A Study of Bevacizumab (Avastin) in Combination With Temozolomide (TMZ) and Radiotherapy in Paediatric and Adolescent Participants With High-Grade Glioma

NCT ID: NCT01390948

Last Updated: 2020-08-06

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

124 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-10-18

Study Completion Date

2020-01-29

Brief Summary

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This randomized, open-label, multicenter, 2-arm study will investigate the efficacy, safety, tolerability and pharmacokinetics of bevacizumab when added to postoperative radiotherapy with concomitant and adjuvant TMZ as compared to postoperative radiotherapy with concomitant and adjuvant TMZ alone in paediatric participants with newly diagnosed histologically confirmed World Health Organization (WHO) Grade III or IV localized supratentorial or infratentorial cerebellar or peduncular high grade glioma (HGG). Participants will be randomly assigned to one of two treatment arms.

Upon approval by the Health Authorities/Ethics Committees in the participating countries, an additional young participant cohort (YPC) (children \>/= 6 months and \< 3 years of age with progressive or relapsed metastatic or localized, supra- or infratentorial, non-brain stem WHO Grade III or IV HGG) was included in the study. Children in the YPC will receive bevacizumab and TMZ without radiation therapy. The anticipated time on study treatment is over 1 year.

Detailed Description

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Conditions

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High Grade Glioma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Bevacizumab + TMZ Young Patient Cohort (YPC)

Participants aged greater than or equal to (\>/=) 6 months and less than (\<) 3 years will receive 10 milligrams per kilogram (mg/kg) Bevacizumab every 2 weeks and 150 to 200 milligrams per meter squared (mg/m\^2) of TMZ daily on Days 1-5 of each cycle. TMZ will be given at a dose of 150 mg/m\^2 on Days 1-5 of cycle 1 and then escalated to 200 mg/m\^2 on days 1-5 from cycle 2 onwards depending on the tolerance during the 1st cycle.

Group Type EXPERIMENTAL

Bevacizumab

Intervention Type DRUG

10 milligrams per kilogram every 2 weeks during the study for up to 12 cycles, each cycle length of 28 days

Temozolomide (TMZ)

Intervention Type DRUG

75 milligrams per square meter (mg/m\^2) daily continuous starting concomitantly with the first radiation fraction and ending with the last radiation fraction for a maximum number of treatment days = 49 days. During the TMZ adjuvant treatment phase and for participants from YPC: TMZ (150 to 200 mg/m\^2/day) x 12 cycles, 1st cycle 150 mg/m\^2/days 1-5, escalated to 200 mg/m\^2 on Days 1-5 from Cycle 2 onwards depending on the tolerance during the 1st cycle. Cycle length = 28 days.

Main Cohort: Chemoradiation + Bevacizumab + TMZ

Participants will receive a total dose of 54 Grey (Gy) units delivered in 30 daily fractions of 1.8 Gy over 6 weeks with 75 mg/m\^2 TMZ daily for up to 49 days followed by a treatment break of approximately 4 weeks. The treatment break will be followed by an adjuvant treatment phase where participants will receive 150 to 200 mg/m\^2 of TMZ daily on Days 1-5 of each cycle. TMZ will be given at a dose of 150 mg/m\^2 on Days 1-5 of cycle 1 and then escalated to 200 mg/m\^2 on days 1-5 from cycle 2 onwards depending on the tolerance during the 1st cycle. Bevacizumab will be given concomitantly at a dose of 10 mg/kg every 2 weeks throughout the entire treatment period.

Group Type EXPERIMENTAL

Bevacizumab

Intervention Type DRUG

10 milligrams per kilogram every 2 weeks during the study for up to 12 cycles, each cycle length of 28 days

Radiotherapy

Intervention Type RADIATION

Total dose of 54 Grey (Gy) units delivered in 30 daily fractions of 1.8 Gy over 6 weeks during the chemoradiation phase.

Temozolomide (TMZ)

Intervention Type DRUG

75 milligrams per square meter (mg/m\^2) daily continuous starting concomitantly with the first radiation fraction and ending with the last radiation fraction for a maximum number of treatment days = 49 days. During the TMZ adjuvant treatment phase and for participants from YPC: TMZ (150 to 200 mg/m\^2/day) x 12 cycles, 1st cycle 150 mg/m\^2/days 1-5, escalated to 200 mg/m\^2 on Days 1-5 from Cycle 2 onwards depending on the tolerance during the 1st cycle. Cycle length = 28 days.

