Radiation Therapy and Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma or Gliosarcoma

This study has been completed.
Sponsor:
Collaborators:
European Organisation for Research and Treatment of Cancer - EORTC
Information provided by (Responsible Party):
Radiation Therapy Oncology Group
ClinicalTrials.gov Identifier:
NCT00304031
First received: March 15, 2006
Last updated: December 19, 2013
Last verified: December 2013
  Purpose

RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving radiation therapy together with temozolomide may kill more tumor cells. It is not yet known which schedule of temozolomide when given together with radiation therapy is more effective in treating glioblastoma or gliosarcoma.

PURPOSE: This randomized phase III trial is studying two different schedules of temozolomide to compare how well they work when given together with radiation therapy in treating patients with newly diagnosed glioblastoma or gliosarcoma.


Condition Intervention Phase
Brain and Central Nervous System Tumors
Drug: temozolomide
Radiation: radiation therapy
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase III Trial Comparing Conventional Adjuvant Temozolomide With Dose-Intensive Temozolomide in Patients With Newly Diagnosed Glioblastoma

Resource links provided by NLM:


Further study details as provided by Radiation Therapy Oncology Group:

Primary Outcome Measures:
  • Overall survival (OS) [ Time Frame: From randomization to date of death or last follow-up. Analysis occurs after 647 deaths have been reported. ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Progression-free survival (PFS) [ Time Frame: From randomization to date of progression, death or last follow-up. Analysis occurs after 647 deaths have been reported. ] [ Designated as safety issue: No ]
  • Comparison of OS and PFS in patients with unmethylated MGMT [ Time Frame: From randomization to date of progression, death or last follow-up. Analysis occurs after 647 deaths have been reported. ] [ Designated as safety issue: No ]
  • Comparison of OS and PFS in patients with methylated MGMT [ Time Frame: From randomization to date of progression, death or last follow-up. Analysis occurs after 647 deaths have been reported. ] [ Designated as safety issue: No ]
  • Correlation of tumor MGMT gene methylation status with treatment response [ Time Frame: From randomization to date of progression, death or last follow-up. Analysis occurs after 647 deaths have been reported. ] [ Designated as safety issue: No ]
  • Toxicity [ Time Frame: From start of treatment to end of follow-up ] [ Designated as safety issue: Yes ]
  • Correlation of PFS with OS at 6 months [ Time Frame: From randomization to date of progression, death or last follow-up. Analysis occurs after 647 deaths have been reported. ] [ Designated as safety issue: No ]

Enrollment: 1173
Study Start Date: January 2006
Primary Completion Date: February 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Arm I
Patients receive oral temozolomide on days 1-5. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients with responding disease may receive up to 6 more courses of temozolomide.
Drug: temozolomide
Given orally
Radiation: radiation therapy
Patients undergo radiotherapy daily, 5 days per week for 6 weeks.
Experimental: Arm II
Patients receive oral temozolomide on days 1-21. Treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients with responding disease may receive up to 6 more courses of temozolomide.
Drug: temozolomide
Given orally
Radiation: radiation therapy
Patients undergo radiotherapy daily, 5 days per week for 6 weeks.

Detailed Description:

OBJECTIVES:

Primary

  • Determine if dose-intensifying (increasing the "dose-density") the adjuvant temozolomide component of the chemoradiation treatment enhances treatment efficacy as measured by overall survival of patients with newly diagnosed glioblastoma or gliosarcoma.

Secondary

  • Determine if dose-intensifying the adjuvant temozolomide component of the chemoradiation treatment enhances treatment efficacy as measured by progression-free survival.
  • Determine in patients with unmethylated MGMT if dose-intensifying the adjuvant temozolomide component of the chemoradiation treatment enhances treatment efficacy (overall and progression-free survival) compared with patients receiving conventional temozolomide dosing.
  • Determine in patients with methylated MGMT if dose-intensifying the adjuvant temozolomide component of the chemoradiation treatment enhances treatment efficacy (overall and progression-free survival) compared with patients receiving conventional temozolomide dosing.
  • Determine if there is an association between tumor MGMT gene methylation status and treatment response.
  • Compare and record the toxicities of the conventional and dose-intense chemotherapy regimens.
  • Evaluate whether 6-month progression-free survival is associated with overall survival.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to recursive partitioning analysis class (III vs IV vs V), MGMT gene methylation status (methylated vs nonmethylated vs indeterminate), and radiotherapy criteria used (standard vs revised European).

Patients undergo radiotherapy daily, 5 days per week for 6 weeks. Patients also receive oral temozolomide daily during radiotherapy. Patients are then randomized to 1 of 2 treatment arms. Randomized treatment begins approximately 4 weeks after completion of radiotherapy.

  • Arm I: Patients receive oral temozolomide on days 1-5.
  • Arm II: Patients receive oral temozolomide on days 1-21. In both arms, treatment repeats every 28 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients with responding disease may receive up to 6 more courses of temozolomide.

After completion of study treatment, patients are followed every 3 months for 1 year, every 4 months for 2 years, and then every 6 months thereafter.

