information.
- Patients with the potential for pregnancy or impregnating their partner must agree to follow acceptable birth control methods to avoid conception. The effects of bevacizumab on developing fetus or nursing infant are not known. Female patients of child-bearing potential must have a negative pregnancy test.
- Patients must have no concurrent malignancy except curatively treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix and breast, adequately treated stage I or II cancer from which the patient is in complete remission. Patients with other prior malignancies must be disease-free for ≥ three years.
- Patients must be maintained on a stable corticosteroid regimen from the time of their baseline scan until the start of treatment and/or for at least 5 days before starting treatment.
Exclusion Criteria:
- Patients who have had previous treatment with bevacizumab, and or NovoTTF 100A system.
- Patients who have undergone major surgery (e.g. intra-thoracic, intra-abdominal or intra-pelvic), open biopsy or significant traumatic injury ≤ 4 weeks prior to starting study drug, or patients who have had minor procedures, percutaneous biopsies or placement of vascular access device ≤1 week prior to starting study drug, or who have not recovered from side effects of such procedure or injury
Patients with impaired cardiac function or clinically significant cardiac diseases, including any of the following:
- History or presence of serious uncontrolled ventricular arrhythmias
- Any of the following within 6 months prior to starting study drug: myocardial infarction (MI), severe/unstable angina, Coronary Artery Bypass Graft (CABG), Congestive Heart Failure (CHF), Cerebrovascular Accident (CVA), Transient Ischemic Attack (TIA), Pulmonary Embolism (PE)
- Uncontrolled hypertension (defined by a systolic blood pressure (SBP) ≥ 160 mm Hg or diastolic blood pressure (DBP) ≥ 100 mm Hg while on anti-hypertensive medications)
- Patients with cirrhosis, or active viral or nonviral hepatitis.
- Implanted pacemaker, defibrillator or deep brain stimulator, other implanted electronic devices in the brain or documented clinically significant arrhythmias.
- Infra-tentorial tumor
- Evidence of increased intracranial pressure (clinically significant papilledema, vomiting and nausea or reduced level of consciousness)
- Known sensitivity to conductive hydrogels
- Known diagnosis of human immunodeficiency virus (HIV) infection (HIV testing is not mandatory)
- Other concurrent severe and/or uncontrolled concomitant medical conditions (e.g. active or uncontrolled infection, uncontrolled diabetes) that could cause unacceptable safety risks or compromise compliance with the protocol
- Pregnant or breast-feeding women
- Patients unwilling or unable to comply with the protocol
- Patients with leptomeningeal disease
Sites / Locations
- University of Cincinnati
- University Hospitals Cleveland Medical Center, Seidman Cancer Center, Case Comprehensive Cancer Center
- Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Bevacizumab and NovoTTF-100A
Arm Description
Bevacizumab will be administered intravenously on days 1 and 15 of each 28 day cycle.The dose of bevacizumab will be 10 mg/kg of actual body weight.
Outcomes
Primary Outcome Measures
Progression Free Survival (PFS)
Number of patients that achieve progression free survival by Kaplan Meier methodology.
Secondary Outcome Measures
Objective response rate based on RANO Criteria
Response will be scored based on a combination of imaging and clinical features as defined by the modified Response Assessment in Neuro-Oncology (RANO) criteria. http://www.iconplc.com/services/imaging/central-imaging-core-lab-/regulatory-expertise/IMI-RANO-Criteria-Booklet-Nov-2011.pdf
Number of patients that experience toxicities with this combination of therapies
Safety and tolerability of combination of bevacizumab and NovoTTF-l00A in this population by CTCAE version 4.0.
Median overall survival
To assess time-to-progression
Median time to progression by Kaplan Meier methodology.
Neurocognitive function (NCF)
Time to reliable change (decline) in neurocognitive function by Kaplan Meier methodology. Memory, verbal fluency, visual-motor speed, executive function and motor dexterity tests will be administered.
Quality of Life (QOL)
Based on the Functional Assessment of Cancer Therapy including Brain Tumor module (FACT-Br) questionnaire
Full Information
NCT ID
NCT01894061
First Posted
July 3, 2013
Last Updated
July 22, 2020
Sponsor
Case Comprehensive Cancer Center
Collaborators
NovoCure Ltd., National Cancer Institute (NCI)
1. Study Identification
Unique Protocol Identification Number
NCT01894061
Brief Title
NovoTTF-100A With Bevacizumab (Avastin) in Patients With Recurrent Glioblastoma
Official Title
A Prospective Phase II Trial of NovoTTF-100A With Bevacizumab (Avastin) in Patients With Recurrent Glioblastoma
Study Type
Interventional
2. Study Status
Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
June 12, 2013 (Actual)
Primary Completion Date
July 28, 2019 (Actual)
Study Completion Date
July 28, 2019 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Case Comprehensive Cancer Center
Collaborators
NovoCure Ltd., National Cancer Institute (NCI)
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
NovoTTF-100A is a device and Bevacizumab is a study drug that have both been approved by the FDA (Food and Drug Administration) for use as monotherapy in treating glioblastoma multiforme. The NovoTTF-l00A is a portable battery operated device which produces TTFields within the human body using surface electrodes (transducer arrays). Intermediate frequency electric fields (TTFields) stunt the growth of tumor cells.
