Brain TumorPhase 3NCT00085098
Radiation Therapy Compared With Chemotherapy and Radiation Therapy in Treating Patients With Newly Diagnosed Primary Central Nervous System (CNS) Germ Cell Tumor
A Phase 3 study testing filgrastim, carboplatin and cisplatin in people with Brain Tumor and Central Nervous System Tumor, run by Children's Oncology Group at 107 sites in 4 countries.
Trial summary
RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. Read more about this study
- Who is it for?
- Ages 3 to 25 years
- Conditions the study is for
- Brain Tumor, Central Nervous System Tumor
- What is being tested?
- filgrastim, carboplatin and cisplatin
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 24 participants
- Where
- 107 sitesin 4 countries
- Study dates
- Jan 2007to May 2009
- Phase
- Phase 3
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 3 to 25 years
- All sexes
- No healthy volunteers
- Child, Adult
DISEASE CHARACTERISTICS:
- Histologically confirmed primary CNS pure germ cell tumor
- Diagnosed within the past 31 days
- Meets any 1 OR none (i.e., M0 [localized disease]) of the following staging criteria:
- M+ (disseminated disease)
- Leptomeningeal or intraventricular metastases visualized on MRI scans of the brain and spine
- Clumps of tumor cells on lumbar cerebrospinal fluid (CSF) cytology
- Visible tumor studding the walls of the lateral or third ventricles noted during endoscopy or surgery
- Primary tumor arising within the parenchyma of the brain, brainstem, or spinal cord
- Measurable multi-focal tumors arising in both the pineal and suprasellar regions (i.e., multiple midline tumors)
- Infiltrative, intra-axial extension on brain MRI > 1 cm beyond enhancing tumor
- Modified M+ (occult multi-focal disease)
- M0 at diagnosis with a localized pineal region tumor with signs and symptoms of diabetes insipidus without measurable disease in the suprasellar region
- Lumbar CSF assay meeting criteria for the following marker profiles:
- Serum and CSF beta human chorionic gonadotropin (β-HCG) ≤ 50 IU/dL
- Serum alpha fetoprotein (AFP) ≤ 10 IU/L AND ≤ institutional norm
- CSF AFP ≤ 2.0 IU/L AND ≤ institutional norm
PATIENT CHARACTERISTICS:
Age
- 3 to 25
Performance status
- Not specified
Life expectancy
- Not specified
Hematopoietic
- Absolute neutrophil count > 1,000/mm^3
- Platelet count > 100,000/mm^3 (transfusion independent)
- Hemoglobin > 10.0 g/dL (transfusion allowed)
Hepatic
- Bilirubin ≤ 1.5 times upper limit of normal (ULN)
- aspartate aminotransferase (AST) or alanine aminotransferase (ALT) < 2.5 times ULN
Renal
- Creatinine adjusted according to age as follows*:
- No greater than 0.4 mg/dL (≤ 5 months)
- No greater than 0.5 mg/dL (6 months -11 months)
- No greater than 0.6 mg/dL (1 year-23 months)
- No greater than 0.8 mg/dL (2 years-5 years)
- No greater than 1.0 mg/dL (6 years-9 years)
- No greater than 1.2 mg/dL (10 years-12 years)
- No greater than 1.4 mg/dL (13 years and over [female])
- No greater than 1.5 mg/dL (13 years to 15 years [male])
- No greater than 1.7 mg/dL (16 years and over [male]) AND
- Creatinine clearance OR radioisotope glomerular filtration rate > 70 mL/min
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Euthyroid (with or without levothyroxine sodium therapy) as determined by normal T4 ± thyroid-stimulating hormone levels*
- Diabetes insipidus allowed provided patient is relatively stable on desmopressin acetate
- Normal endogenous cortisol function*
- Adequate antidiuretic hormone reserves* NOTE: *Unless receiving replacement therapy
PRIOR CONCURRENT THERAPY:
Biologic therapy
- Not specified
Chemotherapy
- Not specified
Endocrine therapy
- Concurrent replacement hormones allowed (e.g., corticosteroids, levothyroxine sodium, and desmopressin acetate)
Radiotherapy
- Not specified
Surgery
- Prior surgery for germ cell tumor allowed
Other
- No other prior therapy for germ cell tumor
- Concurrent anticonvulsants allowed
Trial locations and contacts
107 sites in 4 countries.
