Temozolomide & RT Followed by Dose Dense vs Temozolomide & Retinoic Acid in Pts w/Glioblastoma

Phase 2

Completed

Brief Summary: Patients have a newly diagnosed brain tumor called a malignant glioma and participate in the study to see if it is possible to increase the benefit of temozolomide when given after radiation. A recent study showed that patients with newly diagnosed glioblastoma lived longer when treated with both temozolomide and radiotherapy followed by 6 months of temozolomide than patients treated with radiotherapy alone. Patients will receive standard low dose temozolomide during radiation. After radiation, they will be randomized to receive either more intense temozolomide or continuous low dose temozolomide.

Detailed Description: This is a randomized phase II study that will test two different adjuvant temozolomide regimens in patients with newly diagnosed glioblastoma multiforme. The goal of this study is to identify a regimen that would be appropriate to bring to a phase III trial and compare to the standard dosing regimen of temozolomide recently reported by Stupp et al. in the New England Journal of Medicine. Secondary goals of this study include: prospective analysis of the prognostic impact of MGMT status and generation of preliminary data regarding this treatment strategy for other types of malignant glioma.

The decision regarding which treatment patients receive is made randomly. Neither them or their doctor can select which treatment the patient will receive. There is reason to believe that both of these doses may benefit treating your brain tumor. After 6 months of chemotherapy, and assuming the brain tumor has not shown any sign of growth, they will begin receiving cis-retinoic acid. Cis retinoic acid has been shown in one study to possibly prevent or delay tumor recurrence.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Any prior chemotherapy, radiotherapy and biologic therapy for glioma.
Any prior experimental therapy for glioma.
Other concurrent active malignancy (with the exception of cervical carcinoma in situ or basal cell ca of the skin).
Serious medical or psychiatric illness that would in the opinion of the investigator would interfere with the prescribed treatment.
Pregnant or breast feeding women.
Refusal to use effective contraception.

Arm && Interventions

Group	Intervention	Description
Dose-Dense Therapy Cohort	Temozolomide	Concurrent temozolomide and radiotherapy plus high dose of temozolomide
Metronomic Therapy Cohort	Temozolomide	Concurrent temozolomide and radiotherapy plus lose dose of temozolomide

Primary Outcome Measures

Name	Time	Method
12 Month Overall Survival of Patients With Newly Diagnosed Glioblastoma Multiforme Treated With Concurrent Temozolomide and Radiotherapy Followed by Dose Dense or Metronomic Dosing of Temozolomide and Maintenance Cis-retinoic Acid.	until death or date of last follow up, an average of 12 months

Secondary Outcome Measures

Name	Time	Method
Progression Free Survival at 6 Months	6 months
Prognostic Impact of Methylated MGMT Status.	through study completion, an average of 1 year	MGMT promoter methylation is currently considered the main prognostic biomarker in glioblastoma. Methylation MGMT status will be assessed using real-time PCR.
To Collect Preliminary Data on the Efficacy of This Regimen and Impact of MGMT Status in Other Malignant Glioma Subtypes.	through study completion, an average of 1 year

Locations (3): Memorial Sloan-Kettering Cancer Center at Commack
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Commack, New York, United States
Memorial Sloan-Kettering at Basking Ridge
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Basking Ridge, New Jersey, United States
Memorial Sloan-Kettering Cancer Center
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New York, New York, United States