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Brain NeoplasmsPhase 1NCT00527657

Temozolomide, Thalidomide, and Lomustine (TTL) in Melanoma Patients

A Phase 1 study testing Lomustine, Temozolomide and Thalidomide in people with Brain Neoplasms and Melanoma, run by M.D. Anderson Cancer Center at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The goal of this clinical research study is to find the highest safe dose of lomustine (CCNU, CeeNUTM) that can be given with temozolomide (TemodarTM) and thalidomide (ThalomidTM) in the treatment of metastatic melanoma that has spread to the brain. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Brain Neoplasms, Melanoma
What is being tested?
Lomustine, Temozolomide and Thalidomide
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
17 participants
Where
1 siteUnited States
Study dates
9 Feb 2006to 2 Feb 2012
Phase
Phase 1
Are there results?
None posted in the registry

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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Histologic Documentation: Histologic or cytologic diagnosis of distant metastatic melanoma and clinical evidence of brain metastasis.
  • Pts must have brain lesions of =/> 1.0cm longest dimension by MRI or spiral CT, if MRI not feasible or > 0.5cm by MRI with 3D images. Pts with/without extracranial disease are eligible. Measurable extracranial disease is not required. Lesions that are considered non-measurable include: <1.0 cm by MRI or Spiral CT, Bone lesions, Leptomeningeal disease, Ascites, Pleural/pericardial effusion, Lymphangitis cutis/pulmonis, Abdominal masses that are not confirmed and followed by imaging techniques, Cystic lesions, lesions that are in a previously irradiated area, unless new growth can be documented.
  • Age >/= 18 years of age.
  • Eastern Cooperative Oncology Group (ECOG) Performance Status: 0 or 1
  • No more than 1 prior chemotherapy regimen and no prior chemotherapy for brain metastases. No prior treatment with continuous daily dose of temozolomide; prior immunotherapy and surgical resection are permitted. Patients with prior history of whole brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) are permitted providing that there is measurable lesion with documented growth post radiation or new disease.
  • (#5 continued) Progression of lesions treated with WBRT must be shown by 2 post treatment brain imaging at least 3 weeks apart. Progression of disease is also considered when the patient had increase of lesions as per MRI of brain obtained 4 weeks or more after WBRT completed when compared to baseline MRI obtained less than 1 week prior to start of radiation. Lesions treated with SRS must have responded and then progressed.
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  • The following time periods must have elapsed since prior therapy: 3 weeks since surgical resection or stereotactic radiosurgery; 4weeks since prior whole brain radiation therapy; 6 weeks since prior nitrosureas or mitomycin C. Biologic agents used as adjuvants and vaccines or cellular therapies will not require 4-week wash out period if the patient meets all eligibility criteria.
  • No frequent vomiting and/or medical condition that could interfere with oral medication intake (e.g., partial bowel obstruction).
  • No other concurrent chemotherapy/immunotherapy/radiotherapy.
  • No history of active angina or myocardial infarction within 6 months. No history of significant ventricular arrythmia or uncontrolled arrythmia or bradycardia. The study participants must have resting heart rate of 48 or greater (.e.i - to receive Thalidomide).
  • No prior history of deep vein thrombosis (DVT) or pulmonary embolism (PE).
  • No known HIV disease. Patients with a history of intravenous drug abuse or any other behavior associated with an increased risk of HIV infection should be tested for exposure to the HIV virus. Because peripheral neuropathies are a common toxicity of antiviral therapy and of viral infection in HIV patients, as well as a common significant toxicity with thalidomide, patients who test positive or who are known to be infected are not eligible. An HIV test is not required for entry on this protocol, but is required if the patient is perceived to be at risk.
  • No pre-existing neuropathy that is >/= grade 2, including uncontrolled seizures.
  • No expected need for radiotherapy to brain or any extracranial metastatic site during the period of participation in the study.
  • Patients may not be taking Coumadin, warfarin or heparin products or their derivatives.
  • Patients who require anti-platelet therapy such as daily aspirin, Plavix or ibuprofen are not eligible to participate.
  • Patients requiring the use of bisphosphonates (e.g., zoledronic acid) are not eligible to participate. Patients who receive thalidomide in combination with zoledronic acid are potentially at increased risk of renal dysfunction.
  • Required Initial Laboratory Data: Granulocytes >/= 1,500/ml; Platelet count >/= 100,000/ul; Creatinine </=2 mg/dl; Transaminases (ALT,AST) </= 3 * upper limits of normal; Alkaline phosphatase </= 3 * upper limits of normal; thyroid-stimulating hormone (TSH) Within normal limits Serum beta-HCG Negative (in female patients unless S/P hysterectomy or menopausal or no menses for 24 months). Assay must have a sensitivity of at least 50 mIU/ml. Serum anticonvulsant levels (for patients on a measurable anticonvulsant) must be within therapeutic range. EKG must be without acute abnormalities or uncontrolled arrhythmia.
  • Pregnant and nursing women are not eligible for treatment on this protocol. Women of childbearing potential must agree to abstain from all intercourse or use two methods of birth control for 28 days prior to treatment and while under treatment with thalidomide and for 4 weeks after completing therapy. One of the methods of birth control must be highly active (IUD, hormonal, tubal ligation or partner's vasectomy) and used concomitantly with one additional method(e.g., latex condom, diaphragm or cervical cap. Please see also eligibility criteria 19 and 20.
  • In addition, women of childbearing potential must have morning urine b-HCG performed within 1 week prior to registration and within 24 hours before beginning study treatment. All the precautions for childbearing potential women are required even in patients with infertility unless due to hysterectomy or the patient has been post menopausal (has had no menses for at least 24 consecutive months). Men must agree to abstain from unprotected sexual intercourse. Male patients should request that female partners use a second method of birth control in addition to the male barrier method (condoms).
  • All patients (men and women) must agree to use medically approved contraceptive measures simultaneously prior to starting thalidomide therapy, all during drug therapy, and for at least 1 month after therapy has stopped. Women of childbearing potential should start using medically approved contraceptive measures 4 weeks prior to starting thalidomide therapy.
  • Patients must give written consent.
  • Patients must be willing and able to comply with the FDA-mandated S.T.E.P.S version 3 program.

