Clinical trial NCT00890786: A Study of Bevacizumab Therapy in Patients With Newly Diagnosed High-Grade Gliomas and Diffuse Intrinsic Pontine Gliomas
Official title: A Pilot Study of Bevacizumab-Based Therapy in Patients With Newly Diagnosed High-Grade Gliomas and Diffuse Intrinsic Pontine Gliomas
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: EARLY_PHASE1
Conditions: Newly Diagnosed High-Grade Gliomas
Diffuse Intrinsic Pontine Glioma
Lead sponsor: Children's Hospital Medical Center, Cincinnati
Sponsor class: OTHER
Collaborators: name: Genentech, Inc.
First posted: 2009-04-30
Enrollment: 27
Sex: ALL
Minimum age (years): 3
Maximum age (years): 30
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The outcome for children with high-grade gliomas and diffuse intrinsic brainstem gliomas remains poor despite the use of multi-modal therapy with surgery, radiation therapy and chemotherapy.

Detailed description: Novel therapies are needed to improve the outcome of these children. Recent studies have demonstrated very promising results of treatment with bevacizumab/irinotecan in patients with recurrent high grade gliomas. Based on these promising results, and the tolerability of the irinotecan and bevacizumab in children with recurrent CNS malignancies both anecdotally and in a study conducted by the Pediatric Brain Tumor Consortium, we have designed a novel study incorporating concurrent radiation therapy with bevacizumab ± temozolomide followed by bevacizumab, irinotecan ±temozolomide in patients with newly diagnosed high-grade gliomas and diffuse intrinsic pontine gliomas.

Eligibility criteria: Inclusion Criteria:

* Patients must be ≥ 3 years of age and ≤ 30 years of age at the time of study entry.
* Diagnosis:

  * High-grade glioma;Patients must have had histologically verified anaplastic astrocytoma, glioblastoma multiforme or gliosarcoma.Patients with primary spinal cord tumors are eligible.
  * Diffuse intrinsic pontine glioma (DIPG) are eligible.
* Performance Level: Karnofsky ≥ 50% for patients \> 10 years of age and Lansky ≥ 50 for patients ≤ 10 years of age. Patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purpose of assessing the performance score.
* Prior Therapy: no prior anticancer therapy.
* Concomitant Medications: The use of steroids is permissible.
* Organ Function Requirements All patients must have adequate organ function as defined below.

  * Adequate Bone Marrow Function
  * Adequate Renal Function
  * Adequate Liver Function
* Adequate Blood Clotting Defined As: INR, Fibrinogen, and PTT \< Grade 2
* Central nervous system function. Patients with seizures may be enrolled if the seizures are well-controlled with non-enzyme inducing anticonvulsants.
* Informed Consent. Patients and/or parents/legal guardians must have signed an informed consent.

Exclusion Criteria:

* Patients with metastatic disease (i.e. M+ disease, or disease anywhere other than primary site).
* Patients with evidence of a new intracranial hemorrhage that is larger than a punctate size on baseline MRI scan.
* Allergies: Patients with a history of allergic reaction to Chinese hamster ovary cell products, or other recombinant human antibodies.
* Pregnant or breast feeding women will not be entered on this study.
* Patients of childbearing or child-fathering potential must be willing to use a medically acceptable form of birth control, which includes abstinence, while being treated on this study.
* Infection: Patients who require IV antibiotics at time of enrollment, or who are currently receiving treatment for Clostridium difficile infection are excluded.
* Thrombosis: Patients must not have been previously diagnosed with a deep venous or arterial thrombosis (including pulmonary embolism), and must not have a known thrombophilic condition.
* Serious or Non-Healing Wounds
* Surgical Procedures: Patients who have had major surgery should not receive the first dose of bevacizumab until 28 days after major surgery.
* Patients with uncontrolled systemic hypertension.
* Proteinuria with a urine protein (albumin)/creatinine ratio of ≥1.0.

Primary outcomes:
measure: To determine the toxicities and feasibility of the proposed treatment regimen in patients with high-grade glioma and diffuse intrinsic brainstem glioma
timeFrame: 2-3 years
Secondary outcomes:
measure: To determine 1-year EFS, median PFS and median OS in newly diagnosed patients with high-grade glioma treated with radiotherapy and concurrent temozolomide, bevacizumab followed by bevacizumab, irinotecan and temozolomide for 12 courses
timeFrame: 2-3 years
measure: To determine the 1-year EFS, median PFS and median OS in newly diagnosed patients with diffuse intrinsic brainstem glioma treated with radiotherapy and concurrent bevacizumab followed by bevacizumab and irinotecan for 12 courses
timeFrame: 2-3 years
measure: To estimate blood levels of VEGF in circulating endothelial cells in patients at different time points
timeFrame: 2-3 years
measure: To document changes in MR perfusion and diffusion within 24-48 hours after the 2nd dose of bevacizumab during radiotherapy
timeFrame: 2-3 years
measure: To correlate functional changes in tumor with responses to treatment using MR diffusion/perfusion imaging
timeFrame: 2-3 years
measure: To correlate the results of the biology studies in serum or tumor with PFS
timeFrame: 2-3 years
measure: To conduct gene expression profiling, CGH and SNP arrays in patients with high-grade gliomas
timeFrame: 2-3 years
measure: To assess telomerase activity, hTert expression, and telomere length in patients with high-grade gliomas
timeFrame: 2-3 years
measure: To assess the health-related quality of life of patients by parent report, and when possible, patient report at key points in therapy
timeFrame: 2-3 years
measure: To assess functional abilities and level of independence of patients during and following treatment
timeFrame: 2-3 years
Other outcomes:
Locations:
city: Chicago
country: United States
facility: Ann & Robert H. Lurie Children's Hospital of Chicago
state: Illinois
city: Cincinnati
country: United States
facility: Cincinnati Children's Hospital Medical Center
state: Ohio
Study officials:
affiliation: Children's Hospital Medical Center, Cincinnati
name: Maryam Fouladi, MD
role: PRINCIPAL_INVESTIGATOR
References: