MRI-Guided Laser Surgery and Doxorubicin Hydrochloride in Treating Patients With Recurrent Glioblastoma Multiforme

Glioblastoma Clinical Trial

Official title:

A Pilot Study of Using MRI-Guided Laser Heat Ablation to Induce Disruption of the Peritumoral Blood Brain Barrier to Enhance Delivery and Efficacy of Doxorubicin in the Treatment of Recurrent Glioblastoma Multiforme

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01851733
• Other study ID #: 201305148
• Status: Completed
• Phase: Phase 1
• Start date: August 13, 2013
• Est. completion date: May 30, 2018

Study information

• Verified date: August 2021
• Source: Washington University School of Medicine
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This pilot clinical trial studies magnetic resonance imaging (MRI)-guided laser surgery (MLA) and doxorubicin hydrochloride in treating patients with recurrent glioblastoma multiforme. The blood brain barrier (BBB) is a separation of circulating blood from the tissue of the central nervous system, preventing substances in the blood from entering the brain. MLA disrupts the BBB around the tumor which may allow cancer-killing substances to be carried directly to the tumor and the surrounding area. Using MLA prior to chemotherapy may result in a greater concentration of drug in the tumor to kill the cancer cells while limiting side effects.

Description:

Evaluate imaging techniques (MRI) and blood tests (biomarkers) to help figure out the best time for chemotherapy to be initiated after the blood brain barrier is disrupted, as it is immediately following a procedure like MRI-guided laser ablation (MLA-Monteris Neuroblate).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 37
• Est. completion date: May 30, 2018
• Est. primary completion date: April 12, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria - Arms B and C:

• Histologically confirmed GBM; rare GBM variants, secondary GBM, and suspected secondary GBM are allowed.

• Unequivocal evidence of tumor progression by magnetic resonance imaging (MRI) scan.

• There must be an interval of at least 12 weeks from the completion of radiotherapy to study registration except if there is unequivocal evidence for tumor recurrence per RANO criteria. When the interval is less than 12 weeks from the completion of radiotherapy, the use of PET scan is allowed to differentiate between unequivocal evidence of tumor recurrence and pseudoprogression.

• Candidate for MLA based on size, location, and shape of the recurrent tumor as determined by the performing neurosurgeon

• At least 18 years of age.

• Karnofsky performance status = 60%.

• Scheduled for MRI-guided Laser Ablation (MLA).

• Normal left ventricular ejection fraction on MUGA or echocardiogram within the past 1 year prior to registration for patients with history of congestive heart failure and/or coronary disease requiring medications other than aspirin, or known prior exposure to anthracycline chemotherapy.

• Adequate bone marrow and hepatic function as defined below (must be within 7 days of MLA):

• Absolute neutrophil count (ANC) = 1500/mcl (G-CSF is allowed)

• Platelets = 100,000/mcl

• Hemoglobin = 9 (pRBC transfusion +/- ESA are allowed)

• ALT = 3 x ULN

• AST = 3 x ULN

• ALP = 3 x ULN. If ALP is > 3 x ULN, GGT must be checked and be = 3 x ULN.

• Bilirubin = 2 x ULN

• At the time of registration, patient must have recovered from the toxic effects of prior therapy to no more than grade 1 toxicity.

• At the time of registration, patient must be at least 2 weeks from prior vincristine, 3 weeks from prior procarbazine, and 4 weeks from other prior cytotoxic chemotherapy.

• Women of childbearing 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 must inform her treating physician immediately.

• Ability to understand and willingness to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable).

Exclusion Criteria - Arms B and C:

• Prior treatment with doxorubicin and/or bevacizumab.

• Prior treatment with Gliadel wafer is allowed if it has been at least 3 months from placement.

• Previous treatment with complete cumulative doses of daunorubicin, idarubicin, and/or other anthracyclines and anthracenediones that is equivalent to a total dose of 240 mg/m2 doxorubicin.

• More than 2 prior relapses.

• Currently receiving any other investigational agents that are intended as treatments of GBM.

• A history of allergic reactions attributed to compounds of similar chemical or biologic composition to doxorubicin or other agents used in the study.

• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, recent heart attack within the previous 12 months or severe heart problems, or psychiatric illness/social situations that would limit compliance with study requirements.

• Pregnant and/or breastfeeding. Premenopausal women must have a negative serum pregnancy test within 14 days of study entry.

• Inability to undergo MRI due to personal and medical reasons.

• Known history of HIV or autoimmune diseases requiring immunosuppressant drugs.

Related Conditions & MeSH terms

• Glioblastoma

Intervention

Device:
• MRI-guided Laser Heat Ablation (MLA)

Drug:
• Doxorubicin

Other:
• Blood draw - dendritic cells
The second 10 patients enrolled to Arm B: before MLA (up to 3 days before) 2 weeks after MLA 4 weeks after MLA every 2 weeks thereafter for up to 3 months after biopsy (provided there is no significant chemotherapy induced cytopenia)

Device:
• Dynamic Susceptibility Contrast Magnetic Resonance Imaging

Locations

Country	Name	City	State
United States	Washington University School of Medicine	Saint Louis	Missouri

Sponsors (2)

Lead Sponsor	Collaborator
Washington University School of Medicine	The Foundation for Barnes-Jewish Hospital

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Ktrans from DSC-MRI	Using a 2 compartment model to calculate a the vascular transfer constant (Ktrans) which will provide a quantitative measure of blood brain barrier leakage	6 weeks
Primary	Peritumoral permeability scores, measured by DSC-MRI and serum biomarkers	Pearson correlation coefficient (r) will be determined for each biomarker and Ktrans value. A minimum r=0.5 is required for inclusion for further analysis and will be used as a peritumoral permeability score. This score will then be correlated with the patient outcome data to determine whether it has a predictive value.	6 weeks
Primary	6-month PFS (rate)	Assessed using RANO Response criteria. A log-rank test will be used to compare 6-PFS of Arm B and of Arm C to historical controls.	6 months
Secondary	Overall Survival	Date began MLA treatment to date of death from any cause. A log-rank test will be used to compare OS of Arm B and of Arm C to historical controls.	2 years
Secondary	Quality of Life	Using Karnofsky performance status and the mini-mental state evaluation to assess patient overall response to treatment.	2 years

External Links

•   Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine