Avastin in Combination With Radiation and Temozolomide, Followed by Avastin, Temozolomide and Irinotecan for Glioblastoma Multiformes and Gliosarcomas
The standard of care for grade IV gliomas is radiation therapy with daily temozolomide,
followed by 6 months of temozolomide. The majority of patients progress and die of their
tumor. Many glioma patients are resistant to temozolomide because the tumors have high
O(6)-methylguanine-DNA methyltransferase (MGMT), conferring resistance. Irinotecan is
synergistic with temozolomide, and the combination may overcome high MGMT. Vascular
endothelial growth factor (VEGF) is present on the cell surface and around malignant
gliomas. It appears that the presence of vascular endothelial growth factor is a prognostic
growth factor with more VEGF expression correlating with a poor prognosis. Monoclonal
antibodies to VEGF have inhibited growth of malignant gliomas in a mouse xenograft. Avastin
is a humanized monoclonal immunoglobulin G (IGG) 1 antibody that binds to and inhibits the
biologic activity of human vascular endothelial growth factor. The combination of Avastin
and irinotecan was safe and demonstrated high activity against recurrent malignant gliomas.
The combination of Avastin, temozolomide, and irinotecan as the initial therapy may maximize
the chance for long-term survival. There are other studies completed or ongoing for newly
diagnosed glioblastoma (GBM) patients, including a Radiation Therapy Oncology Group (RTOG)
study that added irinotecan to temozolomide following standard radiation therapy and
temozolomide, and a University of California, Los Angeles (UCLA) study that added Avastin to
standard radiation therapy and temozolomide followed by Avastin and temozolomide.
Interventional
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
16-month Overall Survival (OS)
Percentage of participants surviving sixteen months from the start of study treatment. OS was defined as the time from the date of study treatment initiation to the date of death due to any cause.
16 months
No
Annick Desjardins, MD, FRCPC
Principal Investigator
Duke University Health System
United States: Institutional Review Board
Pro00000458
NCT00597402
July 2007
March 2013
Name | Location |
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Duke University Health System | Durham, North Carolina 27705 |