Peer Reviewed and Funded or Endorsed by Cancer Research UK

PROJECTED ACCRUAL: A total of 834 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically proven glioblastoma or gliosarcoma

    • Diagnosis must be made by open biopsy or tumor resection

      • Diagnosis by stereotactic biopsy not allowed
    • Tumor must have supratentorial component
    • Contrast-enhanced MRI or CT scan (if MRI is not available) of the brain must be performed preoperatively and postoperatively prior to initiation of radiotherapy, within 28 days prior to study entry

      • If pre- and postoperative contrast-enhanced CT scans are obtained, must be of sufficient quality
  • Meets 1 of the following recursive positioning analysis classifications:

    • Class III

      • Age < 50 years and Karnofsky performance status (KPS) 90-100%
    • Class IV, meeting 1 of the following criteria:

      • Age < 50 years and KPS < 90%
      • Age ≥ 50 years and KPS 70-100% and underwent prior partial or total tumor resection with no worse than minor neurofunction impairment
    • Class V, meeting 1 of the following criteria:

      • Age ≥ 50 years and KPS 70-100% and underwent prior partial or total tumor resection with worse than minor neurofunction impairment
      • Age ≥ 50 years and KPS 70-100% and underwent prior tumor biopsy only
      • Age ≥ 50 years and KPS < 70%
  • Underwent most recent brain tumor surgery within the past 5 weeks
  • No recurrent or multifocal malignant gliomas
  • At least 1 block of tissue available for analysis of MGMT gene methylation status
  • No metastases detected below the tentorium or beyond the cranial vault

PATIENT CHARACTERISTICS:

  • KPS 60-100%
  • Absolute neutrophil count ≥ 1,500 cells/mm^3
  • Platelet count ≥ 100,000 cells/mm^3
  • Hemoglobin ≥ 10 g/dL (transfusion or other intervention allowed)
  • BUN ≤ 25 mg/dL
  • Creatinine ≤ 1.7 mg/dL
  • Bilirubin ≤ 2.0 mg/dL
  • AST and ALT ≤ 3 times normal
  • Negative pregnancy test
  • Not pregnant or nursing
  • Fertile patients must use effective contraception
  • No prior invasive malignancy (except for nonmelanomatous skin cancer) unless patient is disease free for ≥ 3 years (e.g., carcinoma in situ of the breast, oral cavity, or cervix allowed)
  • No severe, active comorbidity, including any of the following:

    • Unstable angina and/or congestive heart failure requiring hospitalization
    • Transmural myocardial infarction within the last 6 months
    • Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
    • Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of registration
    • Known hepatic insufficiency resulting in clinical jaundice and/or coagulation defects
    • Known AIDS based upon current CDC definition
    • Major medical illnesses or psychiatric impairments that, in the investigator's opinion, will prevent administration or completion of protocol therapy
    • Active connective tissue disorders, such as lupus or scleredema that, in the opinion of the treating physician, may put the patient at high risk for radiation toxicity
  • No prior allergic reaction to temozolomide

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Recovered from the effects of surgery, postoperative infection, and other complications prior to study entry
  • No prior chemotherapy or radiosensitizers (including polifeprosan 20 with carmustine implant [Gliadel wafers] or any other intratumoral or intracavitary treatment) for cancers of the head and neck region

    • Prior chemotherapy for a different cancer is allowed
  • No prior radiotherapy to the head or neck (except for T1 glottic cancer) that would result in an overlap of radiation fields
  • No treatment on other therapeutic clinical protocols within 30 days prior to study entry or during participation in the study
  • No concurrent prophylactic growth factors
  • No other concurrent investigational drugs
  • No concurrent surgical procedures for tumor debulking
  • No other concurrent chemotherapy, immunotherapy, or biologic therapy
  • No additional concurrent stereotactic boost radiotherapy
  • No concurrent intensity-modulated radiotherapy
  • Concurrent steroids allowed provided dose is stable or decreasing in the past 5 days
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00304031

  Show 351 Study Locations
Sponsors and Collaborators
Radiation Therapy Oncology Group
European Organisation for Research and Treatment of Cancer - EORTC
Investigators
Principal Investigator: Mark R. Gilbert, MD M.D. Anderson Cancer Center
Study Chair: Minesh P. Mehta, MD University of Wisconsin, Madison
Study Chair: Roger Stupp, MD Centre Hospitalier Universitaire Vaudois
  More Information

Additional Information:
Publications:
Gilbert MR, Wang M, Aldape KD, et al.: RTOG 0525: A randomized phase III trial comparing standard adjuvant temozolomide (TMZ) with a dose-dense (dd) schedule in newly diagnosed glioblastoma (GBM). [Abstract] J Clin Oncol 29 (Suppl 15): A-2006, 2011.
Aldape KD, Jones G, Wang M, et al.: MGMT methylation testing in RTOG 0525: A phase III trial of newly diagnosed glioblastoma. [Abstract] J Clin Oncol 27 (Suppl 15): A-2051, 2009.

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Radiation Therapy Oncology Group
ClinicalTrials.gov Identifier: NCT00304031     History of Changes
Other Study ID Numbers: RTOG-0525, CDR0000465183, EORTC-26052, EORTC-22053, NCI-2009-00731
Study First Received: March 15, 2006
Last Updated: December 19, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by Radiation Therapy Oncology Group:
adult glioblastoma
adult giant cell glioblastoma
adult gliosarcoma

Additional relevant MeSH terms:
Glioblastoma
Nervous System Neoplasms
Central Nervous System Neoplasms
Gliosarcoma
Astrocytoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Neoplasms by Site
Nervous System Diseases
Temozolomide
Dacarbazine
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses

ClinicalTrials.gov processed this record on April 22, 2014