107 sites in 4 countries
United States95 sites
Akron Children's Hospital
Akron, Ohio, 44308-1062
University of New Mexico Cancer Center
Albuquerque, New Mexico, 87131-5636
Tulane Cancer Center Office of Clinical Research
Alexandria, Louisiana, 71315-3198
Texas Tech University Health Sciences Center School of Medicine - Amarillo
Amarillo, Texas, 79106
C.S. Mott Children's Hospital at University of Michigan Medical Center
Ann Arbor, Michigan, 48109-0286
Winship Cancer Institute of Emory University
Atlanta, Georgia, 30322
Children's Hospital Center for Cancer and Blood Disorders
Aurora, Colorado, 80045
Dell Children's Medical Center of Central Texas
Austin, Texas, 78723
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, Maryland, 21231-2410
CancerCare of Maine at Eastern Maine Medical Center
Bangor, Maine, 04401
Lurleen Wallace Comprehensive Cancer at University of Alabama - Birmingham
Birmingham, Alabama, 35294
Mountain States Tumor Institute at St. Luke's Regional Medical Center
Boise, Idaho, 83712-6297
Floating Hospital for Children at Tufts - New England Medical Center
Boston, Massachusetts, 02111
Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
Boston, Massachusetts, 02115
Maimonides Cancer Center at Maimonides Medical Center
Brooklyn, New York, 11219
Roswell Park Cancer Institute
Buffalo, New York, 14263-0001
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill
Chapel Hill, North Carolina, 27599-7295
Hollings Cancer Center at Medical University of South Carolina
Charleston, South Carolina, 29425
West Virginia University Health Sciences Center - Charleston
Charleston, West Virginia, 25302
Blumenthal Cancer Center at Carolinas Medical Center
Charlotte, North Carolina, 28232-2861
Children's Memorial Hospital - Chicago
Chicago, Illinois, 60614
University of Chicago Cancer Research Center
Chicago, Illinois, 60637-1470
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, 45229-3039
Rainbow Babies and Children's Hospital
Cleveland, Ohio, 44106-5000
Cleveland Clinic Taussig Cancer Center
Cleveland, Ohio, 44195
Ellis Fischel Cancer Center at University of Missouri - Columbia
Columbia, Missouri, 65203
Palmetto Health South Carolina Cancer Center
Columbia, South Carolina, 29203
Driscoll Children's Hospital
Corpus Christi, Texas, 78411
Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
Dallas, Texas, 75390
Children's Medical Center - Dayton
Dayton, Ohio, 45404-1815
Barbara Ann Karmanos Cancer Institute
Detroit, Michigan, 48201-1379
Southern California Permanente Medical Group
Downey, California, 90027
Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center
Farmington, Connecticut, 06360-2875
Lee Cancer Care of Lee Memorial Health System
Fort Myers, Florida, 33901
Cook Children's Medical Center - Fort Worth
Fort Worth, Texas, 76104
Butterworth Hospital at Spectrum Health
Grand Rapids, Michigan, 49503-2560
Greenville Hospital Cancer Center
Greenville, South Carolina, 29605
Penn State Cancer Institute at Milton S. Hershey Medical Center
Hershey, Pennsylvania, 17033-0850
Baylor University Medical Center - Houston
Houston, Texas, 77030-2399
M. D. Anderson Cancer Center at University of Texas
Houston, Texas, 77030-4009
University of Mississippi Cancer Clinic
Jackson, Mississippi, 39216-4505
Nemours Children's Clinic
Jacksonville, Florida, 32207
CCOP - Kalamazoo
Kalamazoo, Michigan, 49007-5381
Children's Mercy Hospital
Kansas City, Missouri, 64108
East Tennessee Children's Hospital
Knoxville, Tennessee, 37901
CCOP - Nevada Cancer Research Foundation
Las Vegas, Nevada, 89109-2306
Lucille P. Markey Cancer Center at University of Kentucky
Lexington, Kentucky, 40536-0093
Arkansas Cancer Research Center at University of Arkansas for Medical Sciences
