Neoplasms

Symptoms and General Pathology

All Conditions

Nervous System Diseases

Rare Diseases

Neoplasm Metastasis

Recurrence

Glioblastoma

Glioma

Brain Neoplasms

Astrocytoma

Neoplasms, Neuroepithelial

Neuroectodermal Tumors

Neuroectodermal Tumors, Primitive

Neoplasms, Germ Cell and Embryonal

Neoplasms by Histologic Type

Neoplasms, Glandular and Epithelial

Neoplasms, Nerve Tissue

Anaplastic Astrocytoma

Neuroepithelioma

Antineoplastic Agents

All Drugs and Chemicals

Temozolomide

Lomustine

Mitogens

Carmustine

Trabedersen

Antineoplastic Agents, Alkylating

Alkylating Agents

10 µM trabedersen (AP 12009), intratumoral infusion, every other week, 11 cycles, maximum 21 weeks

temozolomide: capsules, up to 200 mg/sqm/day, 5 days per cycle, up to 26 cycles; carmustine: i.v. administration, up to 200 mg/sqm/day, 1 day per cycle, up to 8 cycles; lomustine: capsules, 110 mg/sqm/day, 1 day per cycle, up to 8 cycles. Only 1 of these 3 drugs/interventions is administered per patient in the comparator arm.

trabedersen

temozolomide

Drug delivery system for Convection Enhanced Delivery consists of a portable pump (Pegasus vario or Pega vario) with drug reservoir (Pega Bag) and infusion line (Pega Line). Main implanted parts are the port access system (PORT-A-CATH) and the intratumoral catheter (Medtronic ventricular catheter).

Drug delivery system for administration of AP 12009

Surgery for placement of intratumoral catheter and subcutaneous port access system as per routine clinical practice. Stereotactical catheter placement controlled by CT.

Placement of Drug Delivery System

carmustine

lomustine

Rolando Del Maestro, MD, PhD

In this multinational Phase III study the efficacy and safety of 10 µM AP 12009 is compared to standard chemotherapy (temozolomide or BCNU or CCNU) in adult patients with confirmed recurrent or refractory anaplastic astrocytoma (WHO grade III) or secondary glioblastoma (WHO grade IV).

The purpose of this study is to compare the safety and efficacy of the 10 µM concentration of AP 12009 and standard chemotherapy (temozolomide, BCNU, CCNU) in adult patients with recurrent or refractory anaplastic astrocytoma (AA, WHO grade III) or secondary glioblastoma (GBM, WHO grade IV). AP 12009 (trabedersen) is a phosphorothioate antisense oligodeoxynucleotide specific for the mRNA of human Transforming Growth Factor beta 2 (TGF-beta-2), which is applied intratumorally. The growth factor TGF-beta plays a key role in malignant progression of various tumors by inducing proliferation, invasion, metastasis, angiogenesis, and escape from immunosurveillance. In patients with high-grade glioma, the TGF-beta-2 overexpression is associated with disease stage, clinical prognosis, and the immunodeficient state of the patients. Main objective of the study is to determine survival (rate) and tumor response.

Important note: Due to early trial termination, resulting in limited data availability, all analyses remain descriptive by nature, only. No conclusive endpoint analysis can be performed.

Efficacy and Safety of AP 12009 in Patients With Recurrent or Refractory Anaplastic Astrocytoma or Secondary Glioblastoma

Efficacy and Safety of AP 12009 in Adult Patients With Recurrent or Refractory Anaplastic Astrocytoma or Secondary Glioblastoma as Compared to Standard Chemotherapy Treatment: A Randomized, Actively Controlled, Open Label Clinical Phase III Study.

Survival rate was defined as the proportion of participants known to be alive at 24 months from randomization. If a participant's status was unknown and there was no follow-up information available, they were categorized as 'Died' for the purposes of the analysis.

Survival status was assessed at 24 months from randomization. Participants with unknown or missing status were considered treatment failures, i.e., assumed to be dead. The category "Lost to / insufficient follow-up" includes participants who were alive at last data collection point but did not yet have enough follow-up time to reach the 24 month time point.

Survival rate was defined as the proportion of participants known to be alive at each time-point from randomization. Participants with unknown or missing status were considered treatment failures, i.e., assumed to be dead.

