FMISO-PET in Brain Tumors and SCS Effect

NCT ID: NCT01868906

Last Updated: 2018-08-24

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

TERMINATED

Clinical Phase

PHASE2

Total Enrollment

6 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-06-30

Study Completion Date

2017-09-17

Brief Summary

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The aim of this study is to assess, with 18F-FMISO PET, hypoxia in high grade gliomas and changes by spinal cord stimulation in a subset of patients. Additionally, the potential correlation with pathological, imaging and clinical parameters will be analyzed.

Detailed Description

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Tumour ischaemia-hypoxia decreases the efficacy of radio-chemotherapy. Polarographic probe (and some 18F-FMISO-PET) studies have demonstrated prognostic value. Additionally hypoxia modification may increase survival. However, in high grade gliomas (HGG) there are not well established methods to evaluate and modify tumor hypoxia. We have previously described how spinal cord stimulation (SCS) can modify oxygenation, blood flow and metabolism in malignant gliomas. The aim of this study is to assess with 18F-FMISO PET: hypoxia in HGG and changes by spinal cord stimulation in a subset of patients. Additionally, the potential correlation with pathological, imaging and clinical parameters will be analyzed.

18F-FMISO PET will be performed in 20 patients with diagnosis of HGG: after surgery/biopsy and before radical treatment with 3D radiotherapy and temozolomide. A subset of 10 patients undergo two studies with 18F- FMISO-PET (one with SCS "off" and one with SCS "on"). In these patients, SCS will be connected from 1 hour before to 1 hour after each radiotherapy session, and in the day-time during the days of adjuvant temozolomide.

18F-FMISO PET results will not be taking into account for patient management. Patients will be followed at least until the end of adjuvant temozolomide (6 months after the end of concurrent radiochemotherapy).

Conditions

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Malignant Glioma

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

Study Groups

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Arm-A: 18F-FMISO-PET without SCS

One 18F-FMISO-PET study for assessment of tumor hypoxia before radiotherapy and Temozolomide, without spinal cord stimulation.

Group Type OTHER

18F-FMISO

Intervention Type DRUG

18F-FMISO-PET scanning, for tumor hypoxia assessment before radio-chemotherapy.

PET without SCS

Intervention Type PROCEDURE

PET-scanning using 18F-fluoromisonidazole without SCS

Radiotherapy

Intervention Type RADIATION

Standard radiation therapy

Temozolomide

Intervention Type DRUG

Standard treatment with concurrent and adjuvant Temozolomide.

Arm-B: 18F-FMISO-PET without/with SCS

Two 18F-FMISO-PET studies for assessment of tumor hypoxia before radiotherapy and Temozolomide: one "without" and one "with" spinal cord stimulation

Group Type OTHER

18F-FMISO

Intervention Type DRUG

18F-FMISO-PET scanning, for tumor hypoxia assessment before radio-chemotherapy.

PET without SCS

Intervention Type PROCEDURE

PET-scanning using 18F-fluoromisonidazole without SCS

SCS

Intervention Type DEVICE

Electrical stimulation of spinal cord, minimally invasive neurosurgical technique used to treat refractory pain and ischemic syndromes.

PET without/with SCS

Intervention Type PROCEDURE

Second PET-scanning using 18F-fluoromisonidazole: without/with SCS

Radiotherapy

Intervention Type RADIATION

Standard radiation therapy

Temozolomide

Intervention Type DRUG

Standard treatment with concurrent and adjuvant Temozolomide.

Interventions

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18F-FMISO

18F-FMISO-PET scanning, for tumor hypoxia assessment before radio-chemotherapy.

Intervention Type DRUG

PET without SCS

PET-scanning using 18F-fluoromisonidazole without SCS

Intervention Type PROCEDURE

SCS

Electrical stimulation of spinal cord, minimally invasive neurosurgical technique used to treat refractory pain and ischemic syndromes.

Intervention Type DEVICE

PET without/with SCS

Second PET-scanning using 18F-fluoromisonidazole: without/with SCS

Intervention Type PROCEDURE

Radiotherapy

Standard radiation therapy

Intervention Type RADIATION

Temozolomide

Standard treatment with concurrent and adjuvant Temozolomide.