Main Cohort: Chemoradiation + TMZ

Participants will receive a total dose of 54 Gy units delivered in 30 daily fractions of 1.8 Gy over 6 weeks with 75 mg/m\^2 TMZ daily for up to 49 days followed by a treatment break of approximately 4 weeks. The treatment break will be followed by an adjuvant treatment phase where participants will receive 150 to 200 mg/m\^2 of TMZ daily on Days 1-5 of each cycle. TMZ will be given at a dose of 150 mg/m\^2 on Days 1-5 of cycle 1 and then escalated to 200 mg/m\^2 on days 1-5 from cycle 2 onwards depending on the tolerance during the 1st cycle.

Group Type ACTIVE_COMPARATOR

Radiotherapy

Intervention Type RADIATION

Total dose of 54 Grey (Gy) units delivered in 30 daily fractions of 1.8 Gy over 6 weeks during the chemoradiation phase.

Temozolomide (TMZ)

Intervention Type DRUG

75 milligrams per square meter (mg/m\^2) daily continuous starting concomitantly with the first radiation fraction and ending with the last radiation fraction for a maximum number of treatment days = 49 days. During the TMZ adjuvant treatment phase and for participants from YPC: TMZ (150 to 200 mg/m\^2/day) x 12 cycles, 1st cycle 150 mg/m\^2/days 1-5, escalated to 200 mg/m\^2 on Days 1-5 from Cycle 2 onwards depending on the tolerance during the 1st cycle. Cycle length = 28 days.

Interventions

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Bevacizumab

10 milligrams per kilogram every 2 weeks during the study for up to 12 cycles, each cycle length of 28 days

Intervention Type DRUG

Radiotherapy

Total dose of 54 Grey (Gy) units delivered in 30 daily fractions of 1.8 Gy over 6 weeks during the chemoradiation phase.

Intervention Type RADIATION

Temozolomide (TMZ)

75 milligrams per square meter (mg/m\^2) daily continuous starting concomitantly with the first radiation fraction and ending with the last radiation fraction for a maximum number of treatment days = 49 days. During the TMZ adjuvant treatment phase and for participants from YPC: TMZ (150 to 200 mg/m\^2/day) x 12 cycles, 1st cycle 150 mg/m\^2/days 1-5, escalated to 200 mg/m\^2 on Days 1-5 from Cycle 2 onwards depending on the tolerance during the 1st cycle. Cycle length = 28 days.

Intervention Type DRUG

Other Intervention Names

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Avastin

Eligibility Criteria

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Inclusion Criteria

* Paediatric participants, aged \>= 3 years and \< 18 years
* Written informed consent obtained from the participant/parents or legally acceptable representative
* Newly diagnosed localised, supratentorial or infratentorial cerebellar or peduncular, WHO Grade III or IV gliomas
* Local histological diagnosis confirmed by a designated central reference neuropathologist
* Availability of the baseline magnetic resonance imaging (MRI) performed according to imaging guidelines
* Able to commence trial treatment not before 4 weeks after cranial surgery and no later than 6 weeks following the last major surgery
* Adequate bone marrow, coagulation, liver, and renal function

Young Participant Cohort

* Written informed consent obtained from parents or legal representative
* Age at enrollment: from \>= 6 months to \< 3 years of age
* Progressive or relapsed metastatic or localised, supra- or infratentorial, non-brain stem WHO Grade III or IV glioma (local pathology confirmation made either at initial diagnosis or at relapse)
* Availability of a baseline MRI performed according to imaging guidelines
* Adequate organ function (bone marrow, coagulation, liver, kidney)

Exclusion Criteria

* Metastatic HGG defined as evidence of neuraxis dissemination by MRI or positive cerebrospinal fluid (CSF) cytology
* WHO-defined Gliomatosis cerebri (multifocal HGG)
* Any disease or condition that contraindicates the use of the study medication/treatment or places the patient at an unacceptable risk of experiencing treatment-related complications
* Radiological evidence of surgically related intracranial bleeding
* Prior diagnosis of a malignancy and disease-free for 5 years
* Prior systemic anti-cancer therapy
* Previous cranial irradiation

Young Participant Cohort

* WHO-defined Gliomatosis cerebri (multifocal HGG)
* Newly diagnosed HGG below the age of 3 years
* Relapsed HGG below the age of 6 months or above the age of 3 years regardless of the age at first onset
* Indication for concomitant cranial irradiation, regardless of age
* Any disease or condition that contraindicates the use of the study medication/treatment or places the child at an unacceptable risk of experiencing treatment-related complications
* Any specific contraindication to MRI
Minimum Eligible Age

6 Months

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hoffmann-La Roche

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Clinical Trials

Role: STUDY_DIRECTOR

Hoffmann-La Roche

Locations

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The Children's Hospital at Westmead

Westmead, New South Wales, Australia

Site Status

Lady Cilento Children's Hospital; Oncology Services Group, Level 12b

South Brisbane, Queensland, Australia

Site Status

Kepler Universitätskliniken GmbH - Med Campus IV.

