Temozolomide and Radiation Therapy With or Without Cediranib Maleate in Treating Patients With Newly Diagnosed Glioblastoma
- Conditions
- Adult GlioblastomaAdult Gliosarcoma
- Interventions
- Radiation: 3-Dimensional Conformal Radiation TherapyRadiation: Intensity-Modulated Radiation TherapyDrug: Cediranib MaleateOther: Laboratory Biomarker AnalysisOther: Placebo AdministrationDrug: Temozolomide
- Registration Number
- NCT01062425
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
This randomized phase II trial studies temozolomide, radiation therapy, and cediranib maleate to see how well they work compared with temozolomide, radiation therapy, and a placebo in treating patients with newly diagnosed glioblastoma (a type of brain tumor). 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. Radiation therapy uses high energy x-rays to kill tumor cells. Cediranib maleate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. It is not yet known whether temozolomide and radiation therapy are more effective when given with or without cediranib maleate in treating glioblastoma.
- Detailed Description
PRIMARY OBJECTIVES:
I. To determine if the addition of cediranib (cediranib maleate) to chemoradiation treatment enhances treatment efficacy as measured by the 6-month progression-free survival rate.
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 O6-methylguanine-deoxyribonucleic acid (DNA) methyltransferase (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.
OUTLINE: 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 radiation therapy (intensity-modulated radiation therapy or 3-dimensional conformal radiation therapy) QD, 5 days a week, for 6 weeks and receive temozolomide PO QD and cediranib maleate PO QD for 6 weeks. Patients then receive temozolomide PO QD alone on days 1-5. Treatment with temozolomide 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 radiation therapy (intensity-modulated radiation therapy or 3-dimensional conformal radiation therapy) QD, 5 days a week, for 6 weeks and receive temozolomide PO QD and placebo PO QD for 6 weeks. Patients then receive temozolomide PO QD alone on days 1-5. Treatment with temozolomide repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 1 year, every 4 months for 1 year, and then every 6 months thereafter.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 261
-
Histologically proven diagnosis of glioblastoma or gliosarcoma (World Health Organization [WHO] grade IV) confirmed by central review prior to step 2 registration
-
Tumor tissue that is determined by central pathology review prior to step 2 registration to be of sufficient size for analysis of MGMT status
- Patients must have at least 1 block of tumor tissue; submission of 2 blocks is strongly encouraged
- Cavitron ultrasonic aspirator (CUSA)-derived material is not allowed; fresh frozen tumor tissue acquisition is encouraged
- Diagnosis must be made by surgical excision, either partial or complete; stereotactic biopsy is not allowed because it will not provide sufficient tissue for MGMT analysis
- The tumor tissue must be sent as soon as possible to maximize the likelihood of eligibility; tumor tissue may not be submitted later than 28 days after the surgical procedure, because tissue analysis will not be able to be performed in time for treatment to commence by the mandatory 6-week post-surgery outer limit; submission of tissue earlier than 28 days post-surgery is highly recommended
-
The tumor must have a supratentorial component
-
History/physical examination, including neurologic examination, within 14 days prior to step 2 registration
-
The patient must have recovered from the effects of surgery, post-operative infection, and other complications before step 2 registration
-
A diagnostic contrast-enhanced magnetic resonance imaging (MRI) of the brain must be performed preoperatively and postoperatively prior to step 1 registration; the postoperative scan must be performed within 28 days prior to step 1 registration
-
Documentation of steroid doses/concurrent medications within 14 days prior to step 2 registration
-
Karnofsky performance status >= 70 within 14 days prior to step 2 registration
-
Complete blood count (CBC)/differential obtained within 14 days prior to step 2 registration on study, with adequate bone marrow function defined as follows:
-
Absolute neutrophil count (ANC) >= 1,800 cells/mm^3
-
Platelets >= 100,000 cells/mm^3
-
Hemoglobin >=10.0 g/dl (Note: The use of transfusion or other intervention to achieve hemoglobin (Hgb) >= 10.0 g/dl is acceptable)
-
Adequate renal function, as defined below:
-
Blood urea nitrogen (BUN) =< 30 mg/dl within 14 days prior to step 2 registration
-
Creatinine =< 1.7 mg/dl within 14 days prior to step 2 registration
-
Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) =< 3 x normal range within 14 days prior to step 2 registration
-
