Brain Neoplasms, Malignant, Primary
Conditions
Keywords
brain neoplasm, bioequivalence, temozolomide
Brief summary
The purpose of this crossover, single-dose, bioequivalence study is to compare the rate and extent of absorption of Temozolomide after the administration of the study product (Dralitem®, Monte Verde S.A.) and the reference product (Temodal®, Schering Plough) in primary Central Nervous System patients.
Detailed description
Prospective, randomized, two-period, two treatment, two-way crossover bioequivalence study of two Temozolomide oral formulations (Dralitem vs. Temodal), in primary Central Nervous System tumor patients under fasting conditions. Open label to the patients and investigators and blind to the bioanalytical and clinical laboratories. Study plan: days -21 to 0 (Recruitment period); days 1 to 5 (Treatment period); days 6 to 21 (Safety surveillance period). Sample size: 24 patients will be randomized. The patients will be administered Temozolomide 200 mg/m2 on the first two days (Dralitem) of the treatment cycle. They will be admitted to the study clinical site on the evening of day 2. In the morning of day 3 they will be randomized into two groups of equal size. According to the assigned random number, each subject will receive a single oral dose of Temozolomide 200mg/m2 from either Monte Verde Sociedad Anónima (SA) product (Dralitem) or from Schering-Plough product (Temodal). The single dose of 200 mg/m2 will be reached with three different Temozolomide capsule strengths: 20, 100 and 250 mg. Drugs will be administered with 200-240 ml of water in semi-sitting upright position. The following day (day 4) each subject will receive an oral dose of Temozolomide 200 mg/m2 of the product that did not receive the day before. On days 3 and 4 after drug administration, blood samples will be obtained for pharmacokinetic evaluation. The patient will be discharged from the clinical site on day 4 after completion of sampling for pharmacokinetic analysis. On day 5, all patients will receive Temozolomide 200 mg/m2 (Dralitem). On days 3 and 4, samples of venous blood will be withdrawn from the forearm vein of each volunteer at the following time points: 0 (pre-dose) and 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0 hours post-dose after each period administration. The washout period between the treatment arms was 10 hours, on days 3 and 4. Samples will be processed according to the validated method MANA (Método Analítico) - PLB (Proyecto Laboratorio Bioanalítico) 004 - TEM (Temozolomide) - 01/01. Measurement of plasma concentration of Temozolomide was performed using High Performance Liquid Chromatography (HPLC) followed by detection by tandem mass spectrometry (MS / MS). The area under the curve (AUC) and the Cmax levels of the drug vs. time will be obtained for each subject. The resulting values of the logarithmic transformation of these parameters will be used for statistical comparisons (mixed effects ANOVA). The limits of the 90% confidence interval for the ratio of log transformed pharmacokinetic parameters will be calculated. Bioequivalence criteria: each calculated confidence interval should be within the acceptance range from 80.00 to 125.00.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
1. Male or female patients with primary malignant tumors of the central nervous system (CNS) excluding subjects with primary CNS lymphoma. 2. Age\> 21 years. 3. There should be a gap of two weeks between the last surgery and/or radiotherapy procedure and the day of randomization. If the procedure were intrabdominal, the gap should be of four weeks. 4. Patients with neutrophils\> 1.5 x 109 / L and platelets\> 100 x 109 / L. 5. Signed written informed consent for participation in the trial.
