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Phase I/II Trial of Concurrent RAD001 (Everolimus) With Temozolomide/Radiation Followed by Adjuvant RAD001/Temozolomide in Newly Diagnosed Glioblastoma


Phase 1/Phase 2
18 Years
N/A
Open (Enrolling)
Both
Brain and Central Nervous System Tumors

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Trial Information

Phase I/II Trial of Concurrent RAD001 (Everolimus) With Temozolomide/Radiation Followed by Adjuvant RAD001/Temozolomide in Newly Diagnosed Glioblastoma


OBJECTIVES:

Primary

- To define the maximum tolerated dose of everolimus (up to an established dose of 10
mg/day) when combined with concurrent radiotherapy and temozolomide in patients with
newly diagnosed glioblastoma multiforme. (Phase I)

- To determine the efficacy of everolimus in combination with radiotherapy and
temozolomide followed by adjuvant everolimus in combination with temozolomide, as
measured by progression-free survival, in these patients. (Phase II)

Secondary

- To characterize the safety profile of everolimus in combination with radiotherapy and
temozolomide in these patients. (Phase I)

- To determine the overall survival of these patients. (Phase II)

- To further evaluate the safety profile of everolimus in combination with radiotherapy
and temozolomide in these patients. (Phase II)

- To determine if activation of the Akt/mTOR axis predicts response to everolimus. (Phase
II)

- To determine if there is an association between tumor MGMT gene methylation status and
response to everolimus. (Phase II)

OUTLINE: This is a multicenter, phase I, dose-escalation study of everolimus followed by a
phase II, randomized study.

- Phase I: Patients undergo radiotherapy (intensity-modulated or 3-dimensional conformal
radiotherapy) 5 days a week for 6 weeks and receive oral everolimus and oral
temozolomide once daily for 6 weeks. Beginning 28 days after the completion of therapy,
patients receive adjuvant oral everolimus once daily on days 1-28 and oral temozolomide
once daily on days 1-5. Treatment with adjuvant everolimus and temozolomide repeats
every 28 days for up to 12 courses in the absence of disease progression or
unacceptable toxicity.

- Phase II: Patients are stratified according to recursive partitioning analysis class
(III vs IV vs V). Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients undergo radiotherapy (intensity-modulated or 3-dimensional
conformal radiotherapy) 5 days a week for 6 weeks and receive oral temozolomide
once daily for 6 weeks. Beginning 28 days after the completion of therapy,
patients receive adjuvant oral temozolomide once daily on days 1-5. Treatment with
adjuvant temozolomide repeats every 28 days for up to 12 courses in the absence of
disease progression or unacceptable toxicity.

- Arm II: Patients receive treatment as in phase I. Tumor tissue, plasma, and urine
samples may be collected for correlative laboratory studies (mandatory for phase
II).

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.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed glioblastoma multiforme (GBM) (WHO grade IV) by central
pathology review

- Gliosarcoma allowed

- Tumor must have a supratentorial component

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

- Stereotactic biopsy or Cavitron ultrasonic aspirator-derived tissue are not
allowed

- Tumor tissue available for correlative studies (phase II only)

- Patients must have ≥ 1 block of tissue; if a block cannot be submitted, two
tissue specimens punched with a skin punch (2 mm diameter) from the tissue block
containing the tumor may be submitted

- No recurrent or multifocal malignant glioma

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

PATIENT CHARACTERISTICS:

- 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)

- PT/INR ≤ 1.5

- BUN ≤ 30 mg/dL

- Serum creatinine ≤ 1.5 times upper limit of normal (ULN)

- Bilirubin ≤ 1.5 times normal

- ALT and AST ≤ 2.5 times normal

- Fasting serum cholesterol ≤ 300 mg/dL OR ≤ 7.75 mmol/L AND fasting triglycerides ≤
2.5 times ULN (if one or both of these thresholds are exceeded, patients are eligible
only after initiation of appropriate lipid-lowering medication)

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- No other invasive malignancy within the past 3 years except for nonmelanoma skin
cancer or carcinoma in situ of the breast, oral cavity, or cervix

- No severe, active co-morbidity, defined as follows:

- NYHA class III-IV symptomatic congestive heart failure

- Unstable angina pectoris, symptomatic congestive heart failure, myocardial
infarction within the past 6 months, serious uncontrolled cardiac arrhythmia, or
any other clinically significant cardiac disease

- Severely impaired lung function, defined as spirometry and DLCO that is 50% of
the normal predicted value and/or oxygen saturation that is ≤ 88% at rest on
room air

- Uncontrolled diabetes, defined as fasting serum glucose > 1.5 times ULN

- Active (acute or chronic) or uncontrolled severe infections requiring IV
antibiotics

