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Avastin / Irinotecan in Patients With Recurrent or Progressive Malignant Glioma (AVIRMA01-09)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01144988
Recruitment Status : Unknown
Verified August 2011 by Medical University Innsbruck.
Recruitment status was:  Recruiting
First Posted : June 16, 2010
Last Update Posted : August 2, 2011
Roche, Austria
Information provided by:
Medical University Innsbruck

Brief Summary:

Malignant glioma are the most common and aggressive primary brain tumors in adults. Despite advances in multimodal treatment including surgery, radiation and chemotherapy, most patients have a dismal prognosis of 9-15 months (Stupp et al., NEJM 2005).

A major reason for the aggressiveness of malignant glioma is a pronounced tumor neovascularization, mainly driven by the vascular endothelial growth factor (VEGF) and its receptors. The therapeutic monoclonal antibody Bevacizumab (Avastin®) inhibits the VEGF pathway by binding the VEGF ligand. In Magnetic Resonance Imaging (MRI) this treatment reduces contrast enhancement by restoring both, the blood-brain-barrier and the destabilized vessel integrity. Furthermore, it raises the sensitivity of co-administered chemotherapeutics such as Irinotecan. In conclusion, anti-angiogenic therapy leads to the problem that the routinely used MRI techniques cannot distinguish anti-vascular effects from true anti-tumor effects.

The study hypothesis of the clinical trial part is that in 35% of malignant glioma patients Avastin / Irinotecan chemotherapy results in objective tumor responses assessed by standard / functional MRI and FET- /FLT-PET neuroimaging. The study hypothesis for the translational study part is that the expression of the molecular targets of Avastin and Irinotecan in malignant glioma tissue ( = tumor and vascular cells) are predictive for Avastin / Irinotecan therapy induced treatment response measured by functional MRI and FET- / FLT-PET imaging.

Condition or disease Intervention/treatment Phase
Recurrent Malignant Glioma Drug: Bevacizumab / Irinotecan Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 35 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: An Academic Prospective Single-arm Phase II Clinical Trial for Evaluation of Advanced Functional Neuroimaging Techniques and Molecular Markers in the Course of Anti-angiogenic Therapies in Malignant Gliomas
Study Start Date : March 2010
Estimated Primary Completion Date : March 2013
Estimated Study Completion Date : March 2013

Intervention Details:
  • Drug: Bevacizumab / Irinotecan
    Bevacizumab (10mg/kg KG) Irinotecan (125 mg/ m2 or 340 mg/m2 depending on usage of EIAED)

Primary Outcome Measures :
  1. To determine the objective tumor response criteria (RR, ORR, ORD) assessed by Standard MRI and FET-/FLT-PET during Avastin / Irinotecan chemotherapy. [ Time Frame: three years ]

Secondary Outcome Measures :
  1. Evaluation of the predictive / prognostic value of the VEGF pathway and tumor cell proliferation rate in tumor and vascular cells of malignant gliomas treated with Avastin / Irinotecan Chemotherapy [ Time Frame: three years ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patients present with a first or second tumor recurrence / progression of a histological confirmed supratentorial malignant glioma WHO Grade III-IV (Classification following WHO criteria).
  2. Patients with surgical resection of tumor recurrence / progression: Following standard therapy(first recurrence) or standard therapy / second line chemotherapy (second recurrence, excepting antiangiogenic approaches) patients must have evidence of further tumor progression measured by standard MRI sequences (MacDonald criteria). If possible, patients may have prior surgical resection of the tumor progression and will be eligible if the following conditions apply:

    • Patients must have recovered from the effects of surgery
    • To adequately asses the malignant glioma before surgery and the extent of residual disease postoperatively, two MRIs scans have to be performed:
    • A first standard MRI scan has to be done within 1 week before surgery to document a progressed or recurrent malignant glioma.
    • A second standard / functional MRI scan has to be done between 24 and 48 hours after surgery to document the postoperative malignant glioma (Baseline MRI scan).
    • FET- / FLT-PET scans have to be done within 2 weeks after surgery to document the postoperative malignant glioma (Baseline PET scans).

    Patients without surgical resection of the tumor recurrence / progression: Patients must have evidence of tumor progression measured by standard MRI sequences (MacDonald criteria).

