Cilengitide in Combination With Irradiation in Children With Diffuse Intrinsic Pontine Glioma

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE1

Total Enrollment

32 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-08-31

Study Completion Date

2015-03-31

Brief Summary

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The aim of the study is to determine the safety of Cilengitide in combination with radiation therapy.

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Detailed Description

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The prognosis of children and young adults with a malignant glioma in the brain stem or a recurrent malignant glioma (in whatever site) is very poor. Over the last few decades, many therapeutic trials have been performed but have failed to significantly improve survival in these patients. There is thus a need to test new drugs in these indications. There is a strong biological rationale for the use of anti-angiogenic drugs in high-grade glioma. Cilengitide (EMD121974; Merck KgaA, Darmstadt, Germany), a cyclic pentapeptide containing the sequence RGD (cyclo-\[Arg-Gly-Asp-Dphe-(NmeVal)\]) is a selective antagonist of integrins αvβ3 and αvβ5, which are strongly involved in tumour angiogenesis. Positive results with Cilengitide in preclinical models of glioblastoma, its particularly attractive safety profile and its encouraging efficacy in phase I and II studies in adults and children make it a potentially effective molecule for the treatment of malignant glioma in children. Furthermore, its combination with radiotherapy to be appears synergistic, without any apparent increase in toxicity.

In this study, Cilengitide will be evaluated when concurrently administered with radiotherapy as a first-line treatment and then as a maintenance monotherapy in children and young adults with malignant brain stem glioma. The main objective will be to determine the maximum tolerated dose (MTD) of Cilengitide when administered twice weekly as a 60-minute intra-venous infusion.

Conditions

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Diffuse Intrinsic Pontine Glioma

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Dose escalation

In the first part of the trial, a dose-ranging study in ca. 18-21 patients will be done. A standard dose escalation strategy will be used including 3 to 6 patients at each dose level, the first cohort of patients being treated at dose level one Interventions : Cilengitide dose escalation ; Concomitant radiotherapy ; Pharmacokinetic ; Pharmacogenetic

Group Type EXPERIMENTAL

Cilengitide dose escalation

Intervention Type DRUG

Cilengitide will be administered intravenously over 60 minutes, twice a week, at a given dose.

The Cilengitide dose (mg/m²/infusion)levels are as follows :

* 240
* 480
* 720
* 1200
* 1800

Concomitant radiotherapy

Intervention Type RADIATION

1.8 Gy per fraction for a total of 54 Gy over 6 weeks, from monday to friday of the first cycle. The radiation will imperatively begin between 3 and 7hours after the end of Cilengitide infusion.

Pharmacokinetic

Intervention Type BIOLOGICAL

A pharmacokinetic assessment for Cilengitide will be carried for all patients. The pharmacokinetic (PK) samples will be drawn during day 1 and day 2 of the first cycle of treatment.

Pharmacogenetic

Intervention Type BIOLOGICAL

For every patient 1 blood sample will be taken before study treatment. These blood samples can be made at any hour of the day, and does not require to be taken on an empty stomach. DNA will be extracted in the Laboratory of Pharmacology.Constitutional polymorphisms of genes will be measured before the treatment initiation.

Cohort extension

An additional 20 patients will be treated at the recommended dose in order to confirm the recommended cilengitide dose and to carry out the exploratory investigations Interventions : Cilengitide ; Concomitant radiotherapy ; Pharmacokinetic ; Pharmacogenetic

Group Type EXPERIMENTAL

Cilengitide

Intervention Type DRUG

Patients will be treated at the recommended dose in order to confirm the recommended cilengitide dose and to carry out the exploratory investigations

Concomitant radiotherapy

Intervention Type RADIATION

1.8 Gy per fraction for a total of 54 Gy over 6 weeks, from monday to friday of the first cycle. The radiation will imperatively begin between 3 and 7hours after the end of Cilengitide infusion.

Pharmacokinetic

Intervention Type BIOLOGICAL

A pharmacokinetic assessment for Cilengitide will be carried for all patients. The pharmacokinetic (PK) samples will be drawn during day 1 and day 2 of the first cycle of treatment.

Pharmacogenetic

Intervention Type BIOLOGICAL

For every patient 1 blood sample will be taken before study treatment. These blood samples can be made at any hour of the day, and does not require to be taken on an empty stomach. DNA will be extracted in the Laboratory of Pharmacology.Constitutional polymorphisms of genes will be measured before the treatment initiation.

