Intravitreal Aflibercept Injection for Radiation Retinopathy

Treatment of Radiation Retinopathy With Intravitreal Aflibercept Injection 2.0mg

The purpose of this study is to assess the safety of intravitreal aflibercept injection - in the treatment of macular edema associated with retinopathy secondary to previous radiation therapy.

Study Overview

• Status: Completed
• Conditions: Macular Edema; Radiation Retinopathy
• Intervention / Treatment: Drug: Aflibercept every 2 months; Drug: Aflibercept monthly

Detailed Description

Radiation retinopathy can cause decreased vision in patients who have received either external beam radiation or local plaque therapy to the eye. An early manifestation of radiation retinopathy is macular edema, which represents fluid within the retina that affects central vision. There is currently no approved treatment for this disease, although there have been anecdotal reports of benefit with laser photocoagulation, intravitreal anti-VEGF agents, or intravitreal steroid use. This is a phase 1 study to evaluate aflibercept for the treatment of macular edema associated with retinopathy secondary to previous radiation treatment.

• Study Type: Interventional
• Enrollment (Actual): 9
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • Washington University School of Medicine
  • Texas
    • Houston, Texas, United States, 77030
      • Retina Consultants of Houston

Participation Criteria

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:

• Retinopathy associated with previous I-125 brachytherapy for uveal melanoma (85 Gy over 96 hours) at least 6 months prior to enrollment
• Ability to provide written informed consent and comply with study assessments for the full duration of the study
• Age > 18 years
• Center involved macular edema > 300µm in thickness on SD-OCT
• Best corrected visual acuity of 20/40- 20/400
• Birth control therapy for females of child-bearing age

Exclusion Criteria:

• Pre-existing retinopathy due to other disorders
• Vision decrease is considered to be due to ischemic radiation retinopathy without macular edema or optic neuropathy
• Presence of metastasis
• Pregnancy (positive pregnancy test) or lactation
• Premenopausal women not using adequate contraception. The following are considered effective means of contraception: surgical sterilization or use of oral contraceptives, barrier contraception with either a condom or diaphragm in conjunction with spermicidal gel, an IUD, or contraceptive hormone implant or patch.
• Prior enrollment in any study with intravitreal aflibercept injection
• Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational therapy were initiated
• Uncontrolled glaucoma in the study eye (defined as IOP ≥ 30 mmHg despite treatment with anti-glaucoma medication)
• History of cerebral vascular accident, myocardial infarction, transient ischemic attacks within 4 months of study enrollment.
• Active infectious conjunctivitis, keratitis, scleritis, or endophthalmitis in either eye
• Any concurrent intraocular condition in the study eye (e.g., cataract or diabetic retinopathy) that, in the opinion of the investigator, could either require medical or surgical intervention during the study period to prevent or treat visual loss that might result from that condition, or if allowed to progress untreated, could likely contribute to loss of at least 2 Snellen equivalent lines of BCVA over the 6-month study period
• Presence of significant subfoveal fibrosis or atrophy
• Intraocular surgery (including cataract surgery) in the study eye within 2 months of enrollment
• Active intraocular inflammation (grade trace or above) in the study eye
• History of allergy to fluorescein, ICG or iodine, not amenable to treatment
• Prior/Concomitant Treatment:
• Panretinal photocoagulation treatment
• Previous intraocular steroids or PDT within 3 months
• Previous participation in any studies of investigational drugs within 30 days preceding Day 0 (excluding vitamins and minerals)
• Previous treatment with intravitreally (in either eye) or intravenously administered Avastin (bevacizumab) within 60 days or concomitant use in either eye outside the scope of this study
• Previous use of Eylea, Macugen or Lucentis in study eye within 60 days or concomitant use in either eye outside the scope of this study
• Prior submacular or vitreous surgery

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: aflibercept every 2 months	Drug: Aflibercept every 2 months; 2.0 mg aflibercept intravitreal injections once per month for the first 3 months (M0, M1, M2), then every 2 months (M4, M6, M8, M10); Other Names: EYLEA; VEGF Trap-Eye
EXPERIMENTAL: aflibercept monthly	Drug: Aflibercept monthly; 2.0mg aflibercept intravitreal injections every month (M0-11); Other Names: EYLEA; VEGF Trap-Eye

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Incidence of adverse events	12 months
Severity of adverse events	12 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Mean change in best corrected visual acuity from baseline	12 months
Mean change in central foveal thickness by optical coherence tomography (OCT) from baseline	12 months
Mean visual acuity	12 months
Mean central foveal thickness	12 months
Proportion of patients gaining 3 lines of vision	12 months
Mean change in lesion characteristics (lesion size, leakage)	12 months
Proportion of patients with no fluid on OCT	12 months
Mean change in macular volume	12 months

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Collaborators: Regeneron Pharmaceuticals
• Investigators: Principal Investigator: Prabakar K Rao, MD, Washington University School of Medicine

Publications and helpful links

General Publications

• Horgan N, Shields CL, Mashayekhi A, Teixeira LF, Materin MA, Shields JA. Early macular morphological changes following plaque radiotherapy for uveal melanoma. Retina. 2008 Feb;28(2):263-73. doi: 10.1097/IAE.0b013e31814b1b75.
• Finger PT, Chin K. Anti-vascular endothelial growth factor bevacizumab (avastin) for radiation retinopathy. Arch Ophthalmol. 2007 Jun;125(6):751-6. doi: 10.1001/archopht.125.6.751.
• Wen JC, McCannel TA. Treatment of radiation retinopathy following plaque brachytherapy for choroidal melanoma. Curr Opin Ophthalmol. 2009 May;20(3):200-4. doi: 10.1097/ICU.0b013e328329b62d.

Study record dates

Study Major Dates

• Study Start: November 1, 2012
• Primary Completion (ACTUAL): January 1, 2019
• Study Completion (ACTUAL): March 27, 2019

Study Registration Dates

• First Submitted: April 10, 2012
• First Submitted That Met QC Criteria: April 17, 2012
• First Posted (ESTIMATE): April 18, 2012

Study Record Updates

• Last Update Posted (ACTUAL): April 25, 2019
• Last Update Submitted That Met QC Criteria: April 24, 2019
• Last Verified: April 1, 2019

More Information

Terms related to this study

• Keywords: macular edema; anti-VEGF; radiation; retinopathy; aflibercept; VEGF-Trap
• Additional Relevant MeSH Terms: Eye Diseases; Retinal Degeneration; Macular Degeneration; Retinal Diseases; Macular Edema; Physiological Effects of Drugs; Antineoplastic Agents; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Growth Inhibitors; Aflibercept
• Other Study ID Numbers: aflibercept2012