Systolic blood pressure =< 140 mm Hg AND diastolic pressure =< 90 mm Hg within 14 days prior to step 2 registration in the presence or absence of a stable regimen of anti-hypertensive therapy
-
Prothrombin time/international normalized ratio (PT INR) < 1.4 for patients not on warfarin confirmed by testing within 1 week of step 2 registration
-
Patients on full-dose anticoagulants (e.g., warfarin or low molecular weight [LMW] heparin) must meet both of the following criteria:
- 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) on a stable dose of oral anticoagulant or on a stable dose of low molecular weight heparin
-
Patient must provide study specific informed consent prior to step 1 registration
-
Women of childbearing potential and male participants must practice adequate contraception
-
For females of child-bearing potential, negative serum pregnancy test within 14 days prior to step 2 registration
-
Prior invasive malignancy (except for non-melanomatous skin cancer) unless disease free for >= 3 years; (for example, carcinoma in situ of the breast, oral cavity, and cervix are all permissible)
-
Recurrent or multifocal malignant gliomas
-
Metastases detected below the tentorium or beyond the cranial vault
-
Prior chemotherapy or radiosensitizers for cancers of the head and neck region; note that prior chemotherapy for a different cancer is allowable (except temozolomide or cediranib); prior use of Gliadel wafers or any other intratumoral or intracavitary treatment are not permitted
-
Prior radiotherapy to the head or neck (except for T1 glottic cancer), resulting in overlap of radiation fields
-
Severe, active co-morbidity, defined as follows:
- Unstable angina and/or congestive heart failure requiring hospitalization
- Transmural myocardial infarction within the last 6 months
- Evidence of recent myocardial infarction or ischemia by the findings of S-T elevations of >= 2 mm using the analysis of an electrocardiogram (EKG) performed within 14 days of step 2 registration
- New York Heart Association grade II or greater congestive heart failure requiring hospitalization within 12 months prior to step 2 registration
- History of stroke, cerebral vascular accident (CVA) or transient ischemic attack within 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 or history of abdominal fistula, gastrointestinal perforation, intra-abdominal abscess major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to step 2 registration, with the exception of the craniotomy for tumor resection
- Acute bacterial or fungal infection requiring intravenous antibiotics at the time of step 2 registration
- Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of step 2 registration
- Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
- Acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease Control (CDC) definition; note, however, that human immunodeficiency virus (HIV) testing is not required for entry into this protocol
- Active connective tissue disorders, such as lupus or scleroderma, which in the opinion of the treating physician may put the patient at high risk for radiation toxicity
- Any other major medical illnesses or psychiatric impairments that in the investigator's opinion will prevent administration or completion of protocol therapy
-
Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception
-
Pregnant or lactating women
-
Prior allergic reaction to temozolomide
-
Patients treated on any other therapeutic clinical protocols within 30 days prior to step 1 registration or during participation in the study
-
History of allergic reactions attributed to compounds of similar chemical or biologic composition to cediranib
-
Mean QTc >500 msec (with Bazett's correction) in screening electrocardiogram or history of familial long QT syndrome or other significant ECG abnormality noted within 14 days of treatment
-
Patients receiving concurrent vascular endothelial growth factor (VEGF) inhibitors are prohibited from participating in this study
-
Patients must not be on enzyme-inducing anti-epileptic drugs (EIAED); patients may be on non-enzyme inducing anti-epileptic drugs (NEIAED) or may not be taking any anti-epileptic drugs; in patients who have previously been on EIAED there must be at least a 14 day period since the last dose of an EIAED before the first dose of cediranib