Survival status was assessed at each time-point from randomization. Participants with unknown or missing status were considered treatment failures, i.e., assumed to be dead. The category "Lost to follow-up" for each time-point includes participants who were alive at the last data collection point but did not yet have enough follow-up time to reach the time point.

Median overall survival was defined as the date of randomization to the date of death. If a participant's status was unknown and there was no follow-up information available, they were categorized as 'Died' for the purposes of the analysis. Analysis was by Kaplan-Meier estimation.

Tumor response was classified based on the (neuro-)radiologist's evaluation according to the Macdonald Response Criteria for bidimensionally measurable disease as outlined below:

* Complete Response (CR): Disappearance of all enhancing tumor on consecutive MRI scans at least 1 month apart, off steroids, neurologically stable or improved.
* Partial Response (PR): ≥50% reduction in size of enhancing tumor on consecutive MRI scans at least 1 month apart, steroids stable or reduced, neurologically stable or improved.
* Progressive Disease (PD): ≥25% increase in size of enhancing tumor or any new tumor on MRI scans, steroids stable or increased, neurologically worse.
* Stable Disease (SD): all other situations.

Two qualified neuro-radiologists reviewed scans at each MRI time point, with adjudication of discrepancies by a third reviewer. Their findings and clinical information were independently reviewed by a neuro-oncologist, who made the assessment of overall response.

Overall response rate was the proportion of participants with a best response of Complete Response (CR) or Partial Response (PR) observed from the start of treatment until disease progression.

Tumor control rate was defined as the proportion of participants assessed as having Complete Response (CR), Partial Response (PR), or Stable Disease (SD). Participants with unknown or missing response were treated as non-responders.

Duration of response was defined as the time from the first documentation of confirmed response (Complete Response, CR, or Partial Response, PR) to the first signs of Progressive Disease (PD), as assessed by the study neuro-oncologist. Median Duration of Response was calculated by Kaplan-Meier estimate.

Censoring rules were:

* at the date of randomization -- participants without baseline assessments, or for those with no post-baseline timor assessments who were discontinued for other than progressive disease or death.
* at the date of last tumor assessment -- discontinuation other than PD or death, or if a new treatment was started prior to disease progression
* at the date of death or last tumor assessment -- death or PD after one missed tumor assessment
* at the date of last tumor assessment -- death or PD after more than one missed tumor assessment
* at the date of last tumor assessment -- participants on ongoing treatment at data cut-off

Tumor response was classified based on the (neuro-)radiologist's evaluation:

* Complete Response (CR): Disappearance of all enhancing tumor on consecutive MRI scans at least 1 month apart, off steroids, neurologically stable or improved.
* Partial Response (PR): ≥50% reduction in size of enhancing tumor on consecutive MRI scans at least 1 month apart, steroids stable or reduced, neurologically stable or improved.
* Progressive Disease (PD): ≥25% increase in size of enhancing tumor or any new tumor on MRI scans, steroids stable or increased, neurologically worse.
* Stable Disease (SD): all other situations.

Based on clinical and imaging data, an independent neuro-oncologist made the final assessment of "Progressed" versus "Not Progressed". Participants who had MRI assessment results missing or unknown were "UNK or missing", and were treated as "Progressed" for the purposes of the calculation.

Time to progression was calculated from the date of randomization to the date of the first documented tumor progression. Participants who did not progress or died were censored at the last tumor assessment date or the date of start of a new anti-tumor treatment or death.

Isarna Therapeutics GmbH

Only treatment-emergent adverse events are listed, defined as any AE whose onset occurred or intensity worsened after undertaking the first study procedure or first dose of study drug (whichever occurred first) but less than 28 days after medication/procedures had stopped. Adverse events (including lab tests) were assessed at study visits.

10 µM trabedersen (AP 12009), intratumoral infusion, every other week, 11 cycles, maximum 21 weeks.

Drug delivery system for administration of AP 12009: Drug delivery system for Convection Enhanced Delivery consists of a portable pump (Pegasus vario or Pega vario) with drug reservoir (Pega Bag) and infusion line (Pega Line). Main implanted parts are the port access system (PORT-A-CATH) and the intratumoral catheter (Medtronic ventricular catheter).

Placement of Drug Delivery System: Surgery for placement of intratumoral catheter and subcutaneous port access system as per routine clinical practice. Stereotactical catheter placement controlled by CT.

Trabedersen 10 µM

Temozolomide: capsules, up to 200 mg/sqm/day, 5 days per cycle, up to 26 cycles.

