Simultaneous Integrated Boost FDOPA Positron Emission Tomography (PET) Guided in Patients With Partially- or Non-operated Glioblastoma

Official title

Simultaneous Integrated Boost FDOPA PET Guided in Patients With Partially- or Non-operated Glioblastoma

Overview

Glioblastoma (GBM) is the most common primary brain cancer in adults. Surgery, chemoradiotherapy (temozolomide TMZ) and then adjuvant TMZ is the standard treatment. But, most patients relapse in a median time of 8-9 months; the median overall survival (OS) ranged from 15 to 18 months. Some frail patients received hypofractionated radiation and concomitant and adjuvant TMZ. For some, the radiation dose is not optimal. Moreover, recurrences develop mainly in the initial tumor site. These two reasons justify increasing the dose. To limit the movements of these fragile patients, the method consists of increasing the dose without increasing the number of sessions by using the Simultaneous Integrated Boost (SIB) which increases the dose in targeted volumes while the rest of the volume receives a minimum dose. A phase I trial showed the possibility of increasing the dose in SIB up to 80 Gy in a part of the GBM enhanced on MRI. FDOPA PET detects certain more aggressive tumor areas, areas likely to recur. Integrating them into the SIB seems appropriate. A phase II trial showed the interest of SIB guided by FDOPA PET in terms of progression-free survival but without impact on OS. This study differed from the one the investigators propose, because a dose and conventional fractionation, identical to that of the European Organization for Research and Treatment of Cancer/National Cancer Information Center (NCIC/EORTC) protocol were delivered, the gliomas were unmethylated MGMT, less likely to respond. Studies with SIB and hypofractionation are often retrospective and for others, hypofractionation was debatable and the dose increase was not based on PET capture but on MRI. However, a prospective phase II study, with SIB and hypofractionation, not integrating FDopa PET has demonstrated the relevance of SIB. In this project, the investigators propose to use the integrated boost technique (SIB) guided by PET FDOPA to increase the radiation dose in GBM, in patients either fragile and partially operated, or only biopsied and for whom the prognosis is the most pejorative.

Interventions

• Procedure Integrated boost technique (SIB) guided by PET FDOPA
  intensity-modulated irradiation scheme with integrated boost technique (SIB) guided by PET FDOPA during the chemo-radiotherapy

Primary outcome measures

• Overall Survival (OS) [Time frame: At 24 months after inclusion]

Secondary outcome measures (12)

• Progression-Free Survival (PFS) [Time frame: At 24 months after inclusion]
• Sites of progression: distant, marginal or in-field progression [Time frame: At the date of progression, assessed up to 24 months]
• Assess the rate of acute complications of grade ≥ 3 [Time frame: At 6 months after the start of radiotherapy]
• Characterize the PET parameters during progression [Time frame: At the date of progression, assessed up to 24 months]
• Evolution of the PET parameters [Time frame: Change between baseline and the date of progression, assessed up to 24 months]
• Assess quality of life measured with Quality of Life Questionnaire-Cancer 30items (QLQ-C30) [Time frame: At inclusion]
• Assess quality of life measured with Quality of Life Questionnaire-Brain Neoplasms 20items (QLQ-BN20) [Time frame: At inclusion]
• Assess quality of life measured with Quality of Life Questionnaire-Cancer 30items (QLQ-C30) [Time frame: At 3 months after inclusion]
• Assess quality of life measured with Quality of Life Questionnaire-Brain Neoplasms 20items (QLQ-BN20) [Time frame: At 3 months after inclusion]
• Assess quality of life measured with Quality of Life Questionnaire-Cancer 30items (QLQ-C30) [Time frame: At 6 months after inclusion]
• Assess quality of life measured with Quality of Life Questionnaire-Brain Neoplasms 20items (QLQ-BN20) [Time frame: At 6 months after inclusion]
• Assess quality of life measured with Quality of Life Questionnaire-Cancer 30items (QLQ-C30) [Time frame: At 12 months after inclusion]

Eligibility criteria

Inclusion criteria

• Unfit patient without indication to the STUPP protocol :

Cohort 1 : Non-operable patients and ≥ 18 years old or ≤ 70 years old and Karnofsky Index (KI) ≥ 50% on inclusion AND Result of a biopsy available Cohort 2 : Patients > 70 years old and Balducci score I or II and KI ≥ 60% on inclusion AND Partial resection (defined on the remnographic criteria of postoperative MRI) OR biopsy result available

• Histologically proven glioblastoma
• Increased metabolism of amino acids in PET FDOPA allowing contouring the Biological Target Volume (BTV)

Exclusion criteria

• Patients with an indication for irradiation according to the STUPP protocol (fit patient)
• Patient with a contraindication to MRI or PET
• Limit of the provisional target volume or Planning target volume (PTV), second PTV < 2 cm from the chiasm and the optic nerves
• Absence of uptake of FDopa

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Treatment

Study locations

France · 3 centers

• CHRU de Nancy — Nancy
• Centre Paul Strauss — Strasbourg
• ICL — Vandœuvre-lès-Nancy

Publications

• Perry JR, Laperriere N, O'Callaghan CJ, Brandes AA, Menten J, Phillips C, Fay M, Nishikawa R, Cairncross JG, Roa W, Osoba D, Rossiter JP, Sahgal A, Hirte H, Laigle-Donadey F, Franceschi E, Chinot O, Golfinopoulos V, Fariselli L, Wick A, Feuvret L, Back M, Tills M, Winch C, Baumert BG, Wick W, Ding K, Mason WP; Trial Investigators. Short-Course Radiation plus Temozolomide in Elderly Patients with G PMID 28296618
• Truc G, Bernier V, Mirjolet C, Dalban C, Mazoyer F, Bonnetain F, Blanchard N, Lagneau E, Maingon P, Noel G. A phase I dose escalation study using simultaneous integrated-boost IMRT with temozolomide in patients with unifocal glioblastoma. Cancer Radiother. 2016 May;20(3):193-8. doi: 10.1016/j.canrad.2015.12.005. Epub 2016 Apr 23. PMID 27117900
• Somme F, Bender L, Namer IJ, Noel G, Bund C. Usefulness of 18F-FDOPA PET for the management of primary brain tumors: a systematic review of the literature. Cancer Imaging. 2020 Oct 6;20(1):70. doi: 10.1186/s40644-020-00348-5. PMID 33023662

Identifiers

NCT: NCT05653622 · 2021-010

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