Glioblastoma
Conditions
Brief summary
The primary purpose of the study is to evaluate the efficacy and safety of early postsurgery temozolomide chemotherapy followed by the standard temozolomide regimen, compared to the standard regimen alone, for the treatment of patients with newly diagnosed glioblastoma multiforme.
Interventions
DRUGTemozolomide
RADIATIONRadiotherapy
Sponsors
Merck Sharp & Dohme LLC
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
Only the patients who meet all these criteria can be enrolled in the study: * Patients with prior histological confirmation of newly diagnosed primary glioblastoma multiforme in supratentorial cerebral hemisphere. * Gross total resection or partial resection (imaging) \>70%. * At least be capable to obtain a tissue sample for MGMT analysis during surgery. * Chemo-radiotherapy to be expected from Week 5 (Day 29) after surgery. * Age \>=18 and \<=70 years. * Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2. * Life expectancy \>=9 months. * Laboratory test values must satisfy the following criteria: * absolute neutrophil count \>=1.5 x 10\^9/L; * platelet count \>=100 x 10\^9/L; * hemoglobin \>=80 g/L; * blood urea nitrogen and creatinine \< 1.5 x upper limit of normal value (ULN); * total bilirubin and direct bilirubin \< 1.5 x ULN; * alanine aminotransferase and aspartate aminotransferase \< 3 x ULN; * alkaline phosphatase \< 2 x ULN. * Patients must be willing to provide written informed consent. * Patients of child-bearing potential (including female subjects and the female partners of male subjects) must use an effective method of contraception.
Exclusion criteria
Patients will not be enrolled if any of the following criteria apply: * Patient with previous or current malignancies (except melanoma) at other sites, unless disease free for at least 3 years. * Patient who received chemotherapy, radiotherapy for study indication, or other medications for antitumor indication prior to surgery. * Patient with recurrent or multiple malignant glioma (including gliomatosis cerebri). * Patient with metastatic lesions at the subtentorial or outside of calvaria. * Patient who received chemotherapy or radiotherapy sensitizers for head or neck tumor. * Patient who received radiotherapy at head or neck which leads to radiotherapy domain overlapping. * Patient with acute infections requiring intravenous antibiotics. * Frequent vomiting or medical condition that could interfere with oral medication intake (eg, partial bowel obstruction). * Known human immunodeficiency virus (HIV)-positive or acquired immune deficiency syndrome (AIDS)-related illness. * Woman who is pregnant or breastfeeding. * Patient with a history of hypersensitivity to temozolomide or other analogic alkylating agents. * Patient with any other conditions under which investigators think the subject is not suitable for enrolment, such like having known that the subject may not have good compliance.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Up to 2 years | OS was defined as the time from randomization to death. OS was calculated by the Kaplan-Meier method. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Progression-Free Survival (PFS) | Up to 2 years | PFS was defined as the length of time from randomization to disease progression (the length of time during which the cancer did not get worse) or death. PFS was calculated by the Kaplan-Meier method. |
| Objective Tumor Assessment After Surgery: Overall Response | Up to 2 years | Overall response was based on neuroimaging (magnetic resonance imaging \[MRI\]), clinical neurological examination, and steroid administration. It was assessed as follows: Complete Response (CR): Disappearance of all enhancing tumor (measurable or non-measurable), no corticosteroid use, and neurologically stable or improved. Partial Response (PR): ≥50% reduction in size of enhancing tumor (measurable or non-measurable) for any measurable lesions or definite improvement for any non-measurable lesions, corticosteroid dosage stable or reduced, and neurologically stable or improved. Progressive Disease (PD): ≥25% increase in contrast enhancement for any measurable lesions or definite worsening for any non-measurable lesions, or any new tumor on MRI scans, at an increased dose of corticosteroid, with or without neurologic progression. Clinical or radiological worsening resulting from other than tumor factors were excluded. Stable Disease (SD): All other situations. |
