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Randomized, Phase II, Double-Blind, Placebo-Controlled Trial of Conventional Chemoradiation and Adjuvant Temozolomide Plus Cediranib Versus Conventional Chemoradiation and Adjuvant Temozolomide Plus Placebo in Patients With Newly Diagnosed Glioblastoma


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Adult Giant Cell Glioblastoma, Adult Glioblastoma, Adult Gliosarcoma

Thank you

Trial Information

Randomized, Phase II, Double-Blind, Placebo-Controlled Trial of Conventional Chemoradiation and Adjuvant Temozolomide Plus Cediranib Versus Conventional Chemoradiation and Adjuvant Temozolomide Plus Placebo in Patients With Newly Diagnosed Glioblastoma


PRIMARY OBJECTIVES:

I. To determine if the addition of cediranib to chemoradiation treatment enhances treatment
efficacy as measured by the 6-month progression-free survival rate.

II. To assess the association between overall survival and change in each of the following
markers: Ktrans, gradient echo CBV, and [18F]FLT Ki and K1, from T0 to T1.

SECONDARY OBJECTIVES:

I. To determine if the addition of cediranib to chemoradiation treatment enhances treatment
efficacy as measured by overall survival.

II. To determine if the addition of cediranib to chemoradiation treatment enhances treatment
efficacy as measured by progression-free survival.

III. To determine if there is an association between tumor MGMT gene methylation status and
treatment response and outcome.

IV. To compare and record the toxicities of the cediranib + chemoradiation arm versus the
chemoradiation arm.

V. To evaluate whether 6-month progression-free survival is associated with overall
survival.

VI. To assess the association between progression-free survival and change in each of the
following markers: Ktrans, gradient echo CBV, and [18F]FLT Ki and K1 from T0 to T1.

VII. To assess the association between overall survival and change in each of the following
markers: Ktrans, gradient echo CBV, and [18F]FLT Ki and K1 from T1 to T3.

VIII. To assess the association between progression-free survival and change in each of the
following markers: Ktrans, gradient echo CBV, and [18F]FLT Ki and K1, from T1 to T3.

IX. To assess the association between overall and progression-free survival and the T0
values of each of the following markers: Ktrans, gradient echo CBV, and [18F]FLT Ki and K1.

X. To assess the relationship between [18F]FLT Ki and K1 and markers of tumor proliferation,
both cross-sectionally and longitudinally.

XI. To evaluate the reproducibility of [18F]FLT Ki and K1 measurements. XII. To assess the
association between overall and progression-free survival and the change in the "vascular
normalization index" between T0 and T1.

OUTLINE: This is a multicenter study. Patients are stratified according to recursive
partitioning analysis class (III vs IV vs V) and MGMT methylation status (methylated vs
unmethylated vs invalid). Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive cediranib maleate orally (PO) once daily (QD) for 3 days. Patients
then undergo radiotherapy (intensity-modulated radiotherapy or 3-dimensional conformal
radiotherapy) QD, 5 days a week, for 6 weeks and receive temozolomide PO QD and cediranib
maleate PO QD for 6 weeks. Patients then receive cediranib maleate PO alone QD for 28 days.
Patients then receive temozolomide PO QD for 5 days and cediranib maleate PO QD for 28 days.
Treatment with temozolomide and cediranib maleate repeats every 28 days for up to 12
courses in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive placebo PO QD for 3 days. Patients then undergo radiotherapy
(intensity-modulated radiotherapy or 3-dimensional conformal radiotherapy) QD, 5 days a
week, for 6 weeks and receive temozolomide PO QD and placebo PO QD for 6 weeks. Patients
then receive placebo PO alone QD for 28 days. Patients then receive temozolomide PO QD for 5
days and placebo PO QD for 28 days. Treatment with temozolomide and placebo repeats every 28
days for up to 12 courses in the absence of disease progression or unacceptable toxicity.

Some patients undergo advanced imaging studies including magnetic resonance spectroscopy,
dynamic contrast-enhanced MRI, dynamic susceptibility-contrast MRI, and/or
3'-deoxy-3'-[18F]fluorothymidine positron emission tomography at baseline and periodically
during study.

After completion of study therapy, patients are followed up every 3 months for 1 year, every
4 months for 1 year, and then every 6 months thereafter.


