- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05305885
Intra-pemetrexed Alone or Combined With Concurrent Radiotherapy for Leptomeningeal Metastasis
An Open-label, Randomized, Multicenter Trial of Intrathecal-pemetrexed Combined With Concurrent Involved-field Radiotherapy and Intrathecal-pemetrexed Alone in Patients With Leptomeningeal Metastasis From Solid Tumors
Intrathecal chemotherapy is one of the mainstay treatment options for leptomeningeal metastases. Owing to the limited number of agents available for intrathecal chemotherapy, it is crucial to find a novel agent with efficacy and safety. In our phase 1 study, intrathecal pemetrexed showed controllable toxicities and potential promising efficacy for refractory leptomeningeal metastases from non-small-cell lung cancer patients. In our further study, intrathecal pemetrexed combined with involved-field radiation therapy was administered as the first-line intrathecal chemotherapy for leptomeningeal metastases from solid tumors. In this study, intrathecal pemetrexed combined with involved-field radiation therapy showed feasibility and controllable adverse events. It has been proved that pemetrexed as a novel intrathecal drug exhibited promising antitumor effects in cerebrospinal fluid. Moreover, the concomitant therapeutic modality is an optimal treatment option for leptomeningeal metastases from solid tumors.
Central nervous system radiotherapy is a part of the specific treatment of leptomeningeal metastases. Radiotherapy has been proved to improve neurologic function and control of parenchymal brain metastases in leptomeningeal metastases treatment. Additionally, radiotherapy is revealed to improve the efficacy and attenuate toxicity of intrathecal chemotherapy as a result of normal cerebrospinal fluid reestablishing. However, it is still controversial whether radiotherapy can improve the overall survival. We conduct this study to further demonstrate the efficacy and safety of intrathecal pemetrexed administration for patients with leptomeningeal metastases from solid tumors by multicenter study. Furthermore, the study of effective treatment modality is of great significance. The safety and antitumor activity of intrathecal pemetrexed combined with involved-field radiation therapy and intrathecal pemetrexed alone were also compared to confirm an optimized therapeutic regimen.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Zhenyu Pan, PhD.
- Phone Number: +8615804302753
- Email: dr-zypan@163.com
Study Contact Backup
- Name: Guozi Yang, PhD.
- Phone Number: +8615804302755
- Email: guoziyang_1982@163.com
Study Locations
-
-
Jilin
-
Changchun, Jilin, China, 130021
- Recruiting
- The First Hospital of Jilin University
-
Contact:
- Zhenyu Pan, Professor
- Phone Number: +8615804302753
- Email: dr-zypan@163.com
-
Contact:
- Guozi Yang, Professor
- Phone Number: +8615804302755
- Email: guoziyang_1982@163.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients with a confirmed or probable diagnosis of leptomeningeal metastasis according to European Association of Neuro-Oncology-European Society for Medical Oncology (EANO-ESMO) guidelines;Patients who have been definitely diagnosed as leptomeningeal metastasis according to cerebrospinal fluid cytology, or patients who got the clinical diagnosis by combining with neuroimaging, history of cancer, clinical manifestation, cerebrospinal fluid examination, etc.
- Participants with histologically or cytologically confirmed disease from solid tumors;
- No history of whole brain radiotherapy;
- Normal liver and kidney function; WBC≥4000/mm3, Plt≥100000/mm3.
Exclusion Criteria:
- Patients with primary tumor of hematological tumors or primary central germ cell tumors;
- Patients administrated with new molecular targeted therapy which is effective for leptomeningeal metastasis in 2 weeks;
- Patients with hydrocephalus or other factors suggestive of cerebrospinal fluid circulation obstruction;
- Patients with severe encephalopathy, grade 3 leukoencephalopathy, Glasgow Coma Scale less than 8 score;
- Patients with extensive and lethal systemic diseases with few treatment options;
- Patients with poor compliance, or for other reasons, the researchers considered unsuitable to participate in this clinical study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: NONE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: Group 1
Intrathecal administration, intraventricular administration or via lumbar puncture, pemetrexed plus dexamethasone, first induction intra-cerebrospinal fluid chemotherapy twice per week for 2 weeks, then once per week for 4 times, 6 weeks in total.