Exclusion criteria
1. Known hypersensitivity to Temozolomide or any other ingredient of the pharmaceutical formulation. 2. Any situation (eg. vomiting) that may interfere with the absorption of the product under study. 3. Chemotherapy or biological therapy within four weeks prior to administering the products under study. 4. Patients who experience any symptoms of toxicity to prior antineoplastic therapies upon administration of the products under study. 5. Participation in other clinical research studies during the 90 days before the start of this study. 6. History of alcohol or drugs abuse. 7. History of severe allergic reactions to any type of antigen. 8. History of gastrointestinal surgery (except uncomplicated appendectomy, of at least three months old). 9. Patients whose clinical status would affect the safety of the products under study or interfere with the pharmacokinetic evaluation, at the discretion of the investigator. 10. Pregnant women or women planning to become pregnant during the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cmax | 0, 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0 hours on Days 3 and 4 | Rate of absorption of Temozolomide (Cmax) will be measured after the oral administration of the test product (Dralitem®, Monte Verde S.A.) or the reference product (Temodal®, Schering-Plough). |
| AUC0-t | 0, 0.25, 0.5, 0.75, 1.0, 1.25, 1.75, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0 hours on Days 3 and 4 | Extent of absorption of Temozolomide from time (0) to the last quantifiable concentration (t) will be measured after the oral administration of the test product (Dralitem®, Monte Verde S.A.) or the reference product (Temodal®, Schering-Plough) |
| AUC0-∞ | 0, 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0 hours on Days 3 and 4 | Extent of absorption of Temozolomide from time (0) to infinity (∞) will be measured after oral administration of the test product (Dralitem®, Monte Verde S.A.) or the reference product (Temodal®, Schering-Plough). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Adverse Events (AEs) and Serious Adverse Events (SAEs) | Up to two weeks post last dose | AEs and SAEs will be collected from the start of study treatment and until two weeks post last dose. If AEs or SAEs extend in time and are not resolved before the end of the 2-week follow up period, this period shall last until the event/s are resolved. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Kel | 0, 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0 hours on Days 3 and 4 | Rate at which Temozolomide is removed from the body. |
| T1/2 | 0, 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0 hours on Days 3 and 4 | Time required for Temozolomide plasma concentration to decrease by 50% |
Countries
Argentina
Participant flow
Recruitment details
This study enrolled patients with primary tumours of the Central Nervous System (CNS) excluding patients with primary CNS lymphoma, from FLENI Clinical-Surgical Diagnosis and Treatment Institute, Buenos Aires, Argentina. The last patient completed in October 2013.
Pre-assignment details
Of the initial sample size of 24 patients, 19 were effectively screened during a period from October 2012 and October 2013; 3 patients did not meet inclusion criteria and 16 were randomized to the two intervention arms.
Participants by arm
| Arm | Count |
|---|---|
| Temodal, Then Dralitem During days 1 and 2, all patients received a single oral dose of 200 mg/m2 of Temozolomide from Monte Verde S.A. (Dralitem®). On day 3 patients received 200 mg/m2 of Temozolomide from Schering-Plough (Temodal®) as a single oral dose. After a washout period of 10 hours, they then received 200 mg/m2 of Temozolomide from Monte Verde S.A. (Dralitem®). On day 5 all patients received Temozolomide 200 mg/m2 from Monte Verde S.A. (Dralitem®).All patients were under fasting conditions two hours before and after each drug administration. | 8 |
| Dralitem, Then Temodal During days 1 and 2, all patients received a single oral dose of 200 mg/m2 of Temozolomide from Monte Verde S.A. (Dralitem®). On day 3 patients received 200 mg/m2 of Temozolomide from Monte Verde S.A. (Dralitem®) as a single oral dose. After a washout period of 10 hours, they then received 200 mg/m2 of Temozolomide from Schering-Plough (Temodal®). On day 5 all patients received Temozolomide 200 mg/m2 from Monte Verde S.A.(Dralitem®). All patients were under fasting conditions two hours before and after each drug administration. | 8 |
| Total | 16 |
Baseline characteristics
| Characteristic | Temodal, Then Dralitem | Dralitem, Then Temodal | Total |
|---|---|---|---|
| Age, Continuous | 53.75 Years STANDARD_DEVIATION 9.35 | 39.75 Years STANDARD_DEVIATION 14.5 | 48.44 Years STANDARD_DEVIATION 14.5 |
| Body Mass Index | 26.03 kg/m^2 STANDARD_DEVIATION 2.01 | 28.46 kg/m^2 STANDARD_DEVIATION 2.72 | 27.26 kg/m^2 STANDARD_DEVIATION 2.82 |
| Body Surface, Continuous | 1.89 m^2 STANDARD_DEVIATION 0.22 | 1.95 m^2 STANDARD_DEVIATION 0.16 | 1.92 m^2 STANDARD_DEVIATION 0.19 |
| Height | 169 cm STANDARD_DEVIATION 9.53 | 173.37 cm STANDARD_DEVIATION 8.65 | 170.00 cm STANDARD_DEVIATION 8 |
| Region of Enrollment Argentina | 8 participants | 8 participants | 16 participants |
| Sex: Female, Male Female | 4 Participants | 3 Participants | 7 Participants |
| Sex: Female, Male Male | 4 Participants | 5 Participants | 9 Participants |
| Weight, Continuous | 78.87 kg STANDARD_DEVIATION 14.2 | 81.12 kg STANDARD_DEVIATION 10.78 | 79.40 kg STANDARD_DEVIATION 12 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 5 / 16 | 4 / 16 |
| serious Total, serious adverse events | 0 / 16 | 0 / 16 |
Outcome results
AUC0-∞
Extent of absorption of Temozolomide from time (0) to infinity (∞) will be measured after oral administration of the test product (Dralitem®, Monte Verde S.A.) or the reference product (Temodal®, Schering-Plough).