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo, TMZ, and RT Placebo Administration Placebo (3 days) followed by radiation therapy (RT) + daily temozolomide (TMZ) + placebo followed by placebo monotherapy (4 weeks) followed by TMZ + placebo for 12 cycle maximum. Placebo, TMZ, and RT Intensity-Modulated Radiation Therapy Placebo (3 days) followed by radiation therapy (RT) + daily temozolomide (TMZ) + placebo followed by placebo monotherapy (4 weeks) followed by TMZ + placebo for 12 cycle maximum. Placebo, TMZ, and RT 3-Dimensional Conformal Radiation Therapy Placebo (3 days) followed by radiation therapy (RT) + daily temozolomide (TMZ) + placebo followed by placebo monotherapy (4 weeks) followed by TMZ + placebo for 12 cycle maximum. Placebo, TMZ, and RT Laboratory Biomarker Analysis Placebo (3 days) followed by radiation therapy (RT) + daily temozolomide (TMZ) + placebo followed by placebo monotherapy (4 weeks) followed by TMZ + placebo for 12 cycle maximum. Cediranib, TMZ, and RT 3-Dimensional Conformal Radiation Therapy Cediranib (3 days) followed by radiation therapy (RT) + daily temozolomide (TMZ) + cediranib followed by cediranib monotherapy (4 weeks) followed by TMZ + cediranib for 12 cycle maximum. Cediranib, TMZ, and RT Intensity-Modulated Radiation Therapy Cediranib (3 days) followed by radiation therapy (RT) + daily temozolomide (TMZ) + cediranib followed by cediranib monotherapy (4 weeks) followed by TMZ + cediranib for 12 cycle maximum. Cediranib, TMZ, and RT Laboratory Biomarker Analysis Cediranib (3 days) followed by radiation therapy (RT) + daily temozolomide (TMZ) + cediranib followed by cediranib monotherapy (4 weeks) followed by TMZ + cediranib for 12 cycle maximum. Cediranib, TMZ, and RT Cediranib Maleate Cediranib (3 days) followed by radiation therapy (RT) + daily temozolomide (TMZ) + cediranib followed by cediranib monotherapy (4 weeks) followed by TMZ + cediranib for 12 cycle maximum. Cediranib, TMZ, and RT Temozolomide Cediranib (3 days) followed by radiation therapy (RT) + daily temozolomide (TMZ) + cediranib followed by cediranib monotherapy (4 weeks) followed by TMZ + cediranib for 12 cycle maximum. Placebo, TMZ, and RT Temozolomide Placebo (3 days) followed by radiation therapy (RT) + daily temozolomide (TMZ) + placebo followed by placebo monotherapy (4 weeks) followed by TMZ + placebo for 12 cycle maximum.
- Primary Outcome Measures
Name Time Method 6-month Progression-free Survival Rate From randomization to 6 months. Six-month progression-free survival is the rate of patients who have NOT progressed at six months, where progressive disease is defined as any of the following: ≥ 25% increase in sum of the products of perpendicular diameters of enhancing lesions; any new lesion; or clinical deterioration. Progression will be determined by central review of MRI exams, assessed using MacDonald criteria for progression versus response on 2D T1 and T2 weighted images.
- Secondary Outcome Measures
Name Time Method Overall Survival (OS) From randomization to time of death due to any cause. Patients are followed until death. Analysis occurs after all patients have been potentially followed for six months. OS will be estimated using the Kaplan-Meier method and differences between treatment arms will be tested using the log rank test. Multivariate analyses with the Cox proportional hazard model for OS will be performed with the stratification variables as fixed variables to assess the treatment effect adjusting patient-specific risk factors.
Progression-free Survival (PFS) From randomization to time of first progression or death due to any cause. Patients are followed until death. Analysis occurs after all patients have been potentially followed for six months. Progression-free survival time is defined as time from randomization to date of first progression or death from any cause and is estimated by the Kaplan-Meier method. Patients last known to be alive without progression are censored at the date of last contact. Progression is defined as any of the following: ≥ 25% increase in sum of the products of perpendicular diameters of enhancing lesions; any new lesion; or clinical deterioration.
Incidence of Grade 3+ Toxicities From randomization to six months. The number of patients with reported grade 3 and higher treatment-related toxicities as assessed by Common Terminology Criteria for Adverse Events version 4.0
Trial Locations
- Locations (105)
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
Thomas Jefferson University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
Massachusetts General Hospital Cancer Center
🇺🇸Boston, Massachusetts, United States
Brigham and Women's Hospital
🇺🇸Boston, Massachusetts, United States
University of Washington Medical Center - Montlake
🇺🇸Seattle, Washington, United States
University of Cincinnati Cancer Center-UC Medical Center
🇺🇸Cincinnati, Ohio, United States
Kansas City NCI Community Oncology Research Program
🇺🇸Prairie Village, Kansas, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
The Kirklin Clinic at Acton Road
🇺🇸Birmingham, Alabama, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Ascension Saint John Hospital
🇺🇸Detroit, Michigan, United States
Legacy Good Samaritan Hospital and Medical Center
🇺🇸Portland, Oregon, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Radiation Oncology Associates PC
🇺🇸Fort Wayne, Indiana, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
UH Seidman Cancer Center at Salem Regional Medical Center
🇺🇸Salem, Ohio, United States
Summa Health System - Akron Campus
🇺🇸Akron, Ohio, United States