Concurrent radiotherapy consisted of fractionated, conformal radiation given at a daily dose of 2 Gy.
The planning volume consisted of sites of symptomatic disease, bulky disease observed on MRI, including the whole brain and basis cranii received 40 Gy in 20 fractions, 4 weeks in total, and/or segment of spinal canal received 40 Gy.
|
Intrathecal administration, intraventricular administration or via lumbar puncture, pemetrexed plus dexamethasone, first induction intra-cerebrospinal fluid chemotherapy twice per week for 2 weeks, then once per week for 4 times, 6 weeks in total.
Concurrent radiotherapy consisted of fractionated, conformal radiation given at a daily dose of 2 Gy.
The planning volume consisted of sites of symptomatic disease, bulky disease observed on MRI, including the whole brain and basis cranii received 40 Gy in 20 fractions, 4 weeks in total, and/or segment of spinal canal received 40 Gy.
|
EXPERIMENTAL: Group 2
Intrathecal administration, intraventricular administration or via lumbar puncture, pemetrexed plus dexamethasone, first induction intra-cerebrospinal fluid chemotherapy twice per week for 2 weeks, then once per week for 4 times, 6 weeks in total.
|
Intrathecal administration, intraventricular administration or via lumbar puncture, pemetrexed plus dexamethasone, first induction intra-cerebrospinal fluid chemotherapy twice per week for 2 weeks, then once per week for 4 times, 6 weeks in total.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Clinical response rate
Time Frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 6 months.
|
The response assessment in neuro-oncology criteria (RANO) proposal for response criteria of leptomeningeal metastasis was used to assess the clinical response in this study.
|
From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 6 months.
|
Incidence of treatment-related adverse events
Time Frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 6 months.
|
The incidence of treatment-related adverse events were measured for determining tolerability and safety.
Adverse events (AEs) are evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE, version 4.03).
Events of grade 3-5 are defined as moderate and severe adverse events.
|
From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 6 months.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall survival
Time Frame: From the enrollment of this study until date of death from any cause, whichever came first, or the last follow-up (at least 7 months).
|
Survival time was recorded since the date of patient enrollment.
All patients were followed up until death or the end of the study.
|
From the enrollment of this study until date of death from any cause, whichever came first, or the last follow-up (at least 7 months).
|
Neurological progression-free survival (NPFS)
Time Frame: From date of randomization until the date of first documented neurological progression or date of death from any cause, whichever came first, assessed up to 6 months.
|
NPFS was defined as time from the start of treatment until neurological progression or death.
The neurological progression was determined based on the RANO proposal evaluation criteria which have been established and published on Neuro Oncol.
|
From date of randomization until the date of first documented neurological progression or date of death from any cause, whichever came first, assessed up to 6 months.
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Zhenyu Pan, PhD., The First Hospital of Jilin University
Publications and helpful links
General Publications
- Pan Z, Yang G, He H, Cui J, Li W, Yuan T, Chen K, Jiang T, Gao P, Sun Y, Cong X, Li Z, Wang Y, Pang X, Song Y, Zhao G. Intrathecal pemetrexed combined with involved-field radiotherapy as a first-line intra-CSF therapy for leptomeningeal metastases from solid tumors: a phase I/II study. Ther Adv Med Oncol. 2020 Jul 17;12:1758835920937953. doi: 10.1177/1758835920937953. eCollection 2020.
- Pan Z, Yang G, He H, Gao P, Jiang T, Chen Y, Zhao G. Identification of Cerebrospinal Fluid MicroRNAs Associated With Leptomeningeal Metastasis From Lung Adenocarcinoma. Front Oncol. 2020 Apr 3;10:387. doi: 10.3389/fonc.2020.00387. eCollection 2020.