Time frame: 0, 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0 hours on Days 3 and 4
Population: All those subjects who completed the study and were compliant with all the protocol procedures were considered evaluable for statistical pharmacokinetic analysis. Those who received at least one dose of the products under study but did not comply with the study procedures were included in the safety analysis only.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Temodal | AUC0-∞ | 31.817 mcg*h/mL | Standard Deviation 4.159 |
| Dralitem | AUC0-∞ | 32.290 mcg*h/mL | Standard Deviation 4.174 |
AUC0-t
Extent of absorption of Temozolomide from time (0) to the last quantifiable concentration (t) will be measured after the oral administration of the test product (Dralitem®, Monte Verde S.A.) or the reference product (Temodal®, Schering-Plough)
Time frame: 0, 0.25, 0.5, 0.75, 1.0, 1.25, 1.75, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0 hours on Days 3 and 4
Population: All those subjects who completed the study and were compliant with all the protocol procedures were considered evaluable for statistical pharmacokinetic analysis. Those who received at least one dose of the products under study but did not comply with the study procedures were included in the safety analysis only.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Temodal | AUC0-t | 30.796 mcg*h/mL | Standard Deviation 3.893 |
| Dralitem | AUC0-t | 31.104 mcg*h/mL | Standard Deviation 4.019 |
Cmax
Rate of absorption of Temozolomide (Cmax) will be measured after the oral administration of the test product (Dralitem®, Monte Verde S.A.) or the reference product (Temodal®, Schering-Plough).
Time frame: 0, 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0 hours on Days 3 and 4
Population: All those subjects who completed the study and were compliant with all the protocol procedures were considered evaluable for statistical pharmacokinetic analysis. Those who received at least one dose of the products under study but did not comply with the study procedures were included in the safety analysis only.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Temodal | Cmax | 11.108 mcg/mL | Standard Deviation 2.486 |
| Dralitem | Cmax | 10.575 mcg/mL | Standard Deviation 2.805 |
Number of Adverse Events (AEs) and Serious Adverse Events (SAEs)
AEs and SAEs will be collected from the start of study treatment and until two weeks post last dose. If AEs or SAEs extend in time and are not resolved before the end of the 2-week follow up period, this period shall last until the event/s are resolved.
Time frame: Up to two weeks post last dose
Kel
Rate at which Temozolomide is removed from the body.
Time frame: 0, 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0 hours on Days 3 and 4
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Temodal | Kel | 0.3743 1/h | Standard Deviation 0.0451 |
| Dralitem | Kel | 0.3691 1/h | Standard Deviation 0.0258 |
T1/2
Time required for Temozolomide plasma concentration to decrease by 50%
Time frame: 0, 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.5, 3.0, 4.0, 6.0, 8.0, 10.0 hours on Days 3 and 4
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Temodal | T1/2 | 1.87 hours | Standard Deviation 0.2 |
| Dralitem | T1/2 | 1.89 hours | Standard Deviation 0.13 |