Regorafenib per meningioma ricorrente di grado 2 e 3 (studio MIRAGE) (MIRAGE)
Regorafenib per meningioma ricorrente di grado 2 e 3. Uno studio multicentrico, randomizzato di fase II (studio MIRAGE)
The focus of this study will be to investigate whether Regorafenib demonstrates antitumor activity against recurrent meningiomas.
Small trials and case series suggest clinical relevant activity of several VEGF inhibitors such as sunitinib, bevacizumab and valatinib reporting a 6m-PFS rate of 42-64%. Indeed, VEGF and VEGF receptors (VEGFR) are regularly overexpressed in meningiomas and can correlate with outcome.
Regorafenib inhibits angiogenic receptor tyrosine kinases (RTKs) and is highly selective for VEGFR1/2/3; moreover Regorafenib inhibits PDGFRB, FGFR1 and oncogenic intracellular signalling cascades involving c-RAF/RAF1 and BRAF highly expressed in meningiomas.
Noteworthy, Regorafenib showed antitumor activity in vitro and in vivo in a recent study; indeed, Regorafenib showed significant inhibition of meningioma cell motility and invasion and in vivo, mice with orthotopic meningioma xenografts showed a reduced volume of signal enhancement in MRI following Regorafenib therapy; this translated in a significantly increased overall survival time (p<0.05) for Regorafenib treated mice.
Moreover, Regorafenib showed good efficacy in different cancer types, such as colorectal cancer, GIST, hepatocellular carcinoma and glioblastoma (REGOMA trial) , maintainingmaintaining a good quality of life.
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Tipo di studio
Tipo di studio
Iscrizione (Stimato)
Iscrizione
Fase
Fase
- Fase 2
Contatti e Sedi
Contatto studio
Contatto studio
- Nome: Gian Luca De Salvo, MD
- Numero di telefono: +39 049 8215704
- Email: gianluca.desalvo@iov.veneto.it
Luoghi di studio
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Bari, Italia
- Reclutamento
- A.O.U. Policlinico di Bari
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Contatto:
- Valeria Internò
- Email: valeria.interno@policlinico.ba
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Investigatore principale:
- Valeria Internò
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Bari, Italia
- Completato
- Ospedale San Paolo
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Bologna, Italia
- Reclutamento
- Ospedale Bellaria - AUSL Bologna
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Investigatore principale:
- Enrico Franceschi, MD
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Contatto:
- Enrico Franceschi, MD
- Email: e.franceschi@isnb.it
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Florence, Italia
- Reclutamento
- Azienda Ospedaliero Universitaria Careggi
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Contatto:
- Isacco Desideri, MD
- Email: isacco.desideri@unifi.it
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Investigatore principale:
- Isacco Desideri, MD
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Genova, Italia
- Reclutamento
- Policlinico San Martino
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Contatto:
- Elisa Bennicelli, MD
- Email: elisa.bennicelli@hsanmartino.it
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Investigatore principale:
- Elisa Bennicelli, MD
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Livorno, Italia
- Reclutamento
- Spedali Riuniti
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Contatto:
- Anna Luisa Di Stefano, MD
- Email: annaluisa.distefano@uslnordovest.toscana.it
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Investigatore principale:
- Anna Luisa Di Stefano, MD
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Milan, Italia
- Reclutamento
- Fondazione IRCCS Istituto Neurologico Carlo Besta
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Contatto:
- Paola Gaviani, MD
- Email: paola.gaviani@istituto-besta.it
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Investigatore principale:
- Paola Gaviani, MD
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Milan, Italia
- Reclutamento
- IRCCS Ospedale San Raffaele
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Contatto:
- Nicole Liscia, MD
- Email: liscia.nicole@hsr.it
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Investigatore principale:
- Nicole Liscia, MD
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Naples, Italia
- Reclutamento
- Ospedale del Mare
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Investigatore principale:
- Bruno Daniele, MD
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Contatto:
- Pasqualina Giordano, MD
- Email: giopas@email.it
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Padova, Italia, 35128
- Reclutamento
- Istituto Oncologico Veneto
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Contatto:
- Giuseppe Lombardi, MD
- Email: giuseppe.lombardi@iov.veneto.it
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Perugia, Italia
- Non ancora reclutamento
- Azienda Ospedaliera di Perugia
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Contatto:
- Mario Mandalà, Prof
- Email: mario.mandala@unipg.it
