Temozolomide in Treating Patients With Invasive Pituitary Tumors

An Open Label, Multicenter, Phase II Study Evaluating the Safety and Efficacy of Temozolomide Treatment in Patients With Invasive Pituitary Tumors

RATIONALE: Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing.

PURPOSE: This phase II trial is studying how well temozolomide works in treating patients with invasive pituitary tumors.

Study Overview

• Status: Withdrawn
• Conditions: Brain and Central Nervous System Tumors
• Intervention / Treatment: Drug: temozolomide; Genetic: protein expression analysis; Other: laboratory biomarker analysis; Genetic: DNA methylation analysis; Genetic: proteomic profiling; Genetic: microarray analysis

Detailed Description

OBJECTIVES:

Primary

• To assess the effect of temozolomide on pituitary tumor growth in patients with invasive pituitary tumors.
• To assess the effect of temozolomide on pituitary tumor response and the duration of tumor response in these patients.

Secondary

• To assess the effect of temozolomide on pituitary tumor hormone secretion in these patients.
• To assess the effect of temozolomide on other aspects of pituitary function in these patients.
• To assess the overall safety and tolerability of temozolomide in these patients.
• To assess the overall quality of life of patients treated with temozolomide.

OUTLINE: This is a multicenter study.

Patients receive oral temozolomide once daily on days 1-5. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. After completion of 12 courses, patients achieving a complete or partial tumor response may continue to receive temozolomide at the investigator's discretion in the absence of disease progression or unacceptable toxicity.

Tumor tissue samples are collected periodically to assess methylation status of the methyl-guanine methyl-transferase promoter (MGMT) gene and to quantitate immunocytochemical expression of the tumor suppressor proteins p53, p16, and p27. Tissue samples are also analyzed by microarray and proteomics to determine a genetic "signature" of invasive vs non-invasive pituitary tumors and to determine if this signature correlates with response to temozolomide. Blood samples are also periodically for biomarker laboratory studies.

Patients complete a quality of life questionnaire periodically.

After completion of study therapy, patients are followed for 28 days.

• Study Type: Interventional
• Phase: Phase 2

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

DISEASE CHARACTERISTICS:

• Clinically demonstrable invasive pituitary macroadenoma, including any of the following subtypes:

  • Growth hormone-secreting
  • Prolactin-secreting
  • Adrenocorticotrophic hormone-secreting
  • Non-secreting

• Must have biochemical evidence of any of the following:

  • Acromegaly as measured by serum insulin-like growth factor-1 (IGF-1)
  • Prolactinoma as measured by serum prolactin (PRL)
  • Cushing's disease as measured by 24-hour urinary-free cortisol
• Inadequate tumor control, defined as a visible pituitary tumor ≥ 1 cm in maximal diameter encasing the carotid arteries, and/or invading into the cavernous sinuses, and/or abutting/invading the optic chiasma as demonstrated by MRI scan with or without contrast

• Previously assessed by radiosurgery and meets ≥ 1 of the following criteria:

  • Not a suitable candidate for radiotherapy (e.g., tumor abutting and/or invading the optic chiasm)
  • Declined radiotherapy (in light of side effects or personal choice)
  • Has not exhibited tumor shrinkage or tumor continues to grow ≥ 1 year after completion of radiotherapy

• Must have a normal visual field evaluation by Goldman perimetry

  • No visual field abnormalities

• Hypopituitarism allowed as evidenced by any or all of the following:

  • Subnormal growth hormone response to arginine/growth hormone-releasing hormone testing (normal response is an increase of > 4 ng/mL)
  • Low age- and sex-matched IGF-1 levels
  • Low thyroid-stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4) levels
  • Low estradiol levels
  • Low luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels in postmenopausal female patients OR low testosterone, LH, and FSH levels in male patients
  • Serum cortisol < 3 ng/mL (at 8 am)
• Patients diagnosed with hypopituitarism (except for post-menopausal females) are required to initiate hormone replacement therapy for the 12-month duration of the study and to discontinue hormone replacement therapy at the end of 12 months to re-evaluate hypopituitarism

PATIENT CHARACTERISTICS:

• Able to undergo a pituitary MRI scan
• No clinically significant renal, hematologic, or hepatic abnormalities
• No prior or concurrent medical condition that may interfere with the conduct of the study or the evaluation of its results, in the opinion of the Investigator or the Data Safety Monitoring Board compliance officer
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception for ≥ 2 months prior to, during, and for 1 month after completion of study therapy
• No history of immunocompromise, including known HIV positivity as measured by enzyme linked immunosorbent assay (ELISA) and western blot
• No alcohol or drug abuse within the past 6 months
• No blood donation within the past 2 months
• No history of noncompliance to medical regimens, potential unreliability, or inability to complete the entire study
• No other active malignant disease within the past 5 years, except basal cell carcinoma or carcinoma in situ of the cervix
• No active or suspected acute or chronic uncontrolled infection

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• Prior pituitary surgery allowed provided the surgery failed to induce complete tumor response and the patient is deemed unsuitable for further pituitary surgeries
• At least 3 months since prior pituitary surgery
• More than 1 month since prior unlicensed drugs or participation in a clinical trial with an investigational drug
• No concurrent pituitary surgery or pituitary radiotherapy
• No other concurrent therapy to reduce pituitary tumor size

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Change from baseline of pituitary tumor control as assessed by MRI at 3, 6, 9, and 12 months	1 year
Change in Tumor response rate (complete response or partial response) from baseline as assessed by RECIST criteria at 3, 6, 9, and 12 months	1 year
Rebound tumor growth as assessed by MRI at 6 months after completion of treatment	6 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Biochemical control as assessed by measurement of hormones secreted in excess by the pituitary tumor at baseline, at 3, 6, 9, and 12 months during treatment, and then at 2 months after completion of treatment	14 months
Pituitary function as assessed by standard pituitary function tests at baseline and at 6 months and 12 months	1 year
Safety and tolerability of temozolomide as assessed by NCI CTC v2.0 at screening, baseline, and then monthly until study completion	1 year
Overall quality of life as assessed by Karnofsky performance status questionnaire periodically during study	1 year

Collaborators and Investigators

• Sponsor: Jonsson Comprehensive Cancer Center
• Investigators: Study Chair: Anthony Heaney, MD, Jonsson Comprehensive Cancer Center

Study record dates

Study Major Dates

• Study Start: December 1, 2009
• Primary Completion (Actual): October 1, 2010

Study Registration Dates

• First Submitted: January 25, 2008
• First Submitted That Met QC Criteria: January 25, 2008
• First Posted (Estimate): January 28, 2008

Study Record Updates

• Last Update Posted (Actual): July 31, 2020
• Last Update Submitted That Met QC Criteria: July 29, 2020
• Last Verified: July 1, 2012

More Information

Terms related to this study

• Keywords: ACTH-producing pituitary tumor; growth hormone-producing pituitary tumor; nonfunctioning pituitary tumor; prolactin-producing pituitary tumor; recurrent pituitary tumor; pituitary chromophobe adenoma; pituitary basophilic adenoma; pituitary eosinophilic adenoma; prolactin secreting adenoma
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neoplasms; Neoplasms by Site; Endocrine System Diseases; Endocrine Gland Neoplasms; Hypothalamic Diseases; Hypothalamic Neoplasms; Supratentorial Neoplasms; Brain Neoplasms; Pituitary Neoplasms; Pituitary Diseases; Nervous System Neoplasms; Central Nervous System Neoplasms; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents; Antineoplastic Agents, Alkylating; Alkylating Agents; Temozolomide
• Other Study ID Numbers: CDR0000577534; 07-05-077-01