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A Study of Gliadel Followed by Avastin + Irinotecan for Glioblastoma Multiforme (GBM)
This study is currently recruiting participants.
Verified by Duke University, December 2008
Sponsors and Collaborators: Duke University
Eisai Inc.
Genentech
Information provided by: Duke University
ClinicalTrials.gov Identifier: NCT00735436
  Purpose

The primary objective of the study is to use 24 week survival to assess the efficacy of the combination of Gliadel followed by Avastin and irinotecan in the treatment of grade IV malignant glioma patients following surgical resection. The secondary objectives are to determine the progression-free survival following the combination of Gliadel followed by Avastin and irinotecan and to describe the toxicity of Gliadel followed by Avastin and irinotecan.


Condition Intervention Phase
Malignant Glioma
Glioblastoma Multiforme
Gliosarcoma
Other: Taking EIAEDs (enzyme-inducing anticonvulsant medications)
Other: NOT taking EIAEDs
Phase II

Drug Information available for: Carmustine Irinotecan Irinotecan hydrochloride Bevacizumab Carbamazepine Phenytoin Phenytoin sodium Phenobarbital Phenobarbital sodium
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Active Control, Single Group Assignment, Safety/Efficacy Study
Official Title: Phase II Trial for Patients With Glioblastoma Multiforme (GBM) Treated With Gliadel Followed by Avastin Plus Irinotecan

Further study details as provided by Duke University:

Primary Outcome Measures:
  • To use 24-week survival to assess the efficacy of the combination of Gliadel followed by Avastin and irinotecan in the treatment of grade IV malignant glioma patients following surgical resection. [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • To determine the progression-free survival following the combination of Gliadel followed by Avastin and irinotecan [ Time Frame: 24 weeks ] [ Designated as safety issue: No ]
  • To describe the toxicity of Gliadel followed by Avastin and irinotecan. [ Time Frame: 24 weeks ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 50
Study Start Date: December 2008
Estimated Study Completion Date: December 2011
Estimated Primary Completion Date: December 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
1
Subjects taking enzyme-inducing anticonvulsant medications (EIAEDs) such as dilantin, tegretol, or phenobarbital.
Other: Taking EIAEDs (enzyme-inducing anticonvulsant medications)
Those subjects who are taking EIAEDs (enzyme-inducing anticonvulsant medications) such as dilantin, tegretol, or phenobarbital.
2
Subjects NOT taking enzyme-inducing anticonvulsant medications such as dilantin, tegretol, or phenobarbital.
Other: NOT taking EIAEDs
Subjects NOT taking EIAEDs (enzyme-inducing anticonvulsant medications such as dilantin, tegretol, or phenobarbital.

Detailed Description:

This is a phase II study of the combination of Gliadel followed by Avastin and irinotecan in grade IV malignant glioma patients. The study will have survival and toxicity endpoints. Subjects will be identified by the investigator as those patients who have histologically documented grade IV malignant glioma (glioblastoma multiforme or gliosarcoma) with recurrent or progressive disease who are able to undergo a GTR (gross total resection).

Gliadel wafer 1-8 wafers inserted at time of gross total resection (Phase I). Treatment cycle is 42 days in length. For patients with ≥ Grade 1 toxicity will allow 84 days prior to beginning therapy with Avastin and CPT-11.

Avastin Plus Irinotecan (Phase II, Cycles 1-12) consists of the following (cycle length is 6 weeks):

  • Irinotecan 125 mg/m2 (not taking EIAEDs) or 340 mg/m2 (taking EIAEDs) given every two weeks on days 1, 15, 29, etc.;
  • If the patient has the UGT 1A1 polymorphism (7/7), they do not metabolize the irinotecan normally, so these patients will start out at a two dose level reduction; For patients on an EIAED, the starting dose will be 275 mg/M2, and for patients not on an EIAED, the starting dose will be 75 mg/M2;
  • Avastin 10 mg/kg immediately after the irinotecan given every 2 weeks on days 1, 15, 29, etc.

The primary objective of this phase II study is to determine whether the administration of Gliadel wafers followed by Avastin and irinotecan to patients with recurrent GBM is a treatment regimen worthy of further investigation in a randomized clinical trial. The basis for making this decision will be the proportion of patients who survive at least 24 weeks after initiation of protocol treatment.

In the initial Phase I and II clinical trials, four potential Avastin-associated safety signals were identified: hypertension, proteinuria, thromboembolic events, and hemorrhage. The two major toxicities associated with irinotecan are myelosuppression and diarrhea. Side effects associated with Gliadel are seizures, brain edema (swelling), healing abnormalities, wound infection and body pain.

  Eligibility

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

Inclusion Criteria:

  • Patients must have histologically confirmed diagnosis of WHO grade IV primary malignant glioma (glioblastoma multiforme or gliosarcoma). Patients have to be able to undergo a GTR.
  • Age > or = 18 years
  • Evidence of a unilateral, single focus of measurable CNS neoplasm on contrast-enhanced MRI, unless medically contraindicated (CT scan will then be used)
  • Patients must have < or = 2 disease progressions
  • An interval of at least 4 weeks from the end of prior radiotherapy or one week from the end of a cycle of chemotherapy and enrollment on this protocol
  • Karnofsky > or = 70%
  • Hemoglobin > or = 9.0 g/dl, ANC > or = 1,500 cells/microliters, platelets > or = 125,000 cells/microliters
  • Serum creatinine < or = 1.5 mg/dl, serum SGOT and bilirubin < or = 1.5 times upper limit of normal
  • Patients on corticosteroids must have been on a stable dose for 1 week prior to entry, if clinically possible, and the dose should not be escalated over entry dose level
  • If patient received chemotherapy or investigational agent as part of their prior therapy, the patient must recover from all toxicities (> or = Grade 1) prior to enrollment on this protocol
  • Signed informed consent approved by the Institutional Review Board
  • No evidence of CNS hemorrhage on the baseline MRI or CT scans
  • If sexually active, patients will take contraceptive measures for the duration of treatment as stated in the informed consent

