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Recurrent GlioblastomaNCT01987830

Bevacizumab w / Temozolomide PET & Vascular MRI For GBM

A study testing MRI-PET and TMZ-PET in people with Recurrent Glioblastoma, run by Massachusetts General Hospital 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

This research study is exploring how the blood vessels in the participant's tumor change from treatment with bevacizumab, and how these changes affect the way their tumor absorbs temozolomide (TMZ). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Recurrent Glioblastoma
What is being tested?
MRI-PET and TMZ-PET
Could I receive a placebo?
No, everyone receives an active treatment
How many people
13 participants
Where
1 siteUnited States
Study dates
Nov 2013to Apr 2019
Phase
Interventional
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Participants must meet the following criteria on screening examination to be eligible to participate in the study:
  • Participants must have histologically confirmed glioblastoma and evidence of recurrence > 2 months since last cycle of temozolomide. Patients with low-grade tumors who have progressed to glioblastoma are eligible.
  • Patients must have received at least 6 months of monthly temozolomide previously.
  • Participants must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as > 10 mm. See section 10 for the evaluation of measureable disease.
  • Only patients for whom their neuro-oncologist has planned to give bevacizumab and temozolomide 50mg/m2/day as part of their treatment are eligible for this study
  • Age > 18 years. Because no dosing or adverse event data are currently available on the use of radiolabeled temozolomide in participants <18 years of age, children are excluded from this study but will be eligible for future pediatric trials.
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  • Life expectancy of greater than 3 months.
  • Karnofsky performance status > 60 (see Appendix A).
  • Participants must have normal organ and marrow function as defined below:
  • Leukocytes > 3,000/mcL
  • Absolute neutrophil count > 1,000/mcL
  • Platelets > 100,000/mcL
  • total bilirubin within normal institutional limits
  • AST (SGOT)/ALT (SGPT) < 2.5 X institutional upper limit of normal
  • creatinine within normal institutional limits or creatinine clearance > 60 mL/min/1.73 m2 for subjects with creatinine levels about institutional normal .
  • Patient must be able to undergo MRI and PET scans.
  • Patients must be maintained on a stable corticosteroid regimen for 5 days prior each MR-PET scan.
  • The effects of radiolabeled temozolomide on the developing human fetus are unknown. For this reason and because radiopharmaceuticals agents are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  • Ability to understand and the willingness to sign a written informed consent document.

Who cannot join

  • Participants who exhibit any of the following conditions at screening will not be eligible for admission into the study.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to temozolomide.
  • Participants who have already received anti-VEGF or experimental anti-angiogenic therapy for glioblastoma.
  • Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Pregnant women are excluded from this study because radiolabeled temozolomide is a radiopharmaceutical agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk of adverse events in nursing infants secondary to treatment of the mother with radiopharmaceutical agents, breastfeeding should be discontinued if the mother is treated with radiopharmaceutical agents. These potential risks may also apply to other agents used in this study.
  • HIV-positive individuals on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with radiolabeled temozolomide. In addition, these individuals are at increased risk of lethal infections when treated with marrow-suppressive therapy. Appropriate studies will be undertaken in participants receiving combination antiretroviral therapy when indicated.
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  • Patients who are no suitable to undergo MRI or use gadolinium contrast due to:
  • Claustrophobia
  • Presence of metallic objects or implanted medical devices in body (i.e. cardiac pacemaker, aneurysm clips, surgical clips, prostheses, artificial hearts, valves with steel parts, metal fragments, shrapnel, tattoos near the eye, or steel implants)
  • Sickle cell disease
  • Renal failure
  • Reduced renal function, as determined by creatinine clearance < 30 mL/min based on a serum creatinine level obtained within 28 days prior to registration

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Massachuesett General Hospital

    Boston, Massachusetts, 02215

Other trials in United States

About this study

Official title: A Study to Evaluate Vascular Normalization in Patients With Recurrent Glioblastoma Treated With Bevacizumab Using [11C]Temozolomide PET and Vascular MRI

This research study is exploring how the blood vessels in the participant's tumor change from treatment with bevacizumab, and how these changes affect the way their tumor absorbs temozolomide (TMZ).

