Radiation Therapy With or Without Thalidomide in Treating Patients With Brain Metastases

October 29, 2020 updated by: National Cancer Institute (NCI)

A Phase III Study of Conventional Radiation Therapy Plus Thalidomide (NSC#66847) Versus Conventional Radiation Therapy for Multiple Brain Metastases

Randomized phase III trial to compare the effectiveness of radiation therapy with or without thalidomide in treating patients who have brain metastases. Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs such as thalidomide may stop the growth of brain metastases by stopping blood flow to the tumor. It is not yet known whether radiation therapy is more effective with or without thalidomide in treating brain metastases.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

OBJECTIVES:

I. Compare the overall survival of patients with multiple brain metastases treated with radiotherapy with or without thalidomide.

II. Compare the time to tumor progression in patients treated with these regimens.

III. Compare the time to neuro-cognitive progression in patients treated with these regimens.

IV. Compare the cause of death distribution in patients treated with these regimens.

V. Compare the frequency of toxic effects of these regimens in these patients. VI. Evaluate and compare the quality of life of patients treated with these regimens.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to recursive partitioning analysis class (I vs II) and planned chemotherapy after whole brain irradiation (yes vs no). Patients are randomized to 1 of 2 treatment arms.

Arm I: Patients undergo radiotherapy once daily 5 days a week for 3 weeks. Arm II: Patients undergo radiotherapy as in arm I. Beginning on the first day of radiotherapy, patients receive oral thalidomide once daily.

Treatment with thalidomide continues for 2 years in the absence of disease progression or unacceptable toxicity. Quality of life is assessed at baseline, at completion of radiotherapy, and then every 2 months for 1 year.

Patients are followed every 2 months for 1 year, every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 332 patients (166 per treatment arm) will be accrued for this study within 14.5 months.

Study Type

Interventional

Enrollment (Actual)

332

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19103
        • Radiation Therapy Oncology Group

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Histologically confirmed extracranial primary malignancy
  • Multiple brain metastases

  • At least 1 measurable brain metastasis by MRI

    • More than 4.0 cm
    • Located in midbrain or brainstem (radiosurgery ineligible)
  • Performance status - Zubrod 0-1
  • At least 8 weeks
  • Absolute neutrophil count at least 1,500/mm^3
  • Platelet count at least 100,000/mm^3
  • Hemoglobin at least 11 g/dL*
  • Hematocrit at least 35%*
  • Bilirubin no greater than 1.5 mg/dL
  • ALT no greater than 2 times normal
  • Creatinine no greater than 1.5 mg/dL
  • BUN no greater than 25 mg/dL
  • No history of deep venous thrombosis
  • No sensory neuropathy grade 2 or greater
  • No known AIDS
  • No other major medical illness or psychiatric impairments that would preclude study therapy
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective barrier method of contraception during and for at least 4 weeks after study
  • No prior thalidomide
  • More than 2 weeks since prior chemotherapy
  • Concurrent chemotherapy allowed if more than 6 weeks past study entry (allowed during first 6 weeks of study if disease progression occurs)
  • See Disease Characteristics
  • No prior radiotherapy to the head or neck
  • No prior radiosurgery
  • Prior resection of brain metastases allowed
  • No concurrent anticoagulant therapy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Arm I (radiation therapy)
Patients undergo radiotherapy once daily 5 days a week for 3 weeks.
Procedure: quality-of-life assessment
Ancillary studies
Other Names:
  • quality of life assessment
Radiation: radiation therapy
Undergo conventional radiation therapy
Other Names:
  • irradiation
  • radiotherapy
  • therapy, radiation
Experimental: Arm II (radiation therapy, thalidomide)
Patients undergo radiotherapy as in arm I. Beginning on the first day of radiotherapy, patients receive oral thalidomide once daily.
Procedure: quality-of-life assessment
Ancillary studies
Other Names:
  • quality of life assessment
Drug: thalidomide
Given orally
Other Names:
  • Kevadon
  • Synovir
  • THAL
  • Thalomid
Radiation: radiation therapy
Undergo conventional radiation therapy
Other Names:
  • irradiation
  • radiotherapy
  • therapy, radiation

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Overall survival
Time Frame: Up to 6 years
The log-rank statistic will be used.
Up to 6 years
Time to tumor progression
Time Frame: Date of randomization to documentation of progression, assessed up to 6 years
Cumulative incidence model will be used to analyze the data. A multivariate Cox model analysis will be performed.
Date of randomization to documentation of progression, assessed up to 6 years
Time to neuro-cognitive progression as assessed by the Mini Mental State Exam
Time Frame: Up to 6 years
Cumulative incidence model will be used to analyze the data.
Up to 6 years

Secondary Outcome Measures

Outcome Measure
Time Frame
Cause of death distribution
Time Frame: Up to 6 years
Up to 6 years
Frequency of toxicities, graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v3.0
Time Frame: Up to 6 years
Up to 6 years
Quality of life as measured by the Spitzer Quality of Life Index (SQLI)
Time Frame: 6 months
6 months
Quality of life as measured by the SQLI
Time Frame: 12 months
12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

National Cancer Institute (NCI)

Collaborators

NRG Oncology

Investigators

  • Principal Investigator: Jonathan Knisely, Radiation Therapy Oncology Group

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

March 1, 2002

Primary Completion (Actual)

May 1, 2006

Study Registration Dates

First Submitted

April 9, 2002

First Submitted That Met QC Criteria

January 26, 2003

First Posted (Estimate)

January 27, 2003

Study Record Updates

Last Update Posted (Actual)

October 30, 2020

Last Update Submitted That Met QC Criteria

October 29, 2020

Last Verified

October 1, 2020

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • NCI-2012-02461
  • U10CA021661 (U.S. NIH Grant/Contract)
  • RTOG-BR-0118
  • CDR0000069268

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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