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Bevacizumab in Reducing CNS Side Effects in Patients Who Have Undergone Radiation Therapy to the Brain for Primary Brain Tumor, Meningioma, or Head and Neck Cancer
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), October 2007
Sponsors and Collaborators: M.D. Anderson Cancer Center
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00492089
  Purpose

RATIONALE: Bevacizumab may reduce CNS side effects caused by radiation therapy.

PURPOSE: This randomized phase II trial is studying how well bevacizumab works in reducing CNS side effects in patients who have undergone radiation therapy to the brain for primary brain tumor, meningioma, or head and neck cancer.


Condition Intervention Phase
Brain and Central Nervous System Tumors
Cancer-Related Problem/Condition
Head and Neck Cancer
Sarcoma
Drug: bevacizumab
Drug: placebo
Phase II

MedlinePlus related topics: Brain Cancer Cancer Head and Neck Cancer Salivary Gland Disorders Soft Tissue Sarcoma Tonsils and Adenoids
Drug Information available for: Bevacizumab
U.S. FDA Resources
Study Type: Interventional
Study Design: Supportive Care, Randomized, Double-Blind, Placebo Control
Official Title: A Randomized Phase 2 Trial of Bevacizumab to Control Brain Radiation Damage

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Change in MRI from baseline to the first evaluation at 6 weeks

Secondary Outcome Measures:
  • Dexamethasone dosing
  • Quality of life as measured by M.D. Anderson Symptom Inventory (MDASI) scores
  • Neurological scores
  • Neurocognitive performance

Estimated Enrollment: 16
Study Start Date: February 2007
Estimated Primary Completion Date: September 2007 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Arm I: Experimental
Patients receive bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 3 weeks for up to 2 courses in the absence of disease progression or unacceptable toxicity.
Drug: bevacizumab
Given IV
Arm II: Placebo Comparator
Patients receive placebo IV over 30-90 minutes on day 1. Treatment repeats every 3 weeks for up to 2 courses in the absence of disease progression or unacceptable toxicity.
Drug: placebo
Given IV

Detailed Description:

OBJECTIVES:

Primary

  • Determine to what extent bevacizumab can reduce active radiation toxicity to the CNS in patients who have undergone cranial irradiation for primary brain neoplasm, meningioma, or head and neck cancer.

Secondary

  • Determine to what extent this drug can reduce dexamethasone dependence in these patients.
  • Determine to what extent this drug can improve neurologic function in these patients.
  • Determine to what extent this drug can improve quality of life of these patients.

OUTLINE: This is a randomized, placebo-controlled, crossover, double-blind study. Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 3 weeks for up to 2 courses in the absence of disease progression or unacceptable toxicity.
  • Arm II: Patients receive placebo IV over 30-90 minutes on day 1. Treatment repeats every 3 weeks for up to 2 courses in the absence of disease progression or unacceptable toxicity.

Patients in arm II who have failed to respond to treatment at 6 or 12 weeks may cross over to arm I and receive 2 courses of bevacizumab as in arm I. Patients in arm I (including crossover patients) who have responded to treatment may receive 2 additional courses of bevacizumab.

Patients undergo MRI after courses 2 and 4.

Quality of life and neurologic function are assessed at baseline, periodically during study treatment, and at 12 and 24 weeks after completion of study treatment.

After completion of study treatment, patients are followed at 12 and 24 weeks.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed primary brain neoplasm, meningioma, or head and neck cancer

    • WHO grade 2 or 3 disease

      • No WHO grade 4 primary brain neoplasms (i.e., glioblastoma or gliosarcoma)
  • Patients with head and neck cancer must not have any of the following:

    • Evidence of metastatic disease
    • Evidence of tumor invasion to major vessels (e.g., the carotid)
    • History of bleeding related to tumor or radiotherapy during or after completion of radiotherapy
  • Must have undergone cranial irradiation
  • Must have radiographic evidence to support the diagnosis of radiation necrosis and/or surgical biopsy evidence of necrosis without tumor within the past 2 months
  • Must have evidence of progressive neurologic signs or symptoms appropriate to the location of the radiation necrosis
  • No evidence of active CNS hemorrhage

PATIENT CHARACTERISTICS:

  • Karnofsky performance status 60-100%
  • Platelet count > 75,000/mm^3
  • Hemoglobin ≥ 9.0 g/dL
  • Granulocyte count > 1,500/mm^3
  • Bilirubin ≤ 1.5 times upper limit of normal (ULN)
  • Creatinine < 1.0 times ULN
  • AST < 2.5 times ULN
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for ≥ 2 months after completion of study therapy
  • No diarrhea ≥ grade 1
  • No abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within the past 28 days
  • No significant traumatic injury within the past 28 days
  • No clinically significant cardiovascular disease, including any of the following:

    • Inadequately controlled hypertension (i.e., systolic BP > 140 mm Hg and/or diastolic BP > 90 mm Hg despite antihypertensive medication)
    • Large vessel cerebrovascular accident within the past 6 months
    • Myocardial infarction or unstable angina within the past 6 months
    • NYHA class II-IV congestive heart failure
    • Serious or inadequately controlled cardiac arrhythmia
    • Significant vascular disease (e.g., aortic aneurysm or history of aortic dissection)
    • Clinically significant peripheral vascular disease
  • No evidence of bleeding diathesis or coagulopathy
  • History of seizures allowed provided the patient is receiving anticonvulsant therapy

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • At least 6 months since prior radiotherapy
  • No prior bevacizumab
  • Prior chemotherapy for tumor allowed
  • Prior tyrosine kinase inhibitors of VEGF receptor (VEGFR) allowed
  • More than 28 days since prior and no concurrent major surgical procedure or open biopsy
  • More than 7 days since prior core biopsy
  • Concurrent dexamethasone allowed provided patient is on a stable dose for ≥ 1 week prior to study entry
  • Concurrent full-dose anticoagulants (e.g., warfarin) with PT INR > 1.5 allowed provided the following criteria are met:

    • In-range INR (usually between 2 and 3) and patient is on a stable dose of oral anticoagulant for 1 week or on a stable dose of low molecular weight heparin
    • No active bleeding or pathological condition that carries a high risk of bleeding
    • No evidence of serious or nonhealing wound, ulcer, or bone fracture
  • No concurrent chemotherapy or tyrosine kinase inhibitors of VEGFR
  • No other concurrent investigational agents
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00492089

Locations
United States, Texas
M. D. Anderson Cancer Center at University of Texas Recruiting
Houston, Texas, United States, 77030-4009
Contact: Clinical Trials Office - M. D. Anderson Cancer Center at the U     713-792-3245        
Sponsors and Collaborators
M.D. Anderson Cancer Center
Investigators
Study Chair: Victor A. Levin, MD M.D. Anderson Cancer Center
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site

Study ID Numbers: CDR0000553135, MDA-2006-0890
Study First Received: June 25, 2007
Last Updated: December 6, 2008
ClinicalTrials.gov Identifier: NCT00492089  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
adult mixed glioma
adult grade II meningioma
adult grade III meningioma
stage I squamous cell carcinoma of the hypopharynx
stage II squamous cell carcinoma of the hypopharynx
stage III squamous cell carcinoma of the hypopharynx
recurrent squamous cell carcinoma of the hypopharynx
stage I squamous cell carcinoma of the larynx
stage I verrucous carcinoma of the larynx
stage II squamous cell carcinoma of the larynx
stage II verrucous carcinoma of the larynx
stage III squamous cell carcinoma of the larynx
stage III verrucous carcinoma of the larynx
recurrent squamous cell carcinoma of the larynx
recurrent verrucous carcinoma of the larynx
stage I adenoid cystic carcinoma of the oral cavity
stage I basal cell carcinoma of the lip
stage I mucoepidermoid carcinoma of the oral cavity
stage I squamous cell carcinoma of the lip and oral cavity
stage I verrucous carcinoma of the oral cavity
stage II adenoid cystic carcinoma of the oral cavity
stage II basal cell carcinoma of the lip
stage II mucoepidermoid carcinoma of the oral cavity
stage II squamous cell carcinoma of the lip and oral cavity
stage II verrucous carcinoma of the oral cavity
stage III adenoid cystic carcinoma of the oral cavity
stage III basal cell carcinoma of the lip
stage III mucoepidermoid carcinoma of the oral cavity
stage III squamous cell carcinoma of the lip and oral cavity
stage III verrucous carcinoma of the oral cavity

Study placed in the following topic categories:
Choroid Plexus Neoplasms
Meningeal Neoplasms
Malignant mesenchymal tumor
Squamous cell carcinoma
Bevacizumab
Central Nervous System Neoplasms
Adenoid cystic carcinoma
Ependymoma
Soft tissue sarcomas
Carcinoma, Adenoid Cystic
Carcinoma, squamous cell
Laryngeal carcinoma
Meningioma
Glioma
Choroid Plexus neoplasms
Papilloma
Salivary Gland Diseases
Nervous System Neoplasms
Astrocytoma
Carcinoma, Basal Cell
Granuloma
Hemangiopericytoma
Recurrence
Carcinoma
Epidermoid carcinoma
Brain Neoplasms
Nasopharyngeal carcinoma
Head and Neck Neoplasms
Sarcoma
Hypopharyngeal cancer

Additional relevant MeSH terms:
Neoplasms by Histologic Type
Antineoplastic Agents
Growth Substances
Neoplasms, Nerve Tissue
Nervous System Diseases
Physiological Effects of Drugs
Angiogenesis Inhibitors
Pharmacologic Actions
Neoplasms
Neoplasms by Site
Therapeutic Uses
Neoplasms, Vascular Tissue
Angiogenesis Modulating Agents
Growth Inhibitors

ClinicalTrials.gov processed this record on January 16, 2009