Glioblastoma WHO grade IV (Giant cell glioblastoma, Epitheloid Glioblastoma, Glioblastoma IDH-wildtype, Glioblastoma NOS, Gliosarcoma, Glioblastoma IDH-mutant)(9441/3, 9440/3, 9442/3, 9445/3*) Diffuse midline glioma H3 K27M-mutant (9385/3*) Anaplastic astrocytoma WHO Grad III (IDH mutant, IDH-wildtype, NOS) (9401/3) Diffuse intrinsic pontine glioma (9385/3) Gliomatosis cerebri (9381/3)
Conditions
Interventions
Group 1: - Trial treatment will be performed as follows: Surgery with best possible extent of tumour resection
- Start as soon as diagnosis is confirmed with VPA 10 mg/kg/d in two daily doses preferen
oral temozolomide treatment may be started in single cases at maximum 7 days before radiotherapy if the 49 days treatment period still fully covers radiotherapy).
- Maintenance therapy with daily VPA
Sponsors
Universitätsmedizin Göttingen
Eligibility
Sex/Gender
All
Age
3 Years to 17 Years
Inclusion criteria
Inclusion criteria: • Newly diagnosed, previously untreated diffuse paediatric high grade glioma with central neuropathological review including paedHGG (WHO grade IV) and anaplastic astrocytoma (WHO grade III). • Newly diagnosed, previously untreated diffuse intrinsic pontine glioma with central neuroradiological review • Newly diagnosed, previously untreated gliomatosis cerebri of all tumour grades with central neuroradiological review • Patient = 3 years and < 18 years of age at time of diagnosis • Written informed consent of the patient and/or the patient’s parents or legal guardian according to national laws
Exclusion criteria
Exclusion criteria: - Pre-treatment of paedHGG (WHO grade IV), anaplastic astrocytoma (WHO grade III), diffuse intrinsic pontine glioma (as confirmed by neuroradiological review), and gliomatosis cerebri (as confirmed by neuroradiological review). - Known hypersensitivity or contraindication to study drugs and/or dacarbazine - Prior chemotherapy within the last 30 days before HIT-HGG-2013 treatment or radiotherapy which prevents adequate performance of radiotherapy as outlined by the present protocol. This may mainly apply to patients with secondary high grade glioma after previous malignant brain tumour, e.g. medulloblastoma, ependymoma, craniopharyngeoma. If previous treatment does not prevent the adequate performance of the outlined treatment protocol patients with secondary high grade glioma will be eligible for the present trial. - Other (simultaneous) malignancies - Pregnancy and / or lactation - Patients who are sexually active refusing to use effective contraception (oral contraception, intrauterine devices, barrier - method of contraception in conjunction with spermicidal jelly) - Current or recent (within 30 days prior to start of trial treatment) treatment with another investigational drug or participation in another investigational trial. - Clinical (e.g. a constitutional mismatch repair deficiency score = 3; Wimmer et al. 2014) and/or other hints (e.g. absent intratumoral immunohistochemical expression of at least one of the MLH1, MSH2, MSH6, or PMS2 mismatch repair proteins and/or high microsatellite instability) for an underlying biallelic (constitutional) mismatch repair deficiency (bMMRD/CMMRD) or a heterozygous mismatch repair deficiency (hereditary non-polyposis colon cancer syndrome/HNPCC syndrome/Lynch syndrome): These patients and their relatives should be offered human genetic counseling and rapid genetic diagnostics to confirm or rule out these conditions. These patients might not benefit from the present study treatment but maybe from other therapeutic strategies (Bouffet et al. 2016). Since patients with clinically suspected neurofibromatosis type 1 may display similar symptoms as in CMMRD, patients with clinically suspected neurofibromatosis type 1 should be also checked for CMMRD as suggested above. - Very poor clinical condition as defined by demand of mechanical ventilation and/or demand for intravenous catecholamines and/or very severe neurological damage equivalent to a coma and/or tetraplegia with complete incapability for communication (deafness, blindness, mutism) - Severe concomitant diseases (e.g. immune deficiency syndrome; known tumour predisposition syndromes which do not affect adequate performance of the trial represent no exclusion criterion a priori - Known HIV positivity - Known severe manifest hepatic disease including hepatic porphyria as well as personal or family history of severe hepatic dysfunction, especially drug-related - Known severe pancreatic disease - Known lethal hepatic dysfunction in a sibling during valproic acid treatment - Known urea cycle defect - Known mitochondrial diseases caused by genetic mutations within the gene coding for the enzyme polymerase gamma (POLG), e.g. Alpers-Huttenlocher syndrome, as well as suspected POLG-related disorders in children under the age of two years - Known severe coagulation disorders (in regards to thrombopenia see prerequisite for blood cell count before starting treatment) - Valproic acid as antiepileptc drug for any pre-existing epilepsy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| To confirm that the Event-Free Survival (EFS) in patients = 3 years of age with paed HGG WHO grade IV, anaplastic astrocytoma WHO grade III (AAIII), DIPG, and gliomatosis cerebri differs for children treated with additional VPA compared to children in the historical HIT-HGG-2007 study sample. | — |
Secondary
| Measure | Time frame |
|---|---|
| - To investigate (also in comparison with the historical HIT-HGG-2007 study sample and the terminated ´CQ´ sample, respectively) the relation between Overall Survival (OS) as well as Event-Free Survival (EFS) and further factors (Tumour location, Tumour grading, Histone mutations, Centrally reviewed histology, Extent of tumour resection, Genetic syndromes, Secondary malignancies, Age at diagnosis, Sex, Relapse treatment, Epilepsy, Biological markers). - To analyse the relation between toxic event rates and the three groups ‘VPA', ‘CQ' and ‘standard’ (from the sample of the present study and the historical HIT-HGG-2007 study sample as well as the terminated ´CQ´ sample, respectively). | — |
Countries
Germany
Contacts
Public ContactChristof Kramm
Universitätsmedizin Göttingen Klinik für Kinder- und Jugendmedizin Pädiatrische Hämatologie und Onkologie
Outcome results
None listed