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Radiation Therapy or Temozolomide in Treating Patients With Gliomas

Primary Chemotherapy With Temozolomide Versus Radiotherapy in Patients With Low Grade Gliomas After Stratification for Genetic 1p Loss: A Phase III Study

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00182819
Enrollment
709
Registered
2005-09-16
Start date
2005-07-31
Completion date
2014-05-31
Last updated
2016-10-12

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Brain and Central Nervous System Tumors

Keywords

adult oligodendroglioma, adult diffuse astrocytoma, adult mixed glioma

Brief summary

RATIONALE: Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. It is not yet known whether radiation therapy is more effective than temozolomide in treating gliomas. PURPOSE: This randomized phase III trial is studying radiation therapy to see how well it works compared to temozolomide in treating patients with gliomas.

Detailed description

OBJECTIVES: Primary * Compare the progression-free survival of patients with low-grade gliomas treated with radiotherapy vs temozolomide. Secondary * Compare the overall survival of patients treated with these regimens. * Determine whether the incidence of late toxicity can be decreased in patients who are randomized to receive temozolomide. * Compare the toxic effects of these regimens in these patients. * Compare the quality of life of patients treated with these regimens. OUTLINE: This is a randomized, controlled, multicenter study. Patients are stratified according to participating center, chromosome 1p status (deleted vs normal vs undeterminable), contrast enhancement on MRI (yes vs no), age (\< 40 years vs ≥ 40 years), and WHO performance status (0 or 1 vs 2). Patients are randomized to 1 of 2 treatment arms. * Arm I: Patients undergo radiotherapy once daily, 5 days a week, for a total of 28 fractions (i.e., 5½ weeks). * Arm II: Patients receive oral temozolomide once daily on days 1-21. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Quality of life is assessed at baseline and then every 3 months until disease progression. After completion of study treatment, patients are followed every 6 months for survival. Peer Reviewed and Funded or Endorsed by Cancer Research UK PROJECTED ACCRUAL: A minimum of 699 patients (a total of 466 randomized \[233 per treatment arm\]) will be accrued for this study within 5 years.

Interventions

DRUGtemozolomide

Temozolomide 75 mg/m2 daily x 21 days, q 28 days until progression or for max. 12 cycles

RADIATIONradiation therapy

50.4 Gy, standard fractionation (28 x 1.8 Gy), conformal techniques

Sponsors

NCIC Clinical Trials Group
CollaboratorNETWORK
British Medical Research Council
CollaboratorOTHER_GOV
Trans Tasman Radiation Oncology Group
CollaboratorOTHER
European Organisation for Research and Treatment of Cancer - EORTC
Lead SponsorNETWORK

Study design

Allocation
RANDOMIZED
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Histologically confirmed low-grade glioma, including any of the following types: * Astrocytoma (gemistocytic, fibrillary, or protoplasmatic) * Oligoastrocytoma * Oligodendroglioma * WHO grade II disease * Supratentorial tumor location only * RTOG neurological function 0-3 * Not a candidate for surgical treatment alone * Requires treatment, as determined by ≥ 1 of the following criteria: * Age ≥ 40 years * Radiologically-proven progressive lesion * New or worsening neurological symptoms other than seizures only (e.g., focal deficits, signs of increased intracranial pressure, or mental deficits) * Intractable seizures, defined by both of the following criteria: * Experiences persistent seizures that interfere with everyday life activities except driving a car * Failed 3 anti-epileptic drug regimens, including ≥ 1 combination regimen * Tumor material (paraffin-embedded) or histopathologic slides available PATIENT CHARACTERISTICS: Age * 18 and over Performance status * WHO 0-2 Life expectancy * Not specified Hematopoietic * Absolute neutrophil count ≥ 1,500/mm\^3 * Platelet count ≥ 100,000/mm\^3 Hepatic * No chronic hepatitis B or C infection * Bilirubin ≤ 1.5 times upper limit of normal (ULN) * AST or ALT ≤ 2.5 times ULN * Alkaline phosphatase ≤ 2.5 times ULN Renal * Creatinine ≤ 1.5 times ULN Other * Not pregnant or nursing * Fertile patients must use effective contraception during and for 6 months after completion of study treatment * No known HIV positivity * No other serious medical condition * No other prior or concurrent malignancy except surgically cured carcinoma in situ of the cervix or nonmelanoma skin cancer * No psychological, familial, sociological, or geographical condition that would preclude study participation * No medical condition that would preclude receiving oral medication (e.g., frequent vomiting or partial bowel obstruction) PRIOR CONCURRENT THERAPY: Biologic therapy * No concurrent growth factors for elevating absolute neutrophil counts for the purpose of temozolomide administration * No concurrent epoetin alfa * No concurrent immunotherapy or biologic therapy Chemotherapy * No prior chemotherapy * No other concurrent chemotherapy, including adjuvant chemotherapy for patients randomized to undergo radiotherapy Endocrine therapy * Not specified Radiotherapy * No prior radiotherapy to the brain * No concurrent integrated boost with intensity-modulated radiotherapy Surgery * Recovered from prior surgery * No concurrent surgical tumor debulking Other * No prior randomization to this study * No other concurrent investigational drugs * No concurrent regular use of agents known to be radiosensitizers or radioprotectors (e.g., cyclooxygenase-2 inhibitors, thalidomide, or amifostine) during study radiotherapy * Occasional use of nonsteroidal anti-inflammatory drugs for pain allowed

Design outcomes

Primary

MeasureTime frame
Progression-free survival5 years

Secondary

MeasureTime frame
Overall survival5 years
Quality of life as measured by QLQ-C30 v3.0 and EORTC BN-20every 3 months until progression, and then every 6 months until death
Mini-Mental State Examinationevery 3 months until progression, and then every 6 months until death
Adverse events as measured by CTCAE v3.0As indicated in the protocol

Countries

Australia, Austria, Belgium, Canada, Egypt, France, Germany, Hungary, Israel, Italy, Luxembourg, Netherlands, New Zealand, Portugal, Singapore, Spain, Sweden, Switzerland, United Kingdom

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Mar 12, 2026