Little Rock, Arkansas, 72205
Loma Linda University Cancer Institute at Loma Linda University Medical Center
Loma Linda, California, 92354
Jonathan Jaques Children's Cancer Center at Miller Children's Hospital
Long Beach, California, 90801
Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center
Los Angeles, California, 90048-1865
Kosair Children's Hospital
Louisville, Kentucky, 40232
Children's Hospital Central California
Madera, California, 93638-8762
Marshfield Clinic - Marshfield Center
Marshfield, Wisconsin, 54449
St. Jude Children's Research Hospital
Memphis, Tennessee, 38105
University of Miami Sylvester Comprehensive Cancer Center - Miami
Miami, Florida, 33136
Miami Children's Hospital
Miami, Florida, 33155
Midwest Children's Cancer Center at Children's Hospital of Wisconsin
Milwaukee, Wisconsin, 53226
Children's Hospitals and Clinics of Minnesota - Minneapolis
Minneapolis, Minnesota, 55404
Overlook Hospital
Morristown, New Jersey, 07962
Saint Peter's University Hospital
New Brunswick, New Jersey, 08901
Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
New Brunswick, New Jersey, 08903
NYU Cancer Institute at New York University Medical Center
New York, New York, 10016
Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center
New York, New York, 10032
Memorial Sloan-Kettering Cancer Center
New York, New York, 10065
Newark Beth Israel Medical Center
Newark, New Jersey, 07112
Advocate Christ Medical Center
Oak Lawn, Illinois, 60453
Oklahoma University Cancer Institute
Oklahoma City, Oklahoma, 73104
Florida Hospital Cancer Institute at Florida Hospital Orlando
Orlando, Florida, 32803-1273
St. Joseph's Hospital and Medical Center
Paterson, New Jersey, 07503
Sacred Heart Cancer Center at Sacred Heart Hospital
Pensacola, Florida, 32504
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, 19104-9786
St. Christopher's Hospital for Children
Philadelphia, Pennsylvania, 19134-1095
Phoenix Children's Hospital
Phoenix, Arizona, 85016-7710
Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, 15213
Legacy Emanuel Hospital and Health Center and Children's Hospital
Portland, Oregon, 97227
Rhode Island Hospital Comprehensive Cancer Center
Providence, Rhode Island, 02903
Mayo Clinic Cancer Center
Rochester, Minnesota, 55905
James P. Wilmot Cancer Center at University of Rochester Medical Center
Rochester, New York, 14642
Sutter Cancer Center
Sacramento, California, 95816
Primary Children's Medical Center
Salt Lake City, Utah, 84113-1100
University of Texas Health Science Center at San Antonio
San Antonio, Texas, 78207
Methodist Children's Hospital of South Texas
San Antonio, Texas, 78229-3993
Children's Hospital and Regional Medical Center - Seattle
Seattle, Washington, 98105
Sanford Cancer Center at Sanford USD Medical Center
Sioux Falls, South Dakota, 57117-5039
Cardinal Glennon Children's Hospital
St Louis, Missouri, 63104
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
St Louis, Missouri, 63110
All Children's Hospital
St. Petersburg, Florida, 33701
Stanford Cancer Center
Stanford, California, 94305-5824
Stony Brook University Cancer Center
Stony Brook, New York, 11794-9446
St. Joseph's Cancer Institute at St. Joseph's Hospital
Tampa, Florida, 33607
Albert Einstein Cancer Center at Albert Einstein College of Medicine
The Bronx, New York, 10461
Children's National Medical Center
Washington D.C., District of Columbia, 20010-2970
Walter Reed Army Medical Center
Washington D.C., District of Columbia, 20307-5001
Alfred I. duPont Hospital for Children
Wilmington, Delaware, 19803
Canada8 sites
University of Alberta Hospital
Edmonton, Alberta, T6G 1Z2
McMaster Children's Hospital at Hamilton Health Sciences
Hamilton, Ontario, L8N 3Z5
