GlioblastomaPhase 1NCT00977431
Open Label Trial to Explore Safety of Combining Afatinib (BIBW 2992) and Radiotherapy With or Without Temozolomide in Newly Diagnosed Glioblastoma Multiform
A Phase 1 study testing Temozolomide, Radiotherapy and BIBW2992 in people with Glioblastoma, run by Boehringer Ingelheim at 5 sites in United Kingdom.
Trial summary
This study is a phase I, open label trial to determine the Maximum Tolerated Dose (MTD), safety, pharmacokinetics, and efficacy of BIBW 2992 (an epidermal growth factor receptor(EGFR)inhibitor) to be used in combination with: radiotherapy alone (in patients with an unmethylated (functioning) MGMT gene regulator) or… Read more about this study
- Who is it for?
- Ages 18 to 69 years
- Conditions the study is for
- Glioblastoma
- What is being tested?
- Temozolomide, Radiotherapy and BIBW2992
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 36 participants
- Where
- 5 sitesUnited Kingdom
- Study dates
- 17 Sep 2009to 12 Sep 2017
- Phase
- Phase 1
- 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 18 to 69 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Histologically-confirmed WHO Grade IV newly diagnosed malignant glioma.
- Proven MGMT gene promoter methylation status
- Available early postoperative Gd-enhanced MRI (within 72 hours after initial surgery). In case a patient did not perform a Gd-enhanced MRI within 72 hours post surgery, a Gd-MRI is to be performed prior to start of study treatment.
- Age more or equal to 18 years and less than 70 years at entry
- Karnofsky Performance Scale (KPS) more or equal to 70%
- Patients receiving corticosteroids have to receive a stable or decreasing dose for at least 14 days before start of treatment.
- Written informed consent that is consistent with local law and ICH- Good Clinical Practice (GCP) guidelines.
Who cannot join
- Less than two weeks from surgical resection or other major surgical procedure at start of treatment.
- Planned surgery for other diseases
- Placement of Gliadel® wafer at surgery.
- Prior or planned radiotherapy of the cranium including brachytherapy and/or radiosurgery for GBM.
- Treatment with other investigational drugs; participation in another clinical study including exposure to the investigational product within the past 4 weeks before start of therapy or concomitantly with this study.
- Active infectious disease requiring intravenous therapy.
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- Known human immunodeficiency virus (HIV) infection or chronic Hepatitis B or C.
- Gastrointestinal disorders that may interfere with the absorption of the study drug or chronic diarrhoea.
- Patients with known pre-existing interstitial lung disease
- Serious illness or concomitant non-oncological disease considered by the investigator to be incompatible with the protocol.
- Patient is less than 3 years free of another primary malignancy except: if the other primary malignancy is either not currently clinically significant or does not require active intervention (such as a basal cell skin cancer or a cervical carcinoma in situ). Existence of any other malignant disease is not allowed.
- Cardiac left ventricular function with resting ejection fraction less than 50%.
- Absolute neutrophil count (ANC) less than 1500/mm3.
- Platelet count less than 100,000/mm3.
- Bilirubin greater than 1.5 x upper limit of institutional norm.
- Aspartate amino transferase (AST) greater than 3 x upper limit of institutional norm.
- Serum creatinine greater than 1.5 x upper limit of institutional norm.
- Patients who are sexually active and unwilling to use a medically acceptable method of contraception.
- Pregnancy or breast-feeding.
- Patients unable to comply with the protocol.
- Known or suspected active drug or alcohol abuse.
- Known hypersensitivity to BIBW 2992 or the excipients of any of the trial drugs.
Trial locations and contacts
5 sites in 1 country.
5 sites in 1 country
United Kingdom5 sites
Addenbrooke's Hospital
Cambridge, CB2 0QQ
Ninewells Hospital & Medical School
Dundee, DD1 9SY
Beatson West of Scotland Cancer Centre
Glasgow, G12 0YN
The Christie Hospital
Manchester, M20 4BX
The Royal Marsden Hospital
Sutton, SM2 5PT
About this study
Official title: Phase I, Open Label Trial to Explore Safety of Combining BIBW 2992 and Radiotherapy With or Without Temozolomide in Newly Diagnosed GBM
This study is a phase I, open label trial to determine the Maximum Tolerated Dose (MTD), safety, pharmacokinetics, and efficacy of BIBW 2992 (an epidermal growth factor receptor(EGFR)inhibitor) to be used in combination with:
- radiotherapy alone (in patients with an unmethylated (functioning) MGMT gene regulator) or
- radiotherapy and Temozolomide (in patients with a methylated (silenced) O6-methylguanine-DNA methyltransferase gene (MGMT) to treat newly diagnosed patients with Grade IV Glioblastoma (primary brain cancer).
