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Radiation Therapy and Temsirolimus or Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma

Primary Purpose

Brain and Central Nervous System Tumors

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
temozolomide
temsirolimus
Sponsored by
European Organisation for Research and Treatment of Cancer - EORTC
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 glioblastoma

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS:

  • Histologically confirmed (by open brain biopsy or from a neurosurgical resection of the tumor) supratentorial glioblastoma multiforme (GBM)

    • WHO grade IV disease
    • Newly diagnosed disease
  • Must provide demonstration of an unmethylated MGMT-promoter
  • At least 2 weeks and no more than 6 weeks since surgery or open biopsy
  • Tumor tissue specimens (paraffin-embedded and/or frozen) from the GBM surgery or open biopsy must be available for central pathology review, MGMT status determination, and exploratory analysis of PI3-K/Akt/mTOR targets (P70S6K)

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • Life expectancy ≥ 12 weeks
  • WBC ≥ 3.0 x 10^9/L
  • Absolute neutrophil count ≥ 1.5 x10^9/L
  • Platelet count ≥ 75.0 x 10^9/L
  • Hemoglobin ≥ 10.0 g/dL
  • Bilirubin ≤ 1.5 times the upper limit of normal (ULN)
  • Alkaline phosphatase ≤ 2.5 x ULN
  • AST and/or ALT ≤ 2.5 x ULN
  • Serum creatinine < 1.5 x ULN
  • PT and PTT normal
  • Negative pregnancy test
  • Not pregnant or nursing
  • Fertile patients must use highly effective contraception
  • No ischemic heart disease in the past 6 months
  • 12-lead ECG normal
  • No history of stroke
  • No psychological, familial, sociological, or geographical condition potentially hampering compliance with the study protocol and follow-up schedule
  • No other malignancy within the past 5 years except adequately treated carcinoma in situ of the cervix or nonmelanoma skin cancer (with no subsequent evidence of recurrence)
  • No serious concurrent systemic disorder including any of the following that, in the opinion of the investigator, would compromise the patient's ability to adhere to the protocol:

    • Active infection
    • HIV infection
    • Cardiac disease
    • QTc prolongation > 450/470 msec (males/females)
    • No patients with a congenital long-QT-syndrome in their own or family medical history, unless eligible at the investigator's discretion
  • No known hypersensitivity to the study treatment
  • No known hypersensitivity to antihistamines or other medical reason that prohibits the intake of antihistamines
  • No current alcohol dependence or drug abuse
  • No legal incapacity or limited legal capacity
  • Able to undergo a gadolinium-enhanced MRI of the brain

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • At least 4 weeks since prior and no concurrent investigational agent
  • No prior stereotactic biopsy
  • At least 30 days since prior drug therapy that has not received regulatory approval for any indication
  • No chemotherapy within the past 5 years
  • No prior chemotherapy for a brain tumor
  • No prior radiotherapy to the head
  • No other concurrent anticancer therapy
  • No concurrent anticoagulation therapy except low-dose prophylactic low molecular weight heparin
  • Concurrent steroid therapy allowed provided patient is on a stable or decreasing dose for ≥ 1 week
  • At least 14 days since prior and no concurrent enzyme-inducing anticonvulsants (e.g., carbamazepine, phenobarbital, and phenytoin)
  • No concurrent strong inducers or inhibitors of CYP3A4
  • No concurrent planned surgery for other diseases (e.g., dental extraction)
  • No placement of Gliadel® wafer during prior surgery

Sites / Locations

  • UZ Leuven
  • Institut de Cancerologie de l'Ouest (ICO) - Centre Rene Gauducheau
  • CHU Pitie-Salpetriere AP-HP
  • Universitaetsklinikum Freiburg
  • Universitatsklinikum Heidelberg
  • Ospedale Bellaria
  • Medisch Centrum Haaglanden - Westeinde
  • Erasmus MC - Daniel den Hoed Cancer Center
  • ICO Badalona - Hospital Germans Trias i Pujol
  • Ospedale Regionale Bellinzona e Valli
  • UniversitaetsSpital Zuerich
  • Clatterbridge Cancer Centre NHS Foundation Trust
  • Western General Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Other

Experimental

Arm Label

Temozolomide

Temsirolimus

Arm Description

TMZ will be given at 75 mg/m2 daily for the whole period of RT including weekends as registered.

CCI-779 will be given i.v. once every week at 25 mg. Each treatment should be preceded by supportive medication with a histamine H2-receptor antagonist. A first dose of CCI-779, being 25 mg, will be given on day -7 from RT start.