Hopital Sainte Justine
Montreal, Quebec, H3T 1C5
Children's Hospital of Eastern Ontario
Ottawa, Ontario, K1H 8L1
Janeway Children's Health and Rehabilitation Centre
St. John's, Newfoundland and Labrador, A1B 3V6
Hospital for Sick Children
Toronto, Ontario, M5G 1X8
Children's & Women's Hospital of British Columbia
Vancouver, British Columbia, V6H 3V4
CancerCare Manitoba
Winnipeg, Manitoba, R3E 0V9
Australia3 sites
Royal Children's Hospital
Brisbane, Queensland, 4029
Royal Children's Hospital
Parkville, Victoria, 3052
Princess Margaret Hospital for Children
Perth, Western Australia, 6001
About this study
Official title: Radiotherapy Alone Versus Chemotherapy Followed By Response-Based Radiotherapy For Newly Diagnosed Primary CNS Germinoma
RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known whether radiation therapy alone is as effective as chemotherapy plus radiation therapy in treating germ cell tumor.
PURPOSE: This randomized phase III trial is studying radiation therapy alone to see how well it works compared to chemotherapy and radiation therapy in treating patients with newly diagnosed primary CNS germ cell tumor.
Read the detailed description
OBJECTIVES:
Primary
- Compare event-free survival and overall survival of patients with newly diagnosed primary CNS germ cell tumor treated with conventional radiotherapy alone (regimen A) vs chemotherapy followed by tumor response-based radiotherapy (regimen B).
Secondary
- Determine the complete response rate in patients treated with regimen B.
- Determine the acute and subacute toxicity of regimen B in these patients.
- Compare treatment-related morbidity, in terms of verbal learning and memory, executive functioning, and quality of life, in patients treated with these regimens.
- Determine the prognostic value of baseline serum, lumbar, and intraventricular levels of human chorionic gonadotropin levels from patients treated with these regimens.
- Determine the prognostic value of extent of disease (M+ vs modified M+ vs M0) on event-free survival and overall survival of patients treated with these regimens.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to tumor location (pineal vs suprasellar vs pineal + suprasellar or other), and disease stage (disseminated vs occult multi-focal vs localized). Patients are randomized to 1 of 2 treatment regimens.
All patients undergo an operative procedure (endoscopic biopsy, stereotactic biopsy, or open craniotomy) to confirm the diagnosis of pure germ cell germinoma followed by an intraoperative and perioperative staging evaluation.
- Regimen A (radiotherapy only): Within 52 days of surgery, patients undergo standard-dose radiotherapy once daily on days 1-5 for approximately 5-6 weeks.
- Regimen B (chemotherapy plus radiotherapy):
- Courses 1 and 2: Patients receive carboplatin IV over 1 hour on days 1 and 2 and etoposide IV over 2 hours on days 1-3. Treatment repeats every 21 days for 2 courses.
Patients achieving a complete response (CR) proceed to reduced-dose radiotherapy. Patients with minimal residual disease (MRD), a partial response (PR), or stable disease (SD) receive chemotherapy courses 3 and 4 as outlined below. Patients with progressive disease undergo a second surgical procedure for biopsy and are restaged. Patients with a confirmed diagnosis of germ cell tumor with no change in tumor markers and no new lesions after restaging proceed to chemotherapy courses 3 and 4.
- Courses 3 and 4: Patients receive cisplatin IV over 6 hours on day 1, cyclophosphamide IV over 1 hour on days 2 and 3, and filgrastim (G-CSF) subcutaneously or IV beginning on day 4 and continuing until blood counts recover. Treatment repeats every 21 days for 2 courses.