- Conditions
- Glioblastoma
- Being tested
- Temozolomide, Radiotherapy, BIBW2992
- Medical subject headings
- Glioblastoma
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
TemozolomideDrug
During RT: 75 mg/m2 daily , 4 weeks after RT: given days 1 to 5 of 28 day cycles (150 mg/m2 in cycle 1, 200 mg/m2 in cycle 2 up to cycle 6)
RadiotherapyProcedure or surgery
Day 1 to day 42
BIBW2992Drug
Escalating dose cohorts during Radiotherapy(RT) period, fixed dose after RT
RadiotherapyProcedure or surgery
Day 1 to day 42
BIBW2992Drug
Escalating dose cohorts during Radiotherapy(RT) period , fixed dose after RT
| Study group | Role | What they receive |
|---|---|---|
| Regimen U | Experimental | BIBW2992 + Radiotherapy Receives: Procedure: Radiotherapy; Drug: BIBW2992 |
| Regimen M | Experimental | BIBW2992 + Temozolomide + Radiotherapy Receives: Drug: Temozolomide; Drug: BIBW2992; Procedure: Radiotherapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Number of Patients With Investigator Defined Dose Limiting Toxicities (DLT) During the RT Phase
Adverse event (AE) related to afatinib with any one criteria; Hematological: Common terminology criteria for adverse events (CTCAE) Grade 4 neutropenia (Absolute neutrophil count, including bands <500/cubic millimeter (mm³)) for >7 days, CTCAE Grade 3 or 4 neutropenia of any duration associated with fever >38.3 Celsius, CTCAE Grade 3 thrombocytopenia (platelet count <50000 - 25000/mm³), All other toxicities of CTCAE Grade ≥3 leading interruption of treatment > 14 days.
Non-hematological: CTCAE Grade ≥3 nausea or vomiting despite appropriate use of standard anti-emetics for ≥3 days, CTCAE Grade ≥3 diarrhea despite appropriate use of standard anti-diarrheal therapy for ≥3 days, CTCAE Grade ≥3 rash despite standard medical management and lasting >7 days, CTCAE Grade ≥2 cardiac left ventricular function, CTCAE Grade ≥2 worsening of renal function as measured by serum creatinine, newly developed proteinuria or decrease in glomerular filtration rate, All other toxicities of CTCAE Grade ≥3.
Measured: 6 weeks
Maximum Tolerated Dose (MTD) of Afatinib
The MTD was defined as the highest afatinib dose level, at which no more than 1 out of 6 patients experienced drug-related DLT, i.e. the highest afatinib dose with a DLT incidence ≤17%. A separate MTD was determined for afatinib and RT (Regimen U), and for afatinib, TMZ, and RT (Regimen M).
Measured: 6 weeks
Secondary outcomes (3)
Incidence and Intensity of Adverse Events (AE) According to Common Terminology Criteria of Adverse Events (CTCAE v.3.0)
Incidence and intensity of adverse events (AE) according to Common Terminology Criteria of Adverse Events (CTCAE v.3.0). The CTCAE grades are: 1 (mild AE), 2 (moderate AE), 3 (severe AE), 4 (life-threatening or disabling AE), 5 (death related to AE).
Measured: From the first administration of trial medication until 4 weeks after the last administration of trial medication, up to approximately 338 weeks
The Objective Tumour Response According to the Macdonald Criteria
Objective response was defined as a best overall response of complete response (CR) or partial response (PR). The best overall response was the best overall response to trial medication according to the Macdonald criteria recorded since the first administration of trial medication and until the earliest of disease progression, death, or start of further anti-cancer treatment. Tumour response was assessed based on local radiological image evaluation by the investigators according to the Macdonald criteria: Complete Response (CR): Disappearance of all enhancing tumour on consecutive Magnetic resonance imaging (MRI) scans at least 28 days apart, off steroids, and neurologically stable or improved. Partial Response (PR): At least 50% reduction in size of enhancing tumour on consecutive MRI scans at least 28 days apart, steroids stable or reduced, and neurologically stable or improved.