Dana-Farber Cancer Institute
🇺🇸Boston, Massachusetts, United States
Cancer Treatment Center
🇺🇸Wooster, Ohio, United States
Northeast Radiation Oncology Center
🇺🇸Dunmore, Pennsylvania, United States
UPMC Washington Hospital Radiation Oncology
🇺🇸Washington, Pennsylvania, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Jefferson Abington Hospital
🇺🇸Abington, Pennsylvania, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
University of Rochester
🇺🇸Rochester, New York, United States
Ascension Saint Mary's Hospital
🇺🇸Saginaw, Michigan, United States
Bryn Mawr Hospital
🇺🇸Bryn Mawr, Pennsylvania, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Lake Huron Medical Center
🇺🇸Port Huron, Michigan, United States
Summa Health System - Barberton Campus
🇺🇸Barberton, Ohio, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Cleveland Clinic Akron General
🇺🇸Akron, Ohio, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
UPMC Cancer Centers - Arnold Palmer Pavilion
🇺🇸Greensburg, Pennsylvania, United States
Rapid City Regional Hospital
🇺🇸Rapid City, South Dakota, United States
Natalie Warren Bryant Cancer Center at Saint Francis
🇺🇸Tulsa, Oklahoma, United States
Saint George Regional Medical Center
🇺🇸Saint George, Utah, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
Allegheny General Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
Aspirus Regional Cancer Center
🇺🇸Wausau, Wisconsin, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
Intermountain Medical Center
🇺🇸Murray, Utah, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
Wheeling Hospital/Schiffler Cancer Center
🇺🇸Wheeling, West Virginia, United States
Utah Valley Regional Medical Center
🇺🇸Provo, Utah, United States
Utah Cancer Specialists-Salt Lake City
🇺🇸Salt Lake City, Utah, United States
IU Health Methodist Hospital
🇺🇸Indianapolis, Indiana, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
University Hospitals Portage Medical Center
🇺🇸Ravenna, Ohio, United States
Compass Oncology Vancouver
🇺🇸Vancouver, Washington, United States
Maine Medical Center- Scarborough Campus
🇺🇸Scarborough, Maine, United States
Banner University Medical Center - Tucson
🇺🇸Tucson, Arizona, United States
Arizona Oncology Services Foundation
🇺🇸Scottsdale, Arizona, United States
City of Hope Comprehensive Cancer Center
🇺🇸Duarte, California, United States
Saint Joseph Hospital - Orange
🇺🇸Orange, California, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
AdventHealth Orlando
🇺🇸Orlando, Florida, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
The Hospital of Central Connecticut
🇺🇸New Britain, Connecticut, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸Hartford, Connecticut, United States
Bay Medical Center
🇺🇸Panama City, Florida, United States
Emory University Hospital Midtown
🇺🇸Atlanta, Georgia, United States
Emory University Hospital/Winship Cancer Institute
🇺🇸Atlanta, Georgia, United States
Parkview Hospital Randallia
🇺🇸Fort Wayne, Indiana, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Clackamas Radiation Oncology Center
🇺🇸Clackamas, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸Portland, Oregon, United States
Saint Luke's University Hospital-Bethlehem Campus
🇺🇸Bethlehem, Pennsylvania, United States
Paoli Memorial Hospital
🇺🇸Paoli, Pennsylvania, United States
Penn State Milton S Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Lankenau Medical Center
🇺🇸Wynnewood, Pennsylvania, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
Spartanburg Medical Center
🇺🇸Spartanburg, South Carolina, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
McKay-Dee Hospital Center
🇺🇸Ogden, Utah, United States
Inova Fairfax Hospital
🇺🇸Falls Church, Virginia, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸Flint, Michigan, United States
Henry Ford Macomb Hospital-Clinton Township
🇺🇸Clinton Township, Michigan, United States
University of Alabama at Birmingham Cancer Center
🇺🇸Birmingham, Alabama, United States
Carolinas Medical Center/Levine Cancer Institute
🇺🇸Charlotte, North Carolina, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Sparta Cancer Treatment Center
🇺🇸Sparta, New Jersey, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
University of Cincinnati Cancer Center-West Chester
🇺🇸West Chester, Ohio, United States
University of Hawaii Cancer Center
🇺🇸Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸Honolulu, Hawaii, United States
Yale University
🇺🇸New Haven, Connecticut, United States
Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
University of Wisconsin Carbone Cancer Center
🇺🇸Madison, Wisconsin, United States
Baptist Health Lexington
🇺🇸Lexington, Kentucky, United States
University of Kentucky/Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Saint Luke's Hospital of Kansas City
🇺🇸Kansas City, Missouri, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Novant Health Forsyth Medical Center
🇺🇸Winston-Salem, North Carolina, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States