The purpose of this study is to determine the efficacy of the combination of Bevacizumab and NovoTTF-100A in Bevacizumab naive (meaning have never received bevacizumab before) patients with recurrent glioblastoma (GBM) as measured by 6-month progression free survival.
Detailed Description
This will be an open label Phase II trial in adults with recurrent glioblastoma (GBM). The NovoTTF-100A treatment and Bevacizumab will be administered on an outpatient basis; NovoTTF-100A treatment will be initiated in the outpatient clinic.
PRIMARY OBJECTIVES:
I. To determine the efficacy of the combination of bevacizumab and NovoTTF-100A in bevacizumab-naive patients with recurrent glioblastoma (GBM) as measured by 6-month progression-free survival (PFS6).
SECONDARY OBJECTIVES:
I. To assess safety and tolerability of the combination of bevacizumab and Novo-TTF-100A in this patient population.
II. To evaluate overall survival in this population. III. To determine objective response rate (ORR) by modified Revised Assessment in Neuro-Oncology (RANO) criteria in this population.
IV. To assess time-to-progression in this population. V. To assess neurocognitive function (NCF) and quality of life (QOL) in this population.
OUTLINE:
Patients receive bevacizumab intravenously (IV) on days 1 and 15. Patients also undergo electric field therapy with NovoTTF-100A for at least 18 hours daily. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up for at least 28 days.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adult Giant Cell Glioblastoma, Adult Glioblastoma, Adult Gliosarcoma, Recurrent Adult Brain Tumor
Keywords
adult giant cell glioblastoma, adult glioblastoma, adult gliosarcoma, recurrent adult brain tumor, Bevacizumab-naive, NovoTTF-100A
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
25 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Bevacizumab and NovoTTF-100A
Arm Type
Experimental
Arm Description
Bevacizumab will be administered intravenously on days 1 and 15 of each 28 day cycle.The dose of bevacizumab will be 10 mg/kg of actual body weight.
Intervention Type
Biological
Intervention Name(s)
Bevacizumab
Other Intervention Name(s)
Avastin, anti-VEGF humanized monoclonal antibody, anti-VEGF monoclonal antibody, anti-VEGF rhuMAb, recombinant humanized anti-VEGF monoclonal antibody, rhuMAb VEGF
Intervention Description
Bevacizumab will be administered intravenously on days 1 and 15 of each 28 day cycle. The dose of bevacizumab will be 10 mg/kg of actual body weight.
Intervention Type
Device
Intervention Name(s)
NovoTTF-l00A
Other Intervention Name(s)
electric field therapy
Intervention Description
NovoTTF-100A will be worn continuously.
Intervention Type
Other
Intervention Name(s)
Quality of Life Assessment
Other Intervention Name(s)
FACT-Br questionnaire
Intervention Description
Functional Assessment of Cancer Therapy including Brain Tumor module (FACT-Br) questionnaire
Primary Outcome Measure Information:
Title
Progression Free Survival (PFS)
Description
Number of patients that achieve progression free survival by Kaplan Meier methodology.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Objective response rate based on RANO Criteria
Description
Response will be scored based on a combination of imaging and clinical features as defined by the modified Response Assessment in Neuro-Oncology (RANO) criteria. http://www.iconplc.com/services/imaging/central-imaging-core-lab-/regulatory-expertise/IMI-RANO-Criteria-Booklet-Nov-2011.pdf
Time Frame
30 days after treatment completion
Title
Number of patients that experience toxicities with this combination of therapies
Description
Safety and tolerability of combination of bevacizumab and NovoTTF-l00A in this population by CTCAE version 4.0.
Time Frame
30 days after treatment completion
Title
Median overall survival
Time Frame
30 days after treatment completion
Title
To assess time-to-progression
Description
Median time to progression by Kaplan Meier methodology.
Time Frame
30 days after treatment completion
Title
Neurocognitive function (NCF)
Description
Time to reliable change (decline) in neurocognitive function by Kaplan Meier methodology. Memory, verbal fluency, visual-motor speed, executive function and motor dexterity tests will be administered.
