Radiation Therapy Combined With Chemotherapy in Treating Patients With Anaplastic Astrocytoma or Mixed Gliomas
Condition: Brain and Central Nervous System Tumors
MeSH terms: Astrocytoma; Nervous System Neoplasms; Central Nervous System Neoplasms
Study type: Interventional
Phase: Phase 3

Summary: 
      RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs used in
      chemotherapy, such as temozolomide, carmustine, and lomustine, use different ways to stop
      tumor cells from dividing so they stop growing or die. Combining radiation therapy with
      chemotherapy may kill more tumor cells.

      PURPOSE: This randomized phase III trial is studying radiation therapy and temozolomide to
      see how well they work compared to radiation therapy and carmustine or lomustine in treating
      patients with anaplastic astrocytoma or mixed gliomas.
    

Detailed description: 
      OBJECTIVES:

        -  Compare the overall survival and time to tumor progression in patients with anaplastic
           astrocytoma or mixed gliomas treated with radiotherapy combined with temozolomide vs
           carmustine or lomustine vs temozolomide and carmustine (arm discontinued as of 8/15/02).

        -  Compare the relative toxic effects of these regimens in these patients.

        -  Correlate molecular analyses with overall survival and time to tumor progression in
           patients treated with these regimens.

      OUTLINE: This is a randomized, multicenter study. Patients are stratified according to age
      (under 50 vs 50 and over), Karnofsky performance status (60-80% vs 90-100%), and prior
      surgery (biopsy only vs resection).

      Phase I

        -  Pilot Arms I and II: Prior to initiating the randomization to 1 of 3 treatment arms in
           phase III, Patients are accrued to Arm III regimen to determine tolerability.

      Phase III

        -  Patients are randomized to 1 of 2 treatment arms (3rd arm was dropped).

             -  Arm I: Patients undergo radiotherapy 5 days a week for 6 weeks. Patients receive
                oral temozolomide on days 1-5 of the first week of radiotherapy. Chemotherapy
                repeats every 4 weeks for a total of 12 courses.

             -  Arm II: Patients undergo radiotherapy as in arm I. Patients receive carmustine IV
                or lomustine IV over 1-2 hours on days 1-3 of the first week of radiotherapy and a
                second course on days 56-58. Chemotherapy repeats every 8 weeks for a total of 6
                courses.

             -  Arm III (dropped, did not open): Patients undergo radiotherapy as in arm I.
                Patients receive carmustine IV or lomustine IV over 3 hours on day 5 and oral
                temozolomide (2 hours after completion of carmustine or lomustine infusion) on days
                1-5 of the first week of radiotherapy. Combination chemotherapy repeats every 8
                weeks for 6 courses.

      Patients are followed every 3 months for 1 year, every 6 months for 2 years, and then
      annually thereafter.

      PROJECTED ACCRUAL: Phase I: 30 patients; Phase III: 454 patients (227 per treatment arm)
      within 4 years.
    

Intervention name(s): BCNU 80mg/m2; TMZ 200mg/m2; radiation therapy; CCNU; BCNU 150mg/m2; BCNU 200mg/m2; TMZ 150mg/m2 six 6-week cycles; TMZ 150mg/m2 six 8-week cycles
Intervention type(s): Drug; Drug; Radiation; Drug; Drug; Drug; Drug; Drug
Intervention description(s): BCNU 80 mg/m2 will be administered as an intravenous infusion on days 1, 2, and 3 of the first week of radiotherapy and on days 56, 57, and 58, then every eight weeks for four more cycles for a total of 6 cycles (maximum BCNU dose 1440 mg/m2).; 200 mg/m2 orally on days 1-5 of the first week of radiotherapy. Repeat every 28 days for a total of 12 cycles.; 1.8 Gy fractions (to isocenter), 1 fraction per day, 5 days per week to a dose of 59.4 Gy in 33 fractions.; CCNU at 130 mg/m2 orally every 8 weeks for a total of 6 cycles. Administered on day 1 of the first week of radiotherapy and on day 56, then administered every 8 weeks for four more cycles for a total of 6 cycles.; BCNU 150 mg/m2 will be administered as an intravenous infusion on day 5 of radiotherapy, and it will be repeated every eight weeks for a total of six cycles (maximum total BCNU dose 900 mg/m2).; BCNU 200 mg/m2 will be administered as an intravenous infusion on day 1 of radiotherapy and will be repeated every six weeks for a total of 6 cycles (maximum BCNU dose 1200 mg/m2).; 150 mg/m2 orally on days 1-5 of the first week of radiotherapy. Repeat for a total of six 6-week cycles; 150 mg/m2 orally on days 1-5 of the first week of radiotherapy. Repeat for a total of six 8-week cycles
Intervention MeSH terms: Carmustine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Phase I (sequential) followed by phase III (parallel)
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: adult anaplastic astrocytoma; adult mixed glioma