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Roma, Italia
- Reclutamento
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS
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Contatto:
- Silvia Chiesa, MD
- Email: silvia.chiesa@policlinicogemelli.it
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Investigatore principale:
- Silvia Chiesa, MD
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Roma, Italia
- Non ancora reclutamento
- Policlinico Umberto I - Università Sapienza Roma
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Contatto:
- Giuseppe Minniti, MD
- Email: giuseppe.minniti@uniroma1.it
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Investigatore principale:
- Giuseppe Minniti, MD
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Roma, Italia
- Reclutamento
- IRCCS Istituto Tumori Regina Elena
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Contatto:
- Veronica Villani, MD
- Email: veronica.villani@ifo.it
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Investigatore principale:
- Veronica Villani, MD
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Torino, Italia
- Reclutamento
- A.O.U. Città della Salute e della Scienza di Torino
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Contatto:
- Roberta Rudà, MD
- Email: roberta.ruda@unito.it
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Investigatore principale:
- Roberta Rudà, MD
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Forlì-Cesena
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Meldola, Forlì-Cesena, Italia
- Reclutamento
- IRST Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori"
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Investigatore principale:
- Lorena Gurrieri, MD
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Contatto:
- Lorena Gurrieri, MD
- Email: lorena.gurrieri@irst.emr.it
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Italia/Messina
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Messina, Italia/Messina, Italia, 98124
- Reclutamento
- Azienda Ospedaliera Universitaria Gaetano Martino
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Contatto:
- Mariacarmela Santarpia, MD
- Email: mariacarmela.santarpia@unime.it
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Italy, Firenze
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Bagno a Ripoli, Italy, Firenze, Italia, 50012
- Non ancora reclutamento
- Ospedale Santa Maria Annunziata
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Contatto:
- Silvia Scoccianti, MD
- Email: silvia.scoccianti@uslcentro.toscana.it
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Italy, PN
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Aviano, Italy, PN, Italia, 33081
- Non ancora reclutamento
- Centro di Riferimento Oncologico di Aviano (CRO), IRCCS
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Contatto:
- Lorenzo Vinante, MD
- Email: lorenzo.vinante@cro.it
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Milano
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Rozzano, Milano, Italia
- Reclutamento
- Humanitas Cancer Center
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Contatto:
- Matteo Simonelli, MD
- Email: matteo.simonelli@hunimed.eu
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Investigatore principale:
- Matteo Simonelli, MD
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Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
- Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted
- Patients capable of taking oral medication
- Subject is willing and able to adhere to the study visit schedule and other protocol requirements.
- Histological diagnosis of meningioma according to the WHO 2021 classification
- Radiologically documented progression of any existing tumor with an estimated planar growth >25% (bidirectional) in the last 12 months or appearance of new lesions
- Ineligible for further surgery and/or radiotherapy
- at least 1 Measurable lesion (minimum 10 x 10mm) on baseline MRI
- Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 to 1 (or KPS ³70)
- Male or female ≥ 18 years of age
- Subjects must have life expectancy of at least 6 months
- Paraffin-embedded tumor tissue available (mandatory)
- Dosage of dexamethasone or equivalent steroid within 7 days prior the randomization ≤4mg/die
- Stable or decreasing dosage of steroids for 7 days prior to the randomization.
- Adequate cardiac function and adequate liver, renal and hematological function
- Subject must have the following laboratory values at screening within 14 days before starting Regorafenib:
- Absolute neutrophil count (ANC) ≥ 1.5 x 109/L without growth factor support for 7 days (14 days if subject received pegfilgrastim).
- Hemoglobin (Hgb) ≥10 g/dL
- Platelet count (plt) ≥100x 109/L
- Serum potassium concentration within normal range, or correctable with supplements
- Serum glutamic oxaloacetic transaminase (SGOT)/aspartate aminotransferase (AST) and serum glutamate pyruvic transaminase (SGPT)/alanine aminotransferase (ALT) ≤ 3.0 x Upper Limit of Normal (ULN).