Exploratory investigation

Intervention Type BIOLOGICAL

Evaluate the metabolic impact of the treatment with dynamic MRI (diffusion, perfusion, spectro), and with FDG-PETand sestamibi SPECT.

Interventions

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Cilengitide dose escalation

Cilengitide will be administered intravenously over 60 minutes, twice a week, at a given dose.

The Cilengitide dose (mg/m²/infusion)levels are as follows :

* 240
* 480
* 720
* 1200
* 1800

Intervention Type DRUG

Cilengitide

Patients will be treated at the recommended dose in order to confirm the recommended cilengitide dose and to carry out the exploratory investigations

Intervention Type DRUG

Concomitant radiotherapy

1.8 Gy per fraction for a total of 54 Gy over 6 weeks, from monday to friday of the first cycle. The radiation will imperatively begin between 3 and 7hours after the end of Cilengitide infusion.

Intervention Type RADIATION

Pharmacokinetic

A pharmacokinetic assessment for Cilengitide will be carried for all patients. The pharmacokinetic (PK) samples will be drawn during day 1 and day 2 of the first cycle of treatment.

Intervention Type BIOLOGICAL

Pharmacogenetic

For every patient 1 blood sample will be taken before study treatment. These blood samples can be made at any hour of the day, and does not require to be taken on an empty stomach. DNA will be extracted in the Laboratory of Pharmacology.Constitutional polymorphisms of genes will be measured before the treatment initiation.

Intervention Type BIOLOGICAL

Exploratory investigation

Evaluate the metabolic impact of the treatment with dynamic MRI (diffusion, perfusion, spectro), and with FDG-PETand sestamibi SPECT.

Intervention Type BIOLOGICAL

Other Intervention Names

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Cilengitidine cilengitidine

Eligibility Criteria

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Inclusion Criteria

* Histologically confirmed diffuse intrinsic pontine glioma
* Metastatic disease allowed
* MRI measurable disease according to the WHO criteria and for extension cohort

* Patient is able to undergo functional MRI (diffusion, perfusion, spectro)
* Patient is able to undergo FDG-PET and sestamibi SPECT
* Life expectancy \> 8 weeks after the start of study treatment.
* No prior chemotherapy for the present cancer; no treatment for any other cancer during the last 5 years.
* No prior cerebral radiation therapy
* Age \> 6 months and \< 21 years
* Lansky Play Scale \> 50 or ECOG Performance Status \< 2; NB: Children and young adults with a worse performance status due to glioma-related motor paresis can be included.
* Absolute neutrophils count \> 1.5 x 109/l, Platelets \> 100 x 109/l
* Total bilirubin \< 1,5 x ULN, AST and ALT\< 2,5 x ULN
* Serum creatinine ≤ 1,5 X ULN for age. If serum creatinine \> 1,5 ULN, creatinine clearance must be \> 70 ml/min/1.73 m² (EDTA radioisotope GFR or 24 hours urines collection)
* Normal coagulation tests : prothrombin rate (prothrombin time = PT), TCA (PTT), fibrinogen
* No current organ toxicity \> grade 2 according to the NCICTCAE version 4.0, especially cardiovascular or renal disease (nephrotic syndrome, glomerulopathy, uncontrolled high blood pressure despite adequate treatment). In case of known or possible cardiac disease, a cardiological advice will be required prior to the inclusion in the study
* If anticonvulsants are currently administered, the dosing regimen must be stable within 1 week prior to the first dose of Cilengitide
* If corticosteroids are administered, the dosing regimen must be stable ≥ 5 days prior to the first dose of Cilengitide.
* Effective contraception for patients (male and female) of reproductive potential during their entire participation in the study and during 6 months after the last administration of Cilengitide.
* Negative pregnancy test (serum beta-HCG) within 1 week prior to start of study treatment in females of reproductive potential
* Patient covered by government health insurance
* Written informed consent given by patient and/or parents/ guardians prior to the study participation

* History of coagulation disorder associated with bleeding or recurrent thrombotic events.
* Prior anti-angiogenic therapy
* Any other concomitant anti-cancer treatment not foreseen by this protocol.
* Concomitant inclusion in another therapeutic clinical trial; participation in another therapeutic clinical trial during the last 30 days.
* Pregnancy or breast feeding woman
* Uncontrolled intercurrent illness or active infection
* Unable for medical follow-up (geographic, social or mental reasons)

Minimum Eligible Age

6 Months

Maximum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No