The pilot part of this study is to evaluate the use of [11C] temozolomide PET (TMZ-PET) scans and MRI scans to tell investigators more about how standard treatment with bevacizumab affects the blood vessels in the participant's tumor, and how these changes affect the way the participant's tumor absorbs temozolomide. "Investigational" means that the role of TMZ-PET scans is still being studied and that research doctors are trying to find out more about it.

Read more

Bevacizumab is approved by the U.S. Food and Drug Administration for use in people with the participant's type of cancer. It works by blocking signals on a specific protein called vascular endothelial growth hormone (VEGF), which plays a role in promoting the growth of spread of tumor blood vessels. Bevacizumab is an "anti-VEGF' agent because it is designed to slow the growth of the participant's cancer.

Since anti-VEGF agents also affect normal blood vessels in the brain, they can inhibit the way other drugs used in combination with bevacizumab are delivered to the tumor. Researchers are looking for how bevacizumab affects delivery of chemotherapy, in this case temozolomide.

In PET scans, a radioactive substance is injected into the body. The scanning machine finds the radioactive substance, which tends to go to cancer cells.

For the PET scans in this research study, the investigators are using a radioactive substance called [11C] temozolomide, which is chemically identical to the prescription drug TMZ. TMZ is FDA approved as a chemotherapeutic agent in cancer but [11C] temozolomide is an investigational agent.

In this research study, participants will receive standard treatment with bevacizumab and oral temozolomide as well as standard MRI scans. In addition, participants will undergo TMZ-PET scans before and after treatment with bevacizumab. The first TMZ-PET scan will occur 7-13 days after starting treatment with oral temozolomide but before beginning treatment with bevacizumab, day 1 after starting treatment with bevacizumab and 1 month after starting bevacizumab. TMZ-PET scans will be given at the same time as a vascular MRI, which will evaluate the changes in tumor blood flow, blood volume, and how receptive blood vessels are while also measuring how much TMZ is in the brain.

Read the detailed description

Before the research starts (screening): After signing the consent form, the participant will be asked to undergo some screening tests or procedures to find out if they can be in the research study. Many of these tests and procedures are likely to be part of regular cancer care and may be done even if it turns out that the participant does not take part in the research study. If the participant has had some of these tests or procedures recently, they may or may not have to be repeated.

  • A medical history, which includes questions about the participant's health, current medications, and any allergies.
  • Physical Exam including measuring the participant's height, weight, and vital signs
  • Performance status, which evaluates how the participant is able to carry on with your usual activities.
  • Blood tests.
  • Blood pregnancy test for women of childbearing potential
  • Urine test.

If these tests show that the participant is eligible to participate in the research study, the participant will begin the study treatment. If the participant does not meet the eligibility criteria, the participant will not be able to participate in this research study.

After the screening procedures confirm that the participant is eligible to participate in the research study:

Please note that this study does not add any additional treatment to participants with your type of cancer. There will be no change in your treatment with bevacizumab and daily temozolomide based on the results of any procedures or tests carried out as a part of the study.

Before each set of scans the participant will have the following tests and procedures:

  • Routine blood tests to check the participant's overall health
  • Creatinine clearance blood test to check for proper kidney function
  • Blood pregnancy test for women of childbearing potential

After the participant have been taking oral TMZ for 7-13 days, the participant will have:

  • An assessment of their tumor by DCE-MRI (Dynamic Contrast Enhanced-Magnetic Resonance Imaging) scans and PET (Positron Emission Tomography) scan

MRI-PET Scan Procedure:

The participant will have their scans performed in Charlestown, MA at the Martinos Center. The participant will be injected with two separate intravenous (IV) lines for:

  • [11C] temozolomide for PET scan and a contrast dye for the MRI scan
  • Drawing blood to assess the radioactivity of [11C] temozolomide [11C] temozolomide PET Scans (TMZ PET Scan):
  • The PET scan will take approximately 90 minutes. The participant will receive one injection of [11C] temozolomide. Following the injection of the radioactive substance, blood samples will be taken from the second IV line.

