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Subventricular Zone (SVZ) and Temozolomide in Glioblastoma Multiforme

Primary Purpose

Glioblastoma Multiforme

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Temozolomide
Subventricular Zone radiation
Neural Progenitor Cell Sparing radiation
Sponsored by
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Glioblastoma Multiforme focused on measuring Subventricular Zone, progenitor cell, radiation therapy, temozolomide

Eligibility Criteria

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

Inclusion Criteria:

  • Patient must have newly diagnosed, histologically confirmed GBM.
  • Patient must have undergone gross total resection, subtotal resection, or biopsy with the extent of resection determined by the treating neurosurgeon, and must begin radiation within 12 weeks of this procedure.
  • Patients must not have received previous irradiation to the brain.
  • Patient must be at least 18 years of age since the diagnosis of GBM in patients younger than 18 is rare and accurate evaluation of neurocognitive function would require a different battery of examinations than employed in this study.
  • ECOG performance status 0-2 (Karnofsky >60%; see Appendix A).
  • Patient must be scheduled to receive temozolomide concurrent with and following radiation (temozolomide may be started late due to insurance reasons, insufficient counts, or other reasons).
  • If a woman is of child-bearing potential, a negative urine or serum pregnancy test must be demonstrated prior to treatment. Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) for the duration of study participation and for up to 12 weeks following the study. Should a women become pregnant or suspect she is pregnant while participating in this study she should inform her treating physician immediately.
  • Patient must have the ability to understand and the willingness to sign a written informed consent document.
  • All patients must be informed of the investigational nature of this study and must be given written informed consent in accordance with institutional and federal guidelines.
  • Radiation therapy must begin within 12 weeks of surgery.

Exclusion Criteria:

  • 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.
  • Use of Avastin or another VEG-F inhibitor prior to progression is not permitted.

Sites / Locations

  • Sibley Memorial HospitalRecruiting
  • The SKCCC at Johns HopkinsRecruiting
  • Suburban HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Temozolomide plus radiation therapy to the tumor and SVZ

Temozolomide and neural progenitor cell sparing radiation

Arm Description

Patients will be scheduled to receive continuous daily temozolomide (75 mg per square meter of body surface area per day, 7 days per week from the first to the last day of radiation therapy), followed by 6 cycles of adjuvant temozolomide (150 to 200 mg per square meter for 5 days during each 28 day cycle). Patients will receive 60 Gy of radiation therapy in 30 fractions, 5 days per week using IMRT. The target delineation and treatment volumes will be as follows: Initial treatment plan will include the tumor bed and MRI changes based on T1 post gadolinium series and FLAIR series, plus the bilateral subventricular zone Will be prescribed to 46 Gy in 2 Gy fractions Cone down treatment plan will include the tumor bed, areas of contrast enhancement on T1 post gadolinium series MRI plus the ipsilateral subventricular zone Will be prescribed to 14 Gy in 2 Gy fractions

Patients will receive continuous daily temozolomide (75 mg per square meter of body surface area per day, 7 days per week from the first to the last day of radiation therapy), followed by 6 cycles of adjuvant temozolomide (150 to 200 mg per square meter for 5 days during each 28 day cycle). Patients will receive 60 Gy in 30 fractions, 5 days per week using IMRT. The target delineation and treatment volumes will be as follows: Initial treatment plan will include the tumor bed and MRI abnormalities based on T1 post gadolinium series and FLAIR series. Will be prescribed to 46 Gy in 2 Gy fractions Cone down treatment plan will include the tumor bed and MRI changes based on T1 post gadolinium series. Will be prescribed to 14 Gy in 2 Gy fractions

Outcomes

Primary Outcome Measures

Change from Baseline to Initial Progression
Compare progression-free survival in patients receiving subventricular zone irradiation for newly diagnosed glioblastoma multiforme versus patients receiving a radiation treatment plan that does not intentionally include this area.