- Pan Z, Yang G, Cui J, Li W, Li Y, Gao P, Jiang T, Sun Y, Dong L, Song Y, Zhao G. A Pilot Phase 1 Study of Intrathecal Pemetrexed for Refractory Leptomeningeal Metastases From Non-small-cell Lung Cancer. Front Oncol. 2019 Aug 30;9:838. doi: 10.3389/fonc.2019.00838. eCollection 2019.
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Pathologic Processes
- Nervous System Diseases
- Neoplasms
- Neoplasms by Site
- Neoplastic Processes
- Central Nervous System Neoplasms
- Nervous System Neoplasms
- Meningeal Neoplasms
- Neoplasm Metastasis
- Meningeal Carcinomatosis
- Molecular Mechanisms of Pharmacological Action
- Nucleic Acid Synthesis Inhibitors
- Enzyme Inhibitors
- Antineoplastic Agents
- Folic Acid Antagonists
- Pemetrexed
Other Study ID Numbers
- PMRT
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- CSR
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.
Clinical Trials on Leptomeningeal Metastasis
-
Memorial Sloan Kettering Cancer CenterFred Hutchinson Cancer CenterActive, not recruitingLeptomeningeal MetastasesUnited States
-
Memorial Sloan Kettering Cancer CenterCenter for Experimental Therapeutics; F.M. KIRBY FOUNDATIONRecruitingLeptomeningeal MetastasesUnited States
-
Memorial Sloan Kettering Cancer CenterCompletedLeptomeningeal MetastasesUnited States
-
Second Affiliated Hospital, School of Medicine,...Recruiting
-
West China HospitalNot yet recruitingNSCLC Associated With Leptomeningeal Metastases
-
The First Hospital of Jilin UniversityThe Second Hospital of Hebei Medical University; Second Affiliated Hospital... and other collaboratorsActive, not recruiting
-
Biocept, Inc.ICON plcTerminatedBreast Cancer | Non-Small Cell Lung Cancer | Leptomeningeal Disease | Leptomeningeal Metastasis | Leptomeningeal NeoplasmsUnited States
-
The First Hospital of Jilin UniversityCompletedLeptomeningeal MetastasesChina
-
City of Hope Medical CenterNational Cancer Institute (NCI)WithdrawnLeptomeningeal Metastases
-
H. Lee Moffitt Cancer Center and Research InstituteGenentech, Inc.RecruitingHER2-positive Breast Cancer | Leptomeningeal Disease | Leptomeningeal MetastasisUnited States
Clinical Trials on Pemetrexed
-
Boehringer IngelheimTerminatedCarcinoma, Non-Small-Cell LungJapan
-
Shanghai Shengdi Pharmaceutical Co., LtdNot yet recruitingNon-squamous Non-small Cell Lung CancerChina
-
Rongjie TaoNational Natural Science Foundation of ChinaUnknown
-
PfizerTerminatedCarcinoma, Non-Small Cell LungUnited States, Germany, Italy
-
Norwegian University of Science and TechnologySt. Olavs HospitalTerminatedCarcinoma, Non-small-cell LungNorway
-
Eli Lilly and CompanyCompletedNon-Small Cell Lung Cancer Metastatic | Nonsquamous Non-Small Cell Neoplasm of Lung | Non-Small Cell Lung Cancer Stage IIIBUnited Kingdom, Sweden
-
Northwestern UniversityNational Cancer Institute (NCI)UnknownLymphoma | Brain and Central Nervous System Tumors | Metastatic CancerUnited States
-
University Hospital, AntwerpEli Lilly and Company; Universiteit AntwerpenCompleted
-
The First Affiliated Hospital with Nanjing Medical...UnknownNon-squamous Non-small-cell Lung Cancer
-
Sun Yat-sen UniversityRecruitingCarcinoma,Non-Small-Cell LungChina