Evaluation of Memantine in the Preservation of Memory and Neurocognition Following CSI (MEMENTO)

Memantine to Preserve Memory and Neurocognition Following Craniospinal Irradiation- A Randomised Controlled Trial (MEMENTO)

The goal of this clinical trial is to evaluate the role of memantine in preservation of memory and neurocognition in patients undergoing craniospinal irradiation. Participants will be randomised into two arms and the interventional arm will receive memantine along with the standard treatment. Researchers will compare the neurocognitive tests of participants in both the arms to see if memantine leads to significant preservation of memory and cognition post radiation therapy.

Study Overview

• Status: Recruiting
• Conditions: Neurocognitive Dysfunction
• Intervention / Treatment: Drug: Memantine Oral Tablet

Detailed Description

Craniospinal irradiation (CSI) involving radiation (RT) of brain and spine, along with tumor-bed boost with or without chemotherapy, is the current standard treatment for medulloblastoma and other primitive embryonal tumors of the central nervous system (CNS). The delayed side effects following CSI include memory loss, hearing and balance difficulties, hormonal imbalance, and secondary cancers. Decline in memory severely affects the quality of life in long term survivors of these diseases. Hence, various strategies are being tried to prevent it. Memantine has been proven to effectively prevent the memory decline induced by RT. It is FDA-approved for Alzheimer's disease and is widely used in the children for several developmental disorders. With this study, we are trying to investigate the role of memantine in patients receiving CSI to prevent memory decline.

After screening for the study, eligible patients will be randomly allocated (by computerised system) to one of the two arms that are described as follows. Patients in the experimental arm (memantine) will be started on memantine, starting dose of the same will be 5mg once daily at bedtime for 1 week, followed by 5mg twice daily for 1 week, and finally increased to the full dose of 10 mg twice daily for 6 months. Patients will continue on radiation and chemotherapy (when indicated) as per schedule. All patients in the study will undergo neurocognitive evaluation, the time points for which will be pre-radiation (baseline), 6 months post-RT, 1-year post-RT, and annually after that for 5 years from radiation. Following completion of RT or treatment, standard follow-up protocols will include a clinical examination 3 monthly for the first 2 years, followed by 6 monthly visits till 5 years post-RT. No additional risk is expected from the current study other than the common side effects of the standard treatment. Based on the results from the study, if primary endpoints are achieved, it will establish the role of memantine in preventing memory decline from CSI, which can be used as a standard treatment measure to help patients in the future.

• Study Type: Interventional
• Enrollment (Estimated): 101
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Tejpal Gupta, MD; Phone Number: 6015 02224177000; Email: drtejpalgupta@gmail.com

Study Locations

• India
  • Maharashtra
    • Mumbai, Maharashtra, India, 400012
      • Recruiting
      • Tata Memorial hospital
      • Contact: Dr Tejpal Gupta, MD; Phone Number: 6015 022-24177000; Email: tejpalgupta@rediffmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age at irradiation: 5 to 39 years
• Planned for CSI (with or without boost dose) with or without systemic chemotherapy
• Informed consent or assent taken
• Karnofsky Performance Status / Lansky Performance Status ≥ 60

Exclusion Criteria:

• Re-irradiation
• Prior exposure to memantine
• Inability to undergo Wechsler test