Measured: From the first administration of trial medication until 4 weeks after the last administration of trial medication, up to approximately 338 weeks
Concentration of Afatinib in Plasma at Steady State Pre-dose on Days 8, 15 and 29
Concentration of afatinib in plasma at steady state pre-dose (Cpre,ss) on days 8, 15 and 29.
Measured: Pharmacokinetic blood sample were taken at 5 minutes before drug on days 8, 15 and 29 and 1, 3 and 6 hours after drug administration on day 15
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted15 Sep 2009 (estimated)
- Study start17 Sep 2009
- Primary completion12 Sep 2017
- Study completion12 Sep 2017
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.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for GlioblastomaStudies of the same condition, open and under way.
- More trials run by Boehringer IngelheimThe 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 1
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 36 participants (actual)
Sponsor and investigators
- Lead sponsor
- Boehringer Ingelheim
- Sponsor type
- Industry (pharma, biotech, devices)
- Responsible party
- Sponsor
- Investigators
- Boehringer Ingelheim, Study chair, Boehringer Ingelheim
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00977431
- Sponsor's protocol ID
- 1200.38
- Other IDs
- 2008-007284-17, 2008
- Status last verified
- Feb 2019
- First submitted
- 14 Sep 2009
- Last updated
- 18 Feb 2019
- Results posted
- Yes, on ClinicalTrials.gov
Publications
Saran F, Welsh L, James A, McBain C, Gattamaneni R, Jefferies S, Harris F, Pemberton K, Schaible J, Bender S, Cseh A, Brada M. Afatinib and radiotherapy, with or without temozolomide, in patients with newly diagnosed glioblastoma: results of a phase I trial. J Neurooncol. 2021 Dec;155(3):307-317. doi: 10.1007/s11060-021-03877-6. Epub 2021 Nov 17.
PubMed 34787778
Study at a glance
From the registry record, last updated by the sponsor on 18 Feb 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Phase I, Open Label Trial to Explore Safety of Combining BIBW 2992 and Radiotherapy With or Without Temozolomide in Newly Diagnosed GBM
- ClinicalTrials.gov ID
- NCT00977431
- Acronym / sponsor ID
- 1200.38
- Conditions
- Glioblastoma
- Phase
- Phase 1
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 36 participants (actual)
- Lead sponsor
- Boehringer IngelheimIndustry (pharma, biotech, devices)
- Study start
- 17 Sep 2009 (actual)
- Primary completion
- 12 Sep 2017 (actual)
- Study completion
- 12 Sep 2017 (actual)
- First posted
- 15 Sep 2009 (estimated)
- Results
- Posted 18 Feb 2019
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study is a phase I, open label trial to determine the Maximum Tolerated Dose (MTD), safety, pharmacokinetics, and efficacy of BIBW 2992 (an epidermal growth factor receptor(EGFR)inhibitor) to be used in combination with:
- radiotherapy alone (in patients with an unmethylated (functioning) MGMT gene regulator) or
- radiotherapy and Temozolomide (in patients with a methylated (silenced) O6-methylguanine-DNA methyltransferase gene (MGMT) to treat newly diagnosed patients with Grade IV Glioblastoma (primary brain cancer).
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Regimen U | Experimental | Procedure: Radiotherapy, Drug: BIBW2992BIBW2992 + Radiotherapy |
| Regimen M | Experimental | Drug: Temozolomide, Drug: BIBW2992, Procedure: RadiotherapyBIBW2992 + Temozolomide + Radiotherapy |
Who may qualify
- Ages
- 18 to 69 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (7 listed)
- Histologically-confirmed WHO Grade IV newly diagnosed malignant glioma.
- Proven MGMT gene promoter methylation status
- Available early postoperative Gd-enhanced MRI (within 72 hours after initial surgery). In case a patient did not perform a Gd-enhanced MRI within 72 hours post surgery, a Gd-MRI is to be performed prior to start of study treatment.
- Age more or equal to 18 years and less than 70 years at entry
- Karnofsky Performance Scale (KPS) more or equal to 70%
Key exclusion criteria (22 listed)
- Less than two weeks from surgical resection or other major surgical procedure at start of treatment.
- Planned surgery for other diseases
- Placement of Gliadel® wafer at surgery.
- Prior or planned radiotherapy of the cranium including brachytherapy and/or radiosurgery for GBM.