Inclusion Criteria:



- Histologically confirmed glioblastoma or gliosarcoma (WHO grade IV)

- Diagnosis must have been made by partial or complete surgical excision within
the past 3-5 weeks

- Cavitron ultrasonic aspirator-derived material or stereotactic biopsy not
allowed

- Tumor must have a supratentorial component

- Must have ≥ 1 block of tumor tissue available for analysis of MGMT status

- Tumor tissue must be of sufficient size for analysis of MGMT status, as
determined by central pathology review

- No recurrent or multifocal malignant gliomas

- No metastases detected below the tentorium or beyond the cranial vault

- Karnofsky performance status 70-100%

- ANC ≥ 1,800/mm^3

- Platelet count ≥ 100,000/mm^3

- Hemoglobin ≥ 10.0 g/dL (transfusion or other intervention allowed)

- BUN ≤ 30 mg/dL

- Creatinine ≤ 1.7 mg/dL

- Urine protein:creatinine ratio ≤ 0.5 by urinalysis OR urine protein < 1,000 mg by
24-hour urine collection

- Bilirubin ≤ 2.0 mg/dL

- ALT and AST ≤ 3 times normal

- PT/INR < 1.4 (unless on full-dose anticoagulation)

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- Able to undergo MRI or PET scan (i.e., no pacemaker or weight limitation) (for
advanced imaging substudy)

- Able to tolerate 2 IV lines, 1 in each arm (for advanced imaging substudy)

- Systolic BP ≤ 150 mm Hg or diastolic BP ≤ 90 mm Hg within the past 14 days (in the
presence or absence of a stable regimen of anti-hypertensive therapy)

- Mean QTc ≤ 500 msec (with Bazett's correction) on screening EKG

- No familial long QT syndrome or other significant ECG abnormality within the past 14
days

- No severe, active co-morbidity including, but not limited to, any of the following:

- Unstable angina and/or congestive heart failure requiring hospitalization

- Transmural myocardial infarction within the past 6 months

- Recent myocardial infarction or ischemia as evidenced by S-T elevations of ≥ 2
mm on EKG within the past 14 days

- NYHA class II-IV congestive heart failure requiring hospitalization within the
past 12 months

- Stroke, cerebral vascular accident, or transient ischemic attack within the past
6 months

- Serious and inadequately controlled cardiac arrhythmia

- Significant vascular disease (e.g., aortic aneurysm, history of aortic
dissection) or clinically significant peripheral vascular disease

- Evidence of bleeding diathesis or coagulopathy

- Serious or non-healing wound, ulcer, or bone fracture

- Abdominal fistula, gastrointestinal perforation, intra-abdominal abscess, or
significant traumatic injury within the past 28 days

- Acute bacterial or fungal infection requiring IV antibiotics

- Chronic obstructive pulmonary disease exacerbation or other respiratory illness
requiring hospitalization or precluding study therapy

- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects

- Laboratory tests for liver function and coagulation parameters not required

- AIDS based upon current CDC definition

- HIV testing not required

- Active connective tissue disorders, such as lupus or scleroderma, that, in the
opinion of the treating physician, may put the patient at high risk for
radiation toxicity

- Any other major medical illness or psychiatric impairment that, in the
investigator's opinion, would prevent administration or completion of study
therapy

- No other invasive malignancy within the past 3 years except adequately treated
nonmelanomatous skin cancer or curatively treated carcinoma in situ of the breast,
oral cavity, or cervix

- No prior allergic reaction to temozolomide

- No prior allergic reactions attributed to compounds of similar chemical or biologic
composition to cediranib maleate

- No prior allergic reactions attributed to compounds of similar chemical or biological
composition to gadolinium or [18F]FLT contrast agents (for advanced imaging substudy)

- See Disease Characteristics

- Must have recovered from prior surgery, post-operative infection, and other
complications

- More than 28 days since prior major surgical procedure or open biopsy (other than
craniotomy for tumor resection)

- More than 30 days since prior and no concurrent treatment on other therapeutic
clinical trials

- At least 14 days since prior and no concurrent enzyme-inducing anti-epileptic drugs
(EIAEDs)

- Concurrent non-EIAEDs allowed

- No prior chemotherapy or radiosensitizers for cancer of the head and neck region

