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A Phase III Trial of With Marizomib in Patients With Newly Diagnosed Glioblastoma

A Phase III Trial of Marizomib in Combination With Standard Temozolomide-based Radiochemotherapy Versus Standard Temozolomide-based Radiochemotherapy Alone in Patients With Newly Diagnosed Glioblastoma

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03345095
Acronym
MIRAGE
Enrollment
749
Registered
2017-11-17
Start date
2018-07-26
Completion date
2023-06-30
Last updated
2025-07-01

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Newly Diagnosed Glioblastoma

Keywords

Marizomib, Temozolomide, Glioblastoma, Phase III

Brief summary

The standard of care for newly diagnosed glioblastoma includes surgery, involved-field radiotherapy, and concomitant and six cycles of maintenance temozolomide chemotherapy, however the prognosis remains dismal. Marizomib has been tested in patients with newly diagnosed and recurrent glioblastoma in phase I and phase II studies. In patients with recurrent glioblastoma, marizomib was administered as a single agent or in combination with bevacizumab (NCT02330562). Based on encouraging observations, a phase I/II trial of marizomib in combination with Temozolomide+Radiotherapy(TMZ/RT) followed by Temozolomide (TMZ) in newly diagnosed glioblastoma has been launched (NCT02903069) which explores safety and tolerability of this triple combination and which shall help to determine the dose for further clinical trials in glioblastoma. In this context, given that marizomib has been established as a safe addition to the standard TMZ/RT --\>TMZ, a phase III study is considered essential to establishing its impact on overall survival.

Interventions

Intravenous administration of Marizomib

DRUGTemozolomide

Oral Administration of Temozolomide

RADIATIONradiotherapy

60 Gy in 30 fractions over 6 weeks

Sponsors

Celgene
CollaboratorINDUSTRY
Canadian Cancer Trials Group
CollaboratorNETWORK
European Organisation for Research and Treatment of Cancer - EORTC
Lead SponsorNETWORK

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Histologically confirmed newly diagnosed glioblastoma (WHO grade IV) * Tumor resection (gross total or partial), or biopsy only * Availability of formalin-fixed paraffin-embedded (FFPE) tumor block or 24 unstained slides for o6-methylguanine-DNA-methyltransferase (MGMT) analysis * Patient must be eligible for standard TMZ/RT + TMZ * Karnofsky performance score (KPS) ≥ 70 * Recovered from effects of surgery, postoperative infection and other complications of surgery (if any) * The patient is at least 18 years of age on day of signing informed consent * Stable or decreasing dose of steroids for at least 1 week prior to inclusion * The patient has a life expectancy of at least 3 months * Patient has undergone a brain MRI within 14 days of randomization but after intervention (resection or biopsy) * The patient shows adequate organ functions as assessed by the specified laboratory values within 2 weeks prior to randomization defined as adequate bone marrow, renal and hepatic function within the following ranges: * white blood cell count (WBC) ≥ 3×10\*9/L * absolute neutrophil count (ANC) ≥ 1.5×10\*9/L * Platelet count of ≥ 100×10\*9/L independent of transfusion * Hemoglobin ≥ 10 g/dl * Total Bilirubin ≤ 1.5 upper limit of normal (ULN) * Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) ≤ 2.5 × ULN * Serum creatinine \< 1.5 x ULN or creatinine clearance (CrCl) \> 30 mL/min(using the Cockcroft-Gault formula) * Women of child bearing potential (WOCBP) must have a negative urine or serum pregnancy test within 7 days prior to the first dose of study treatment. * Patients of childbearing / reproductive potential must agree to use adequate birth control measures, as defined by the investigator, during the study treatment period and for at least 6 months after the last study treatment. A highly effective method of birth control is defined as those which result in low failure rate (i.e. less than 1 percent per year) when used consistently and correctly. Patients must also agree not to donate sperm during the study and for 6 months after receiving the last dose of study treatment. * Women who are breast feeding must agree to discontinue nursing prior to the first dose of study treatment and until 6 months after the last study treatment. * Ability to take oral medication * Ability to understand the requirements of the study, provide written informed consent and authorization of use and disclosure of protected health information, and agree to abide by the study restrictions and return for the required assessments. * Before patient registration/randomization, written informed consent must be given according to International Council for Harmonisation (ICH) / Good clinical practice (GCP), and national/local regulations.

Design outcomes

Primary

MeasureTime frameDescription
Overall Survival (OS)From the date of randomization up to the date of death, assessed up to 49 monthsOverall Survival (OS): OS is defined as the number of days from date of randomization to the date of death due to any cause. If a patient has not died, the data will be censored at the last date documented to be alive.