Secondary Outcome Measures

Progression Free Survival
Compare of progression free survival in the subgroup of patients undergoing gross total resection followed by subventricular zone irradiation versus a treatment plan that does not intentionally include this area
Rate of Distant Brain Progression
Compare the rate of progression outside of the initial radiation treatment planning target volume in patients treated with subventricular zone irradiation versus a treatment plan that does not intentionally include this area
Multifocal Disease Development
Compare the rate of development of multifocal disease in patients treated with subventricular zone irradiation versus a treatment plan that does not intentionally include this area
Location of Disease Progression
Explore whether the location of progression in relationship to subventricular zone in patients treated with subventricular zone irradiation is different from patients receiving a treatment plan that does not intentionally include this area.
Neurocognitive Function Change from Baseline
Explore if the potential change from baseline to six and twelve months in neurocognitive function as measured by the Trail Making Test, Controlled Oral Word Association test (COWAT), Hopkins Verbal Learning Test-Revised, Digit Symbol Substitution Test is greater than in patients receiving subventricular zone irradiation versus a treatment plan that does not intentionally include this area
Composite Cognitive Function Change from Baseline
Evaluate composite cognitive function at 6 and 12 months following subventricular zone irradiation versus a treatment plan that does not intentionally include this area.
Cognitive Function Change from Baseline
Explore the change in neurocognitive function from baseline to six and twelve months following SVZ irradiation as measured by the Brief Visuospatial Memory Test-Revised, Digit Span, Trail Making Test, Controlled Oral Word Association test (COWAT), Hopkins Verbal Learning Test-Revised, Digit Symbol Substitution Test.
Quality of Life Change from Baseline
Evaluate quality of life following subventricular zone irradiation.
Acute and Late Toxicity Change from Baseline
Estimate if radiation-associated acute and late toxicity following subventricular zone irradiation is different from a treatment plan that does not intentionally include this area.
Pathologically Confirmed Necrosis Change from Baseline
Estimate if the rate of pathologically confirmed necrosis in patients treated with subventricular zone irradiation is greater than in patients receiving a treatment plan that does not intentionally deliver radiation dose to this area.
Pseudo-Progression Change from Baseline
Estimate if the rate of pseudo-progression within the first year of completion of subventricular zone irradiation is greater than in patients receiving a treatment plan that does no intentionally deliver radiation dose to this area
Overall Survival
Compare overall survival in patients treated with subventricular zone irradiation versus a treatment plan that does not intentionally include this area.

Full Information

First Posted
May 6, 2014
Last Updated
May 30, 2023
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
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1. Study Identification

Unique Protocol Identification Number
NCT02177578
Brief Title
Subventricular Zone (SVZ) and Temozolomide in Glioblastoma Multiforme
Official Title
A Randomized Phase II Study of Subventricular Zone (SVZ) Irradiation Plus Temozolomide in Newly Diagnosed Glioblastoma Multiforme
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 8, 2014 (Actual)
Primary Completion Date
December 2028 (Anticipated)
Study Completion Date
December 2032 (Anticipated)

3. Sponsor/Collaborators

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

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
In this study patients will be treated with 6 weeks of radiation therapy plus temozolomide chemotherapy according to the standard of care. However, the radiation treatment plan will be modified to deliver an higher than routine radiation dose to the subventricular zone which is an area of the brain that contains stem cells that some scientists believe may contribute to glioblastoma recurrence. The purpose of the study is to see if the tumor is controlled for a longer period of time in patients treated with this modified radiation technique than it is in patients treated with standard radiation therapy plus temozolomide chemotherapy.
Detailed Description
There is pre-clinical data to suggest that neural progenitor cells in the subventricular zone may play a role in glioblastoma recurrence. Retrospective studies in humans suggest potentially improved survival in patients who received high doses of radiation to the subventricular zone when compared with patients who received lower radiation doses to this area. The purpose of this study is to prospectively examine progression free survival in patients with newly diagnosed glioblastoma treated with adjuvant temozolomide plus a radiation treatment plan which intentionally prescribes radiation dose to both the tumor and the subventricular zone compared to patients treated with standard radiation therapy. 3 patients out of every 4 will be treated with the modified study radiation treatment and 1 patient out of every 4 will received a more standard radiation treatment plan.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Glioblastoma Multiforme
Keywords
Subventricular Zone, progenitor cell, radiation therapy, temozolomide