- Prior chemotherapy for a different cancer allowed

- No prior temozolomide or cediranib maleate

- No prior Gliadel wafers or any other intratumoral or intracavitary treatment

- No prior radiotherapy to the head or neck (except for T1 glottic cancer) resulting in
overlap of radiotherapy fields

- No other concurrent VEGF inhibitors

- Concurrent full-dose anticoagulants (e.g., warfarin or low molecular weight heparin)
allowed provided both of the following criteria are met:

- No active bleeding or pathological condition that carries a high-risk of
bleeding (e.g., tumor involving major vessels or known varices)

- In-range INR (usually between 2 and 3) and patient is on a stable dose of oral
anticoagulant or low molecular weight heparin

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment

Outcome Measure:

6-month PFS as assessed using MacDonald criteria and Response Evaluation Criteria in Solid Tumors (RECIST)

Outcome Description:

Standard MRI exams will be submitted to the ACRIN Imaging Core Laboratory for determination of progression-free survival by two readers. Images will be assessed using MacDonald criteria for progression versus response on 2D T1 and T2 weighted images. The primary measure of response will be by serial measures of the product of the two largest cross-sectional diameters. Progression (P): A > 25% increase in tumor area (two diameters) provided that the patient has not had his/her dose of steroids decreased since the last evaluation period.

Outcome Time Frame:

From registration to 6 months

Safety Issue:

No

Principal Investigator

Tracy Batchelor

Investigator Role:

Principal Investigator

Investigator Affiliation:

Radiation Therapy Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2011-02012

NCT ID:

NCT01062425

Start Date:

February 2010

Completion Date:

Related Keywords:

  • Adult Giant Cell Glioblastoma
  • Adult Glioblastoma
  • Adult Gliosarcoma
  • Glioblastoma
  • Gliosarcoma