Linz, , Austria

Site Status

Medizinische Universität Wien

Vienna, , Austria

Site Status

UZ Leuven Gasthuisberg

Leuven, , Belgium

Site Status

Alberta Children'S Hospital

Calgary, Alberta, Canada

Site Status

Hospital For Sick Children

Toronto, Ontario, Canada

Site Status

Fakultni nemocnice Brno; 2. detska klinika, pracoviste Detska nemocnice

Brno, , Czechia

Site Status

Fakultni Nemocnice V Motole, S.P.

Prague, , Czechia

Site Status

Skejby Sygehus - Aarhus University Hospital; CF Center, Børneafdeling A

Aarhus N, , Denmark

Site Status

Rigshospitalet; Onkologisk Klinik

København Ø, , Denmark

Site Status

Centre Hospitalier d'Angers; Service de cancérologie pédiatrique

Angers, , France

Site Status

CHU ESTAING; Centre Regional de Cancérologie et Thérapie Cellulaire Pédiatrique (CRCTCP)

Clermont-Ferrand, , France

Site Status

Centre Oscar Lambret; Service de Pediatrie

Lille, , France

Site Status

Centre Leon Berard

Lyon, , France

Site Status

Hopital Timone Enfants; Onco Pediatrie

Marseille, , France

Site Status

Hopital Lenval; Service Hématologie Infantile

Nice, , France

Site Status

Institut Curie - Centre de Lutte Contre le Cancer (CLCC) de Paris; Service d Oncologie Pediatrique

Paris, , France

Site Status

CHRU de Rennes - Hôpital Sud- Service d'Hématologie Pédiatrique

Rennes, , France

Site Status

Hopital Nord;Consult Pediatrie

Saint-Priest-en-Jarez, , France

Site Status

Hôpital Hautepierre

Strasbourg, , France

Site Status

Hopital Des Enfants; Service d Hemato-Oncologie

Toulouse, , France

Site Status

CHRU de Tours - Centre de Pédiatrie Clocheville; Service d'Oncopédiatrie

Tours, , France

Site Status

Hopital Brabois Enfants

Vandœuvre-lès-Nancy, , France

Site Status

Institut Gustave Roussy; Service Pediatrique

Villejuif, , France

Site Status

Semmelweis University, 2nd Dept of Pediatrics Neurooncology Unit

Budapest, , Hungary

Site Status

Azienda Ospedaliera Universitaria Policlinico Sant'Orsola Malpigh

Bologna, Emilia-Romagna, Italy

Site Status

Istituto Giannina Gaslini-Ospedale Pediatrico IRCCS; U.O.S. Neuroncologia

Genoa, Liguria, Italy

Site Status

Fondazione IRCCS Istituto Nazionale dei Tumori

Milan, Lombardy, Italy

Site Status

Azienda Ospedaliera di Padova

Padua, Veneto, Italy

Site Status

UMC St Radboud

Nijmegen, , Netherlands

Site Status

Erasmus Mc/Sophia's Childrens Hospital; Dept. of Pediatric Oncology

Rotterdam, , Netherlands

Site Status

Instytut Pomnik-Centrum Zdrowia Dziecka; Klinika Onkologii

Warsaw, , Poland

Site Status

Hospital Sant Joan De Deu

Esplugues de Llobregas, Barcelona, Spain

Site Status

Hospital Universitari Vall d'Hebron

Barcelona, , Spain

Site Status

Hospital Universitario La Fe

Valencia, , Spain

Site Status

Sahlgrenska Universitetssjukhuset, Östra Sjukhus; Drottning Silvias Barnsjukhus

Gothenburg, , Sweden

Site Status

Universitetssjukhuset Linköping; Barn och Ungdomskliniken

Linköping, , Sweden

Site Status

Skånes Universitetssjukhus

Lund, , Sweden

Site Status

Karolinska Universitetssjukhuset, Solna; Astrid Lindgrens Barnsjukhus, Barcanceravdelningen

