Recurrent Glioblastoma
Conditions
Keywords
Cancer, Tumour, Advanced Solid Tumour, GBM, Glioblastoma
Brief summary
The purpose of this study is to see how effective cediranib is in treating a brain tumour called recurrent glioblastoma. Two drugs are being tested in this study. Lomustine is an approved oral chemotherapy that belongs to the class of drugs called alkylating agents. Cediranib is a new drug that has not yet been approved for this disease. This study will compare the use of lomustine with cediranib, cediranib alone or lomustine with placebo (inactive substance) to see whether the combination or cediranib alone will be more effective than the chemotherapy alone (lomustine) in preventing the growth of cancer cells.
Interventions
30 mg/day, oral, until progression
110 mg/m2 / Q6W, oral, until progression
Oral, until progression
Sponsors
Study design
Eligibility
Inclusion criteria
* Confirmation of recurrent glioblastoma * Life expectancy ≥ 12 weeks * Received only one prior systemic chemotherapy regimen and this regimen must contain temozolomide
Exclusion criteria
* Patients on enzyme-inducing anti-epileptic drugs within 3 weeks prior to randomisation * Poorly controlled hypertension * Previous anti-angiogenesis (eg bevacizumab, sorafenib, sunitinib) therapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Progression Free Survival (PFS) | Baseline at 6 weeks and then every 6 weeks to discontinuation | For patients with measurable disease at entry (at least one lesion that has a shortest diameter ≥10 mm at baseline on 2 axial slices), PFS will be defined as the earliest time that: 1. The sum of the products of the largest perpendicular diameters of contrast enhancement for all lesions has increased by a greater than or equal to 25% in comparison to the nadir scan as long as the shortest diameter is ≥15 mm. If the dose of steroids has been reduced within the 10 days prior to the scan being conducted, progression will be based on a follow-up scan performed after the dose of steroids has been stabilized for 10 days. 2. The patient has died from any cause. 3. A new lesion is detected that is outside the original tumor volume and has a shortest diameter ≥10 mm. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival (OS) | Baseline through to date of death up to 25th April 2010 | Number of months from randomisation to the date of death from any cause |
| Response Rate | Baseline at 6 weeks and then every 6 weeks to discontinuation | An individual visit response of PR was defined as a greater than or equal to 50% reduction in the sum of the products of the largest perpendicular diameters of contrast enhancement for all lesions compared to baseline as long as the steroid dose has not been increased within the previous 10 days and no new lesions are present. An individual visit response of CR was defined as the complete disappearance of all tumor on MRI scan. |
| Alive and Progression Free Rate at 6 Months (APF6) | 6 Months | Proportion of patients alive and progression free at 6 months (based on central review) as estimated from Kaplan-Meier techniques. Values are percentages. |
| Daily Steroid Dose | Baseline to the date of first documented progression or date of death or study discontinuation, whichever came first, assed up to 2014-April-25 | The mean steroid dosage prior to treatment will be considered as the patient's baseline. The percent change in average daily steroid dosage from baseline is calculated by following formula: PC = (md - bm)/bm\*100; where PC is the percent change in average daily steroid dosage from baseline; md the mean daily steroid dosage recorded from the first day of therapy to progression; and bm the baseline mean. |
| Steroid Free Days | Baseline to the date of first documented progression or date of death or study discontinuation, whichever came first, assessed up to 2014-April-25 | Number of days known not to have used any steroids prior to progression |
Countries
Australia, Austria, Belgium, Canada, Czechia, France, Germany, Netherlands, United Kingdom, United States
Participant flow
Recruitment details
423 patients were enrolled in to the study but did not start the study. They did not go on to be randomized.