Patients achieving a CR or MRD proceed to reduced-dose radiotherapy. Patients with a PR, SD, or progressive disease are restaged. Patients with a confirmed diagnosis of germ cell tumor after restaging undergo standard radiotherapy as in regimen A.
- Reduced-dose radiotherapy: Within 6 weeks of starting course 4, patients undergo lower-dose radiotherapy once daily on days 1-5 for 5 weeks.
Treatment in both regimens continues in the absence of unacceptable toxicity or in the event that a non-germinomatous germ cell tumor is detected.
Quality of life and neuropsychological function within the domains of intelligence, attention-concentration, memory, and executive functioning are assessed at 9, 30, and 60 months after diagnosis.
Patients are followed every 4 months for 2 years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 225 patients (approximately 112 per treatment regimen) will be accrued for this study within 5 years.
- Conditions
- Brain Tumor, Central Nervous System Tumor
- Being tested
- filgrastim, carboplatin, cisplatin, cyclophosphamide, etoposide
- Keywords
- childhood central nervous system germ cell tumor
- Medical subject headings
- Brain Neoplasms, Central Nervous System Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
filgrastimBiological
Also called Granulocyte Colony-Stimulating Factor, r-metHuG-CSF, G-CSF, Neupogen
Given by infusion or injection
carboplatinDrug
Also called Paraplatin, NSC #241240
Given IV over 1 hour
cisplatinDrug
Also called Cis-diamminedichloroplatinum II, Platinol-AQ, NSC #119875
Given IV over 6 hours
cyclophosphamideDrug
Also called Cytoxan, NSC #26271
Given IV over 1 hour
etoposideDrug
Also called VePesid, Etopophos, VP-16, NSC #141540
Given IV over 2 hours
radiation therapyRadiation
Patients undergo radiotherapy 5 days a week
| Study group | Role | What they receive |
|---|---|---|
| Regimen A (radiotherapy only) | Experimental | Within 52 days of surgery, patients will undergo standard-dose radiation therapy 5 days a week for approximately 5-6 weeks. Receives: Radiation: radiation therapy |
| Regimen B (chemotherapy plus radiotherapy) | Experimental | Courses 1 and 2: Patients receive carboplatin IV over 1 hour on days 1 and 2 and etoposide IV over 2 hours on days 1-3. Treatment repeats every 21 days for 2 courses.
Within 3 weeks of completing chemotherapy, patients with CR undergo low-dose radiation therapy 5 days a week for 5 weeks. Patients with MRD, a PR, or SD receive chemotherapy courses 3 and 4 as outlined below.
Courses 3 and 4: Patients receive cisplatin IV over 6 hours on day 1, cyclophosphamide IV over 1 hour on days 2 and 3, and filgrastim (G-CSF), subcutaneous (SC) or IV beginning on day 4 and continuing until blood counts recover.
Treatment repeats every 21 days for 2 courses. Patients achieving a CR or MRD proceed to reduced-dose radiotherapy. Patients with a PR, SD, or progressive disease (PD) are restaged and may undergo standard radiation therapy as in regimen A. Reduced-dose radiation therapy: Within 6 weeks of starting course 4, patients undergo lower-dose radiation therapy once daily on days 1-5 for 5 weeks Receives: Biological: filgrastim; Drug: carboplatin; Drug: cisplatin; Drug: cyclophosphamide; Drug: etoposide; Radiation: radiation therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Event-free Survival
Data will be summarized as number of patients in the following categories at the time of data cutoff for analyses of 3-year EFS: 1)Experienced a qualifying event (QE) (see below);2)Event-free through 3 years of follow-up;3)Event-free until data cutoff (if less than 3 years of follow-up);4)Withdrew from study;5)Lost to follow-up.
QEs: 1)disease progression, defined as increase >= 40% in tumor volume or >= 25% in tumor area of target lesions;2)development of new lesions;3)occurrence of a second malignant neoplasm, defined as a malignancy with different histological type from trial-qualifying diagnosis;4)death from any cause.
