Brain Metastases, Brain Tumor
Conditions
Keywords
Recurrent, Symptomatic
Brief summary
Purpose: The primary objective of this study is to determine if chemotherapy with carboplatin and temozolomide significantly affects the response rates, or size of disease, in patients with brain metastases, originating from cancer in other parts of the body, compared to patients who have already been treated with radiation. Survival, causes of death, recurrence of disease in the central nervous system, toxicity, and quality of life will all be measured as secondary objective in this study.
Detailed description
Rationale: Surgery and radiation are often used as treatments for brain metastases, or tumors in the brain that originate from other parts of the body. It is currently unknown whether patient survival or time to progression would experience additional benefits through the addition of chemotherapy. Previous research does appear to suggest that a chemotherapy regimen may improve outcomes of patients with brain metastases previously treated with radiation. The current study further evaluates this research question by providing patients with recurrent or symptomatic residual brain metastases with carboplatin and temozolomide, two chemotherapy agents. Temozolomide has demonstrated clinical antitumor efficacy against malignant gliomas and has been tested with some efficacy against several other types of cancer. This drug appears to have less adverse effects compared to other commonly used cancer drugs. Recent research indicates that temozolomide also has some efficacy against brain metastases. In addition, previous research indicates carboplatin's lack of severe toxicity in patients with this disease. Treatment: Study participants will be treated with carboplatin and temozolomide. Carboplatin will be administered through intravenous infusions. Temozolomide will be given through oral pills. Before these drugs are administered, study participants will undergo a pre-treatment evaluation with physical and neuropsychological examinations, neuro-imaging, laboratory tests, quality of life assessment, and other procedures. Carboplatin will be given for two consecutive days. Temozolomide will be taken by study participants daily for five consecutive days. Both of these treatment schedules will be repeated every 28 days. Several tests and exams will be given throughout the study to closely monitor patients. Study treatments will be discontinued due to disease growth or unacceptable adverse events.
Interventions
DRUGcarboplatin
IA carboplatin 200 mg/m2/day for each arterial injection on days 1 and 2.
DRUGtemozolomide
150 mg/m2/day orally Days 1-5. Treatment cycles to be repeated every 4 weeks.
Sponsors
Ohio State University Comprehensive Cancer Center
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Pathologically confirmed systemic cancer
Exclusion criteria
* Pregnant * Known CNS meningeal involvement with cancer
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Affects of Response Rate of Chemotherapy With Intra-arterial Carboplatin and Oral Temozolomide | up to 1 year | Response was evaluated by MRI Criteria (MacDonald Criteria). The MacDonald criteria for determining tumor progression is determined through assessing the increase in size of an enhancing tumor on consecutive MRI scans and clinical assessment. Complete response occurs when there is a disappearance of all enhancing tumor on consecutive MRI scans at least one month apart. Partial response occurs at a \>50% reduction in size of enhancing tumor on consecutive MRI scans at least one month apart. Progressive disease occurs when there is a \>25% increase in size of enhancing tumor on consecutive MRI scans. Stable disease occurs in all remaining situations. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Analyze Patients Time to Progression | up to 60 weeks | Responses to treatment was determined by comparing new enhanced MRI scans with those obtained at the previous evaluation (i.e., 2 treatment cycles ago) or with the pre-IA chemotherapy baseline scan, if it is the first follow-up MRI scan during treatment. MRI is the neuro-imaging modality of choice, since it is more accurate than CT for small tumors, multiple tumors, and tumors in the posterior fossa.58 The methodology used (techniques and equipment) must be identical for all scans. Lesions should be measured as the largest diameter seen on scan and the largest diameter perpendicular to that dimension. |
| Determine the Overall Survival of Patients | up to 64 weeks | From the time of protocol initiation |
| Determine the Cause of Death of Patients After Treatment | up to 1 year | To determine the cause of death (i.e., CNS tumor versus systemic disease progression) in patients after treatment. |
| The Incidence and Severity of Centeral Nervous System (CNS) Toxicities | up to 24 weeks | To determine the incidence and severity of CNS toxicity in patients treated with intra-arterial carboplatin and oral temozolomide. |
| Quality of Life Assessment | up to 2 years | To determine the impact of treatment on quality of life. |
Countries
United States
Participant flow
Pre-assignment details
All patients had received prior systemic chemotherapy for the primary tumor
Participants by arm
| Arm | Count |
|---|---|
| Temozolomide & Intra-Arterial (IA) Carboplatin Patients will be administered Temozolomide orally once a day for 5 consecutive days and and will receive Intra Arterial Carboplatin
temozolomide : 150 mg/m2/day orally Days 1-5. Treatment cycles to be repeated every 4 weeks.