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Temozolomide plus radiation therapy to the tumor and SVZ
Arm Type
Experimental
Arm Description
Patients will be scheduled to receive continuous daily temozolomide (75 mg per square meter of body surface area per day, 7 days per week from the first to the last day of radiation therapy), followed by 6 cycles of adjuvant temozolomide (150 to 200 mg per square meter for 5 days during each 28 day cycle). Patients will receive 60 Gy of radiation therapy in 30 fractions, 5 days per week using IMRT. The target delineation and treatment volumes will be as follows: Initial treatment plan will include the tumor bed and MRI changes based on T1 post gadolinium series and FLAIR series, plus the bilateral subventricular zone Will be prescribed to 46 Gy in 2 Gy fractions Cone down treatment plan will include the tumor bed, areas of contrast enhancement on T1 post gadolinium series MRI plus the ipsilateral subventricular zone Will be prescribed to 14 Gy in 2 Gy fractions
Arm Title
Temozolomide and neural progenitor cell sparing radiation
Arm Type
Active Comparator
Arm Description
Patients will receive continuous daily temozolomide (75 mg per square meter of body surface area per day, 7 days per week from the first to the last day of radiation therapy), followed by 6 cycles of adjuvant temozolomide (150 to 200 mg per square meter for 5 days during each 28 day cycle). Patients will receive 60 Gy in 30 fractions, 5 days per week using IMRT. The target delineation and treatment volumes will be as follows: Initial treatment plan will include the tumor bed and MRI abnormalities based on T1 post gadolinium series and FLAIR series. Will be prescribed to 46 Gy in 2 Gy fractions Cone down treatment plan will include the tumor bed and MRI changes based on T1 post gadolinium series. Will be prescribed to 14 Gy in 2 Gy fractions
Intervention Type
Drug
Intervention Name(s)
Temozolomide
Intervention Description
Patients will be scheduled to receive continuous daily temozolomide (75 mg per square meter of body surface area per day, 7 days per week from the first to the last day of radiation therapy), followed by 6 cycles of adjuvant temozolomide (150 to 200 mg per square meter for 5 days during each 28 day cycle).
Intervention Type
Radiation
Intervention Name(s)
Subventricular Zone radiation
Intervention Description
Patients will receive 60 Gy in 30 fractions, 5 days per week using IMRT. The target delineation and treatment volumes will be as follows: Initial treatment plan: Will be prescribed to 46 Gy in 2 Gy fractions Cone down treatment plan: Will be prescribed to 14 Gy in 2 Gy fractions
Intervention Type
Radiation
Intervention Name(s)
Neural Progenitor Cell Sparing radiation
Intervention Description
Patients will receive 60 Gy in 30 fractions, 5 days per week using IMRT. The target delineation and treatment volumes will be as follows: Initial treatment plan: Will be prescribed to 46 Gy in 2 Gy fractions Cone down treatment plan: Will be prescribed to 14 Gy in 2 Gy fractions
Primary Outcome Measure Information:
Title
Change from Baseline to Initial Progression
Description
Compare progression-free survival in patients receiving subventricular zone irradiation for newly diagnosed glioblastoma multiforme versus patients receiving a radiation treatment plan that does not intentionally include this area.
Time Frame
MRIs and clinical evaluations will be completed starting at the end of radiation therapy, at 1 month, 2 months, 4 months, 6 months, 8 months, 10 months, 12 months, and at 24 months to identify the time of initial disease progression
Secondary Outcome Measure Information:
Title
Progression Free Survival
Description
Compare of progression free survival in the subgroup of patients undergoing gross total resection followed by subventricular zone irradiation versus a treatment plan that does not intentionally include this area
Time Frame
MRIs and clinical evaluations will be performed 1 month, 2 months, 4 months, 6 months, 8 months, 10 months, 12 months, 24 months following completion of of radiation therapy
Title
Rate of Distant Brain Progression
Description
Compare the rate of progression outside of the initial radiation treatment planning target volume in patients treated with subventricular zone irradiation versus a treatment plan that does not intentionally include this area
Time Frame
MRIs and clinical evaluations will be performed 1 month, 2 months, 4 months, 6 months, 8 months, 10 months, 12 months, 24 months following completion of of radiation therapy
Title
Multifocal Disease Development
Description
Compare the rate of development of multifocal disease in patients treated with subventricular zone irradiation versus a treatment plan that does not intentionally include this area
Time Frame
MRIs and clinical evaluations will be performed 1 month, 2 months, 4 months, 6 months, 8 months, 10 months, 12 months, 24 months following completion of of radiation therapy
Title
Location of Disease Progression
Description
Explore whether the location of progression in relationship to subventricular zone in patients treated with subventricular zone irradiation is different from patients receiving a treatment plan that does not intentionally include this area.
Time Frame
MRIs and clinical evaluations will be performed 1 month, 2 months, 4 months, 6 months, 8 months, 10 months, 12 months, 24 months following completion of of radiation therapy
Title
Neurocognitive Function Change from Baseline
Description
Explore if the potential change from baseline to six and twelve months in neurocognitive function as measured by the Trail Making Test, Controlled Oral Word Association test (COWAT), Hopkins Verbal Learning Test-Revised, Digit Symbol Substitution Test is greater than in patients receiving subventricular zone irradiation versus a treatment plan that does not intentionally include this area
Time Frame
Baseline and then in follow-up post radiation treatment at 6 months, 12 months and 24 months
Title
Composite Cognitive Function Change from Baseline
Description
Evaluate composite cognitive function at 6 and 12 months following subventricular zone irradiation versus a treatment plan that does not intentionally include this area.
Time Frame
Baseline and then in follow-up post radiation treatment at 6 months, 12 months and 24 months
Title
Cognitive Function Change from Baseline
Description
Explore the change in neurocognitive function from baseline to six and twelve months following SVZ irradiation as measured by the Brief Visuospatial Memory Test-Revised, Digit Span, Trail Making Test, Controlled Oral Word Association test (COWAT), Hopkins Verbal Learning Test-Revised, Digit Symbol Substitution Test.
Time Frame
Baseline and then in follow-up post radiation treatment at 6 months, 12 months and 24 months
Title
Quality of Life Change from Baseline
Description
Evaluate quality of life following subventricular zone irradiation.
Time Frame
Baseline and then in follow-up post radiation treatment at 6 months, 12 months and 24 months
Title
Acute and Late Toxicity Change from Baseline
Description
Estimate if radiation-associated acute and late toxicity following subventricular zone irradiation is different from a treatment plan that does not intentionally include this area.
Time Frame
MRIs and clinical evaluations will be performed 1 month, 2 months, 4 months, 6 months, 8 months, 10 months, 12 months, 24 months following completion of of radiation therapy
Title
Pathologically Confirmed Necrosis Change from Baseline
Description
Estimate if the rate of pathologically confirmed necrosis in patients treated with subventricular zone irradiation is greater than in patients receiving a treatment plan that does not intentionally deliver radiation dose to this area.
Time Frame
MRIs and clinical evaluations will be performed 1 month, 2 months, 4 months, 6 months, 8 months, 10 months, 12 months, 24 months following completion of of radiation therapy
Title
Pseudo-Progression Change from Baseline
Description
Estimate if the rate of pseudo-progression within the first year of completion of subventricular zone irradiation is greater than in patients receiving a treatment plan that does no intentionally deliver radiation dose to this area
Time Frame
One year post completion of radiation treatment
Title
Overall Survival
Description
Compare overall survival in patients treated with subventricular zone irradiation versus a treatment plan that does not intentionally include this area.
Time Frame
MRIs and clinical evaluations will be performed 1 month, 2 months, 4 months, 6 months, 8 months, 10 months, 12 months, 24 months following completion of of radiation therapy