Stat. analyses will be based on time from enrollment to the earliest of: 1)occurrence of any of the QEs;2)withdrawal from study or lost to follow-up;3)completion of three years of follow-up event-free;4)data cutoff for completion of the statistical analyses for the protocol's primary objective.
NOTE: Reported data are through May 2009 (see Caveats section).
Measured: Study enrollment until date of earliest qualifying event (QE), date last known to be QE-free if the patient is followed for less than three years and is QE-free at the time of analysis, or 3 years if the patient is QE-free at 3 years
Secondary outcomes (3)
Number of Participants With a Response to Regimen B
To assess the complete response rate to pre-radiotherapy chemotherapy (Reg B only). Response was determined after completing 2-4 cycles of chemotherapy on Reg B. Complete Response (CR) is defined as disappearance of all target lesions.
Measured: 5 years from beginning of treatment
Toxicity and Safety as Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0
The analysis of toxicity will focus on estimating the rates of key acute and subacute toxicity occurring during the first induction chemotherapy. The list of toxicities of interest include Anemia or Febrile Neutropenia; Nausea or Vomiting; Infections and Infestations; Neutrophil or White blood count decrease; and Hypokalemia or Hyponatremia
Measured: From the beginning of treatment, assessed up to 5 years
Quality of Life (QOL) and Neurocognitive Assessment (NP)
The primary endpoints for QOL and NP assessments will be the global scale value from each of these instruments at the two-year time point. Analyses of subscales (if they exist) and of assessments at other times will be of secondary interest. It is assumed that scale values are standardized to a reference normal population. The scores range from 0 to 100 with higher score reflecting better QoL or neurocognitive assessment.
Measured: 2 years from beginning of treatment
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted11 Jun 2004 (estimated)
- Study startJan 2007
- Primary completionMay 2009
- Study completionMay 2009
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for Brain TumorStudies of the same condition, open and under way.
- More trials run by Children's Oncology GroupThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 24 participants (actual)
Sponsor and investigators
- Lead sponsor
- Children's Oncology Group
- Sponsor type
- Research network
- Collaborators
- National Cancer Institute (NCI)
- Responsible party
- Sponsor
- Investigators
- Jeffrey C. Allen, MD, Study chair, NYU Langone Health
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00085098
- Sponsor's protocol ID
- ACNS0232
- Other IDs
- CDR0000367294, COG-ACNS0232
- Status last verified
- Aug 2018
- First submitted
- 10 Jun 2004
- Last updated
- 7 Sep 2018
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
Study at a glance
From the registry record, last updated by the sponsor on 7 Sep 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Radiotherapy Alone Versus Chemotherapy Followed By Response-Based Radiotherapy For Newly Diagnosed Primary CNS Germinoma
- ClinicalTrials.gov ID
- NCT00085098
- Acronym / sponsor ID
- ACNS0232
- Conditions
- Brain Tumor, Central Nervous System Tumor
- Keywords
- childhood central nervous system germ cell tumor
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 24 participants (actual)
- Lead sponsor
- Children's Oncology GroupResearch network
- Collaborators
- National Cancer Institute (NCI)
- Study start
- Jan 2007
- Primary completion
- May 2009 (actual)
- Study completion
- May 2009 (actual)
- First posted
- 11 Jun 2004 (estimated)
- Results
- Posted 6 Nov 2013
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
RATIONALE: Radiation therapy uses high-energy x-rays to damage tumor cells. Drugs used in chemotherapy work in different ways to stop tumor cells from dividing so they stop growing or die. It is not yet known whether radiation therapy alone is as effective as chemotherapy plus radiation therapy in treating germ cell tumor.
PURPOSE: This randomized phase III trial is studying radiation therapy alone to see how well it works compared to chemotherapy and radiation therapy in treating patients with newly diagnosed primary CNS germ cell tumor.