Intervention Type DRUG

Other Intervention Names

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Fluoromisonidazole FMISO Positron emission tomography scanning Electrical Neurostimulation Spinal Cord Stimulation Positron emission tomography scanning Radiation therapy Temodar Temodal Temcad

Eligibility Criteria

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Inclusion Criteria

* Patients with pathologically confirmed (first presentation or relapsed) high grade glioma (Grade III or Grade IV according WHO criteria) proposed for radical treatment with 3D radiotherapy and temozolomide.
* Patients 18-75 years old.
* Karnofsky \>= 60% and ECOG =\< 2.
* Signed informed consent.

Exclusion Criteria

* Clinical or psychological contraindications to fly (if 18F-FMISO-PET is realized in Madrid) or to SCS-placement (only for this subset).
* Pregnant or breastfeeding women and women of fertile age who are not using a safe contraceptive method or do not intend to use one during the trial. Safe contraceptive methods are oral or parenteral contraceptive treatments or barrier methods: masculine or feminine condom, diaphragm and/or intrauterine device (IUD) or withdrawal over the course of the study.
* Serious co-existing or concurrent illness, including any of the following: uncontrolled or severe infection, heart, liver or kidney disease
* Lung thromboembolism.
* Another malignancy in the last 5 years other than basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix.
* Patients with life expectancy \<3 months.
* Patients with any of the following: creatinine \> 2 mg/dl, neutrophils \<1.5 \* 10\^9/L, platelets \<100 \* 10\^9/L or hemoglobin \<8.5 g/dL.
* Contraindications to receive radiotherapy or chemotherapy Clinical or psychological contraindications for placement of spinal cord stimulation devices (only for that specific subset of patients).
* Patients who are unable or unwilling to meet the protocol study.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto Tecnologico Servicios Sanitarios, in MD Anderson Cancer Center, Madrid

UNKNOWN

Sponsor Role collaborator

Instituto de Salud Carlos III

OTHER_GOV

Sponsor Role collaborator

Grupo de Investigación Clínica en Oncología Radioterapia

OTHER

Sponsor Role collaborator

Instituto Canario de Investigación del Cáncer

OTHER

Sponsor Role collaborator

RSbiomed

UNKNOWN

Sponsor Role collaborator

Fundación DISA, Canary Islands, Spain

UNKNOWN

Sponsor Role collaborator

Bernardino Clavo, MD, PhD

OTHER

Sponsor Role lead

Responsible Party

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Bernardino Clavo, MD, PhD

Radiation Oncologist, MD, PhD

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Bernardino Clavo, MD, PhD

Role: STUDY_CHAIR

Dr. Negrin University Hospital, Las Palmas

Bernardino Clavo, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Dr. Negrin University Hospital, Las Palmas

Francisco Robaina, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Dr. Negrin University Hospital, Las Palmas

Juan C Alonso, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Instituto Tecnologico Servicios Sanitarios, in MD Anderson Cancer Center, Madrid

Locations

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Dr. Negrin University Hospital

Las Palmas, , Spain

Site Status

Instituto Tecnologico Servicios Sanitarios, in MD Anderson Cancer Center, Madrid

Madrid, , Spain

Site Status

Countries

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Spain

References

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Clavo B, Robaina F, Morera J, Ruiz-Egea E, Perez JL, Macias D, Carames MA, Catala L, Hernandez MA, Gunderoth M. Increase of brain tumor oxygenation during cervical spinal cord stimulation. Report of three cases. J Neurosurg. 2002 Jan;96(1 Suppl):94-100. doi: 10.3171/spi.2002.96.1.0094.

Reference Type BACKGROUND
PMID: 11795721 (View on PubMed)

Clavo B, Robaina F, Catala L, Valcarcel B, Morera J, Carames MA, Ruiz-Egea E, Panero F, Lloret M, Hernandez MA. Increased locoregional blood flow in brain tumors after cervical spinal cord stimulation. J Neurosurg. 2003 Jun;98(6):1263-70. doi: 10.3171/jns.2003.98.6.1263.

Reference Type BACKGROUND
PMID: 12816274 (View on PubMed)

Clavo B, Robaina F, Catala L, Perez JL, Lloret M, Carames MA, Morera J, Lopez L, Suarez G, Macias D, Rivero J, Hernandez MA. Effect of cervical spinal cord stimulation on regional blood flow and oxygenation in advanced head and neck tumours. Ann Oncol. 2004 May;15(5):802-7. doi: 10.1093/annonc/mdh189.