Secondary

MeasureTime frameDescription
Progression Free Survival (PFS)From the date of randomization until the date of first objective progression or the date of patient's death whichever occurs first, assessed up to 49 monthsPFS is defined as the number of days from date of randomization to the date of earliest disease progression based on Response Assessment in Neuro-Oncology criteria (by investigator) or to the date of death due to any cause, if disease progression does not occur. Patients for whom neither death nor progression have been documented were censored on the date of the last radiological assessment that the patient was progression-free. If a patient with no post-baseline radiological assessment then the data were censored at the date of randomization. Patients with two or more missing response assessments prior to a visit with documented disease progression (or death) were censored at the last visit where the patient was documented to be progression free. Patients who received new anti-cancer therapy or cancer-related surgery prior to progression or death were not censored at the last assessment where the patient was documented as progression free prior to the new therapy.
Health-related Quality of Life (HRQol)From randomization until progression or death which ever occurs first, reported at week 16 by the mean difference from baseline assessment.HRQoL was assessed with the EORTC Quality of Life Questionnaire (QLQ-C30) version 3. The primary HRQol score is Physical Functioning. It is reported at week 16 during the Temozolomide (TMZ) maintenance phase. Physical functioning score is ranging 0 to 100. A large scores indicate a good physical functioning. A negative difference indicates a worsening physical functioning.
Mini Mental State Examination (MMSE)From the date of randomization until end of treatment. It is reported at week 16 by the mean difference from baseline assessment.MMSE is a brief, standardized tool to grade patients' neurocognitive function. It is an 11-question measure that tests five areas of neurocognitive function: orientation, registration, attention and calculation, recall, and language. A large MMSE score indicates a good cognitive functioning. The maximum MMSE score is 30 which corresponds to the best neurocognitive function and minimum MMSE score is 0 the worst neurocognitive function.The patient's neurocognitive function are considered 'impaired' if MMSE is 26 or less and 'normal' if it is 27 or more. MMSE has been validated and extensively used in both clinical practice and research. It is reported at week 16 during the Temozolomide (TMZ) maintenance phase. A negative difference indicates a worsening cognitive functioning. Difference range reported in the data table is min -19 and max 10. The mean difference is reported with 95% confidence interval (CI). A CI which excludes 0 indicates a significant mean MMSE score change.

Countries

Austria, Belgium, Canada, Denmark, France, Germany, Netherlands, Norway, Spain, Switzerland, United Kingdom, United States

Participant flow

Recruitment details

Patient registration was accepted from authorized investigators. Patients were registered on the Electronic Data Capture system. To access it, the investigator needed a user name and a password which were provided by the EORTC Headquarters. In case of problems investigators could contact the EORTC Clinical Data Manager. A Subject Identifier was allocated to the patient. This number allowed the identification of the patient in the Electronic Data Capture.

Pre-assignment details

Eligibility criteria were checked at time of randomization. Once eligibility had been verified, treatment was randomly allocated to the patient, together with a sequential patient identification number. This number allowed the identification of the patients in the Electronic Data Capture system that was used to complete the Case Report Forms.

Participants by arm

ArmCount
Experimental Arm
Radiotherapy + Temozolomide + Marizomib followed by adjuvant Temozolomide + Marizomib Marizomib: Intravenous administration of Marizomib Temozolomide: Oral Administration of Temozolomide radiotherapy: 60 Gy in 30 fractions over 6 weeks
374
Standard Arm
Radiotherapy + Temozolomide followed by adjuvant Temozolomide Temozolomide: Oral Administration of Temozolomide radiotherapy: 60 Gy in 30 fractions over 6 weeks
375
Total749

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event36118
Overall StudyDeath24
Overall StudyLack of Efficacy184156
Overall StudyOther reasons211
Overall StudyPhysician Decision318
Overall StudyProtocol Violation01
Overall StudyWithdrawal by Subject2259

Baseline characteristics

CharacteristicExperimental ArmStandard ArmTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
87 Participants99 Participants186 Participants
Age, Categorical
Between 18 and 65 years
287 Participants276 Participants563 Participants
Age, Continuous58.5 years58.0 years58.0 years
Extent of surgery
Gross total
192 Participants192 Participants384 Participants
Extent of surgery
Partial/biopsy
182 Participants183 Participants365 Participants
Karnofsky Performance Status
70/80
126 Participants123 Participants249 Participants
Karnofsky Performance Status
90/100
248 Participants252 Participants500 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants1 Participants1 Participants
Race (NIH/OMB)
Asian
7 Participants5 Participants12 Participants
Race (NIH/OMB)
Black or African American
2 Participants0 Participants2 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
1 Participants0 Participants1 Participants
Race (NIH/OMB)
Unknown or Not Reported
85 Participants79 Participants164 Participants
Race (NIH/OMB)
White
279 Participants290 Participants569 Participants
Region of Enrollment
Austria
6 participants7 participants13 participants
Region of Enrollment
Belgium
30 participants32 participants62 participants
Region of Enrollment
Canada
104 participants108 participants212 participants
Region of Enrollment
Denmark
9 participants10 participants19 participants
Region of Enrollment
France
55 participants54 participants109 participants
Region of Enrollment
Germany
38 participants37 participants75 participants
Region of Enrollment
Netherlands
45 participants44 participants89 participants
Region of Enrollment
Norway
4 participants4 participants8 participants
Region of Enrollment
Spain
34 participants29 participants63 participants
Region of Enrollment
Switzerland
20 participants24 participants44 participants
Region of Enrollment
United Kingdom
8 participants7 participants15 participants
Region of Enrollment
United States
21 participants19 participants40 participants
Sex: Female, Male
Female
119 Participants142 Participants261 Participants
Sex: Female, Male
Male
255 Participants233 Participants488 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
55 / 30957 / 307
other
Total, other adverse events
300 / 305283 / 297
serious
Total, serious adverse events
114 / 30580 / 297