Detailed description
OBJECTIVES:
Primary
- Compare event-free survival and overall survival of patients with newly diagnosed primary CNS germ cell tumor treated with conventional radiotherapy alone (regimen A) vs chemotherapy followed by tumor response-based radiotherapy (regimen B).
Secondary
- Determine the complete response rate in patients treated with regimen B.
- Determine the acute and subacute toxicity of regimen B in these patients.
- Compare treatment-related morbidity, in terms of verbal learning and memory, executive functioning, and quality of life, in patients treated with these regimens.
- Determine the prognostic value of baseline serum, lumbar, and intraventricular levels of human chorionic gonadotropin levels from patients treated with these regimens.
- Determine the prognostic value of extent of disease (M+ vs modified M+ vs M0) on event-free survival and overall survival of patients treated with these regimens.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to tumor location (pineal vs suprasellar vs pineal + suprasellar or other), and disease stage (disseminated vs occult multi-focal vs localized). Patients are randomized to 1 of 2 treatment regimens.
All patients undergo an operative procedure (endoscopic biopsy, stereotactic biopsy, or open craniotomy) to confirm the diagnosis of pure germ cell germinoma followed by an intraoperative and perioperative staging evaluation.
- Regimen A (radiotherapy only): Within 52 days of surgery, patients undergo standard-dose radiotherapy once daily on days 1-5 for approximately 5-6 weeks.
- Regimen B (chemotherapy plus radiotherapy):
- Courses 1 and 2: Patients receive carboplatin IV over 1 hour on days 1 and 2 and etoposide IV over 2 hours on days 1-3. Treatment repeats every 21 days for 2 courses.
Patients achieving a complete response (CR) proceed to reduced-dose radiotherapy. Patients with minimal residual disease (MRD), a partial response (PR), or stable disease (SD) receive chemotherapy courses 3 and 4 as outlined below. Patients with progressive disease undergo a second surgical procedure for biopsy and are restaged. Patients with a confirmed diagnosis of germ cell tumor with no change in tumor markers and no new lesions after restaging proceed to chemotherapy courses 3 and 4.
- Courses 3 and 4: Patients receive cisplatin IV over 6 hours on day 1, cyclophosphamide IV over 1 hour on days 2 and 3, and filgrastim (G-CSF) subcutaneously or IV beginning on day 4 and continuing until blood counts recover. Treatment repeats every 21 days for 2 courses.
Patients achieving a CR or MRD proceed to reduced-dose radiotherapy. Patients with a PR, SD, or progressive disease are restaged. Patients with a confirmed diagnosis of germ cell tumor after restaging undergo standard radiotherapy as in regimen A.
- Reduced-dose radiotherapy: Within 6 weeks of starting course 4, patients undergo lower-dose radiotherapy once daily on days 1-5 for 5 weeks.
Treatment in both regimens continues in the absence of unacceptable toxicity or in the event that a non-germinomatous germ cell tumor is detected.
Quality of life and neuropsychological function within the domains of intelligence, attention-concentration, memory, and executive functioning are assessed at 9, 30, and 60 months after diagnosis.