Solna, , Sweden

Site Status

Birmingham Childrens Hospital; Oncology Dept

Birmingham, , United Kingdom

Site Status

Bristol Royal Hospital for Children; Paediatric Haematology, Oncology, BMT

Bristol, , United Kingdom

Site Status

Addenbrookes Hospital; Paediatric Oncology Ward C2

Cambridge, , United Kingdom

Site Status

Royal Hospital for Sick Children

Edinburgh, , United Kingdom

Site Status

Leeds General Infirmary; Ward 35

Leeds, , United Kingdom

Site Status

Alder Hey Children's NHS Foundation Trust

Liverpool, , United Kingdom

Site Status

University College London NHS Foundation Trust

London, , United Kingdom

Site Status

Great Ormond Street Hospital; Dept. Of Pediatric Oncology

London, , United Kingdom

Site Status

Royal Manchester Childrens Hospital

Manchester, , United Kingdom

Site Status

Newcastle University & The Newcastle upon Tyne Hospitals NHS Foundation Trust

Newcastle upon Tyne, , United Kingdom

Site Status

Queens Medical Centre

Nottingham, , United Kingdom

Site Status

Southampton General Hospital

Southampton, , United Kingdom

Site Status

Royal Marsden Hospital; Pediatric Unit

Surrey, , United Kingdom

Site Status

Countries

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Australia Austria Belgium Canada Czechia Denmark France Hungary Italy Netherlands Poland Spain Sweden United Kingdom

References

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Rodriguez D, Calmon R, Aliaga ES, Warren D, Warmuth-Metz M, Jones C, Mackay A, Varlet P, Le Deley MC, Hargrave D, Canete A, Massimino M, Azizi AA, Saran F, Zahlmann G, Garcia J, Vassal G, Grill J, Peet A, Dineen RA, Morgan PS, Jaspan T. MRI and Molecular Characterization of Pediatric High-Grade Midline Thalamic Gliomas: The HERBY Phase II Trial. Radiology. 2022 Jul;304(1):174-182. doi: 10.1148/radiol.211464. Epub 2022 Apr 12.

Reference Type DERIVED
PMID: 35412366 (View on PubMed)

Varlet P, Le Teuff G, Le Deley MC, Giangaspero F, Haberler C, Jacques TS, Figarella-Branger D, Pietsch T, Andreiuolo F, Deroulers C, Jaspan T, Jones C, Grill J. WHO grade has no prognostic value in the pediatric high-grade glioma included in the HERBY trial. Neuro Oncol. 2020 Jan 11;22(1):116-127. doi: 10.1093/neuonc/noz142.

Reference Type DERIVED
PMID: 31419298 (View on PubMed)

Rodriguez D, Chambers T, Warmuth-Metz M, Aliaga ES, Warren D, Calmon R, Hargrave D, Garcia J, Vassal G, Grill J, Zahlmann G, Morgan PS, Jaspan T. Evaluation of the Implementation of the Response Assessment in Neuro-Oncology Criteria in the HERBY Trial of Pediatric Patients with Newly Diagnosed High-Grade Gliomas. AJNR Am J Neuroradiol. 2019 Mar;40(3):568-575. doi: 10.3174/ajnr.A5982. Epub 2019 Feb 28.

Reference Type DERIVED
PMID: 30819765 (View on PubMed)

Mackay A, Burford A, Molinari V, Jones DTW, Izquierdo E, Brouwer-Visser J, Giangaspero F, Haberler C, Pietsch T, Jacques TS, Figarella-Branger D, Rodriguez D, Morgan PS, Raman P, Waanders AJ, Resnick AC, Massimino M, Garre ML, Smith H, Capper D, Pfister SM, Wurdinger T, Tam R, Garcia J, Thakur MD, Vassal G, Grill J, Jaspan T, Varlet P, Jones C. Molecular, Pathological, Radiological, and Immune Profiling of Non-brainstem Pediatric High-Grade Glioma from the HERBY Phase II Randomized Trial. Cancer Cell. 2018 May 14;33(5):829-842.e5. doi: 10.1016/j.ccell.2018.04.004.

Reference Type DERIVED
PMID: 29763623 (View on PubMed)

Grill J, Massimino M, Bouffet E, Azizi AA, McCowage G, Canete A, Saran F, Le Deley MC, Varlet P, Morgan PS, Jaspan T, Jones C, Giangaspero F, Smith H, Garcia J, Elze MC, Rousseau RF, Abrey L, Hargrave D, Vassal G. Phase II, Open-Label, Randomized, Multicenter Trial (HERBY) of Bevacizumab in Pediatric Patients With Newly Diagnosed High-Grade Glioma. J Clin Oncol. 2018 Apr 1;36(10):951-958. doi: 10.1200/JCO.2017.76.0611. Epub 2018 Feb 7.

Reference Type DERIVED
PMID: 29412784 (View on PubMed)

Other Identifiers

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2010-022189-28

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

ITCC-019

Identifier Type: OTHER

Identifier Source: secondary_id

HGG-01

Identifier Type: OTHER

Identifier Source: secondary_id

BO25041

Identifier Type: -

Identifier Source: org_study_id

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