Clinical trial NCT03291990: 5 Fraction Stereotactic Radiosurgery With Temozolomide for Glioblastoma Multiforme
Official title: A Pilot Study to Assess Feasibility of 5 Fraction Hypofractionated Stereotactic Radiosurgery Along With Standard Temozolomide as a Lymphocyte Sparing Therapy for Glioblastoma Multiforme
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: EARLY_PHASE1
Conditions: Glioblastoma Multiforme
Lead sponsor: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Sponsor class: OTHER
First posted: 2017-09-25
Enrollment: 3
Sex: ALL
Minimum age (years): 18
Maximum age (years): 100
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Intervention model description: 5 fraction hypofractionated stereotacic radiosurgery along with standard temozolomide
Primary purpose: OTHER

Brief summary: This investigation is not only to develop an improved radiation/temozolomide approach, but also develop a regimen with potential to form the basis of better combined therapy with immune based treatments.

Detailed description: Glioblastoma has a poor prognosis with median survival is 14-16 months for patients enrolling in clinical trials, and across the United States one year survival is reported in the Surveillance, Epidemiology, and End Results (SEER) registry to be only 35%. Radiation treatment related lymphopenia has been associated with poor tumor outcome in Glioblastoma and a variety of other tumor types. As this lymphopenias is prolonged, it may also reduce efficacy of the checkpoint inhibitor lymphocyte mediated immune therapies now approved by the FDA for an increasing number of indications. Modeling and clinical studies suggest that administering radiation over 5 or fewer days (rather than standard 30 days of treatment) may reduce the incidence of lymphopenia.

Eligibility criteria: Inclusion Criteria:

* Patients must be at least 18 years of age.
* Patients must have confirmed glioblastoma multiforme (GBM)
* Maximum postoperative dimension of cavity plus residual contrast enhancing tumor of \< \* If a patient is found on the radiation planning scan to have a tumor target larger than this size, the patient will be removed from the study.
* Patient must be selected for standard temozolomide chemotherapy to be administered with radiotherapy.
* Patient agrees to have 10 week follow-up visit at a participating Johns Hopkins facility.
* Patient agrees to allow access to or provide clinical, imaging, and laboratory follow-up information for three years whether or not obtained from Johns Hopkins providers.

3.1.7. Patients must not have received prior radiation therapy, chemotherapy, immunotherapy or therapy with biologic agents (including immunotoxins, immunoconjugates, antisense, peptide receptor antagonists, interferons, interleukins, Tumor-infiltrating lymphocytes (TIL), Lymphokine-Activated Killer Cell (LAK) or gene therapy), or hormonal therapy for their brain tumor. Glucocorticoid therapy is allowed.

* Patients must have a Karnofsky performance status 60% or higher (i.e. the patient must be able to care for himself/herself with occasional help from others).
* Patients must be able to provide written informed consent.
* Patients with the potential for pregnancy or impregnating their partner must agree to follow acceptable birth control methods to avoid conception. Women of childbearing potential must have a negative pregnancy test.
* Patients must be able to undergo MRI scan with gadolinium contrast for treatment planning.

Exclusion Criteria:

* Patients may not plan to receive any other approved or investigational agents to treat their glioblastoma besides temozolomide prior to the evaluation visit 10 weeks after the initiation of radiotherapy and temozolomide.
* No prior malignancy is allowed except for adequately treated basal cell or squamous cell skin cancer, cervical carcinoma in situ, or other cancer from which the patient has been disease free for at least 2 years.
* Patients with uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements will be excluded.
* Pregnant and breastfeeding women are excluded. Women of child-bearing potential who are unwilling or unable to use an acceptable method of birth control to avoid pregnancy for the entire study period and up to 12 weeks after the study are excluded. This applies to any woman who has not experienced menarche and who has not undergone successful surgical sterilization or is not postmenopausal (defined as amenorrhea for at least 12 consecutive months). Male subjects must also agree to use effective contraception for the same period as above.

Primary outcomes:
measure: Rate of change of lymphopenia
timeFrame: 10 weeks
Secondary outcomes:
measure: Percentage change in Cluster of differentiation 4 (CD4) count (antigen found on helper T cells)
timeFrame: 10 weeks
measure: Rate of change of lymphocytes
timeFrame: 10 weeks
measure: Rate of survival
timeFrame: 10 weeks
measure: Rate of change in serious adverse events
timeFrame: 10 weeks
Other outcomes:
Locations:
city: Washington
country: United States
facility: Sibley Hospital
state: District of Columbia
city: Washington
country: United States
facility: Suburban Hospital
state: District of Columbia
city: Baltimore
country: United States
facility: SKCCC at Johns Hopkins (East Baltimore)
state: Maryland
Study officials:
affiliation: SKCCC at Johns Hopkins (East Baltimore)
name: Lawrence Kleinberg, MD
role: PRINCIPAL_INVESTIGATOR
References: