Efficacy of Hypofractionated XRT w/Bev. + Temozolomide for Recurrent Gliomas

Inclusion Criteria:

• Patients must have histologically confirmed diagnosis of glioblastoma multiforme (GBM) or anaplastic glioma, World Health Organization (WHO) grade 3 or 4

  • Patients must have measurable or non-measurable (evaluable) disease recurrence
  • Recurrence must be documented based on a combination of clinical and imaging parameters, consistent with routine clinical practice, with or without histologic confirmation
  • Patients may have had any number of relapses and be eligible for the study
  • Patients must have been previously treated with radiation therapy and temozolomide (bevacizumab-naïve - Groups 1 and 3) or radiation therapy, temozolomide and bevacizumab (bevacizumab-exposed -Groups 2 and 4); therapy with these agents may be given together or sequentially in the past
  • All patients may have had prior surgery, chemotherapy, and radiation therapy; prior biologic therapy is permitted only for bevacizumab-exposed patients (Groups 2 and 4); prior treatment with Gliadel is permitted for all groups
  • For bevacizumab-naïve patients (Groups 1 and 3) a minimum of 6 months must have elapsed since completion of radiation therapy for study entry, and there is no minimum time since completion of last chemotherapy; for bevacizumab-exposed patients (Groups 2 and 4) no minimum time since completion of last radiation therapy, biologic agents, or chemotherapy will be required for study entry
  • Patients must have an ECOG performance status of =< 2
  • Hemoglobin >= 10
  • Platelets >= 100,000/mm^3
  • Absolute neutrophil count >= 1500/mm^3
  • Bilirubin =< 1.5 x upper limit of normal range (ULN)
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 x ULN
  • Blood urea nitrogen (BUN) =< 1.5 x ULN
  • Creatinine =< 1.5 x ULN
  • Urine protein/creatinine ratio should be =< 1
  • Patients' baseline blood pressure must be adequately controlled with or without antihypertensive medications prior to enrollment (systolic < 140 mmHg, diastolic < 90 mmHg)
  • Patients must have a baseline evaluation including history and physical examination with neurological evaluation and magnetic resonance imaging (MRI) of the brain (with and without gadolinium-based contrast), all completed within 30 days prior to initiation of treatment

  • Female patients of child-bearing potential must have a negative pregnancy test within 14 days prior to enrollment on study; child-bearing potential is defined as any female (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets one of the following criteria:

    • Has not undergone a hysterectomy or bilateral oophorectomy
    • Or has not been naturally postmenopausal for at least 12 consecutive months (i.e. has had menses at any time in the preceding consecutive 12 months)
  • Females of child-bearing potential and sexually-active males must consent to follow acceptable birth control methods to avoid contraception while on treatment
  • All subjects must have given signed, informed consent prior to registration on study
  • Patients previously treated outside of Northwestern must have their pathology slides sent to Northwestern for review and confirmation - NOTE: a copy of the pathology report is sufficient for registration

Exclusion Criteria:

• • Patients who are pregnant or breast-feeding will NOT be eligible for participation

  • Patients with a prior malignancy will NOT be eligible for participation aside from the following exception:

• Patients who have had any curatively treated malignancy and have been disease free without treatment for 1 year prior to study entry ARE eligible for participation

  • Patients with an active second malignancy (other than non-melanoma skin cancer or cervical cancer in situ) are NOT eligible for participation
  • Patients with uncontrolled hypertension (>= 140/90 mmHg) are NOT eligible for participation
  • Patients who exhibit any other serious concurrent infection or other medical illness which would jeopardize their ability to receive the therapy outlined in this protocol with reasonable safety will NOT be eligible for participation
  • The eligibility criteria listed above are interpreted literally and cannot be waived