Outcomes

Primary Outcome Measures

Overall survival at 1 year

Secondary Outcome Measures

Percentages of worst Adverse Events or Laboratory Event grades as measured by CTCAEs Version 4.0 criteria
Progression-free survival (PFS) probability at 6 months and at 12 months, and overall survival (OS) probability at 2 years
Correlation between biomarkers relevant to temsirolimus and PFS and OS

Full Information

First Posted
November 24, 2009
Last Updated
July 6, 2018
Sponsor
European Organisation for Research and Treatment of Cancer - EORTC
Collaborators
Pfizer
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1. Study Identification

Unique Protocol Identification Number
NCT01019434
Brief Title
Radiation Therapy and Temsirolimus or Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma
Official Title
Radiation Therapy and Concurrent Plus Adjuvant Temsirolimus (CCI-779) Versus Chemo-Irradiation With Temozolomide in Newly Diagnosed Glioblastoma Without Methylation of the MGMT Gene Promoter - A Randomized Multicenter, Open-Label, Phase II Study.
Study Type
Interventional

2. Study Status

Record Verification Date
July 2018
Overall Recruitment Status
Completed
Study Start Date
October 2009 (undefined)
Primary Completion Date
December 2013 (Actual)
Study Completion Date
March 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
European Organisation for Research and Treatment of Cancer - EORTC
Collaborators
Pfizer

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Temsirolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. It is not yet known whether radiation therapy is more effective when given together with temsirolimus or temozolomide in treating patients with glioblastoma. PURPOSE: This randomized phase II trial is studying giving radiation therapy together with temsirolimus to see how well it works compared with giving radiation therapy together with temozolomide in treating patients with newly diagnosed glioblastoma.
Detailed Description
OBJECTIVES: Primary Document the activity profile of temsirolimus by the evaluation of overall survival at 1 year in patients with newly diagnosed glioblastoma multiforme, without methylation of the MGMT gene promoter, treated with temsirolimus before and concomitantly with radiotherapy, followed by temsirolimus maintenance therapy. Secondary Investigate safety and tolerability of this therapy regimen in these patients. Assess progression-free survival and overall survival of these patients. Assess biomarkers in the tumor tissue relevant to temsirolimus and disease state, and their correlation to clinical outcome in these patients. OUTLINE: This is a multicenter study. Patients are stratified according to institution, age in years (< 50 vs ≥ 50), Karnofsky performance status (PS) (< 80% vs ≥ 80%) OR ECOG PS (0 or 1 vs 2), and corticosteroid use (yes vs no). Patients are randomized to 1 of 2 treatment arms. Arm I: Within 7 weeks after surgery or open biopsy, patients undergo radiotherapy 5 days a week for 6 weeks and receive oral temozolomide concurrently once daily for 6 weeks. Beginning 4 weeks after completion of concurrent chemoradiotherapy, patients receive adjuvant oral temozolomide once daily on days 1-5. Treatment with adjuvant temozolomide repeats every 28 days for up to 12 courses in the absence of disease progression and unacceptable toxicity. Arm II: Within 7 weeks after surgery or open biopsy, patients undergo radiotherapy 5 days a week for 6 weeks. Patients also receive temsirolimus IV over 30-60 minutes once weekly beginning 7 days before initiation of radiotherapy. After completion of chemoradiotherapy, patients receive maintenance temsirolimus IV once weekly in the absence of disease progression and unacceptable toxicity. Frozen tumor biopsies or paraffin-embedded tumor material obtained from surgery or open biopsy and blood samples are collected for analysis of molecular markers, determination of the methylation status of the MGMT gene promoter (before randomization and at a later time), and other studies. After completion of study therapy, patients are followed every 3 months.

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 glioblastoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
111 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Temozolomide
Arm Type
Other
Arm Description
TMZ will be given at 75 mg/m2 daily for the whole period of RT including weekends as registered.
Arm Title
Temsirolimus
Arm Type
Experimental
Arm Description
CCI-779 will be given i.v. once every week at 25 mg. Each treatment should be preceded by supportive medication with a histamine H2-receptor antagonist. A first dose of CCI-779, being 25 mg, will be given on day -7 from RT start.
Intervention Type
Drug
Intervention Name(s)
temozolomide
Intervention Description
TMZ will be given at 75 mg/m2 daily for the whole period of RT including weekends as registered.
Intervention Type
Drug
Intervention Name(s)
temsirolimus
Intervention Description
CCI-779 will be given i.v. once every week at 25 mg. Each treatment should be preceded by supportive medication with a histamine H2-receptor antagonist. A first dose of CCI-779, being 25 mg, will be given on day -7 from RT start.
Primary Outcome Measure Information:
Title
Overall survival at 1 year
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Percentages of worst Adverse Events or Laboratory Event grades as measured by CTCAEs Version 4.0 criteria
Time Frame
end of trial
Title
Progression-free survival (PFS) probability at 6 months and at 12 months, and overall survival (OS) probability at 2 years
Time Frame
end of trial
Title
Correlation between biomarkers relevant to temsirolimus and PFS and OS
Time Frame
end of trial