OR carmustine: i.v. administration, up to 200 mg/sqm/day, 1 day per cycle, up to 8 cycles;

OR lomustine: capsules, 110 mg/sqm/day, 1 day per cycle, up to 8 cycles.

Only 1 of these 3 drugs/interventions is administered per patient in the comparator arm.

Chemotherapy

Total

Age, Continuous

Sex: Female, Male

White

Black

Asian

Hispanic or Latino

American Indian or Native Alaskan

Native Hawaiian or Other Pacific Islander

Race/Ethnicity, Customized

Spain

Austria

Russian Federation

India

Mexico

Canada

Germany

Israel

Poland

Study was discontinued early because of the inability to recruit a sufficient number of suitable participants within the planned recruitment period, therefore not all planned sites recruited participants. Only those regions that recruited at least one participant are listed.

Region of Enrollment

Height is missing for one participant in the Chemotherapy group.

Height (cm) (Descriptive analysis, only)

Weight is missing for one participant in the Chemotherapy group.

Weight (kg) (Descriptive analysis, only)

Refractory

Recurrent

Twenty-six participants were diagnosed with Anaplastic Astrocytoma, and one participant was diagnosed with Secondary Glioblastoma Multiforme.

Diagnosis of Anaplastic Astrocytoma (AA) World Health Organization (WHO) Grade III

Time of first diagnosis (in years before study entry) is available for all 14 participants in the Trabedersen group and 11 participants in the chemotherapy group.

Time of first diagnosis of AA WHO Grade III (years) (Descriptive analysis, only)

AA WHO Grade I

AA WHO Grade II

Not diagnosed with Other Brain Tumor

Other diagnosis

Diagnosis of other brain tumor prior to diagnosis of Anaplastic Astrocytoma WHO Grade III

Diagnosis of Secondary Glioblastoma Multiforme (GBM) (WHO Grade IV)

Time of first diagnosis (in years before study entry) of Secondary Glioblastoma Multiforme. One participant in the Chemotherapy group was diagnosed with Secondary Glioblastoma Multiforme (GBM); all other participants were diagnosed with Anaplastic Astrocytoma (AA).

Time to first diagnosis of Secondary GBM (years) (Descriptive analysis, only)

Previous diagnosis of Astrocytoma

Previous diagnosis of Anaplastic Astrocytoma

Previous diagnosis of Astrocytoma or AA before diagnosis of Secondary Glioblastoma Multiforme

One or more Prior Surgical Treatments

One or more Prior Radiotherapy Regimens

One or more Prior Chemotherapy

One or more Prior Immunotherapy

The Intent-to-treat population includes all participants randomized.

Early termination of the study leading to recruitment of 27 of 180 planned subjects and incomplete collection of data. Survival results are based on post-study collection of additional survival data under a protocol amendment.

Medical Officer

The Intent-to-treat population includes all participants randomized. Early study discontinuation with site closures led to a high proportion of participants being censored or lost to follow-up in the initial analysis. Additional survival data were collected in a post-hoc fashion under a protocol amendment. These data are presented.

Survival Rate at 24 Months in the Intent-to-treat Population - Percentage of Participants (Descriptive Analysis, Only)

Survival rates at 12 months

Survival rates at 18 months

Survival rates at 21 months

Survival Rate at 12, 18, and 21 Months in the Intent-to-treat Population - Percentage of Participants (Descriptive Analysis, Only)

Alive at 12 months

Died at 12 months

Lost to follow-up at 12 months

Alive at 18 months

Died at 18 months

Lost to follow-up at 18 months

Alive at 21 months

Died at 21 months

Lost to follow-up at 21 months

Survival at 12, 18, and 21 Months in the Intent-to-treat Population - Number of Participants

Median Overall Survival (Days) From Randomization in the Intent-to-treat Population (Descriptive Analysis, Only)

Complete Response (CR)

Partial Response (PR)

Stable Disease (SD)

Progressive Disease (PD)

Unknown

Missing

Response Category by Independent Review in the Intent-to-treat Population - Number of Participants

Overall Response Rate (CR+PR) by Independent Review in the Intent-to-treat Population - Percentage of Participants (Descriptive Analysis, Only)

Tumor Control Rate (CR+PR+SD) by Independent Review in the Intent-to-treat Population - Percentage of Participants (Descriptive Analysis, Only)

