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Neo-adjuvant Treatment With Temozolomide and Bevacizumab Previous to Temozolomide Plus Radiation Plus Bevacizumab Therapy in Unresectable Glioblastoma

Study Purpose

In the last 20 years, only temozolomide has obtained indication for the treatment of High-grade glioma (HGG). Temozolomide during and later radiation therapy has doubled one year survival and is the standard treatment for glioblastoma. But 30% of glioblastomas receive only a biopsy as they can't be resected and don't get benefit from this treatment. They and should be treated immediately after the biopsy to prevent neurological deterioration but in spite of this approach they often deteriorate neurologically during radiotherapy. . An effective pre-radiation treatment should improve their prognosis and allow them to complete concomitant radiotherapy and temozolomide treatment. Bevacizumab in recurrent HGG displays 63% of objective responses when combined with irinotecan. But irinotecan is not the most active treatment in this disease. We propose a phase II, two arms, open label, randomized, multicentric study with 2 cycles of temozolomide before radiation therapy and concomitant temozolomide, in patients with glioblastoma and 'biopsy-only'. Bevacizumab will be added to one arm.

Recruitment Criteria

Accepts Healthy Volunteers Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms	No
Study Type An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes. An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes. Searching Both is inclusive of interventional and observational studies.	Interventional
Eligible Ages	18 Years - 75 Years
Gender	All

More Inclusion & Exclusion Criteria

Inclusion Criteria:

1. Patients with glioblastoma, non-resectable, biopsy only. Accepting a craniotomy with resection attempted if an RMN within a period of about 72 hours to confirm that the resection was less than 25% of the tumor and fulfill criterion. 2. Measurable disease and contrast uptake ≥ 3 cm in one of its diameters. 3. Stable doses of dexamethasone during the week prior to inclusion. 4. Performance Status ≤ 2. 5. Age ≤ 75 years. 6. MiniMental Status> 25/30. 7. Bartel index > 50%. 8. The surgical incision should be healed prior to randomization. The treatment can be started at 3 weeks of a simple stereotactic biopsy or 4 weeks in case of open biopsy (craniotomy). 9. Maximum baseline MRI performed 4 weeks before starting treatment (acceptance of the MRI done for neuronavegation biopsy as baseline). 10. Adequate bone marrow reserve: neutrophils>2000x109/L, platelets>100x109/L, hemoglobin≥106g/dl. 11. Not received prior treatment with chemotherapy or radiation. 12. Adequate renal function: Creatinine <1.5 ULN of the laboratory performing the analysis. 13. Adequate liver function: Serum bilirubin <1.5/ULN SGOT, SGPT<2.5ULN. Serum alkaline phosphatase<3/ULN. 14. Absence of proteinuria. 15. Effective method of contraception for patients and their partners. 16. Written informed consent. 17. Collecting material for a double histological confirmation of diagnosis.

Exclusion Criteria:

1. Prior radiotherapy or chemotherapy for the treatment of glioma. 2. Less than 5 years prior to any invasive neoplasia. Accepted carcinoma in situ of cervix carcinoma or cutaneous vasocelular. 3. Cerebral hemorrhage after biopsy. 4. Pregnancy or lactation. 5. Clinically significant cardiovascular disease:

- Myocardial infarction or unstable angina (≤ 6 months before randomization) - Congestive heart failure (CHF) class ≥ II NYHA, New York Heart Association.

- Cardiac Arrhythmia uncontrolled despite medication (may include patients with atrial fibrillation often controlled).

- Peripheral vascular disease ≥ grade 3 (ie, symptomatic and interfering with everyday activities or specifying repairs or review).

6. Continued use of aspirin> 325 mg / day, currently or recently (within the 10 days prior to randomization). 7. Currently established treatment with therapeutic doses of anticoagulants Coumarin derivatives (courmarina, warfarin) or a week before starting treatment. It allows the administration of heparin for control of Deep Vein Thrombosis (DVT) 8. Patients with PTSD and patients with inflammatory bowel disease, with risk of perforation. 9. HT with values above 150 mmHg systolic pressure of 100 mmHg and diastolic tension is not controllable with standard antihypertensive drugs. 10. Not healed scars, ulcers or recent bone fracture. 11. Bleeding diathesis or coagulopathy.

Trial Details

Trial ID: This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries.	NCT01102595
Phase Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans. Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data. Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs. Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use.	Phase 2
Lead Sponsor The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data.	Grupo Español de Investigación en Neurooncología
Principal Investigator The person who is responsible for the scientific and technical direction of the entire clinical study.	N/A
Principal Investigator Affiliation	N/A
Agency Class Category of organization(s) involved as sponsor (and collaborator) supporting the trial.	Other
Overall Status	Completed
Countries	Spain
Conditions The disease, disorder, syndrome, illness, or injury that is being studied.	Glioblastomas

Arms & Interventions

Arms

Experimental: 1: Temozolomide plus Radiation

Group 1: Neoadjuvant phase: Temozolomide 85 mg/m2/d x 21 days every 28 days for 2 cycles. Adjuvant phase: Temozolomide 75 mg/m2/d x 42-49 days with standard radiation therapy (60 Gy). Maintenance phase: Temozolomide 150 - 200 mg/m2 d1-d5 q 28d for 6 cycles.

Experimental: 2: Temozolomide plus Radiation plus Bevacizumab

Neoadjuvant phase: Temozolomide 85 mg/m2/d x 21 days every 28 days for 2 cycles + bevacizumab 10 mg/kg every 15 days. Adjuvant phase: Temozolomide 75 mg/m2/d x 42-49 days with standard radiation therapy (60 Gy) + bevacizumab 10 mg/kg every 15 days. Maintenance phase: Temozolomide 150 - 200 mg/m2 d1-d5 q 28d for 6 cycles.

Interventions

Drug: - Temozolomide

- Temozolomide 85 mg/m2/d x 21 days every 28 days for 2 cycles. - Temozolomide 75 mg/m2/d x 42-49 days - Temozolomide 150 - 200 mg/m2 d1-d5 q 28d for 6 cycles.

Drug: - Bevacizumab

- 2 cycles + bevacizumab 10 mg/kg every 15 days each two cycles. - Bevacizumab 10 mg/kg every 15 days, three dosis.

Radiation: - Standard radiation therapy

42-49 days with standard radiation therapy (60 Gy): 2 Gy per day.

Contact a Trial Team

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International Sites

Madrid, Spain

Status

Address

Grupo Español de Investigacion en Neurooncologia

Madrid, , 28001

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