Who cannot join

  • Presence of any ongoing toxic effect from prior treatment.
  • Serious infection requiring intravenous antibiotics, or nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by the complications of this therapy.
  • Concurrent active malignancy other than non-melanoma skin cancers or carcinoma-in-situ of the cervix. Patients with previous malignancies, but which have not required anti-tumor treatment within the preceding 24 months will be allowed to enter the trial. Patients with a history of a T1a or b prostate cancer (detected incidentally at transurethral prostatectomy (TURP) and comprising less than 5% of resected tissue) may participate if the prostate-specific antigen (PSA) remained within normal limits since TURP.
  • Any other medical condition or reason that, in the principal investigator's opinion, makes the patient unsuitable to participate in a clinical trial including but not limited to active bleeding, prior surgical procedures affecting absorption or gastrointestinal tract disease resulting in inability to take oral medication.
  • Pregnant and lactating women.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • UT MD Anderson Cancer Center

    Houston, Texas, 77030

Other trials in United States

About this study

Official title: A Phase I Study of Temozolomide, Thalidomide, and Lomustine (TTL) in Patients With Metastatic Melanoma in the Brain

The goal of this clinical research study is to find the highest safe dose of lomustine (CCNU, CeeNUTM) that can be given with temozolomide (TemodarTM) and thalidomide (ThalomidTM) in the treatment of metastatic melanoma that has spread to the brain. The safety and effectiveness of this combination therapy will also be studied.

Read the detailed description

Temozolomide works by blocking a tumor cell's ability to grow. Lomustine is also a chemotherapy drug that works by killing tumor cells. Studies have shown that when lomustine and temozolomide are given together, they decrease the amount of a certain protein, allowing the tumor cells to be more easily killed. Thalidomide is a drug that alters the immune system. it may also interfere with the development of tiny blood vessels that help support tumor growth. Therefore, in theory, it may decrease or prevent the growth of cancer cells.

If you are found to be eligible to take part in this study, you will begin treatment. All 3 drugs will be taken by mouth at home. Each treatment cycle will last for 8 weeks. You will take temozolomide once a day for 6 weeks followed by two weeks off. The best time to take temozolomide is around bedtime, since you must not eat for at least 1 hour before and 1 hour after taking it. The number of capsules you will take is based on your height and weight. You must swallow all the temozolomide capsules at the same time with 8 ounces of water (do not chew them).

