- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03137888
Spectroscopic MRI-Guided Radiation Therapy Planning in Glioblastoma
Pilot Study of Spectroscopic MRI-Guided, Dose-Escalated Radiation Therapy for Newly-Diagnosed Glioblastoma
Study Overview
Status
Conditions
Detailed Description
PRIMARY OBJECTIVES:
I. To determine the feasibility of using spectroscopic MRI (sMRI) to guide dose-escalated radiation therapy (RT) for newly-diagnosed glioblastoma (GBM)s.
II. To determine the safety of using sMRI to guide dose-escalated RT for newly-diagnosed GBMs.
SECONDARY OBJECTIVE:
I. To determine whether the progression free survival at 1 year with sMRI-guided, dose-escalated RT is improved for newly-diagnosed GBMs.
TERTIARY OBJECTIVES:
I. To determine whether sMRI-guided, dose-escalated RT increases the overall survival of patients with newly diagnosed GBMs.
II. To determine whether sMRI data obtained after initiation of therapy (at 2 weeks after RT/TMZ start and prior to cycle 1 and 5 of adjuvant temozolomide [TMZ]) will provide early evidence of GBM progression not seen on standard MRIs.
III. To determine whether performance on neurocognitive and quality-of-life (QOL) assessments in newly-diagnosed GBM patients treated with sMRI-guided, dose-escalated RT differ from historical controls.
OUTLINE:
Patients undergo sMRI-guided radiation therapy daily for the first 5 days of every week (Monday - Friday) over 6 weeks. Patients also receive standard of care temozolomide orally (PO) daily during radiation therapy for up to 42 days.
After completion of study treatment, patients are followed up every 3 months for up to 2 years and then periodically.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
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Florida
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Miami, Florida, United States, 33136
- University of Miami Miller School of Medicine-Sylvester Cancer Center
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Georgia
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Atlanta, Georgia, United States, 30322
- Emory University/Winship Cancer Institute
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Maryland
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Baltimore, Maryland, United States, 21287
- Johns Hopkins University/Sidney Kimmel Cancer Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients must have a newly-diagnosed glioblastoma or gliosarcoma that has been confirmed pathologically by a board-certified neuropathologist
- Patients must be able to have MRI scans
Patients must have the following lab values ≤ 14 days prior to registration:
- White blood cell (WBC) ≥ 3,000/µL
- Absolute neutrophil count (ANC) ≥ 1,500/µL
- Platelet count of ≥ 75,000/µL
- Hemoglobin ≥ 9.0 gm/dL (transfusion is allowed to reach minimum level)
- Serum glutamic-oxaloacetic transaminase (SGOT) ≤ 2.0 x upper limit of normal (ULN)
- Bilirubin ≤ 2 x ULN
- Creatinine ≤ 1.5 mg/dL
- Patients must have a life expectancy of ≥ 12 weeks
- Patients must have a Karnofsky performance status (KPS) ≥ 60
- Patients who are women of childbearing potential must have a negative pregnancy test documented ≤ 14 days prior to registration; this is not specific to dose escalation and is mandatory for standard care for patients being treated with radiation therapy; the cost of this test will be covered by standard of care
- Patients must be able to understand and provide written informed consent
- Members of all races and ethnic groups are eligible for this trial; subjects will be approximately representative of the demographics of the referral base for the participating institutions
- Patient must be able to swallow capsules
- Patients must be willing to forego other cytotoxic and non-cytotoxic therapies against the tumor while being treated on this protocol
Exclusion Criteria:
- Patients with pacemakers, aneurysm clips, neurostimulators, cochlear implants, metal in ocular structures, history of being a steel worker, or other incompatible implants which makes MRI safety an issue are excluded
- Patients that have any significant medical illnesses that in the investigator's opinion cannot be adequately controlled with appropriate therapy or would compromise the patient's ability to tolerate this therapy are excluded
- Patients with a history of any other invasive cancer (except non-melanoma skin cancer and excluding carcinoma in-situ), unless in complete remission and off of all therapy for that disease for ≥ 3 years, are ineligible
- Patients with an active infection or serious intercurrent medical illness are ineligible
- Patients receiving any other investigational agents are excluded
- Patients who have received prior cytotoxic, non-cytotoxic or experimental drug therapies for brain tumor are excluded
- Patients with a history of prior cranial radiation are ineligible
- Patients may not be enrolled on any other therapeutic trial for which they are receiving an anti-tumor therapy
- Patients with GBMs located in the following anatomical regions known to have magnetic susceptibility or poor signal will be excluded: mesial temporal lobe, orbitofrontal cortex, prefrontal cortex, medial frontal gyrus, brainstem, and cerebellum
- The maximum radiation target volume for gross tumor volume 3 (GTV3) is 65 cc (per NRG Oncology guide); patient may be excluded after the first sMRI scan if the GTV3 volume is greater than 65 cc (we anticipate that contrast-enhancing tumor volume [residual tumor volume following tumor resection] would be less than 20 cc)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: sMRI-Guided RT with TMZ
Patients undergo spectroscopic magnetic resonance imaging-guided dose-escalated radiation therapy daily for the first 5 days of every week (Monday - Friday) over 6 weeks.