- Treatment with other investigational drugs; participation in another clinical study including exposure to the investigational product within the past 4 weeks before start of therapy or concomitantly with this study.
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 |
|---|---|---|
| TemozolomideDuring RT: 75 mg/m2 daily , 4 weeks after RT: given days 1 to 5 of 28 day cycles (150 mg/m2 in cycle 1, 200 mg/m2 in cycle 2 up to cycle 6) | Drug | Regimen M |
| RadiotherapyDay 1 to day 42 | Procedure or surgery | Regimen U |
| BIBW2992Escalating dose cohorts during Radiotherapy(RT) period, fixed dose after RT | Drug | Regimen M |
| RadiotherapyDay 1 to day 42 | Procedure or surgery | Regimen M |
| BIBW2992Escalating dose cohorts during Radiotherapy(RT) period , fixed dose after RT | Drug | Regimen U |
Primary outcome
Number of Patients With Investigator Defined Dose Limiting Toxicities (DLT) During the RT Phase
Time frame: 6 weeks
Adverse event (AE) related to afatinib with any one criteria; Hematological: Common terminology criteria for adverse events (CTCAE) Grade 4 neutropenia (Absolute neutrophil count, including bands <500/cubic millimeter (mm³)) for >7 days, CTCAE Grade 3 or 4 neutropenia of any duration associated with fever >38.3 Celsius, CTCAE Grade 3 thrombocytopenia (platelet count <50000 - 25000/mm³), All other toxicities of CTCAE Grade ≥3 leading interruption of treatment > 14 days. Non-hematological: CTCAE Grade ≥3 nausea or vomiting despite appropriate use of standard anti-emetics for ≥3 days, CTCAE Grade ≥3 diarrhea despite appropriate use of standard anti-diarrheal therapy for ≥3 days, CTCAE Grade ≥3 rash despite standard medical management and lasting >7 days, CTCAE Grade ≥2 cardiac left ventricular function, CTCAE Grade ≥2 worsening of renal function as measured by serum creatinine, newly developed proteinuria or decrease in glomerular filtration rate, All other toxicities of CTCAE Grade ≥3.
Maximum Tolerated Dose (MTD) of Afatinib
Time frame: 6 weeks
The MTD was defined as the highest afatinib dose level, at which no more than 1 out of 6 patients experienced drug-related DLT, i.e. the highest afatinib dose with a DLT incidence ≤17%. A separate MTD was determined for afatinib and RT (Regimen U), and for afatinib, TMZ, and RT (Regimen M).
3 secondary outcomes
Incidence and Intensity of Adverse Events (AE) According to Common Terminology Criteria of Adverse Events (CTCAE v.3.0)
Time frame: From the first administration of trial medication until 4 weeks after the last administration of trial medication, up to approximately 338 weeks
The Objective Tumour Response According to the Macdonald Criteria
Time frame: From the first administration of trial medication until 4 weeks after the last administration of trial medication, up to approximately 338 weeks
Concentration of Afatinib in Plasma at Steady State Pre-dose on Days 8, 15 and 29
Time frame: Pharmacokinetic blood sample were taken at 5 minutes before drug on days 8, 15 and 29 and 1, 3 and 6 hours after drug administration on day 15
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 Feb 2019.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Derived from this study: PubMed 34787778Saran F, Welsh L, James A, McBain C, Gattamaneni R, Jefferies S, Harris F, Pemberton K, Schaible J, Bender S, Cseh A, Brada M. Afatinib and radiotherapy, with or without temozolomide, in patients with newly diagnosed glioblastoma: results of a phase I trial. J Neurooncol. 2021 Dec;155(3):307-317. doi: 10.1007/s11060-021-03877-6. Epub 2021 Nov 17.
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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.
Boehringer Ingelheim study chair
Boehringer Ingelheim
5 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1 study testing Temozolomide, Radiotherapy and BIBW2992 in people with Glioblastoma, run by Boehringer Ingelheim at 5 sites in United Kingdom.
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 7 inclusion and 22 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 18 Feb 2019. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 5 sites in United Kingdom. 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?
Yes. Results are posted in the registry (first posted 18 Feb 2019). 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?
Number of Patients With Investigator Defined Dose Limiting Toxicities (DLT) During the RT Phase (time frame: 6 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00977431, which also lists 1 linked publication.
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 18 Feb 2019.