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental arm; Participants in the experimental arm (memantine) will be started on memantine. The starting dose of memantine will be 5mg once daily at bedtime for 1 week, followed by 5mg twice daily for 1 week, and finally increased to the full dose of 10 mg twice daily for 6 months.	Drug: Memantine Oral Tablet; Drug to preserve memory and neurocognitive dysfunction induced by radiation therapy; Other Names: Memantine
No Intervention: Standard arm; Participants in the standard arm will continue the standard treatment as planned.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cognitive-deterioration-free survival at 2 years	Cognitive-deterioration-free survival at 2 years; defined by a drop of 5 points in any of Full Scale Intelligence Quotient (FSIQ), Verbal Intelligence Quotient (VIQ), or Performance Intelligence Quotient (PIQ) compared to baseline (pre-radiation) on Wechsler Adult Intelligence Scale (WAIS), and Wechsler Intelligence Scale for Children (WISC).	2 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Full-Scale Intelligence Quotient (FSIQ) in children	The slope of decline of FSIQ with time as measured using age-appropriate neurocognitive test battery for children (Wechsler Intelligence Scale for Children- WISC)	7 years
Overall survival (OS)	Comparison of survival outcomes in both the arms	7 years
Academic performance by scholastic performance and grades	Comparison of scholastic performance as graded in school examinations in pediatric participants in both arms	7 years
Incidence of Treatment-Emergent Adverse Events [Safety and Tolerability] of Memantine	Recording of any unexpected adverse drug reactions according to CTCAE v 5.0	2 years
Progression-Free Survival (PFS)	Comparison of progression-free survival time in both arms	7 years
Full-Scale Intelligence Quotient (FSIQ) in adults	The slope of decline of FSIQ with time as measured using age-appropriate neurocognitive test battery for adults (Wechsler Adult Intelligence Scale-WAIS)	7 years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Full Scale Intelligence Quotient change in subgroups	Subgroup analysis of FSIQ slope. Subgroup stratification based on age, prior treatment of chemotherapy, dose of radiation received	7 years
Radiological features of cognitive decline on Magnetic Resonance Imaging	Fractional decline in volume of anatomical structures like hippocampus with radiation and correlation with FSIQ using Pearson correlation.	7 years
Neuroinflammatory markers correlation with neurocognitive decline and survival	Neuro-inflammatory markers in Cerebrospinal Fluid (CSF), blood and its correlation with Full-Scale Intelligence Quotient scores. List of markers to be measured:-; Inflammatory panel using ELISA: Interleukin(IL)- 6, IL-1, IL-4, IL-8, IL-10, IL-11, IL-12, Tumor Necrosis Factor- alpha, Interferon- gamma, Granulocyte macrophage colony-stimulating factor, Chitinase-3-like protein 1, Transforming Growth Factor- beta, C- reactive protein, Glial Fibrillary Acidic Protein, Ubiquitin, Carboxy- terminal hydrolase L1; Cell free Deoxyribo Nucleic Acid- using MagMax cell free DNA isolation kit; Circulating cancer cells using cell search circulating tumor cell kit	7 years

Collaborators and Investigators

• Sponsor: Tata Memorial Centre

Publications and helpful links

General Publications

• Brown PD, Pugh S, Laack NN, Wefel JS, Khuntia D, Meyers C, Choucair A, Fox S, Suh JH, Roberge D, Kavadi V, Bentzen SM, Mehta MP, Watkins-Bruner D; Radiation Therapy Oncology Group (RTOG). Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial. Neuro Oncol. 2013 Oct;15(10):1429-37. doi: 10.1093/neuonc/not114. Epub 2013 Aug 16.
• Brown PD, Gondi V, Pugh S, Tome WA, Wefel JS, Armstrong TS, Bovi JA, Robinson C, Konski A, Khuntia D, Grosshans D, Benzinger TLS, Bruner D, Gilbert MR, Roberge D, Kundapur V, Devisetty K, Shah S, Usuki K, Anderson BM, Stea B, Yoon H, Li J, Laack NN, Kruser TJ, Chmura SJ, Shi W, Deshmukh S, Mehta MP, Kachnic LA; for NRG Oncology. Hippocampal Avoidance During Whole-Brain Radiotherapy Plus Memantine for Patients With Brain Metastases: Phase III Trial NRG Oncology CC001. J Clin Oncol. 2020 Apr 1;38(10):1019-1029. doi: 10.1200/JCO.19.02767. Epub 2020 Feb 14.

Study record dates

Study Major Dates

• Study Start (Actual): February 22, 2024
• Primary Completion (Estimated): January 1, 2026
• Study Completion (Estimated): January 1, 2031

Study Registration Dates

• First Submitted: January 17, 2024
• First Submitted That Met QC Criteria: February 16, 2024
• First Posted (Actual): February 23, 2024

Study Record Updates

• Last Update Posted (Actual): April 9, 2025
• Last Update Submitted That Met QC Criteria: April 8, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Cognitive Dysfunction; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Neurotransmitter Agents; Dopamine Agents; Antiparkinson Agents; Anti-Dyskinesia Agents; Excitatory Amino Acid Agents; Excitatory Amino Acid Antagonists; Memantine
• Other Study ID Numbers: 4235

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual Participant Data from the study will not be shared publicly but anonymized data can be made available upon reasonable request to the Principal Investigator

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No