You will take thalidomide every day for the entire 8-week cycle. Thalidomide should also be taken near bedtime, usually 30 to 45 minutes before the temozolomide dose. If you are under 70 years of age, you will start at a set dose and take the same dose throughout the study. If you are age 70 or over, the dose will start lower and will increase every 2 weeks until you are taking the prearranged set dose that those under the age of 70 are taking. Your doctor will be watching for side effects as the dose increases and may keep you at a lower dose if necessary.

In the first groups of patients (3-6 patients per group, total up to 18 patients) to be enrolled, each new group of participants will be given a higher dose of lomustine than the previous group until the highest safe dose of lomustine is found or until 18 patients have been enrolled. Responses to these doses will be evaluated. Once the best dose is found, all future participants will receive that dose of lomustine.

You will take 2 doses of lomustine every 8 weeks. You will take the first dose of lomustine on Day 1 of the 8-week cycle. You will take the second dose, which will be half as big as the first dose, on Day 29 (the day after the first 4 weeks) of the 8-week cycle. The dose of lomustine is also based on your height and weight. Lomustine should be swallowed and not chewed.

During treatment, every 2-4 weeks, you will have a complete physical exam and blood drawn for testing (1-2 tablespoons). These tests will let the doctor know if the treatment should be changed, briefly interrupted, or stopped. Women who are able to have children must have a negative pregnancy test every week for the first 4 weeks if they have regular menstruation and every 2 weeks if their periods are irregular.

At the end of 8 weeks, you will have x-rays or scans done again to see how the tumors have responded. If they are the same size or have gotten smaller, you may continue the treatment. You may stay on treatment as long as you are not having severe side effects and your tumor is either staying the same size or getting smaller. Treatment will be stopped if the tumors are getting bigger.

If you are withdrawn from the study for any reason you will be contacted by phone every three months to learn how are you doing health wise.

This is an investigational study. None of the 3 drugs used in this study have been approved by the FDA for the treatment of melanoma. Temozolomide has been approved for the treatment of brain cancer. Thalidomide has not yet been approved for the treatment of cancer. Lomustine is approved for the treatment of brain tumors and Hodgkin's disease. All of the drugs are commercially available. Their use together in this study is experimental.

Up to 18 patients will take part in this Phase I portion of the study, and another 30 patients in Phase II if progresses, with up to 48 patients total. All will be enrolled at M. D. Anderson.

Being tested
Lomustine, Temozolomide, Thalidomide
Keywords
Brain Neoplasms, Melanoma, Metastatic Melanoma, Brain Metastasis, Temozolomide, Temodar, Thalidomide, Thalomid, Lomustine, CCNU, CeeNU
Medical subject headings
Brain Neoplasms, Melanoma

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • LomustineDrug

    Also called CCNU, CeeNU

    Starting dose 30 mg/m^2 by mouth daily on Day 1 and 29.

  • TemozolomideDrug

    Also called Temodar

    75 mg/m^2 by mouth daily on Days 1 to 42.

  • ThalidomideDrug

    Also called Thalomid

    200 mg/m^2 by mouth daily.

Study groups in NCT00527657
Study groupRoleWhat they receive
Lomustine + Temozolomide + ThalidomideExperimentalLomustine starting dose 30 mg/m^2 by mouth daily on Day 1 and 29. Temozolomide 75 mg/m^2 by mouth daily on Days 1 to 42. Thalidomide 200 mg/m^2 by mouth daily.
Receives: Drug: Lomustine; Drug: Temozolomide; Drug: Thalidomide

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Maximum tolerated dose (MTD)

    Measured: 1 cycle (8 weeks) of therapy

Secondary outcomes (1)
  1. Objective (CR+PR) response rate at the MTD

    Measured: 1 cycle (8 weeks) of therapy

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Sep 2007 (estimated)
  2. Study start9 Feb 2006
  3. Primary completion2 Feb 2012
  4. Study completion2 Feb 2012

Resources

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 1
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
17 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00527657
Sponsor's protocol ID
2004-0595
Other IDs
NCI-2012-01587
Status last verified
Nov 2018
First submitted
10 Sep 2007
Last updated
14 Nov 2018
Results posted
No
Data monitoring committee
No

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Lomustine, Temozolomide and Thalidomide in people with Brain Neoplasms and Melanoma, run by M.D. Anderson Cancer Center at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 23 inclusion and 5 exclusion criteria. 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 14 Nov 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. 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 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Maximum tolerated dose (MTD) (time frame: 1 cycle (8 weeks) of therapy). 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 14 Nov 2018.

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