Brain Tumour Cancer Malignant neoplasm of brain
Conditions
Interventions
This is a randomised double blind multicentre phase II trial of daily cediranib +/- gefitinib for patients with recurrent/progression Glioblastoma. Patients will continue treatment until confirmed pro
Sponsors
University College London (UK)
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Provision of informed consent 2. Age =18 years 3. Life expectancy = 12 weeks 4. Histological/cytological confirmation of glioblastoma (WHO grade IV) 5. Patients with measurable disease (contrast-enhancing tumour =10 mm by shortest diameter on 2 axial slices) by MRI imaging within 7 days prior to enrolment. (If patients have recently had a routine MRI scan, this should be assessed before deciding whether or not to screen the patient, and booking the screening/baseline MRI.) 6. Patients must have been on no steroids or a stable dose of steroids (dexamethasone) for at least 5 days before the baseline MRI 7. Patients must have completed standard first-line treatment for glioblastoma including surgery (with exception, if patient does not receive surgery as part of first-line treatment due to anatomical location, based on neurosurgeon's assessment), cranial radiotherapy and chemotherapy with concomitant temozolomide 7.1. It is not essential that the entire Stupp regimen of 6 cycles of adjuvant temozolomide following chemoradiotherapy has been completed 7.2. The last dose of temozolomide must be more than 28 days from enrolment 7.3. Gliadel® wafers are permitted, as it is part of local treatment 7.4. No other previous treatment for glioblastoma is permitted (other than steroids) 8. Patients must have a Karnofsky Performance Score of 70 or above 9. Patients must have a mini-mental status examination score of 15 or greater 10. Patients who require either oral anticoagulants (coumadin, warfarin) or low molecular weight heparin are eligible provided there is increased vigilance with respect to monitoring INR. 11. For inclusion in the genetic research, patients must fulfil the following criterion: 11.1. Provision of informed consent for genetic research (separate consent required for tumour biopsy, blood sample, and post mortem donations) 11.2. If a patient declines to participate in any of the genetic research, there will be no penalty or loss of benefit to the patient 11.3. The patient will not be excluded from other aspects of the study described in this Clinical Study Protocol, so long as they consent to the main study
Exclusion criteria
Exclusion criteria: 1. Patients on enzyme-inducing anti-epileptic drugs within 2 weeks prior to study enrolment Note: Patients are eligible if they switched to non-enzyme inducing agents and discontinued enzyme-inducing agents for more than or equal to 2 weeks prior to randomisation 2. Inadequate bone marrow reserve as demonstrated by an absolute neutrophil count =1.5 x 109 /L or platelet count =100 x 109 /L or requiring regular blood transfusions to maintain haemoglobin >9g/dL 3. Serum bilirubin =1.5 x ULRR (except for patients with known documented cases of Gilbert?s Syndrome) 4. ALT or AST =5 x ULRR 5. Serum creatinine >1.5 x ULRR or a creatinine clearance of =50mL/min calculated by Cockcroft-Gault 6. Greater than +1 proteinuria on two consecutive dipsticks taken no less than 1 week apart unless urinary protein 150/100mmHg in the presence or absence of a stable regimen of anti-hypertensive therapy, or patients who are requiring maximal doses of calcium channel blockers to stabilise blood pressure 9. Any evidence of severe or uncontrolled diseases (e.g. unstable or uncompensated respiratory, cardiac, hepatic or renal disease) 10. Unresolved toxicity >CTC AE grade 1 from previous anti-cancer therapy (including radiotherapy) except alopecia (if applicable) 11. Mean QTc with Bazetts correction >470msec in screening ECG or history of familial, long QT syndrome 12. Cardiac ventricular arrhythmias requiring anti-arrhythmic therapy 13. Significant haemorrhage (>30mL bleeding/episode in previous 3 months) or haemoptysis (>5mL fresh blood in previous 4 weeks) 14. Recent (<14 days) major surgery or brain biopsy 15. Recent craniotomy (<28 days) prior to first dose, or a surgical incision that is not fully healed 16. Pregnant or breast-feeding women or women of childbearing potential with a positive pregnancy test prior to receiving study medication 17. Known hypersensitivity to cediranib, gefitinib or any of its excipients 18. History of other malignancies (except for adequately treated basal or squamous cell carcinoma or carcinoma in situ) within 5 years, unless the patient has been disease free for 2 years and they have tissue diagnosis of the target lesion 19. Known infection with hepatitis B or C or HIV 20. Involvement in the planning and conduct of the study (applies to both UCL CTC, AstraZeneca staff and staff at the study site) 21. Past medical history of interstitial lung disease, idiopathic pulmonary fibrosis, drug-induced interstitial disease, radiation pneumonitis which required steroid treatment or any evidence of clinically active interstitial lung disease 22. Previous enrolment as part of the present study 23. Treatment with an investigational drug within 30 days prior to the first dose of cediranib/gefitinib
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| 1. Progression free survival 2. Timepoint(s): throughout trial | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Overall survival, timepoint(s): date of death 2. Overall survival rate at 12 months, timepoint(s): 12 months 3. Progression free survival at 6 months, timepoint(s): 6 months 4. Radiographic response rate, timepoint(s): at each MRI scan (6 weekly) 5. Safety and tolerability, timepoint(s): throughout trial 6. Steroid use, timepoint(s): thoughout trial 7. Time to deterioration of neurological status or death, timepoint(s): throughout trial, death 8. Time to sustained increase in steroid dosage, timepoint(s): throughout trial | — |
Countries
England, United Kingdom
Outcome results
None listed