Pre-assignment details
Randomised=Full Analysis Set (ITT): Cediranib 30 mg=131, Cediranib 20 mg + Lomustine=129, Placebo + Lomustine=65; ITT with measurable disease at baseline (based on site review): Cediranib 30 mg=115, Cediranib 20 mg + Lomustine=112, Placebo + Lomustine=55; Safety Set: Cediranib 30 mg=128, Cediranib 20 mg + Lomustine=123, Placebo + Lomustine=64
Participants by arm
| Arm | Count |
|---|---|
| Cediranib 30mg Cediranib 30mg/Day | 131 |
| Cediranib 20mg + Lomustine 110mg Cediranib 20mg/Day + Lomustine 110mg/m2/Day | 129 |
| Lomustine 110mg Lomustine 110mg/m2/Day + Placebo cediranib | 65 |
| Total | 325 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Death | 85 | 73 | 33 |
| Overall Study | Incorrect enrol/elig crit not fulfilled | 1 | 5 | 1 |
| Overall Study | Lost to Follow-up | 1 | 1 | 0 |
| Overall Study | Withdrawal by Subject | 3 | 4 | 3 |
Baseline characteristics
| Characteristic | Cediranib 30mg | Cediranib 20mg + Lomustine 110mg | Lomustine 110mg | Total |
|---|---|---|---|---|
| Age, Continuous | 53.4 years STANDARD_DEVIATION 11.81 | 53.7 years STANDARD_DEVIATION 10.78 | 52.0 years STANDARD_DEVIATION 13.09 | 53.3 years STANDARD_DEVIATION 11.67 |
| Gender Female | 46 Participants | 44 Participants | 24 Participants | 114 Participants |
| Gender Male | 85 Participants | 85 Participants | 41 Participants | 211 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 124 / 128 | 120 / 123 | 61 / 64 |
| serious Total, serious adverse events | 55 / 128 | 45 / 123 | 26 / 64 |
Outcome results
Progression Free Survival (PFS)
For patients with measurable disease at entry (at least one lesion that has a shortest diameter ≥10 mm at baseline on 2 axial slices), PFS will be defined as the earliest time that: 1. The sum of the products of the largest perpendicular diameters of contrast enhancement for all lesions has increased by a greater than or equal to 25% in comparison to the nadir scan as long as the shortest diameter is ≥15 mm. If the dose of steroids has been reduced within the 10 days prior to the scan being conducted, progression will be based on a follow-up scan performed after the dose of steroids has been stabilized for 10 days. 2. The patient has died from any cause. 3. A new lesion is detected that is outside the original tumor volume and has a shortest diameter ≥10 mm.
Time frame: Baseline at 6 weeks and then every 6 weeks to discontinuation
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cediranib 30mg | Progression Free Survival (PFS) | 92 Days |
| Cediranib 20mg+ Lomustine 110mg | Progression Free Survival (PFS) | 125 Days |
| Lomustine 110mg | Progression Free Survival (PFS) | 82 Days |
Alive and Progression Free Rate at 6 Months (APF6)
Proportion of patients alive and progression free at 6 months (based on central review) as estimated from Kaplan-Meier techniques. Values are percentages.
Time frame: 6 Months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cediranib 30mg | Alive and Progression Free Rate at 6 Months (APF6) | 16.2 % of patients alive and progression free |
| Cediranib 20mg+ Lomustine 110mg | Alive and Progression Free Rate at 6 Months (APF6) | 34.5 % of patients alive and progression free |
| Lomustine 110mg | Alive and Progression Free Rate at 6 Months (APF6) | 24.5 % of patients alive and progression free |
Daily Steroid Dose
The mean steroid dosage prior to treatment will be considered as the patient's baseline. The percent change in average daily steroid dosage from baseline is calculated by following formula: PC = (md - bm)/bm\*100; where PC is the percent change in average daily steroid dosage from baseline; md the mean daily steroid dosage recorded from the first day of therapy to progression; and bm the baseline mean.
Time frame: Baseline to the date of first documented progression or date of death or study discontinuation, whichever came first, assed up to 2014-April-25
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cediranib 30mg | Daily Steroid Dose | -17.6 percentage of change |
| Cediranib 20mg+ Lomustine 110mg | Daily Steroid Dose | -1.8 percentage of change |
| Lomustine 110mg | Daily Steroid Dose | 36.6 percentage of change |
Overall Survival (OS)
Number of months from randomisation to the date of death from any cause
Time frame: Baseline through to date of death up to 25th April 2010
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Cediranib 30mg | Overall Survival (OS) | 8.0 Months |
| Cediranib 20mg+ Lomustine 110mg | Overall Survival (OS) | 9.4 Months |
| Lomustine 110mg | Overall Survival (OS) | 9.8 Months |
Response Rate
An individual visit response of PR was defined as a greater than or equal to 50% reduction in the sum of the products of the largest perpendicular diameters of contrast enhancement for all lesions compared to baseline as long as the steroid dose has not been increased within the previous 10 days and no new lesions are present. An individual visit response of CR was defined as the complete disappearance of all tumor on MRI scan.
Time frame: Baseline at 6 weeks and then every 6 weeks to discontinuation
Population: Patients are only included in the analysis if they have measurable disease at baseline based on central.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Cediranib 30mg | Response Rate | 18 Participants |
| Cediranib 20mg+ Lomustine 110mg | Response Rate | 21 Participants |
| Lomustine 110mg | Response Rate | 5 Participants |
Steroid Free Days
Number of days known not to have used any steroids prior to progression
Time frame: Baseline to the date of first documented progression or date of death or study discontinuation, whichever came first, assessed up to 2014-April-25
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Cediranib 30mg | Steroid Free Days | 75.8 Days | Standard Deviation 110.1 |
| Cediranib 20mg+ Lomustine 110mg | Steroid Free Days | 74.8 Days | Standard Deviation 91.7 |
| Lomustine 110mg | Steroid Free Days | 92.3 Days | Standard Deviation 122 |