- Serum total bilirubin ≤ 1.5 x ULN
- Serum creatinine ≤ 1.5 x ULN or measured glomerular filtration rate (GFR) ≥ 50 mL/min/1.73 m2 using an exogenous filtration marker such as iohexol, inulin, 51Cr EDTA or 1125 iothalamate, or creatinine clearance of ≥ 50 mL/min using Cockroft-Gault equation.
- Serum albumin > 3.5 g/dL
- PT (or INR) and APTT within normal range
- For women who are not postmenopausal (i.e., < 2 years after last menstruation) or surgically sterile (absence of ovaries and/or uterus) and who are sexually active: agreement to use an adequate method of contraception (oral contraceptives, intrauterine contraceptive device, or barrier method of contraception in conjunction with spermicidal jelly) during the Treatment period and for at least 6 months after the last dose of study drug.
- For male patients who are partners of premenopausal women: agreement to use a barrier method of contraception during the Treatment period and for at least 6 months after the last dose of study drug.
- Participants with type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to participate.
- 19. Patients with measurable, progressive meningioma who received radiation therapy are potentially eligible but need to show evidence of progression at least 24 weeks from completion of radiation therapy.
- 20. Possible prior use of bevacizumab in the treatment of radionecrosis (3-24 months after radiosurgery or radiotherapy; 5mg/kg q14w, 4-6 cycles)
Exclusion Criteria:
- Prior antineoplastic therapy for meningioma
- Subject incapacitated to understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted
- Are taking strong cytochrome P (CYP) CYP3A4 inhibitors (eg, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telithromycin, voriconazole) or strong CYP3A4 inducers (eg, carbamazepine, phenobarbital, phenytoin, rifampin, St. John's Wort)
- Are taking strong UGT1A9 inhibitors (e.g. mefenamic acid, diflunisal and niflumic acid)
- Receiving additional, concurrent, active therapy for Meningioma outside of the trial.
- Disease outside the brain (ie. spinal cord or bone or metastasis to a distant organ)
- Candidate for urgent palliative intervention for primary disease (e.g., impending herniation) as judged by the Investigator
- History of allergy or hypersensitivity to any of the study treatments or any of their excipients.
- In the presence of therapeutic intent to anticoagulate the patient:,INR or PT and aPTT not within therapeutic limits (according to the medical standard in the institution)
- Unable or unwilling to undergo brain MRI scans with intravenous (IV) gadolinium
- History of another malignancy in the previous 3 years, with a disease-free interval of< 3 years. Patients with prior history of in situ cancer or basal or squamous cell skin cancer are eligible.
- Serious, non-healing wound, ulcer, bone fracture, or abscess.
- Any cerebrovascular accident (including transient ischemic attacks) within the last 6 months prior to initiation of study treatment.
- Have an ongoing infection with severity of Grade 2 or above (CTCAE 5.0)
- Any hemorrhage or bleeding event that is ≥ Grade 3 based on the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Event (CTCAE), Grade 2 intracranial hemorrhage, or persistent thrombotic/embolic event within 4 weeks prior to the start of study medication.
- Uncontrolled or severe cardiac disease (e.g., history of unstable angina, myocardial infarction, coronary stenting, or bypass surgery within the last 6 months prior to initiation of study treatment), symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia (including atrial flutter/fibrillation), requirement for inotropic support or use of devices for cardiac conditions (e.g.,pacemakers/defibrillators), or hypertension (participants with systolic blood pressure[BP] of > 160 mmHg or diastolic BP of > 100 mmHg despite optimal medical management are to be excluded).
- History of interstitial lung disease, history of slowly progressive dyspnea and unproductive cough, sarcoidosis, silicosis, idiopathic pulmonary fibrosis, pulmonary hypersensitivity pneumonitis, or symptomatic pleural effusion.
- Active, known, or suspected auto-immune disease, including systemic lupus erythematosus, Hashimotos thyroiditis, scleroderma, polyarteritis nodosa, or auto-immune hepatitis.
