Stereotactic Radiosurgery Compared With Hippocampal-Avoidant Whole Brain Radiotherapy (HA-WBRT) Plus Memantine for 5 or More Brain Metastases

Официальное название

A Phase III Trial of Stereotactic Radiosurgery Compared With Hippocampal-Avoidant Whole Brain Radiotherapy (HA-WBRT) Plus Memantine for 5 or More Brain Metastases

Обзор

Stereotactic radiosurgery (SRS) is a commonly used treatment for brain tumors. It is a one-day (or in some cases two day), out-patient procedure during which a high dose of radiation is delivered to small spots in the brain while excluding the surrounding normal brain. Whole brain radiation therapy with hippocampal avoidance (HA-WBRT) is when radiation therapy is given to the whole brain, while trying to decrease the amount of radiation that is delivered to the area of the hippocampus. The hippocampus is a brain structure that is important for memory. Memantine is a drug that is given to help relieve symptoms that can be caused by WBRT, including problems with memory and other mental symptoms. Health Canada, the regulatory body that oversees the use of drugs in Canada, has not approved the sale or use of memantine in combination with WBRT to treat this kind of cancer, although they have allowed its use in this study.

Подробное описание

The purpose of this research study is to compare the effects (good or bad) of receiving stereotactic radiosurgery (SRS) versus receiving hippocampal-avoidant whole brain radiotherapy (HA-WBRT) plus a drug called memantine, on brain metastases. Receiving SRS could control cancer that has spread to the brain.

This study will allow the researchers to know whether this different approach is better, the same, or worse than the usual approach. To decide if it is better, the study doctors will be looking to see if the stereotactic radiosurgery (SRS) helps to either slow the growth of cancer or stop it from coming back, compared to the usual approach. Doctors will also look to see if this new approach increases the life span of patients with this type of cancer, and if it helps with quality of life and cancer related symptoms.

The usual approach for patients who are not in a study is treatment with whole brain radiation therapy alone (WBRT).

Вмешательства

• Препарат Memantine
  20 mg (10 mg divided twice daily). Dose will be escalated by 5 mg per week. Memantine should start at 5 mg, and then increased in 5 mg increments at the following schedule, depending on the patient's response and tolerance:
• Лучевая терапия Hippocampal-avoidant (HA-WBRT) Radiotherapy
  30Gy in 10 fractions
• Процедура Stereotactic Radiosurgery (SRS)
  18-20 or 22 Gy in single fraction

Первичные конечные точки

• Overall Survival [Срок оценки: 4.5 years]
• Neurocognitive progression-free survival [Срок оценки: 4.5 years]

Вторичные конечные точки (12)

• Time to central nervous system (CNS) failure (local, distant, and leptomeningeal) in patients who receive SRS compared to patients who receive HA-WBRT + memantine [Срок оценки: 4.5 years]
• Difference in CNS failure patterns (local, distant, or leptomeningeal) in patients who receive SRS compared to patients who receive HA-WBRT + memantine [Срок оценки: 4.5 years]
• Number of salvage procedures following SRS in comparison to HA-WBRT + memantine [Срок оценки: 4.5 years]
• Neurocognitive progression-free survival in patients who receive SRS compared to HA-WBRT + memantine [Срок оценки: 4.5 years]
• Tabulate and descriptively compare the post-treatment adverse events associated with the interventions. [Срок оценки: 4.5 years]
• Time delay to (re-)initiation of systemic therapy in patients receiving SRS in comparison to HA-WBRT + memantine [Срок оценки: 4.5 years]
• Prospectively validate a predictive nomogram for distant brain failure in patients who receive SRS [Срок оценки: 4.5 years]
• Compare the estimated cost of brain-related therapies in patients who receive SRS compared to patients who receive HA-WBRT + memantine. [Срок оценки: 4.5 years]
• Quality of life, as assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) with brain cancer module (BN20) [Срок оценки: 4.5 years]
• Quality of life assessed by ECOG performance status [Срок оценки: 4.5 years]
• Quality of life, as assessed by EQ-5D-5L [Срок оценки: 4.5 years]
• Collect plasma to evaluate whether detectable somatic mutations in liquid biopsy can enhance prediction of the overall survival and development of new brain metastases. [Срок оценки: 4.5 years]