Reference Type BACKGROUND
PMID: 15111351 (View on PubMed)

Clavo B, Robaina F, Montz R, Domper M, Carames MA, Morera J, Pinar B, Hernandez MA, Santullano V, Carreras JL. Modification of glucose metabolism in brain tumors by using cervical spinal cord stimulation. J Neurosurg. 2006 Apr;104(4):537-41. doi: 10.3171/jns.2006.104.4.537.

Reference Type BACKGROUND
PMID: 16619657 (View on PubMed)

Robaina F, Clavo B, Catala L, Carames MA, Morera J. Blood flow increase by cervical spinal cord stimulation in middle cerebral and common carotid arteries. Neuromodulation. 2004 Jan;7(1):26-31. doi: 10.1111/j.1525-1403.2004.04003.x.

Reference Type BACKGROUND
PMID: 22151123 (View on PubMed)

Clavo B, Robaina F, Montz R, Carames MA, Otermin E, Carreras JL. Effect of cervical spinal cord stimulation on cerebral glucose metabolism. Neurol Res. 2008 Jul;30(6):652-4. doi: 10.1179/174313208X305373. Epub 2008 May 29.

Reference Type BACKGROUND
PMID: 18513465 (View on PubMed)

Clavo B, Robaina F, Montz R, Carames MA, Lloret M, Ponce P, Hernandez MA, Carreras JL. Modification of glucose metabolism in radiation-induced brain injury areas using cervical spinal cord stimulation. Acta Neurochir (Wien). 2009 Nov;151(11):1419-25. doi: 10.1007/s00701-009-0400-8. Epub 2009 Jun 5.

Reference Type BACKGROUND
PMID: 19499176 (View on PubMed)

Clavo B, Robaina F, Valcarcel B, Catala L, Perez JL, Cabezon A, Jorge IJ, Fiuza D, Hernandez MA, Jover R, Carreras JL. Modification of loco-regional microenvironment in brain tumors by spinal cord stimulation. Implications for radio-chemotherapy. J Neurooncol. 2012 Jan;106(1):177-84. doi: 10.1007/s11060-011-0660-z. Epub 2011 Jul 12.

Reference Type BACKGROUND
PMID: 21748490 (View on PubMed)

Overgaard J. Hypoxic radiosensitization: adored and ignored. J Clin Oncol. 2007 Sep 10;25(26):4066-74. doi: 10.1200/JCO.2007.12.7878.

Reference Type BACKGROUND
PMID: 17827455 (View on PubMed)

Spence AM, Muzi M, Swanson KR, O'Sullivan F, Rockhill JK, Rajendran JG, Adamsen TC, Link JM, Swanson PE, Yagle KJ, Rostomily RC, Silbergeld DL, Krohn KA. Regional hypoxia in glioblastoma multiforme quantified with [18F]fluoromisonidazole positron emission tomography before radiotherapy: correlation with time to progression and survival. Clin Cancer Res. 2008 May 1;14(9):2623-30. doi: 10.1158/1078-0432.CCR-07-4995.

Reference Type BACKGROUND
PMID: 18451225 (View on PubMed)

Clavo B, Robaina F, Jorge IJ, Cabrera R, Ruiz-Egea E, Szolna A, Otermin E, Llontop P, Carames MA, Santana-Rodriguez N, Sminia P. Spinal cord stimulation as adjuvant during chemotherapy and reirradiation treatment of recurrent high-grade gliomas. Integr Cancer Ther. 2014 Nov;13(6):513-9. doi: 10.1177/1534735414550037. Epub 2014 Sep 15.

Reference Type BACKGROUND
PMID: 25228535 (View on PubMed)

Clavo B, Robaina F, Fiuza D, Ruiz A, Lloret M, Rey-Baltar D, Llontop P, Riveros A, Rivero J, Castaneda F, Quintero S, Santana-Rodriguez N. Predictive value of hypoxia in advanced head and neck cancer after treatment with hyperfractionated radio-chemotherapy and hypoxia modification. Clin Transl Oncol. 2017 Apr;19(4):419-424. doi: 10.1007/s12094-016-1541-x. Epub 2016 Aug 15.

Reference Type BACKGROUND
PMID: 27527617 (View on PubMed)

Other Identifiers

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2009-015852-11

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

PI 06/1413, PI 12/02940

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

TC-FMISO-PET-06-1413

Identifier Type: OTHER

Identifier Source: secondary_id

TC-FMISO-PET-06-1413

Identifier Type: -

Identifier Source: org_study_id

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