| Relationship Between O6-methylguanine-DNA Methyltransferase (MGMT) Status and Therapy Response: Overall Survival for the MGMT Positive Group | Up to 2 years | MGMT was measured by immunohistochemistry (IHC). OS was defined as the length of time from the start of treatment that 1/2 of the participants were still alive. OS was calculated by the Kaplan-Meier method. |
| Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Positive Group | 6, 12, & 18 months | MGMT was measured by IHC. OS rate was defined as the percentage of participants who were still alive 6, 12, & 18 months after starting study treatment. OS was calculated by the Kaplan-Meier method. |
| Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Negative Group | 6, 12, & 18 months | MGMT was measured by IHC. OS rate was defined as the percentage of participants who were still alive 6, 12, & 18 months after starting study treatment. OS was calculated by the Kaplan-Meier method. |
| Relationship Between MGMT Status and Therapy Response: PFS for the MGMT Positive Group | Up to 2 years | MGMT was measured by IHC. PFS: The length of time during and after treatment that a participant lived with the cancer but it does not get worse. PFS was calculated by the Kaplan-Meier method. |
| Relationship Between MGMT Status and Therapy Response: PFS for the MGMT Negative Group | Up to 2 years | MGMT was measured by IHC. PFS: The length of time during and after treatment that a participant lived with the cancer but it does not get worse. PFS was calculated by the Kaplan-Meier method. |
| Relationship Between MGMT Status and Therapy Response: Overall Survival for the MGMT Negative Group | Up to 2 years | MGMT was measured by IHC. OS was defined as the length of time from the start of treatment that 1/2 of the participants were still alive. OS was calculated by the Kaplan-Meier method. |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Temozolomide + Radiation Standard therapy regimen:
Treatment will start 4 weeks after surgery. Temozolomide will be administered concomitantly with radiotherapy, at 75 mg/m\^2/day orally for 42 days. Four weeks after completing concomitant radiotherapy, temozolomide will be administered for an additional six cycles. Each cycle will last 28 days, and temozolomide will be administered once daily from Day 1 to Day 5 of each cycle. The dose of temozolomide in the first cycle will be 150 mg/m\^2/day, and may be increased to 200 mg/m\^2/day for Cycle 2 and subsequent cycles depending on nonhematological toxicity observed and neutrophil and platelet count values. Capsules containing 20 mg or 100 mg of temozolomide will be used.
Radiotherapy will be administered in combination with temozolomide. Radiotherapy will be administered for a total daily dose of 60 Gy in 30 fractions, 5 days a week for 6 weeks. | 47 |
| Temozolomide Alone, Then Temozolomide + Radiation Early postsurgery temozolomide chemotherapy plus standard regimen:
Treatment with temozolomide alone will start 2 weeks after surgery at 75 mg/m\^2/day orally for 14 days. Then, starting on Day 29 after surgery, temozolomide will be administered according to standard treatment as described for the temozolomide + radiation arm (standard therapy regimen).
Radiotherapy will be administered in combination with temozolomide. Radiotherapy will be administered for a total daily dose of 60 Gy in 30 fractions, 5 days a week for 6 weeks. | 52 |
| Total | 99 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 1 | 1 |
| Overall Study | Death | 6 | 3 |
| Overall Study | Lost to Follow-up | 7 | 5 |
| Overall Study | Other | 1 | 3 |
| Overall Study | Progressive Disease | 17 | 23 |
| Overall Study | Protocol Violation | 1 | 3 |
| Overall Study | Withdrawal by Subject | 13 | 4 |
Baseline characteristics
| Characteristic | Temozolomide + Radiation | Temozolomide Alone, Then Temozolomide + Radiation | Total |
|---|---|---|---|
| Age, Continuous | 52.1 years STANDARD_DEVIATION 10.12 | 48.5 years STANDARD_DEVIATION 13.04 | 50.2 years STANDARD_DEVIATION 11.82 |
| Region of Enrollment China | 47 participants | 52 participants | 99 participants |
| Sex: Female, Male Female | 13 Participants | 20 Participants | 33 Participants |
| Sex: Female, Male Male | 34 Participants | 32 Participants | 66 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 24 / 42 | 22 / 52 |
| serious Total, serious adverse events | 11 / 42 | 11 / 52 |
Outcome results
Primary
Overall Survival (OS)
OS was defined as the time from randomization to death. OS was calculated by the Kaplan-Meier method.