carboplatin : IA carboplatin 200 mg/m2/day for each arterial injection on days 1 and 2. | 17 |
| Total | 17 |
Baseline characteristics
| Characteristic | Temozolomide & Intra-Arterial (IA) Carboplatin |
|---|---|
| Age, Continuous | 52 years |
| Region of Enrollment United States | 17 participants |
| Sex: Female, Male Female | 10 Participants |
| Sex: Female, Male Male | 7 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 17 |
| serious Total, serious adverse events | 0 / 17 |
Outcome results
Primary
Affects of Response Rate of Chemotherapy With Intra-arterial Carboplatin and Oral Temozolomide
Response was evaluated by MRI Criteria (MacDonald Criteria). The MacDonald criteria for determining tumor progression is determined through assessing the increase in size of an enhancing tumor on consecutive MRI scans and clinical assessment. Complete response occurs when there is a disappearance of all enhancing tumor on consecutive MRI scans at least one month apart. Partial response occurs at a \>50% reduction in size of enhancing tumor on consecutive MRI scans at least one month apart. Progressive disease occurs when there is a \>25% increase in size of enhancing tumor on consecutive MRI scans. Stable disease occurs in all remaining situations.
Time frame: up to 1 year
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Temozolomide & Intra-Arterial (IA) Carboplatin | Affects of Response Rate of Chemotherapy With Intra-arterial Carboplatin and Oral Temozolomide | 42.8 percentage of patients with response |
Secondary
Analyze Patients Time to Progression
Responses to treatment was determined by comparing new enhanced MRI scans with those obtained at the previous evaluation (i.e., 2 treatment cycles ago) or with the pre-IA chemotherapy baseline scan, if it is the first follow-up MRI scan during treatment. MRI is the neuro-imaging modality of choice, since it is more accurate than CT for small tumors, multiple tumors, and tumors in the posterior fossa.58 The methodology used (techniques and equipment) must be identical for all scans. Lesions should be measured as the largest diameter seen on scan and the largest diameter perpendicular to that dimension.
Time frame: up to 60 weeks
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Temozolomide & Intra-Arterial (IA) Carboplatin | Analyze Patients Time to Progression | 22.6 weeks |
Secondary
Determine the Cause of Death of Patients After Treatment
To determine the cause of death (i.e., CNS tumor versus systemic disease progression) in patients after treatment.
Time frame: up to 1 year
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Temozolomide & Intra-Arterial (IA) Carboplatin | Determine the Cause of Death of Patients After Treatment | CNS tumor | 0 patients |
| Temozolomide & Intra-Arterial (IA) Carboplatin | Determine the Cause of Death of Patients After Treatment | Systemic disease progression | 7 patients |
Secondary
Determine the Overall Survival of Patients
From the time of protocol initiation
Time frame: up to 64 weeks
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Temozolomide & Intra-Arterial (IA) Carboplatin | Determine the Overall Survival of Patients | 25.2 weeks |
Secondary
Quality of Life Assessment
To determine the impact of treatment on quality of life.
Time frame: up to 2 years
Population: Quality of Life Assessment was not done.
Secondary
The Incidence and Severity of Centeral Nervous System (CNS) Toxicities
To determine the incidence and severity of CNS toxicity in patients treated with intra-arterial carboplatin and oral temozolomide.
Time frame: up to 24 weeks
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Temozolomide & Intra-Arterial (IA) Carboplatin | The Incidence and Severity of Centeral Nervous System (CNS) Toxicities | 0 patients |