Критерии участия

Критерии включения

• Patients must have 5 or more brain metastases as counted on a T1 contrast enhanced MRI obtained ≤ 30 days from randomization (maximum 15 brain metastases).
• Patients must have a pathological diagnosis (cytological or histological) of a non-hematopoietic malignancy.
• The largest brain metastasis must measure <2.5 cm in maximal diameter.
• Centre must have the ability to treat patients with either a Gamma Knife, Cyberknife, or a linear accelerator-based radiosurgery system.
• Patient must be > 18 years of age.
• Patient is able (i.e. sufficiently fluent) and willing to complete the quality of life questionnaires in either English or French either alone or with assistance.
• ECOG performance status 0, 1, or 2.
• Creatinine clearance must be ≥ 30 ml/min within 28 days prior to registration.
• The Neurocognitive Testing examiner must have credentialing confirming completion of the neurocognitive testing training.
• Facility is credentialed by IROC to perform SRS and HA-WBRT. The treating centre must have completed stereotactic radiosurgery credentialing of the specific system(s) to be used in study patients. The treating centre must have completed IMRT credintialing of this specific IMRT systems to be used in study patients for the purposes of HA-WBRT.
• Patient consent must be appropriately obtained in accordance with applicable local and regulatory requirements. Each patient must sign a consent form prior to enrolment in the trial to document their willingness to participate.
• A similar process must be followed for sites outside of Canada as per their respective cooperative group's procedures.
• Patients must be accessible for treatment and follow-up. Investigators must assure themselves the patients randomized on this trial will be available for complete documentation of the treatment, adverse events, and follow-up.
• In accordance with CCTG policy, protocol treatment is to begin within 14 days of patient enrolment.
• Women/men of childbearing potential must have agreed to use a highly effective contraceptive method.

Критерии исключения

• Pregnant or nursing women.
• Men or women of childbearing potential who are unwilling to employ adequate contraception.
• Inability to complete a brain MRI.
• Known allergy to gadolinium.
• Prior cranial radiation therapy.
• Planned cytotoxic chemotherapy within 48 hours prior or after the SRS or HA-WBRT.
• Primary germ cell tumour, small cell carcinoma, or lymphoma.
• Widespread definitive leptomeningeal metastasis. This includes cranial nerve palsy, leptomeningeal carcinomatosis, ependymal involvement, cranial nerve involvement on imaging, suspicious linear meningeal enhancement, or cerebrospinal fluid (CSF) positive for tumour cells.
• A brain metastasis that is located ≤ 5 mm of the optic chiasm or either optic nerve.
• Surgical resection of a brain metastasis (stereotactic biopsies will be allowed).
• More than 15 brain metastases on a volumetric T1 contrast MRI (voxels of 1mm or smaller) performed within the past 14 days, or more than 10 metastases in the case of a non-volumetric MRI.
• Prior allergic reaction to memantine.
• Current alcohol or drug abuse.
• Current use of NMDA antagonists, such as amantadine, ketamine, or dextromethorphan.
• Diagnosis of chronic liver disease/cirrhosis of the liver (e.g. Child-Pugh class B or C).
• Patients with architectural distortion of lateral ventricular systems, which, in the opinion of the local investigator, makes hippocampal delineation challenging

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

США · 73 центра

• University of Arizona Cancer Center-Orange Grove Campus — Tucson
• University of Arizona Cancer Center-North Campus — Tucson
• City of Hope Corona — Corona
• City of Hope Comprehensive Cancer Center — Duarte
• City of Hope at Irvine Lennar — Irvine
• UC San Diego Moores Cancer Center — La Jolla
• City of Hope Antelope Valley — Lancaster
• UC Irvine Health/Chao Family Comprehensive Cancer Center — Orange
• … и ещё 65 центров

Канада · 13 центров

• Arthur J E Child Comprehensive Cancer Centre — Calgary
• Cross Cancer Institute — Edmonton
• BCCA-Vancouver Cancer Centre — Vancouver
• QEII Health Sciences Centre/Nova Scotia Health Authority — Halifax
• Juravinski Cancer Centre at Hamilton Health Sciences — Hamilton
• London Regional Cancer Program — London
• University Health Network-Princess Margaret Hospital — Toronto
• … и ещё 6 центров

Идентификаторы

NCT: NCT03550391 · CCTG CE.7 · NCI-2018-00395

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