Time frame: Up to 2 years
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Temozolomide + Radiation | Overall Survival (OS) | 13.17 months |
| Temozolomide Alone, Then Temozolomide + Radiation | Overall Survival (OS) | 17.58 months |
Secondary
Objective Tumor Assessment After Surgery: Overall Response
Overall response was based on neuroimaging (magnetic resonance imaging \[MRI\]), clinical neurological examination, and steroid administration. It was assessed as follows: Complete Response (CR): Disappearance of all enhancing tumor (measurable or non-measurable), no corticosteroid use, and neurologically stable or improved. Partial Response (PR): ≥50% reduction in size of enhancing tumor (measurable or non-measurable) for any measurable lesions or definite improvement for any non-measurable lesions, corticosteroid dosage stable or reduced, and neurologically stable or improved. Progressive Disease (PD): ≥25% increase in contrast enhancement for any measurable lesions or definite worsening for any non-measurable lesions, or any new tumor on MRI scans, at an increased dose of corticosteroid, with or without neurologic progression. Clinical or radiological worsening resulting from other than tumor factors were excluded. Stable Disease (SD): All other situations.
Time frame: Up to 2 years
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Temozolomide + Radiation | Objective Tumor Assessment After Surgery: Overall Response | PR | 0 participants |
| Temozolomide + Radiation | Objective Tumor Assessment After Surgery: Overall Response | PD | 3 participants |
| Temozolomide + Radiation | Objective Tumor Assessment After Surgery: Overall Response | SD | 38 participants |
| Temozolomide + Radiation | Objective Tumor Assessment After Surgery: Overall Response | No overall response data available | 5 participants |
| Temozolomide + Radiation | Objective Tumor Assessment After Surgery: Overall Response | CR | 1 participants |
| Temozolomide Alone, Then Temozolomide + Radiation | Objective Tumor Assessment After Surgery: Overall Response | No overall response data available | 1 participants |
| Temozolomide Alone, Then Temozolomide + Radiation | Objective Tumor Assessment After Surgery: Overall Response | CR | 0 participants |
| Temozolomide Alone, Then Temozolomide + Radiation | Objective Tumor Assessment After Surgery: Overall Response | PR | 0 participants |
| Temozolomide Alone, Then Temozolomide + Radiation | Objective Tumor Assessment After Surgery: Overall Response | SD | 47 participants |
| Temozolomide Alone, Then Temozolomide + Radiation | Objective Tumor Assessment After Surgery: Overall Response | PD | 4 participants |
Secondary
Progression-Free Survival (PFS)
PFS was defined as the length of time from randomization to disease progression (the length of time during which the cancer did not get worse) or death. PFS was calculated by the Kaplan-Meier method.
Time frame: Up to 2 years
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Temozolomide + Radiation | Progression-Free Survival (PFS) | 10.38 months |
| Temozolomide Alone, Then Temozolomide + Radiation | Progression-Free Survival (PFS) | 8.74 months |
Secondary
Relationship Between MGMT Status and Therapy Response: Overall Survival for the MGMT Negative Group
MGMT was measured by IHC. OS was defined as the length of time from the start of treatment that 1/2 of the participants were still alive. OS was calculated by the Kaplan-Meier method.
Time frame: Up to 2 years
Population: Participants with enough tissue to perform MGMT analysis.~Only MGMT-negative participants are included in this outcome measure. MGMT-positive participants are reported in outcome measure 4.
| Arm | Measure | Value (MEDIAN) | Dispersion |
|---|---|---|---|
| Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival for the MGMT Negative Group | 13.81 months | Standard Deviation 1.417 |
| Temozolomide Alone, Then Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival for the MGMT Negative Group | 15.12 months | Standard Deviation 1.171 |
p-value: 0.35Log Rank
Secondary
Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Negative Group
MGMT was measured by IHC. OS rate was defined as the percentage of participants who were still alive 6, 12, & 18 months after starting study treatment. OS was calculated by the Kaplan-Meier method.