Outcome results

Primary

Overall Survival (OS)

Overall Survival (OS): OS is defined as the number of days from date of randomization to the date of death due to any cause. If a patient has not died, the data will be censored at the last date documented to be alive.

Time frame: From the date of randomization up to the date of death, assessed up to 49 months

Population: Analysis population is Intention-to-treat population (ITT): All randomized patients will be analyzed in the arm they were allocated by randomization

ArmMeasureValue (MEDIAN)
Experimental ArmOverall Survival (OS)16.13 Months
Standard ArmOverall Survival (OS)15.08 Months
Secondary

Health-related Quality of Life (HRQol)

HRQoL was assessed with the EORTC Quality of Life Questionnaire (QLQ-C30) version 3. The primary HRQol score is Physical Functioning. It is reported at week 16 during the Temozolomide (TMZ) maintenance phase. Physical functioning score is ranging 0 to 100. A large scores indicate a good physical functioning. A negative difference indicates a worsening physical functioning.

Time frame: From randomization until progression or death which ever occurs first, reported at week 16 by the mean difference from baseline assessment.

Population: At week 16 during the TMZ maintenance phase, HRQol was obtained from 212 patients in the Experimental arm and 207 patients in the Standard arm.

ArmMeasureValue (MEAN)
Experimental ArmHealth-related Quality of Life (HRQol)-11.8 score on a scale
Standard ArmHealth-related Quality of Life (HRQol)-5.4 score on a scale
p-value: 0.000495% CI: [-8.6, -2.5]Wilcoxon (Mann-Whitney)
Secondary

Mini Mental State Examination (MMSE)

MMSE is a brief, standardized tool to grade patients' neurocognitive function. It is an 11-question measure that tests five areas of neurocognitive function: orientation, registration, attention and calculation, recall, and language. A large MMSE score indicates a good cognitive functioning. The maximum MMSE score is 30 which corresponds to the best neurocognitive function and minimum MMSE score is 0 the worst neurocognitive function.The patient's neurocognitive function are considered 'impaired' if MMSE is 26 or less and 'normal' if it is 27 or more. MMSE has been validated and extensively used in both clinical practice and research. It is reported at week 16 during the Temozolomide (TMZ) maintenance phase. A negative difference indicates a worsening cognitive functioning. Difference range reported in the data table is min -19 and max 10. The mean difference is reported with 95% confidence interval (CI). A CI which excludes 0 indicates a significant mean MMSE score change.

Time frame: From the date of randomization until end of treatment. It is reported at week 16 by the mean difference from baseline assessment.

Population: At week 16 during the TMZ maintenance phase, HRQol was obtained from 180 patients in the Experimental arm and 166 patients in the Standard arm.

ArmMeasureValue (MEAN)
Experimental ArmMini Mental State Examination (MMSE)-0.95 score on a scale
Standard ArmMini Mental State Examination (MMSE)-0.39 score on a scale
p-value: 0.1595% CI: [-1.27, 0.16]Wilcoxon (Mann-Whitney)
Secondary

Progression Free Survival (PFS)

PFS is defined as the number of days from date of randomization to the date of earliest disease progression based on Response Assessment in Neuro-Oncology criteria (by investigator) or to the date of death due to any cause, if disease progression does not occur. Patients for whom neither death nor progression have been documented were censored on the date of the last radiological assessment that the patient was progression-free. If a patient with no post-baseline radiological assessment then the data were censored at the date of randomization. Patients with two or more missing response assessments prior to a visit with documented disease progression (or death) were censored at the last visit where the patient was documented to be progression free. Patients who received new anti-cancer therapy or cancer-related surgery prior to progression or death were not censored at the last assessment where the patient was documented as progression free prior to the new therapy.

Time frame: From the date of randomization until the date of first objective progression or the date of patient's death whichever occurs first, assessed up to 49 months

Population: The analysis population is Intention-to-treat population (ITT): All randomized patients will be analyzed in the arm they were allocated by randomization.

ArmMeasureValue (MEDIAN)
Experimental ArmProgression Free Survival (PFS)6.34 Months
Standard ArmProgression Free Survival (PFS)6.11 Months

Source: ClinicalTrials.gov · Data processed: Feb 23, 2026