MRI Scan:

  • MRI scans will last about 60-75 minutes. This will occur at the same time as the PET scan. The participant will be injected with contrast dye twice during the MRI scan.

The MR-PET scan(s) will be performed again on Day 1 after initiation of bevacizumab (or Day 15 after initiation of temozolomide) and Day 30 after initiation of bevacizumab (on Day 45 after initiation of temozolomide).

Blood samples will be collected during both scans in order to measure how your blood vessels are processing the radiotracer [11C] temozolomide and how well it is being delivered to the tumor tissue. Blood samples will be drawn 2.5, 5, 10, 20, 40, 60, 75, and 90 minutes after the [11C] temozolomide injection.

The participant will be assessed for side effects via clinic visit or phone call about 24 hours after each of the visits above.

  • Planned Follow-up: The investigators would like to call the participant every 3 months for three years after their second MR-PET scan to see how they are doing and if the participant is experiencing any side effects. If the participant was removed from the study due to an unacceptable side effect, the participant will be followed until it has been resolved.
Being tested
MRI-PET, TMZ-PET
Keywords
Recurrent glioblastoma
Medical subject headings
Glioblastoma

What participants receive

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

  • MRI-PETDevice

    • [11C] temozolomide for PET scan and a contrast dye for the MRI scan
    • Drawing blood to assess the radioactivity of [11C] temozolomide
  • TMZ-PETDevice

    The PET scan will take approximately 90 minutes. You will receive one injection of [11C] temozolomide. Following the injection of the radioactive substance, blood samples will be taken from the second IV line.

Study groups in NCT01987830
Study groupRoleWhat they receive
TMZ-PET scans/ MRI-PET ScanOtherThe investigators plan to study patients with recurrent glioblastoma whose clinical care plan includes treatment with bevacizumab and temozolomide. Patients taking daily temozolomide 50 mg/m2/day will undergo a PET scan using radiolabeled temozolomide (TMZ-PET) at 3 time points: 7-13 days after initiation of temozolomide but before beginning bevacizumab ("baseline"- temozolomide steady-state scan), 1 day after initiation of bevacizumab (day 15) and 1 month after initiation of bevacizumab (day 45). Arterialized venous blood samples will be collected during the imaging in order to measure radioactivity, blood metabolites, and the relationship between radiotracer uptake and tumor features such as blood-brain barrier (BBB) breakdown and tumor blood flow. In addition, we will explore the link between flow, permeability, and tumor temozolomide retention. These studies will be performed using our human simultaneous MRI-PET imaging camera.
Receives: Device: MRI-PET; Device: TMZ-PET

What is being measured

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

  1. Number of Patients With a Decrease in Median Tumor SUV

    Number of patients with a decrease in median tumor standard uptake value (SUV). Median tumor SUV was used as a marker of temozolomide uptake.

    Measured: Day 15

Timeline

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

  1. First posted19 Nov 2013 (estimated)
  2. Study startNov 2013
  3. Primary completionApr 2019
  4. Study completionApr 2019

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 N/A
Primary purpose
Basic science
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
13 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01987830
Sponsor's protocol ID
13-322
Status last verified
Aug 2020
First submitted
13 Nov 2013
Last updated
4 Sep 2020
Data monitoring committee
Yes

Questions about this trial

What is this clinical trial studying?

A study testing MRI-PET and TMZ-PET in people with Recurrent Glioblastoma, run by Massachusetts General Hospital 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 19 inclusion and 12 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 4 Sep 2020. 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.

Are results available for this study?

Yes. Results are posted in the registry (first posted 4 Sep 2020). 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 a Decrease in Median Tumor SUV (time frame: Day 15). 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 4 Sep 2020.

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