Time frame: 6, 12, & 18 months
Population: Participants with enough tissue to perform MGMT analysis.~Only MGMT-negative participants are included in this outcome measure. MGMT-positive participants are reported in outcome measure 6.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Negative Group | 6 months | 87.5 percentage of participants |
| Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Negative Group | 12 months | 57.7 percentage of participants |
| Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Negative Group | 18 months | 44.9 percentage of participants |
| Temozolomide Alone, Then Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Negative Group | 6 months | 95.8 percentage of participants |
| Temozolomide Alone, Then Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Negative Group | 12 months | 81.4 percentage of participants |
| Temozolomide Alone, Then Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Negative Group | 18 months | 26.7 percentage of participants |
Secondary
Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Positive Group
MGMT was measured by IHC. OS rate was defined as the percentage of participants who were still alive 6, 12, & 18 months after starting study treatment. OS was calculated by the Kaplan-Meier method.
Time frame: 6, 12, & 18 months
Population: Participants with enough tissue to perform MGMT analysis.~Only MGMT-positive participants are included in this outcome measure. MGMT-negative participants are reported in outcome measure 7.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Positive Group | 6 months | 80.8 percentage of participants |
| Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Positive Group | 12 months | 69.3 percentage of participants |
| Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Positive Group | 18 months | 36.9 percentage of participants |
| Temozolomide Alone, Then Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Positive Group | 6 months | 89.2 percentage of participants |
| Temozolomide Alone, Then Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Positive Group | 12 months | 82.8 percentage of participants |
| Temozolomide Alone, Then Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: Overall Survival Rate for the MGMT Positive Group | 18 months | 66.2 percentage of participants |
Secondary
Relationship Between MGMT Status and Therapy Response: PFS for the MGMT Negative Group
MGMT was measured by IHC. PFS: The length of time during and after treatment that a participant lived with the cancer but it does not get worse. PFS was calculated by the Kaplan-Meier method.
Time frame: Up to 2 years
Population: Participants with enough tissue to perform MGMT analysis.~Only MGMT-negative participants are included in this outcome measure. MGMT-positive participants are reported in outcome measure 8.
| Arm | Measure | Value (MEDIAN) | Dispersion |
|---|---|---|---|
| Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: PFS for the MGMT Negative Group | 11.11 months | Standard Deviation 1.441 |
| Temozolomide Alone, Then Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: PFS for the MGMT Negative Group | 10.46 months | Standard Deviation 1.475 |
p-value: 0.915Log Rank
Secondary
Relationship Between MGMT Status and Therapy Response: PFS for the MGMT Positive Group
MGMT was measured by IHC. PFS: The length of time during and after treatment that a participant lived with the cancer but it does not get worse. PFS was calculated by the Kaplan-Meier method.
Time frame: Up to 2 years
Population: Participants with enough tissue to perform MGMT analysis.~Only MGMT-positive participants are included in this outcome measure. MGMT-negative participants are reported in outcome measure 9.
| Arm | Measure | Value (MEDIAN) | Dispersion |
|---|---|---|---|
| Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: PFS for the MGMT Positive Group | 10.04 months | Standard Deviation 2.094 |
| Temozolomide Alone, Then Temozolomide + Radiation | Relationship Between MGMT Status and Therapy Response: PFS for the MGMT Positive Group | 11.19 months | Standard Deviation 1.882 |
p-value: 0.648Log Rank
Secondary
Relationship Between O6-methylguanine-DNA Methyltransferase (MGMT) Status and Therapy Response: Overall Survival for the MGMT Positive Group
MGMT was measured by immunohistochemistry (IHC). OS was defined as the length of time from the start of treatment that 1/2 of the participants were still alive. OS was calculated by the Kaplan-Meier method.
Time frame: Up to 2 years
Population: Participants with enough tissue to perform MGMT analysis.~Only MGMT-positive participants are included in this outcome measure. MGMT-negative participants are reported in outcome measure 5.
| Arm | Measure | Value (MEDIAN) | Dispersion |
|---|---|---|---|
| Temozolomide + Radiation | Relationship Between O6-methylguanine-DNA Methyltransferase (MGMT) Status and Therapy Response: Overall Survival for the MGMT Positive Group | 14.4 months | Standard Deviation 2.385 |
| Temozolomide Alone, Then Temozolomide + Radiation | Relationship Between O6-methylguanine-DNA Methyltransferase (MGMT) Status and Therapy Response: Overall Survival for the MGMT Positive Group | 17.49 months | Standard Deviation 1.491 |
p-value: 0.183Log Rank