A Phase II Randomized Trial of Proton Vs. Photon Therapy (IMRT) for Cognitive Preservation in Patients With IDH Mutant, Low to Intermediate Grade Gliomas
Overview
- Phase
- Phase 2
- Intervention
- Biospecimen Collection
- Conditions
- Not specified
- Sponsor
- NRG Oncology
- Enrollment
- 120
- Locations
- 34
- Primary Endpoint
- Change in cognition as measured by the Clinical Trial Battery Composite (CTB COMP) score
- Status
- Active, not recruiting
- Last Updated
- 9 months ago
Overview
Brief Summary
This randomized phase II clinical trial studies the side effects and how well proton beam or intensity-modulated radiation therapy works in preserving brain function in patients with IDH mutant grade II or III glioma. Proton beam radiation therapy uses tiny charged particles to deliver radiation directly to the tumor and may cause less damage to normal tissue. Intensity-modulated or photon beam radiation therapy uses high-energy x-ray beams shaped to treat the tumor and may also cause less damage to normal tissue. It is not yet known if proton beam radiation therapy is more effective than photon-based beam intensity-modulated radiation therapy in treating patients with glioma.
Detailed Description
PRIMARY OBJECTIVES: I. To determine whether proton therapy, compared to intensity-modulated radiation therapy (IMRT), preserves cognitive outcomes over time as measured by the Clinical Trial Battery Composite (CTB COMP) score (calculated from the Hopkins Verbal Learning Test Revised \[HVLT-R\]) Total Recall, HVLT-R Delayed Recall, HVLT-R Delayed Recognition, Controlled Oral Word Association (COWA) test, Trail Making Test (TMT) part A and part B. SECONDARY OBJECTIVES: I. To assess whether treatment with proton therapy preserves neurocognitive function as measured separately by each test, HVLT-R, TMT parts A \& B, and COWA. II. To document and compare treatment related symptoms, overall symptom impact, and disease related factor groupings, utilizing the M.D. Anderson Symptom Inventory Brain Tumor (MDASI-BT), for both treatment arms. III. To assess whether treatment with proton therapy, compared to IMRT, results in superior quality of life as measured by the Linear Analog Scale Assessment (LASA) scale. IV. To compare local control patterns of failure and overall and progression-free survival between the two treatment arms. V. To assess adverse events. VI. To compare Illumnia MethylationEPIC beadchip array-derived IDH and 1p19q status determined centrally to that submitted by enrolling sites. TERTIARY OBJECTIVES: I. To assess the impact of chemotherapy use on cognitive outcomes, symptom outcomes and quality of life. II. To assess dose-response relationships between neuro-anatomic dosimetry and cognitive outcomes within and between treatment arms. III. To evaluate the association between tumor molecular status and cognition at baseline and within and between treatment arms over time. IV. To assess patterns of failure and pseudo progression as a function of radiation delivery type and dose received. V. To assess local control, overall survival and, progression free survival in IDH mutant grade II and III tumors. VI. To collect blood samples for future studies seeking to correlate changes in peripheral blood biomarkers (genes, micro ribonucleic acid \[RNA\], proteins, lymphocyte count, melatonin, etc) and the study endpoints. VII. To document and compare the impact of low to intermediate gliomas and therapy on patients' work and activity participation (The Work Productivity and Activity Impairment \[WPAI:GH\] Questionnaire: General Health version 2.0) as well as the relationship between changes in patients' work and activity participation and neurocognitive function and patient reported symptoms and interference. OUTLINE: Patients are randomized to 1 of 2 treatment arms. ARM I: Patients undergo photon-based IMRT once daily (QD), 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo magnetic resonance imaging (MRI) and collection of blood samples throughout the trial. ARM II: Patients undergo proton beam radiation therapy QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial. After completion of study treatment, patients are followed up at 6 and 12 months and then yearly for 10 years.