Patients also receive standard of care temozolomide PO daily during radiation therapy for up to 42 days.
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Given PO
Other Names:
Undergo sMRI-guided radiation therapy, dose painted to maximum of 75 Gy over six weeks
Other Names:
Patients will undergo sMRI scans within a 14 day window prior to starting treatment
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Feasibility as assessed by successful co-registration of sMRI-based treatment volumes with clinical images into the radiation treatment execution platform
Time Frame: Up to 2 years after completion of therapy
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Feasibility of this approach will be determined by whether treatment volumes based on sMRI can be co-registered with clinical images and transferred into the radiation treatment execution platform in a seamless manner, so that sMRI information can be efficiently applied to the patient treatment.
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Up to 2 years after completion of therapy
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Incidence of adverse event assessed by Common Terminology Criteria for Adverse Events version 4.0
Time Frame: Up to 2 years after completion of therapy
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The safety of sMRI to guide dose-escalated RT will be confirmed by assessing toxicity potentially attributable to the RT.
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Up to 2 years after completion of therapy
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Progression free survival (PFS)
Time Frame: From the time of surgical resection to the time of either radiographic progression or death, whichever occurs first, assessed at 1 year
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PFS actuarial curves will be assessed and compared to historical controls, and will particularly interested in comparing the 1-year PFS rate which, based on the control arm (receiving standard dose RT with TMZ) of recent GBM trials, is approximately 30% in historical cohorts.
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From the time of surgical resection to the time of either radiographic progression or death, whichever occurs first, assessed at 1 year
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Early evidence of GBM progression assessed by sMRI
Time Frame: At 2 weeks after start of therapy
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Changes in sMRI parameters over time will be assessed to determine whether they will be able to predict development of recurrence.
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At 2 weeks after start of therapy
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Neurocognitive performance: Hopkins Verbal Learning Test
Time Frame: Up to 2 years after completion of therapy
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Neurocognitive performance will be assessed by the Hopkins Verbal Learning Test - Revised.
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Up to 2 years after completion of therapy
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Neurocognitive performance: Controlled Oral Word Association Test
Time Frame: Up to 2 years after completion of therapy
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Neurocognitive performance will be assessed by the Controlled Oral Word Association Test (COWAT) from the Multilingual Aphasia Examination.
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Up to 2 years after completion of therapy
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Overall survival (OS)
Time Frame: From the time of surgical resection to the time of death, assessed up to 1 year
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The OS actuarial curve and 1-year OS rate will be assessed and compared to historical controls.
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From the time of surgical resection to the time of death, assessed up to 1 year
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Quality of life (QOL): European Organization for Research and Treatment of Cancer
Time Frame: Up to 2 years after completion of therapy
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QOL will be assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30/Brain Cancer Module-20.
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Up to 2 years after completion of therapy
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Quality of life (QOL): MD Anderson
Time Frame: Up to 2 years after completion of therapy
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QOL will be assessed by the MD Anderson Symptom Inventory Brain Tumor Module.
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Up to 2 years after completion of therapy
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Hui-Kuo Shu, MD, PhD, Emory University/Winship Cancer Institute
Publications and helpful links
General Publications
- Ramesh K, Gurbani SS, Mellon EA, Huang V, Goryawala M, Barker PB, Kleinberg L, Shu HG, Shim H, Weinberg BD. The Longitudinal Imaging Tracker (BrICS-LIT):A Cloud Platform for Monitoring Treatment Response in Glioblastoma Patients. Tomography. 2020 Jun;6(2):93-100. doi: 10.18383/j.tom.2020.00001.
- Gurbani S, Weinberg B, Cooper L, Mellon E, Schreibmann E, Sheriff S, Maudsley A, Goryawala M, Shu HK, Shim H. The Brain Imaging Collaboration Suite (BrICS): A Cloud Platform for Integrating Whole-Brain Spectroscopic MRI into the Radiation Therapy Planning Workflow. Tomography. 2019 Mar;5(1):184-191. doi: 10.18383/j.tom.2018.00028.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Neoplasms by Histologic Type
- Neoplasms
- Neoplasms, Glandular and Epithelial
- Astrocytoma
- Glioma
- Neoplasms, Neuroepithelial
- Neuroectodermal Tumors
- Neoplasms, Germ Cell and Embryonal
- Neoplasms, Nerve Tissue
- Glioblastoma
- Gliosarcoma
- Molecular Mechanisms of Pharmacological Action
- Antineoplastic Agents
- Antineoplastic Agents, Alkylating
- Alkylating Agents
- Temozolomide
Other Study ID Numbers
- IRB00094188
- P30CA138292 (U.S. NIH Grant/Contract)
- NCI-2017-00424 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
- RAD3383-17 (Other Identifier: Emory University/Winship Cancer Institute)
- R01CA214557 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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