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: Patient must have newly diagnosed, histologically confirmed GBM. Patient must have undergone gross total resection, subtotal resection, or biopsy with the extent of resection determined by the treating neurosurgeon, and must begin radiation within 12 weeks of this procedure. Patients must not have received previous irradiation to the brain. Patient must be at least 18 years of age since the diagnosis of GBM in patients younger than 18 is rare and accurate evaluation of neurocognitive function would require a different battery of examinations than employed in this study. ECOG performance status 0-2 (Karnofsky >60%; see Appendix A). Patient must be scheduled to receive temozolomide concurrent with and following radiation (temozolomide may be started late due to insurance reasons, insufficient counts, or other reasons). If a woman is of child-bearing potential, a negative urine or serum pregnancy test must be demonstrated prior to treatment. Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) for the duration of study participation and for up to 12 weeks following the study. Should a women become pregnant or suspect she is pregnant while participating in this study she should inform her treating physician immediately. Patient must have the ability to understand and the willingness to sign a written informed consent document. All patients must be informed of the investigational nature of this study and must be given written informed consent in accordance with institutional and federal guidelines. Radiation therapy must begin within 12 weeks of surgery. Exclusion Criteria: 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. Use of Avastin or another VEG-F inhibitor prior to progression is not permitted.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Kristin Redmond, M.D.
Phone
410-614-1642
Email
kjanson3@jhmi.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Danielle Wendler, R.N.
Phone
410-502-9243
Email
dschul15@jhmi.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kristin Redmond, M.D.
Organizational Affiliation
The SKCCC at Johns Hopkins
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sibley Memorial Hospital
City
Washington
State/Province
District of Columbia
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Curtiland Deville, MD
Facility Name
The SKCCC at Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21287
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tracy Vannorsdall, Ph.D.
First Name & Middle Initial & Last Name & Degree
Lawrence Kleinberg, M.D.
First Name & Middle Initial & Last Name & Degree
Alfredo Quinones, M.D.
First Name & Middle Initial & Last Name & Degree
Matthew Holdhoff, M.D.
Facility Name
Suburban Hospital
City
Bethesda
State/Province
Maryland
Country
United States
Individual Site Status
Recruiting

12. IPD Sharing Statement

Learn more about this trial

Subventricular Zone (SVZ) and Temozolomide in Glioblastoma Multiforme

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