Investigators
Eligibility Criteria
Inclusion Criteria
- •PRIOR TO STEP 1 REGISTRATION
- •Tumor tissue must be available for submission for central pathology review
- •Grade II and III gliomas IDH mutant gliomas including; diffuse astrocytoma, anaplastic astrocytoma, oligodendroglioma, anaplastic oligodendroglioma, oligoastrocytoma, anaplastic oligoastrocytoma
- •Documentation from the enrolling site confirming the presence of IDH mutation and 1p/19q status; the provided information must document assays performed in clinical laboratory improvement amendments (CLIA)-approved laboratories and be uploaded prior to Step 2 registration
- •Age \>= 18
- •The trial is open to both genders
- •Only English or French speaking patients are eligible to participate as the cognitive assessments are only available in these languages
- •The patient or a legally authorized representative must provide study-specific informed consent prior to study entry
- •History and physical exam, and Karnofsky performance status of \>= 70 within 30 days prior to registration
- •Absolute neutrophil count (ANC) \>= 1,500 cells/mm\^3 (within 60 days prior to registration)
Exclusion Criteria
- •Definitive clinical or radiologic evidence of metastatic disease; if applicable
- •Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years; (for example, carcinoma in situ of the breast, oral cavity or cervix are permissible)
- •Prior cranial radiotherapy or radiotherapy to the head and neck where potential field overlaps would exist
- •Prior chemotherapy or radiotherapy for any brain tumor
- •Histologic diagnosis of glioblastoma (WHO grade IV) or pilocytic astrocytoma (WHO grade I)
- •Definitive evidence of multifocal disease
- •Planned use of cytotoxic chemotherapy during radiation (only adjuvant temozolomide therapy will be used on this protocol)
- •Patients with infra-tentorial tumors are not eligible
- •Prior history of neurologic or psychiatric disease believed to impact cognitive function
- •The use of memantine during or following radiation is NOT allowed
Arms & Interventions
Arm I (photon-based IMRT, temozolomide)
Patients undergo photon-based IMRT QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Biospecimen Collection
Arm I (photon-based IMRT, temozolomide)
Patients undergo photon-based IMRT QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Intensity-Modulated Radiation Therapy
Arm I (photon-based IMRT, temozolomide)
Patients undergo photon-based IMRT QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Laboratory Biomarker Analysis
Arm I (photon-based IMRT, temozolomide)
Patients undergo photon-based IMRT QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Magnetic Resonance Imaging
Arm I (photon-based IMRT, temozolomide)
Patients undergo photon-based IMRT QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Quality-of-Life Assessment
Arm I (photon-based IMRT, temozolomide)
Patients undergo photon-based IMRT QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Questionnaire Administration
Arm I (photon-based IMRT, temozolomide)
Patients undergo photon-based IMRT QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Temozolomide
Arm II (proton beam radiation therapy, temozolomide)
Patients undergo proton beam radiation therapy QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Biospecimen Collection
Arm II (proton beam radiation therapy, temozolomide)
Patients undergo proton beam radiation therapy QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Laboratory Biomarker Analysis
Arm II (proton beam radiation therapy, temozolomide)
Patients undergo proton beam radiation therapy QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Magnetic Resonance Imaging
Arm II (proton beam radiation therapy, temozolomide)
Patients undergo proton beam radiation therapy QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Proton Beam Radiation Therapy
Arm II (proton beam radiation therapy, temozolomide)
Patients undergo proton beam radiation therapy QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Quality-of-Life Assessment
Arm II (proton beam radiation therapy, temozolomide)
Patients undergo proton beam radiation therapy QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Questionnaire Administration
Arm II (proton beam radiation therapy, temozolomide)
Patients undergo proton beam radiation therapy QD, 5 days a week for 6 weeks for a total of 30 fractions. Beginning 28 days after completion of radiation therapy, patients receive standard of care temozolomide for 5 days. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression of unacceptable toxicity. Patients undergo MRI and collection of blood samples throughout the trial.
Intervention: Temozolomide
Outcomes
Primary Outcomes
Change in cognition as measured by the Clinical Trial Battery Composite (CTB COMP) score
Time Frame: Baseline to up to 10 years
Assessed with a general linear model with maximum likelihood estimation. Three models will be conducted. Baseline CTB COMP score, treatment arm, time, treatment by time interaction (if significant) and stratification factors will be included in the model for the primary endpoint. A second model will be built with these same variables and relevant covariates, such as total volume of intracranial disease, gross tumor volume (GTV) and clinical tumor volume (CTV) size, histology, anti-epileptic use, and disease response to therapy (as measured by Response Assessment in Neuro-Oncology \[RANO\] criteria). Other than baseline score CTB COMP, treatment arm, and time, only covariates with a p-value \< 0.10 will be retained in the model. A third model will be conducted at 10 years using the additional time points of neurocognitive assessments.
Secondary Outcomes
- Cognition as measured individually by Hopkins Verbal Learning Test Revised (HVLT-R), Trail Making Test (TMT) parts A and B, and Controlled Oral Word Association (COWA)(Up to 10 years)
- Change in symptoms as measured by M.D. Anderson Symptom Inventory Brain Tumor (MDASI-BT)(Baseline to up to 10 years)
- Change in quality of life as measured by the Linear Analog Scale Assessment (LASA) scale(Up to 10 years)
- Overall survival (OS)(From randomization to the date of death, assessed up to 10 years)
- Local control as assessed by Response Assessment in Neuro-Oncology (RANO) criteria(Up to 10 years)
- Progression-free survival (PFS)(From date of randomization to date of progression or death, whichever occurs first, assessed up to 10 years)
- Incidence of adverse events (AEs) graded according to the National Cancer Institute's Common Terminology for Adverse Events version 5.0(Up to 10 years)
- IDH mutation as assessed by sequencing and 1p19q status as assessed by fluorescence in situ hybridization(Baseline)