Glioma, Medulloblastoma
Conditions
Brief summary
This study will assess the rate of objective confirmed tumor response of irinotecan in combination with temozolomide in children with recurrent or refractory medulloblastoma and in children with newly diagnosed high-grade glioma.
Interventions
Irinotecan 10 mg/m\^2 per day on days 1-5 and days 8-12 in repeated 3 week cycles
Temozolomide 100-125 mg/m\^2 daily on days 1-5 in repeated 3 week cycles
Sponsors
Study design
Eligibility
Inclusion criteria
* Cohort 1: Recurrent or refractory medulloblastoma in which current standard treatment approaches have failed; biopsy is not required for recurrent disease. * Cohort 2: Newly-diagnosed high-grade glioma (World Health Organization \[WHO\] grade 3 or 4) * Life expectancy ≥ 3 months
Exclusion criteria
* Diagnosis of brainstem glioma * Concurrent administration of any other anti-tumor therapy * Pre-existing uncontrolled diarrhea
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Objective Response of Complete Response or Partial Response | Baseline to 1 Year (medulloblastoma), Baseline to 6 Weeks (high-grade glioma) | Percentage of participants with objective response based assessment of confirmed complete response (CR) or confirmed partial response (PR). CR persisted on repeat imaging study at least (≥) 4 weeks after initial documentation of response. PR, for bidimensionally measurable disease, was a decrease by ≥50% of the sum of the products of the largest perpendicular diameters of all measurable lesions as determined by 2 observations not less than 4 weeks apart. Best overall response recorded any time while the participant was receiving treatment. External Response Review Committee (ERRC) assessment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Objective Response of Complete Response or Partial Response, Investigator's Assessment | Baseline to 1 Year (medulloblastoma), Baseline to 6 Weeks (high-grade glioma) | Percentage of participants with objective response based assessment of confirmed CR or confirmed PR. CR persisted on repeat imaging study ≥4 weeks after initial documentation of response. PR, in case of bidimensionally measurable disease, was a decrease by ≥50% of the sum of the products of the largest perpendicular diameters of all measurable lesions as determined by 2 observations not less than 4 weeks apart. Best overall response could be recorded any time while the participant was receiving treatment. Investigator's assessment. |
| Duration of Response | Baseline to Date of Tumor Response (Up to 1 Year) | Median duration (50%) of tumor response for participants with objective disease response: who have not progressed or died due to any cause; with a response and subsequent progression or death due to any cause for duration of response (DR). DR was defined as time from start of first documented objective tumor response (CR or PR) to first documented objective tumor progression or death due to any cause, whichever occurred first. DR (calculated in Weeks) = (the end date for DR minus first subsequent confirmed CR or PR plus 1) divided by 7. Investigator's assessment. |
| Time to Treatment Failure (TTF) | Baseline to Date of Treatment Failure (Up to 1 Year) | TTF was defined as the time from the date of first dose of study treatment to the date of the first documentation of progressive disease (PD), the date of treatment discontinuation except completion of treatment, or date of death due to cancer. Investigator's assessment. |
| Time to Tumor Progression (TTP) | Baseline to Date of Progression (Up to 1 Year) | TTP was defined as the time in months from start of study treatment to first documentation of objective tumor progression or death due to cancer, whichever came first. TTP was calculated as (first event date minus the date of first dose of study medication plus 1) divided by 7 multiplied by 4.33. Tumor progression was determined from oncologic assessment data (where data met the criteria for PD). Investigator's assessment. |
| Overall Survival (OS) | Baseline to Date of Death (Up to 1 Year After Treatment) | Time in months from the start of study treatment to date of death due to any cause. OS was calculated as (the death date minus the date of first dose of study medication plus 1) divided by 7 multiplied by 4.33. Death was determined from adverse event data (where outcome was death) or from follow-up contact data (where the participant current status was death). Investigator's assessment. |
Countries
Australia, Belgium, Denmark, France, Italy, Poland, Spain, United Kingdom
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Temozolomide + Irinotecan for Medulloblastoma For participants with medulloblastoma: Irinotecan 10 mg/m\^2/day on Days 1-5 and Days 8-12 in repeated 3-week cycles. Temozolomide 100-125 mg/m\^2 daily on Days 1-5 in repeated 3-week cycles; treatment duration: up to 1 year or until progression. | 66 |
| Temozolomide + Irinotecan for High-Grade Glioma For participants with high-grade glioma: Irinotecan 10 mg/m\^2/day on Days 1-5 and Days 8-12 in repeated 3-week cycles. Temozolomide 100-125 mg/m\^2 daily on Days 1-5 in repeated 3-week cycles; treatment duration: 2 cycles as a window phase before starting standard therapy. | 17 |
| Total | 83 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 37 | 11 |
| Overall Study | Lost to Follow-up | 5 | 0 |
| Overall Study | Other | 1 | 0 |
| Overall Study | Withdrawal by Subject | 1 | 0 |
Baseline characteristics
| Characteristic | Temozolomide + Irinotecan for Medulloblastoma | Temozolomide + Irinotecan for High-Grade Glioma | Total |
|---|---|---|---|
| Age, Customized >12 years to 18 years | 17 participants | 5 participants | 22 participants |
| Age, Customized 2 years to 12 years | 49 participants | 12 participants | 61 participants |
| Sex: Female, Male Female | 21 Participants | 3 Participants | 24 Participants |
| Sex: Female, Male Male | 45 Participants | 14 Participants | 59 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 64 / 66 | 17 / 17 |
| serious Total, serious adverse events | 31 / 66 | 5 / 17 |
Outcome results
Percentage of Participants With Objective Response of Complete Response or Partial Response
Percentage of participants with objective response based assessment of confirmed complete response (CR) or confirmed partial response (PR). CR persisted on repeat imaging study at least (≥) 4 weeks after initial documentation of response. PR, for bidimensionally measurable disease, was a decrease by ≥50% of the sum of the products of the largest perpendicular diameters of all measurable lesions as determined by 2 observations not less than 4 weeks apart. Best overall response recorded any time while the participant was receiving treatment. External Response Review Committee (ERRC) assessment.