Exclusion Criteria:

  • Pregnancy or breast feeding. Women of childbearing potential must have a negative serum pregnancy test within 72 hours prior to treatment administration
  • Multifocal disease
  • Prior treatment with Gliadel
  • Prior treatment with CPT-11 or Avastin
  • Prior stereotactic radiosurgery or brachytherapy
  • Co-medication that may interfere with study results; e.g. immuno-suppressive agents other than corticosteroids
  • Active infection requiring IV antibiotics
  • Acute or chronic renal insufficiency (a GFR <30 mL/min/1.73m2) or acute renal insufficiency of any severity due to hepato-renal syndrome or in the peri-operative liver transplantation period
  • Inability, in the opinion of the study investigator, to comply with study and/or follow-up procedures
  • Current, recent (within 4 weeks of the first infusion of this study), or planned participation in an experimental drug study other than a Genentech-sponsored Avastin cancer study
  • Life expectancy of less than 12 weeks
  • Active malignancy, other than superficial basal cell and superficial squamous (skin) cell, or carcinoma in situ of the cervix within last five years
  • Inadequately controlled hypertension (defined as systolic blood pressure >150 and/or diastolic blood pressure > 100 mmHg)
  • Prior history of hypertensive crisis or hypertensive encephalopathy
  • New York Heart Association (NYHA) Grade II or greater congestive heart failure
  • History of myocardial infarction or unstable angina within 6 months prior to Day 1
  • History of stroke or transient ischemic attack within 6 months prior to Day 1
  • Significant vascular disease (e.g., aortic aneurysm, requiring surgical repair or recent peripheral arterial thrombosis) within 6 months prior to Day 1
  • History of hemoptysis (> or = 1/2 teaspoon of bright red blood per episode) within 1 month prior to Day 1
  • Evidence of bleeding diathesis or significant coagulopathy (in the absence of therapeutic anticoagulation)
  • Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to Day 1 or anticipation of need for major surgical procedure during the course of the study
  • Core biopsy or other minor surgical procedure, excluding placement of a vascular access device, within 7 days prior to Day 1
  • History of abdominal fistula, gastrointestinal perforation within 6 months prior to Day 1
  • Serious, non-healing wound, active ulcer, or untreated bone fracture
  • Proteinuria at screening as demonstrated by urinalysis (urine protein)
  • Known hypersensitivity to any component of Avastin
  • Pregnancy (positive pregnancy test) or lactation. Use of effective means of contraception (men and women) in subjects of child-bearing potential
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00735436

Contacts
Contact: James J Vredenburgh, MD 919-681-3824 vrede001@mc.duke.edu
Contact: Mary Lou Affronti, RN, MSN, ANP 919-684-6239 affro002@mc.duke.edu

Locations
United States, North Carolina
Duke University Medical Center Recruiting
Durham, North Carolina, United States, 27710
Contact: James J Vredenburgh, MD     919-681-3824     vrede001@mc.duke.edu    
Contact: Sarah Woodring, BS     919-684-2527     sarah.woodring@duke.edu    
Principal Investigator: James J Vredenburgh, MD            
Sub-Investigator: Mary Lou Affronti, RN, MSN, ANP            
Sponsors and Collaborators
Duke University
Eisai Inc.
Genentech
Investigators
Principal Investigator: James J Vredenburgh, MD Duke University
  More Information

Duke University Medical Center Clinical Trials  This link exits the ClinicalTrials.gov site
The Preston Robert Tisch Brain Tumor Center  This link exits the ClinicalTrials.gov site

Responsible Party: Duke University Medical Center ( James Joseph Vredenburgh, MD )
Study ID Numbers: 00006308
Study First Received: August 13, 2008
Last Updated: December 26, 2008
ClinicalTrials.gov Identifier: NCT00735436  
Health Authority: United States: Institutional Review Board

Keywords provided by Duke University:
Gliosarcoma
Malignant glioma
Glioblastoma multiforme
GBM
Gliadel
Carmustine
Irinotecan
CPT-11
Camptosar
Avastin
Bevacizumab

Study placed in the following topic categories:
Excitatory Amino Acids
Glioblastoma
Phenobarbital
Astrocytoma
Carmustine
Irinotecan
Bevacizumab
Phenytoin
Neuroectodermal Tumors
Glioblastoma multiforme
Carbamazepine
Neoplasms, Germ Cell and Embryonal
Neuroepithelioma
Glioma
Gliosarcoma
Neoplasms, Glandular and Epithelial

Additional relevant MeSH terms:
Neurotransmitter Agents
Neoplasms by Histologic Type
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Growth Substances
GABA Modulators
Neoplasms, Nerve Tissue
Physiological Effects of Drugs
Central Nervous System Depressants
Enzyme Inhibitors
Excitatory Amino Acid Agents
Angiogenesis Inhibitors
Pharmacologic Actions
Neoplasms
Therapeutic Uses
Hypnotics and Sedatives
GABA Agents
Growth Inhibitors
Angiogenesis Modulating Agents
Neoplasms, Neuroepithelial
Antineoplastic Agents, Phytogenic
Central Nervous System Agents
Anticonvulsants
Excitatory Amino Acid Antagonists

ClinicalTrials.gov processed this record on January 16, 2009