Name

Location

Akron City Hospital Akron, Ohio  44304
Washington University School of Medicine Saint Louis, Missouri  63110
Abington Memorial Hospital Abington, Pennsylvania  19001
Medical University of South Carolina Charleston, South Carolina  29425-0721
University of Washington Medical Center Seattle, Washington  98195-6043
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
United Hospital St. Paul, Minnesota  55102
Massachusetts General Hospital Cancer Center Boston, Massachusetts  02114
Rapid City Regional Hospital Rapid City, South Dakota  57709
Henry Ford Hospital Detroit, Michigan  48202
Akron General Medical Center Akron, Ohio  44302
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
University of Texas Medical Branch Galveston, Texas  77555-1329
LDS Hospital Salt Lake City, Utah  84143
Rush University Medical Center Chicago, Illinois  60612-3824
University of Kansas Medical Center Kansas City, Kansas  66160-7353
Bay Medical Center Panama City, Florida  32401
Carolinas Medical Center Charlotte, North Carolina  28232-2861
Inova Fairfax Hospital Falls Church, Virginia  22042-3300
University of Wisconsin Hospital and Clinics Madison, Wisconsin  53792-0001
Central Baptist Hospital Lexington, Kentucky  40503
McKay-Dee Hospital Center Ogden, Utah  84403
Brigham and Women's Hospital Boston, Massachusetts  02115
Methodist Estabrook Cancer Center Omaha, Nebraska  68114-4199
Paoli Memorial Hospital Paoli, Pennsylvania  19301-1792
Bryn Mawr Hospital Bryn Mawr, Pennsylvania  19010
Mercy Hospital Coon Rapids, Minnesota  55433
Poudre Valley Radiation Oncology Fort Collins, Colorado  80528
Saint Joseph Mercy Hospital Ann Arbor, Michigan  48106
Regions Hospital Saint Paul, Minnesota  55101
Cancer Treatment Center Wooster, Ohio  44691
Allegheny Cancer Center at Allegheny General Hospital Pittsburgh, Pennsylvania  15212
Spartanburg Regional Medical Center Spartanburg, South Carolina  29303
Genesys Regional Medical Center Grand Blanc, Michigan  48439-8066
Arizona Oncology Services Foundation Phoenix, Arizona  85013
City of Hope Duarte, California  91010
Queen's Medical Center Honolulu, Hawaii  96813
University of Alabama at Birmingham Birmingham, Alabama  35294-3300
Northwestern University Chicago, Illinois  60611
Northwest Cancer Specialists Vancouver, Washington  98664
Cancer Care Center, Incorporated Salem, Ohio  44460
University of Rochester Rochester, New York  14642
Saint Alphonsus Regional Medical Center Boise, Idaho  83706
Yale University New Haven, Connecticut  06520
Emory University Atlanta, Georgia  30322
Ohio State University Medical Center Columbus, Ohio  43210
University of Arizona Health Sciences Center Tucson, Arizona  85724
Radiation Therapy Oncology Group Philadelphia, Pennsylvania  19107
Providence Portland Medical Center Portland, Oregon  97213-3635
University of Texas Southwestern Medical Center Dallas, Texas  
University of Kentucky Lexington, Kentucky  40536-0098
Virginia Mason CCOP Seattle, Washington  98101
Thomas Jefferson University Hospital Philadelphia, Pennsylvania  19131
Lankenau Hospital Wynnewood, Pennsylvania  19096
Florida Hospital Orlando, Florida  32803
University of Cincinnati Cincinnati, Ohio  45267-0502
Hawaii Medical Center East Honolulu, Hawaii  96817
Penn State Milton S Hershey Medical Center Hershey, Pennsylvania  17033
Clackamas Radiation Oncology Center Clackamas, Oregon  97015
Froedtert and the Medical College of Wisconsin Milwaukee, Wisconsin  53226
Wake Forest University Health Sciences Winston-Salem, North Carolina  27157
OSF Saint Francis Medical Center Peoria, Illinois  61637
Saint Joseph Hospital Orange, California  92868
Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
The Hospital of Central Connecticut New Britain, Connecticut  06050
University of Hawaii Honolulu, Hawaii  96813
Carle Foundation dba Carle Cancer Center Urbana, Illinois  61801
Saint John Hospital and Medical Center Detroit, Michigan  48236
Sparrow Hospital Lansing, Michigan  48912
Saint Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Saint Joseph Mercy Port Huron Port Huron, Michigan  48060
Saint Mary's of Michigan Saginaw, Michigan  48601
Saint John Macomb-Oakland Hospital Warren, Michigan  48093
Minnesota Oncology Hematology PA-Maplewood Maplewood, Minnesota  55109
Sparta Cancer Treatment Center Sparta, New Jersey  07871
Summa Barberton Hospital Barberton, Ohio  44203
Natalie W Bryant Cancer Center Tulsa, Oklahoma  74136
Legacy Good Samaritan Hospital and Medical Center Portland, Oregon  97210
Providence Saint Vincent Medical Center Portland, Oregon  97225
Saint Luke's Hospital Bethlehem, Pennsylvania  18015
Swedish Medical Center-First Hill Seattle, Washington  98122-4307
Wheeling Hospital Wheeling, West Virginia  26003
Aspirus Regional Cancer Center Wausau, Wisconsin  54401
University of Maryland Greenebaum Cancer Center Baltimore, Maryland  21201
Northeast Radiation Oncology Center Dunmore, Pennsylvania  18512
Henry Ford Macomb Hospital Clinton Township, Michigan  48038
Christiana Healthcare Services - Christian Hospital Newark, Delaware  19718
Maine Medical Center- Scarborough Campus Scarborough, Maine  04074
Intermountain Medical Center Murray, Utah  84157
Utah Valley Regional Medical Center Provo, Utah  84603
Dixie Medical Center Regional Cancer Center Saint George, Utah  84770
Utah Cancer Specialists-Salt Lake City Salt Lake City, Utah  84106
Crawford-Long Hospital of Emory University Atlanta, Georgia  30308
Kansas City CCOP Prairie Village, Kansas  66208
Forsyth Memorial Hospital Winston-Salem, North Carolina  27103
Robinson Radiation Oncology Ravenna, Ohio  44266
Dana-Farber Harvard Cancer Center Boston, Massachusetts  02115
The Kirklin Clinic at Acton Road Birmingham, Alabama  35243
Radiation Oncology Associates PC Fort Wayne, Indiana  46804
Parkview Memorial Hospital Fort Wayne, Indiana  46805
Clarian Health - Methodist Hospital Indianapolis, Indiana  46202
University Pointe West Chester, Ohio  45069