Patients are followed every 4 months for 2 years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 225 patients (approximately 112 per treatment regimen) will be accrued for this study within 5 years.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Regimen A (radiotherapy only) | Experimental | Radiation: radiation therapyWithin 52 days of surgery, patients will undergo standard-dose radiation therapy 5 days a week for approximately 5-6 weeks. |
| Regimen B (chemotherapy plus radiotherapy) | Experimental | Biological: filgrastim, Drug: carboplatin, Drug: cisplatin, Drug: cyclophosphamide, Drug: etoposide, Radiation: radiation therapyCourses 1 and 2: Patients receive carboplatin IV over 1 hour on days 1 and 2 and etoposide IV over 2 hours on days 1-3. Treatment repeats every 21 days for 2 courses. Within 3 weeks of completing chemotherapy, patients with CR undergo low-dose radiation therapy 5 days a week for 5 weeks. Patients with MRD, a PR, or SD receive chemotherapy courses 3 and 4 as outlined below. Courses 3 and 4: Patients receive cisplatin IV over 6 hours on day 1, cyclophosphamide IV over 1 hour on days 2 and 3, and filgrastim (G-CSF), subcutaneous (SC) or IV beginning on day 4 and continuing until blood counts recover. Treatment repeats every 21 days for 2 courses. Patients achieving a CR or MRD proceed to reduced-dose radiotherapy. Patients with a PR, SD, or progressive disease (PD) are restaged and may undergo standard radiation therapy as in regimen A. Reduced-dose radiation therapy: Within 6 weeks of starting course 4, patients undergo lower-dose radiation therapy once daily on days 1-5 for 5 weeks |
Who may qualify
- Ages
- 3 to 25 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| filgrastimAlso: Granulocyte Colony-Stimulating Factor, r-metHuG-CSF, G-CSF, NeupogenGiven by infusion or injection | Biological | Regimen B (chemotherapy plus radiotherapy) |
| carboplatinAlso: Paraplatin, NSC #241240Given IV over 1 hour | Drug | Regimen B (chemotherapy plus radiotherapy) |
| cisplatinAlso: Cis-diamminedichloroplatinum II, Platinol-AQ, NSC #119875Given IV over 6 hours | Drug | Regimen B (chemotherapy plus radiotherapy) |
| cyclophosphamideAlso: Cytoxan, NSC #26271Given IV over 1 hour | Drug | Regimen B (chemotherapy plus radiotherapy) |
| etoposideAlso: VePesid, Etopophos, VP-16, NSC #141540Given IV over 2 hours | Drug | Regimen B (chemotherapy plus radiotherapy) |
| radiation therapyPatients undergo radiotherapy 5 days a week | Radiation | Regimen A (radiotherapy only), Regimen B (chemotherapy plus radiotherapy) |
Primary outcome
Event-free Survival
Time frame: Study enrollment until date of earliest qualifying event (QE), date last known to be QE-free if the patient is followed for less than three years and is QE-free at the time of analysis, or 3 years if the patient is QE-free at 3 years
Data will be summarized as number of patients in the following categories at the time of data cutoff for analyses of 3-year EFS: 1)Experienced a qualifying event (QE) (see below);2)Event-free through 3 years of follow-up;3)Event-free until data cutoff (if less than 3 years of follow-up);4)Withdrew from study;5)Lost to follow-up. QEs: 1)disease progression, defined as increase >= 40% in tumor volume or >= 25% in tumor area of target lesions;2)development of new lesions;3)occurrence of a second malignant neoplasm, defined as a malignancy with different histological type from trial-qualifying diagnosis;4)death from any cause. Stat. analyses will be based on time from enrollment to the earliest of: 1)occurrence of any of the QEs;2)withdrawal from study or lost to follow-up;3)completion of three years of follow-up event-free;4)data cutoff for completion of the statistical analyses for the protocol's primary objective. NOTE: Reported data are through May 2009 (see Caveats section).
3 secondary outcomes
Number of Participants With a Response to Regimen B
Time frame: 5 years from beginning of treatment
Toxicity and Safety as Assessed by the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 3.0
Time frame: From the beginning of treatment, assessed up to 5 years
Quality of Life (QOL) and Neurocognitive Assessment (NP)
Time frame: 2 years from beginning of treatment
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Sep 2018.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Jeffrey C. Allen, MD study chair
NYU Langone Health
107 sites in 4 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing filgrastim, carboplatin and cisplatin in people with Brain Tumor and Central Nervous System Tumor, run by Children's Oncology Group at 107 sites in 4 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 7 Sep 2018. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 107 sites in United States, Canada, Australia, Puerto Rico. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 6 Nov 2013). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Event-free Survival (time frame: Study enrollment until date of earliest qualifying event (QE), date last known to be QE-free if the patient is followed for less than three years and is QE-free at the time of analysis, or 3 years if the patient is QE-free at 3 years). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Sep 2018.