- Liver disease such as cirrhosis, chronic active hepatitis, or chronic persistent
hepatitis

- AIDS based upon current Centers for Disease Control and Prevention definition or
known HIV seropositivity (HIV testing is not required for study entry)

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

- Other major medical illness or psychiatric impairment that, in the
investigator's opinion, will prevent administration or completion of study
treatment

- No impaired gastrointestinal (GI) function or GI disease that may significantly alter
the absorption of everolimus (e.g., ulcerative disease, uncontrolled nausea,
vomiting, diarrhea, malabsorption syndrome, or small bowel resection)

- No history of deep vein thrombosis or pulmonary embolism

- No prior allergic reaction to temozolomide

- No known hypersensitivity to mTOR inhibitors (e.g., sirolimus, temsirolimus,
everolimus) or to their excipients

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- Recovered from the effects of surgery, postoperative infection, and other
complications

- No prior temozolomide

- No prior mTOR inhibitor (e.g., sirolimus, temsirolimus, everolimus)

- 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 prior chemotherapy or radiosensitizers for cancer of the head and neck region

- Prior chemotherapy for a different cancer is allowed

- No prior radiotherapy or chemotherapy for GBM

- No prior or concurrent treatment on any other therapeutic clinical study

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

- Concurrent anticoagulation allowed provided target INR ≤ 1.5 AND patient is on a
stable dose of warfarin or low molecular weight heparin for > 2 weeks

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Dose-limiting toxicity (phase I)

Outcome Time Frame:

From start of treatment to eight weeks.

Safety Issue:

Yes

Principal Investigator

Prakash Chinnaiyan, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

H. Lee Moffitt Cancer Center and Research Institute

Authority:

United States: Federal Government

Study ID:

RTOG 0913

NCT ID:

NCT01062399

Start Date:

December 2010

Completion Date:

Related Keywords:

  • Brain and Central Nervous System Tumors
  • adult glioblastoma
  • adult giant cell glioblastoma
  • adult gliosarcoma
  • Glioblastoma
  • Nervous System Neoplasms
  • Central Nervous System Neoplasms

Name

Location

University of Texas Health Science Center at San Antonio San Antonio, Texas  78284-7811
CCOP - Christiana Care Health Services Wilmington, Delaware  19899
Medical College of Wisconsin Cancer Center Milwaukee, Wisconsin  53226
Cleveland Clinic Taussig Cancer Center Cleveland, Ohio  44195
Blumenthal Cancer Center at Carolinas Medical Center Charlotte, North Carolina  28232-2861
Waukesha Memorial Hospital Regional Cancer Center Waukesha, Wisconsin  53188
University of Florida Shands Cancer Center Gainesville, Florida  32610-0232
Winship Cancer Institute of Emory University Atlanta, Georgia  30322
Rhode Island Hospital Comprehensive Cancer Center Providence, Rhode Island  02903
James P. Wilmot Cancer Center at University of Rochester Medical Center Rochester, New York  14642
Baptist Cancer Institute - Jacksonville Jacksonville, Florida  32207
St. Barnabas Medical Center Cancer Center Livingston, New Jersey  07039
Huntsman Cancer Institute at University of Utah Salt Lake City, Utah  84112
H. Lee Moffitt Cancer Center and Research Institute at University of South Florida Tampa, Florida  33612
Regional Cancer Center at Singing River Hospital Pascagoula, Mississippi  39581
Summa Center for Cancer Care at Akron City Hospital Akron, Ohio  44309-2090
Barberton Citizens Hospital Barberton, Ohio  44203
McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
York Cancer Center at Apple Hill Medical Center York, Pennsylvania  17405
Dana-Farber/Brigham and Women's Cancer Center Boston, Massachusetts  02115
Integrated Community Oncology Network Jacksonville Beach, Florida  32250
Baptist Medical Center South Jascksonville, Florida  32258
Florida Cancer Center - Palatka Palatka, Florida  32177
Flagler Cancer Center Saint Augustine, Florida  32086
Tyler Cancer Center Tyler, Texas  75702
Integrated Community Oncology Network - Orange Park Orange Park, Florida  32073
New York Oncology Hematology, PC at Albany Regional Cancer Care Albany, New York  12208
St. Agnes Hospital Cancer Center Baltimore, Maryland  21229
University Radiation Oncology at Parkridge Hospital Rochester, New York  14626
Integrated Community Oncology Network at Southside Cancer Center Jacksonville, Florida  32207
Willamette Valley Cancer Center - Eugene Eugene, Oregon  97401
Adams Cancer Center Gettysburg, Pennsylvania  17325
Cherry Tree Cancer Center Hanover, Pennsylvania  17331
St. Vincent Oncology Center Indianapolis, Indiana  46260