Alive

Died

Lost to/insufficient follow-up

Survival at 24 Months in the Intent-to-treat Population - Number of Participants

Median Duration of Response (Days) by Independent Review (Descriptive Analysis, Only)

Progressed at 10 months

Not progressed at 10 months

Status unknown / missing at 10 months

Lost to follow-up at 10 months

Progressed at 12 months

Not progressed at 12 months

Status unknown / missing at 12 months

Progressed at 14 months

Not progressed at 14 months

Status unknown / missing at 14 months

Lost to follow-up at 14 months

Progressed at 16 months

Not progressed at 16 months

Status unknown / missing at 16 months

Lost to follow-up at 16 months

Progressed at 18 months

Not progressed at 18 months

Status unknown / missing at 18 months

Progressed at 21 months

Not progressed at 21 months

Status unknown / missing at 21 months

Progressed at 24 months

Not progressed at 24 months

Status unknown / missing at 24 months

Lost to follow-up at 24 months

Disease Progression at 10, 12, 14, 16, 18, 21, and 24 Months by Independent Review in the Intent-to-treat Population - Number of Participants

Progression rate at 10 months

Progression rate at 12 months

Progression rate at 14 months

Progression rate at 16 months

Progression rate at 18 months

Progression rate at 21 months

Progression rate at 24 months

Disease Progression Rate at 10, 12, 14, 16, 18, 21, and 24 Months by Independent Review in the Intent-to-treat Population - Percentage of Participants (Descriptive Analysis, Only)

Median Time to Progression (Days) by Independent Review for the Intent-to-treat Population (Descriptive Analysis, Only)

Randomization to First Dose

First Dose to End of Study

Disease Progression

Anti-Dyskinesia Agents

Neuroprotective Agents

Cardiotonic Agents

Memantine

Antiparkinson Agents

Dopamine

Dopamine Agents

Neurotransmitter Agents

Excitatory Amino Acid Antagonists

RT techniques and the dose schemes in the cohort of Hypofractionated Stereotactic Radiotherapy (HF-SRT)

The course of hippocampus-sparing whole-brain radiotherapy (HS-WBRT) combined with the synergic use of the neuroprotective agent, memantine

The administered dose-fractionation schemes range between 30 and 35 Gy delivered within two weeks with a dose per fractionation ranging from 6 to 7 Gy.

Hypofractionated Stereotactic Radiotherapy (HF-SRT)

* The prescribed dose is 30 Gy delivered in 12 fractions for therapeutic or adjuvant WBRT.
* The prescription of memantine for finally twice-daily dosing will be prescribed as follows:

  * During the first 3 weeks concurrent with the delivery of hippocampus-sparing WBRT, 5-mg morning dose will be initially prescribed \[Week 1 -3\]
  * 5-mg twice a day in the following week \[Week 4\]
  * A morning dose of 10 mg and an evening dose of 5 mg in the following week \[Week 5\]
  * 10-mg twice a day for the subsequent weeks up to Week 24 \[Week 6 - 24\]

Hippocampus-Sparing Whole-Brain Radiotherapy (HS-WBRT) plus memantine

Din-Li Tsan, M.D.

Shinn-Yn Lin, M.D.

\[Background\] For newly-diagnosed patients with brain metastases (BMs), conventional whole-brain radiotherapy (WBRT) might still remain a common palliative management. However, WBRT-related late consequences, particularly a decline in neurocognitive functions (NCFs), are a major concern. Actually, WBRT-related neurocognitive dysfunction is usually characterized as deterioration involving learning and memory, in which the extremely radiosensitive hippocampus indeed plays a critical role.

To postpone the occurrence and mitigate neurocognitive impairments associated with conventional WBRT, there have been some strategies in the clinical practice of radiation oncology. Among them, the technology/technique of highly precise/accurate stereotactic radiosurgery or stereotactic radiotherapy (i.e., hypofractionated stereotactic radiotherapy, HS-SRT) might have been widely administered in irradiating exclusively the focal brain metastatic lesions, particularly in cancer patients with a limited number of brain metastases. By contrast, the planning strategy of hippocampus avoidance during the course of whole-brain irradiation has also been well-established in preserving NCFs.

