Tumors Metastatic to Brain
Conditions
Brief summary
Randomized phase III trial to compare the effectiveness of radiation therapy with or without thalidomide in treating patients who have brain metastases. Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs such as thalidomide may stop the growth of brain metastases by stopping blood flow to the tumor. It is not yet known whether radiation therapy is more effective with or without thalidomide in treating brain metastases.
Detailed description
OBJECTIVES: I. Compare the overall survival of patients with multiple brain metastases treated with radiotherapy with or without thalidomide. II. Compare the time to tumor progression in patients treated with these regimens. III. Compare the time to neuro-cognitive progression in patients treated with these regimens. IV. Compare the cause of death distribution in patients treated with these regimens. V. Compare the frequency of toxic effects of these regimens in these patients. VI. Evaluate and compare the quality of life of patients treated with these regimens. OUTLINE: This is a randomized, multicenter study. Patients are stratified according to recursive partitioning analysis class (I vs II) and planned chemotherapy after whole brain irradiation (yes vs no). Patients are randomized to 1 of 2 treatment arms. Arm I: Patients undergo radiotherapy once daily 5 days a week for 3 weeks. Arm II: Patients undergo radiotherapy as in arm I. Beginning on the first day of radiotherapy, patients receive oral thalidomide once daily. Treatment with thalidomide continues for 2 years in the absence of disease progression or unacceptable toxicity. Quality of life is assessed at baseline, at completion of radiotherapy, and then every 2 months for 1 year. Patients are followed every 2 months for 1 year, every 4 months for 1 year, every 6 months for 2 years, and then annually thereafter. PROJECTED ACCRUAL: A total of 332 patients (166 per treatment arm) will be accrued for this study within 14.5 months.
Interventions
RADIATIONradiation therapy
Undergo conventional radiation therapy
DRUGthalidomide
Given orally
PROCEDUREquality-of-life assessment
Ancillary studies
Sponsors
NRG Oncology
National Cancer Institute (NCI)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Histologically confirmed extracranial primary malignancy * Multiple brain metastases * At least 1 measurable brain metastasis by MRI * More than 4.0 cm * Located in midbrain or brainstem (radiosurgery ineligible) * Performance status - Zubrod 0-1 * At least 8 weeks * Absolute neutrophil count at least 1,500/mm\^3 * Platelet count at least 100,000/mm\^3 * Hemoglobin at least 11 g/dL\* * Hematocrit at least 35%\* * Bilirubin no greater than 1.5 mg/dL * ALT no greater than 2 times normal * Creatinine no greater than 1.5 mg/dL * BUN no greater than 25 mg/dL * No history of deep venous thrombosis * No sensory neuropathy grade 2 or greater * No known AIDS * No other major medical illness or psychiatric impairments that would preclude study therapy * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective barrier method of contraception during and for at least 4 weeks after study * No prior thalidomide * More than 2 weeks since prior chemotherapy * Concurrent chemotherapy allowed if more than 6 weeks past study entry (allowed during first 6 weeks of study if disease progression occurs) * See Disease Characteristics * No prior radiotherapy to the head or neck * No prior radiosurgery * Prior resection of brain metastases allowed * No concurrent anticoagulant therapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall survival | Up to 6 years | The log-rank statistic will be used. |
| Time to tumor progression | Date of randomization to documentation of progression, assessed up to 6 years | Cumulative incidence model will be used to analyze the data. A multivariate Cox model analysis will be performed. |
| Time to neuro-cognitive progression as assessed by the Mini Mental State Exam | Up to 6 years | Cumulative incidence model will be used to analyze the data. |
Secondary
| Measure | Time frame |
|---|---|
| Cause of death distribution | Up to 6 years |
| Quality of life as measured by the SQLI | 12 months |
| Frequency of toxicities, graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v3.0 | Up to 6 years |
| Quality of life as measured by the Spitzer Quality of Life Index (SQLI) | 6 months |
Countries
United States
Outcome results
None listed