- Known history of hepatitis B, human immunodeficiency virus (HIV), or active hepatitis C infection requiring treatment with antiviral therapy. Note: HIV testing is not required in the absence of clinical suspicion.
- History of bleeding diathesis (irrespective of severity).
- Uncontrolled intercurrent illness including (e.g., symptomatic ascites), but not limited to ongoing or active infection.
- Persistent ≥ Grade 3 Lipase (> 2.0 - 5.0 x upper limit of normal [ULN] with signs or symptoms; > 5.0 x ULN and asymptomatic).
- Persistent proteinuria > 3.5 g/24 hours measured by urine protein creatinine ratio from a random urine sample (≥ Grade 3, CTCAE 5.0)
- Have any malabsorbition condition
- Any condition that could make the subject noncompliant with the study procedures and/or study requirements, as judged by the Investigator (for example: cognitive impairment, psychiatric illness, etc).
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
|
Sperimentale: Arm A (interventional arm)
REGORAFENIB 40 mg tablets once daily (160 mg/die), 3 weeks on, 1 week off, until disease progression or unacceptable toxicity |
REGORAFENIB 40 mg tablets once daily (160 mg/die), 3 weeks on, 1 week off, until disease progression or unacceptable toxicity |
|
Comparatore attivo: Arm B (control arm)
Local Standard of Care until disease progression or unacceptable toxicity |
In this setting there are not drugs with indication. Every site will treat patients as per their experience. |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Progression free survival (PFS)
Lasso di tempo: Up to 54 months
|
The progression free survival (PFS) will be determined as the time from the date of enrolment to the date of disease progression determined using RANO criteria or to the date of death, whichever occurs first. |
Up to 54 months
|
Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
|
Overall survival (OS)
Lasso di tempo: Up to 42 months
|
The overall survival (OS) will be determined as the time from the date of enrolment to the date of death from any cause. |
Up to 42 months
|
|
Objective response rate (ORR)
Lasso di tempo: Up to 42 months
|
The objective response rate (ORR) will be defined as the percentage of patients with complete response (CR) and partial response (PR) determined using modified Macdonald criteria. |
Up to 42 months
|
|
Patient Reported Outcomes (PROs)
Lasso di tempo: Up to 42 months
|
Quality of life will be assessed by EORTC QLQ-C30 questionnaire. |
Up to 42 months
|
|
Patient Reported Outcomes (PROs)
Lasso di tempo: Up to 42 months
|
Quality of life will be assessed by the QLQBN20 questionnaire. |
Up to 42 months
|
|
Toxicity during treatment
Lasso di tempo: Up to 42 months
|
Toxicity during the treatment will be recorded and graded according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) v.5. |
Up to 42 months
|
|
Disease control rate (DCR)
Lasso di tempo: Up to 42 months
|
The disease control rate (DCR) will be defined as the percentage of patients with complete response (CR), partial response (PR) and stable disease (SD) determined using modified Macdonald criteria. |
Up to 42 months
|
Collaboratori e investigatori
Sponsor
Sponsor
Collaboratori
Collaboratori
Investigatori
Investigatori
- Investigatore principale: Giuseppe Lombardi, MD, Istituto Oncologico Veneto IOV IRCCS
Pubblicazioni e link utili
Studiare le date dei record
Studia le date principali
Inizio studio (Effettivo)
Inizio studio
Completamento primario (Stimato)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
- Malattie del sistema nervoso
- Neoplasie per sede
- Neoplasie
- Neoplasie per tipo istologico
- Neoplasie, tessuto nervoso
- Neoplasie del sistema nervoso
- Neoplasie, tessuto vascolare
- Neoplasie meningee
- Neoplasie del sistema nervoso centrale
- Meningioma
- Preparati farmaceutici
- Forme di dosaggio
- Compresse
- Regorafenib
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- IOV-BT-1-2023 MIRAGE
Piano per i dati dei singoli partecipanti (IPD)
Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?
Informazioni su farmaci e dispositivi, documenti di studio
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Studia un dispositivo regolamentato dalla FDA degli Stati Uniti
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