Time frame: Baseline to 1 Year (medulloblastoma), Baseline to 6 Weeks (high-grade glioma)
Population: Primary Evaluable Population: subset of evaluable population predetermined by 2-stage Optimum Simon design. Medulloblastoma cohort: n=consecutive evaluable participants up to 46 if 6 responses obtained in first 15 evaluable participants. Glioma cohort: n=consecutive evaluable participants up to 29 if 1 response in first 10 evaluable participants.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Temozolomide + Irinotecan for Medulloblastoma | Percentage of Participants With Objective Response of Complete Response or Partial Response | 32.6 percentage of participants |
| Temozolomide + Irinotecan for High-Grade Glioma | Percentage of Participants With Objective Response of Complete Response or Partial Response | 0 percentage of participants |
Duration of Response
Median duration (50%) of tumor response for participants with objective disease response: who have not progressed or died due to any cause; with a response and subsequent progression or death due to any cause for duration of response (DR). DR was defined as time from start of first documented objective tumor response (CR or PR) to first documented objective tumor progression or death due to any cause, whichever occurred first. DR (calculated in Weeks) = (the end date for DR minus first subsequent confirmed CR or PR plus 1) divided by 7. Investigator's assessment.
Time frame: Baseline to Date of Tumor Response (Up to 1 Year)
Population: Evaluable local population. Number of participants analyzed=number of participants who responded.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Temozolomide + Irinotecan for Medulloblastoma | Duration of Response | 22.4 weeks |
| Temozolomide + Irinotecan for High-Grade Glioma | Duration of Response | 36.3 weeks |
Overall Survival (OS)
Time in months from the start of study treatment to date of death due to any cause. OS was calculated as (the death date minus the date of first dose of study medication plus 1) divided by 7 multiplied by 4.33. Death was determined from adverse event data (where outcome was death) or from follow-up contact data (where the participant current status was death). Investigator's assessment.
Time frame: Baseline to Date of Death (Up to 1 Year After Treatment)
Population: All participants. One participant in the Temozolomide + Irinotecan for Medulloblastoma cohort did not have recurrent or refractory medulloblastoma and 3 participants in the Temozolomide + Irinotecan for High-Grade Glioma cohort did not have high-grade glioma, and were not considered evaluable for survival.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Temozolomide + Irinotecan for Medulloblastoma | Overall Survival (OS) | 16.7 months |
| Temozolomide + Irinotecan for High-Grade Glioma | Overall Survival (OS) | 9.4 months |
Percentage of Participants With Objective Response of Complete Response or Partial Response, Investigator's Assessment
Percentage of participants with objective response based assessment of confirmed CR or confirmed PR. CR persisted on repeat imaging study ≥4 weeks after initial documentation of response. PR, in case of bidimensionally measurable disease, was a decrease by ≥50% of the sum of the products of the largest perpendicular diameters of all measurable lesions as determined by 2 observations not less than 4 weeks apart. Best overall response could be recorded any time while the participant was receiving treatment. Investigator's assessment.
Time frame: Baseline to 1 Year (medulloblastoma), Baseline to 6 Weeks (high-grade glioma)
Population: Evaluable local population: Participants received at least 1 dose of study medication, had measurable disease under study, at least 1 on-study objective tumor assessment, completed at least 2 cycles of study treatment or progressed. Based on investigator's assessment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Temozolomide + Irinotecan for Medulloblastoma | Percentage of Participants With Objective Response of Complete Response or Partial Response, Investigator's Assessment | 34.9 percentage of participants |
| Temozolomide + Irinotecan for High-Grade Glioma | Percentage of Participants With Objective Response of Complete Response or Partial Response, Investigator's Assessment | 11.8 percentage of participants |
Time to Treatment Failure (TTF)
TTF was defined as the time from the date of first dose of study treatment to the date of the first documentation of progressive disease (PD), the date of treatment discontinuation except completion of treatment, or date of death due to cancer. Investigator's assessment.
Time frame: Baseline to Date of Treatment Failure (Up to 1 Year)
Population: Evaluable local population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Temozolomide + Irinotecan for Medulloblastoma | Time to Treatment Failure (TTF) | 3.8 months |
| Temozolomide + Irinotecan for High-Grade Glioma | Time to Treatment Failure (TTF) | 1.6 months |
Time to Tumor Progression (TTP)
TTP was defined as the time in months from start of study treatment to first documentation of objective tumor progression or death due to cancer, whichever came first. TTP was calculated as (first event date minus the date of first dose of study medication plus 1) divided by 7 multiplied by 4.33. Tumor progression was determined from oncologic assessment data (where data met the criteria for PD). Investigator's assessment.
Time frame: Baseline to Date of Progression (Up to 1 Year)
Population: Evaluable local population
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Temozolomide + Irinotecan for Medulloblastoma | Time to Tumor Progression (TTP) | 5.6 months |
| Temozolomide + Irinotecan for High-Grade Glioma | Time to Tumor Progression (TTP) | 1.6 months |