    • Additional functional MRI sequences have to be done within 1 week prior to study enrollment.
    • FET- / FLT-PET scans have to be done within 2 weeks after surgery to document the postoperative malignant glioma (Baseline PET scans).
  3. Resolution of all acute toxic effects of prior therapy to grade ≤ 1 (except alopecia)
  4. Patients must have an ECOG performance status of 0-2
  5. Patients must be ≥ 18 years and ≤ 80 years of age, with a life expectancy of greater than 8 weeks
  6. Patients must have adequate organ function as defined by the following criteria:

    Bone Marrow Reserve

    • Platelets ≥ 75.000/μL
    • Absolute Neutrophil Count ≥ 1500/μL
    • Hemoglobin ≥ 10.0 g/dL Blood Coagulation
    • aPTT ≤ 1.5 times upper limit of normal (ULN) Hepatic Function
    • ASAT and ALAT ≤ 2.5 times ULN
    • ALP ≤ 2.5 times ULN
    • Total SERUM Bilirubin < 1.5 times ULN Renal Function
    • SERUM Creatinine ≤ 1.5 times ULN Metabolism
    • SERUM Albumin ≥ 3.0 g/dL All tests must be performed ≤ 3 days prior to study enrollment. Eligibility for hemoglobin count may be reached by transfusion.
  7. Signed and dated informed consent document by the patient, indicating that the patient has been informed of all the pertinent aspects of the trial prior to study enrollment.
  8. Willingness and ability of the patient to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures.

    Exclusion Criteria:

  9. The patient is active participant in another clinical trial, which investigates substances with antiangiogenic effectiveness
  10. Exclusion of patients in the event of

    • surgery of a recurrent / progressed malignant glioma within 2 weeks prior to study enrollment
    • chemotherapy (Standard therapy o Second Line Chemotherapy) within 2 weeks prior to study enrollment
    • radiation therapy (Standard therapy) within4 weeks to study enrollment
    • evidence in baseline MRI of intratumoral or peritumoral hemorrhage deemed clinically significant by the treating physician (area of hemorrhage > 25% of tumor area)
  11. Significant Co-Morbidities within 12 months prior to study enrollment

    • myocardial infarction, severe/unstable angina pectoris, coronary/peripheral artery bypass graft, congestive heart failure
    • cerebrovascular accident including transient ischemic attack
  12. Significant Co-Morbidities at Baseline Evaluation

    • Hypertension that cannot be controlled by medications (>150/100 mmHg despite optimal medical therapy)
    • Pulmonary embolism within 4 weeks before study enrollment
    • A known HIV (human immunodeficiency virus) or Hepatitis B/C infection or severe acute infection
  13. Anticoagulation: Current treatment with therapeutic doses of Marcoumar / Sintrom excluding thrombosis prophylaxis with low dose Heparin
  14. Pregnancy, Breastfeeding and Non-Contraception

    • Female patients who are pregnant or nursing
    • Patients who are sexually active and unwilling or unable to use a medically acceptable method of contraception during the trial
  15. Evidence of increased intracranial pressure

    • midline shift > 5 mm
    • headache, distinct nausea and vomiting
  16. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that would impart excess risk associated with study participation or study drug administration, or which would make the patient inappropriate for entry into this study. The decision to enroll the patient in this study is in the judgment of the investigator.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01144988

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Contact: Guenther Stockhammer, MD, Prof.
Contact: Markus Hutterer, MD

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Medical University Innsbruck, Department for Neurology Recruiting
Innsbruck, Austria, A-6020
Contact: Guenther Stockhammer, MD, Prof.   
Contact: Martha Nowosielski, MD   
Principal Investigator: Guenther Stockhammer, MD, Prof.         
Sub-Investigator: Martha Nowosielski, MD         
Sub-Investigator: Markus Glatzer, MD         
Paracelsus Medical University, Christian Doppler Klinik Recruiting
Salzburg, Austria, 5020
Contact: Markus Hutterer, MD   
Principal Investigator: Stefan Golaszewski, MD         
Sub-Investigator: Markus Hutterer, MD         
Sponsors and Collaborators
Medical University Innsbruck
Roche, Austria
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Principal Investigator: Guenther Stockhammer, MD, Prof. Department for Neurology, Medical University Innsbruck
Additional Information:
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Responsible Party: Stockhammer, Guenther, MD, Prof., Medical University Innsbruck, Department for Neurology Identifier: NCT01144988    
Other Study ID Numbers: EUDRACT-Nr: 2009-015036-15
First Posted: June 16, 2010    Key Record Dates
Last Update Posted: August 2, 2011
Last Verified: August 2011
Keywords provided by Medical University Innsbruck:
Recurrent Malignant Glioma
Bevacizumab / Irinotecan
Functional MR Imaging
Metabolic Imaging (FET/FLT-PET)
Additional relevant MeSH terms:
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Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Antineoplastic Agents, Immunological
Antineoplastic Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors
Topoisomerase I Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action