Time Frame
30 days after treatment completion
Title
Quality of Life (QOL)
Description
Based on the Functional Assessment of Cancer Therapy including Brain Tumor module (FACT-Br) questionnaire
Time Frame
30 days after treatment completion
10. Eligibility
Sex
All
Minimum Age & Unit of Time
22 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patients with histologically confirmed glioblastoma or other grade IV malignant glioma (i.e. gliosarcoma, small cell glioblastoma, etc.), recurrent after prior external-beam fractionated radiotherapy and temozolomide chemotherapy.
Patients with up to two prior recurrences are allowed.
Karnofsky performance status ≥70.
Patients must have the following laboratory values:
Absolute neutrophil count (ANC) ≥1.5 x 10^9/L
Platelets ≥ 100 x 10^9/L
Hemoglobin (Hgb) > 9 g/dL
Serum total bilirubin: ≤ 1.5 x ULN
ALT and AST ≤ 3.0 x ULN
Serum creatinine ≤ 1.5 x ULN
Blood coagulation parameters: INR ≤ 1.5
Minimum interval since completion of radiation treatment is 12 weeks
Minimum interval since last drug therapy:
3 weeks since last non-cytotoxic therapy
3 weeks must have elapsed since the completion of a non-nitrosourea-containing chemotherapy regimen
6 weeks since the completion of a nitrosourea-containing chemotherapy regimen.
Patients must have signed an approved informed consent and authorization permitting release of personal health information.
Patients with the potential for pregnancy or impregnating their partner must agree to follow acceptable birth control methods to avoid conception. The effects of bevacizumab on developing fetus or nursing infant are not known. Female patients of child-bearing potential must have a negative pregnancy test.
Patients must have no concurrent malignancy except curatively treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix and breast, adequately treated stage I or II cancer from which the patient is in complete remission. Patients with other prior malignancies must be disease-free for ≥ three years.
Patients must be maintained on a stable corticosteroid regimen from the time of their baseline scan until the start of treatment and/or for at least 5 days before starting treatment.
Exclusion Criteria:
Patients who have had previous treatment with bevacizumab, and or NovoTTF 100A system.
Patients who have undergone major surgery (e.g. intra-thoracic, intra-abdominal or intra-pelvic), open biopsy or significant traumatic injury ≤ 4 weeks prior to starting study drug, or patients who have had minor procedures, percutaneous biopsies or placement of vascular access device ≤1 week prior to starting study drug, or who have not recovered from side effects of such procedure or injury
Patients with impaired cardiac function or clinically significant cardiac diseases, including any of the following:
History or presence of serious uncontrolled ventricular arrhythmias
Any of the following within 6 months prior to starting study drug: myocardial infarction (MI), severe/unstable angina, Coronary Artery Bypass Graft (CABG), Congestive Heart Failure (CHF), Cerebrovascular Accident (CVA), Transient Ischemic Attack (TIA), Pulmonary Embolism (PE)
Uncontrolled hypertension (defined by a systolic blood pressure (SBP) ≥ 160 mm Hg or diastolic blood pressure (DBP) ≥ 100 mm Hg while on anti-hypertensive medications)
Patients with cirrhosis, or active viral or nonviral hepatitis.
Implanted pacemaker, defibrillator or deep brain stimulator, other implanted electronic devices in the brain or documented clinically significant arrhythmias.
Infra-tentorial tumor
Evidence of increased intracranial pressure (clinically significant papilledema, vomiting and nausea or reduced level of consciousness)
Known sensitivity to conductive hydrogels
Known diagnosis of human immunodeficiency virus (HIV) infection (HIV testing is not mandatory)
Other concurrent severe and/or uncontrolled concomitant medical conditions (e.g. active or uncontrolled infection, uncontrolled diabetes) that could cause unacceptable safety risks or compromise compliance with the protocol
Pregnant or breast-feeding women
Patients unwilling or unable to comply with the protocol
Patients with leptomeningeal disease
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Manmeet Ahluwalia, MD
Organizational Affiliation
Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
Official's Role
Study Chair
Facility Information:
Facility Name
University of Cincinnati
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45220
Country
United States
Facility Name
University Hospitals Cleveland Medical Center, Seidman Cancer Center, Case Comprehensive Cancer Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44106
Country
United States
Facility Name
Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
City
Cleveland
State/Province
Ohio
ZIP/Postal Code
44195
Country
United States
12. IPD Sharing Statement
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NovoTTF-100A With Bevacizumab (Avastin) in Patients With Recurrent Glioblastoma
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