\[Methods\] Newly-diagnosed cancer patients harboring 1 - 4 brain metastatic lesions are eligible if they still have fair/good performance status. Eligible and enrolled should receive baseline brain MRI examination and pre-WBRT neurocognitive assessment. Although non-randomized, this phase II trial comprises two prospective (radiotherapeutic) cohorts with individually different planning techniques and prescription schedules. Cohort I represents patients referred for arranging partial-brain irradiation; namely, a course of hypofractionated stereotactic radiotherapy (HF-SRT) is delivered within 2 weeks with a cumulative dose of 3000 - 3500 cGy in 5 fractions. By contrast, Cohort II stands for patients referred for arranging the course of hippocampus-sparing WBRT (HS-WBRT), delivered within 3 weeks with a cumulative dose of 3000 cGy in 12 fractions, during which the planning technique of simultaneous integrated boost (SIB) is employed to focally escalate the dose irradiating the brain metastatic foci. Besides, adhering to several international clinical practice guidelines, the synergic use of the neuroprotective agent (memantine) will be routinely applied in the treatment Cohort II (HS-WBRT). In both treatment cohorts, a battery of neuropsychological measures, which includes 7 standardized neuropsychological tests (e.g., executive functions, verbal and non-verbal memory, working memory, and psychomotor speed), is used to evaluate neurocognitive functions.

The primary outcome measure is the median time of CNS progression-free survival (CNS-PFS). Secondary outcome measures encompass both neuro-oncological endpoints and neurocognitive endpoints, among which there is cognitive-deterioration-free survival (CD-free survival). CD-free survival is defined mainly as the time from enrollment to a NCF decline of exceeding than 1 SD away from the baseline involving at least one of the assessed NCF tests. Additionally, patients who expire before 6 months or are alive but fail to undergo all the neurocognitive testing administered would also be defined as suffering from cognitive deterioration.

\[Expected results\] This prospective observational study aims to examine thoroughly and analyze the comparatively between the two radiotherapeutic cohorts (HF-SRT versus HS-WBRT), addressing both CNS tumor control and neurocognitive functional outcomes. It is expected that the patterns of (CNS) failure and individual time to progression will be clearly demonstrated in this prospective observational study encompassing two distinct radiotherapeutic cohorts.

HF-SRT vs. HS-WBRT in Treating Patients With Brain Oligometastases

Hypofractionated Stereotactic Radiotherapy Versus Hippocampus-sparing Whole-brain Radiotherapy in Treating Cancer Patients With Brain Oligometastases: A Phase II Parallel Non-randomized and Prospective Observational Study

The median CNS progression-free survival (CNS-PFS), which is a time-dependent endpoint, defined as the time from study enrollment to CNS disease progression of death from any cause.

The time from enrollment to a cognitive decline of exceeding more than 1SD away from the baseline in at least one of the assessed NCF tests. Furthermore, regarding cognitive-deterioration-free survival, patients who expire before 6 months or are alive but do not undergo all the neurocognitive testing administered or even fail to receive MMSE evaluation would be assumed reasonably that they suffer cognitive deterioration at the time of death or at the time point, or they fail to receive their first neurocognitive assessment follow-up as long as there are no subsequent NCF assessments.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Efficacy and Safety of AP 12009 in Patients With Recurrent or Refractory Anaplastic Astrocytoma or Secondary Glioblastoma	NCT00761280	Anaplastic Astr... Glioblastoma	trabedersen temozolomide Drug delivery s... Placement of Dr... carmustine lomustine	18 Years - 70 Years	Isarna Therapeutics GmbH
HF-SRT vs. HS-WBRT in Treating Patients With Brain Oligometastases	NCT05807165	Brain Oligometa...	Hypofractionate... Hippocampus-Spa...	20 Years - 85 Years	Chang Gung Memorial Hospital
Efficacy and Safety of AP 12009 in Patients With Recurrent or Refractory Anaplastic Astrocytoma or Secondary Glioblastoma	NCT00761280	Anaplastic Astr... Glioblastoma	trabedersen temozolomide Drug delivery s... Placement of Dr... carmustine lomustine	18 Years - 70 Years	Isarna Therapeutics GmbH
Metformin in Children With Relapsed or Refractory Solid Tumors	NCT01528046	Solid Tumors Primary Brain T...	Vincristine Irinotecan Temozolomide Metformin	1 Year - 18 Years	H. Lee Moffitt Cancer Center and Research Institute

Spots Global Cancer Trial Database for central nervous system (cns)