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed (by open brain biopsy or from a neurosurgical resection of the tumor) supratentorial glioblastoma multiforme (GBM) WHO grade IV disease Newly diagnosed disease Must provide demonstration of an unmethylated MGMT-promoter At least 2 weeks and no more than 6 weeks since surgery or open biopsy Tumor tissue specimens (paraffin-embedded and/or frozen) from the GBM surgery or open biopsy must be available for central pathology review, MGMT status determination, and exploratory analysis of PI3-K/Akt/mTOR targets (P70S6K) PATIENT CHARACTERISTICS: ECOG performance status 0-2 Life expectancy ≥ 12 weeks WBC ≥ 3.0 x 10^9/L Absolute neutrophil count ≥ 1.5 x10^9/L Platelet count ≥ 75.0 x 10^9/L Hemoglobin ≥ 10.0 g/dL Bilirubin ≤ 1.5 times the upper limit of normal (ULN) Alkaline phosphatase ≤ 2.5 x ULN AST and/or ALT ≤ 2.5 x ULN Serum creatinine < 1.5 x ULN PT and PTT normal Negative pregnancy test Not pregnant or nursing Fertile patients must use highly effective contraception No ischemic heart disease in the past 6 months 12-lead ECG normal No history of stroke No psychological, familial, sociological, or geographical condition potentially hampering compliance with the study protocol and follow-up schedule No other malignancy within the past 5 years except adequately treated carcinoma in situ of the cervix or nonmelanoma skin cancer (with no subsequent evidence of recurrence) No serious concurrent systemic disorder including any of the following that, in the opinion of the investigator, would compromise the patient's ability to adhere to the protocol: Active infection HIV infection Cardiac disease QTc prolongation > 450/470 msec (males/females) No patients with a congenital long-QT-syndrome in their own or family medical history, unless eligible at the investigator's discretion No known hypersensitivity to the study treatment No known hypersensitivity to antihistamines or other medical reason that prohibits the intake of antihistamines No current alcohol dependence or drug abuse No legal incapacity or limited legal capacity Able to undergo a gadolinium-enhanced MRI of the brain PRIOR CONCURRENT THERAPY: See Disease Characteristics At least 4 weeks since prior and no concurrent investigational agent No prior stereotactic biopsy At least 30 days since prior drug therapy that has not received regulatory approval for any indication No chemotherapy within the past 5 years No prior chemotherapy for a brain tumor No prior radiotherapy to the head No other concurrent anticancer therapy No concurrent anticoagulation therapy except low-dose prophylactic low molecular weight heparin Concurrent steroid therapy allowed provided patient is on a stable or decreasing dose for ≥ 1 week At least 14 days since prior and no concurrent enzyme-inducing anticonvulsants (e.g., carbamazepine, phenobarbital, and phenytoin) No concurrent strong inducers or inhibitors of CYP3A4 No concurrent planned surgery for other diseases (e.g., dental extraction) No placement of Gliadel® wafer during prior surgery
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Wolfgang Wick
Organizational Affiliation
Universitatsklinikum Heidelberg
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Gianfranco Pesce, MD
Organizational Affiliation
Istituto Oncologico della Svizzera Italiana - Ospedale San Giovanni
Official's Role
Study Chair
Facility Information:
Facility Name
UZ Leuven
City
Leuven
Country
Belgium
Facility Name
Institut de Cancerologie de l'Ouest (ICO) - Centre Rene Gauducheau
City
Nantes-Saint Herblain
ZIP/Postal Code
44805
Country
France
Facility Name
CHU Pitie-Salpetriere AP-HP
City
Paris
ZIP/Postal Code
FR 75651
Country
France
Facility Name
Universitaetsklinikum Freiburg
City
Freiburg
ZIP/Postal Code
DE 79106
Country
Germany
Facility Name
Universitatsklinikum Heidelberg
City
Heidelberg
ZIP/Postal Code
D-69120
Country
Germany
Facility Name
Ospedale Bellaria
City
Bologna
ZIP/Postal Code
I-40139
Country
Italy
Facility Name
Medisch Centrum Haaglanden - Westeinde
City
Den Haag
ZIP/Postal Code
NL 2501
Country
Netherlands
Facility Name
Erasmus MC - Daniel den Hoed Cancer Center
City
Rotterdam
ZIP/Postal Code
NL 3008
Country
Netherlands
Facility Name
ICO Badalona - Hospital Germans Trias i Pujol
City
Badalona
ZIP/Postal Code
ES 08916
Country
Spain
Facility Name
Ospedale Regionale Bellinzona e Valli
City
Bellinzona
Country
Switzerland
Facility Name
UniversitaetsSpital Zuerich
City
Zurich
ZIP/Postal Code
CH-8091
Country
Switzerland
Facility Name
Clatterbridge Cancer Centre NHS Foundation Trust
City
Bebington
State/Province
Wirral
Country
United Kingdom
Facility Name
Western General Hospital
City
Edinburgh
Country
United Kingdom

12. IPD Sharing Statement

Learn more about this trial

Radiation Therapy and Temsirolimus or Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma

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