Nivolumab in Combination With Temozolomide and Radiotherapy in Children and Adolescents With Newly Diagnosed High-grade Glioma

NCT ID: NCT04267146

Last Updated: 2024-12-02

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/PHASE2

Total Enrollment

41 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-07-15

Study Completion Date

2024-11-26

Brief Summary

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Multicenter, open label, prospective study including successively a phase I trial and then a phase II trial Phase I : Open label, non-randomized, safety run study in nine patients. In case of safety issue a -1 dose level will be tested.

Phase II : Open label, non randomized, efficacy study of nivolumab in addition to radiotherapy and temozolomide. This phase will start when the RP2D has been defined after the last patients evaluable for DLT achieved the first 6 weeks of treatment (the radio-chemotherapy period) with a DLT rate below 30% during the the phase I study.

Detailed Description

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Conditions

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High Grade Glioma

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Multicenter, open label, prospective study including successively a phase I trial and then a phase II trial
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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newly diagnosed high-grade glioma

Phase I : Open label, non-randomized, safety run study in nine patients. In case of safety issue a -1 dose level will be tested.

Phase II : Open label, non randomized, efficacy study of nivolumab in addition to radiotherapy and temozolomide. This phase will start when the RP2D has been defined after the last patients evaluable for DLT achieved the first 6 weeks of treatment (the radio-chemotherapy period) with a DLT rate below 30% during the the phase I study.

Group Type EXPERIMENTAL

Nivolumab

Intervention Type DRUG

Solution for intravenous injection 10 mg/ml. Initial dose : 3 mg/kg Nivolumab will be given at 3 mg/kg/injection every two weeks from the first day of radiotherapy to the last day of chemotherapy.

One de-escalation dose : 1 mg/kg

Temozolomide

Intervention Type DRUG

Capsules: 5, 20, 100, 140, 180 and 250 mg orally. Temozolomide will be given at 75mg/m2/day from the day of start of radiotherapy to the last day of radiotherapy, then, after one month rest at 200mg/m2/day for five consecutive days for 12 cycles (28 days cycle).

Radiotherapy

Intervention Type RADIATION

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

Interventions

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Nivolumab

Solution for intravenous injection 10 mg/ml. Initial dose : 3 mg/kg Nivolumab will be given at 3 mg/kg/injection every two weeks from the first day of radiotherapy to the last day of chemotherapy.

One de-escalation dose : 1 mg/kg

Intervention Type DRUG

Temozolomide

Capsules: 5, 20, 100, 140, 180 and 250 mg orally. Temozolomide will be given at 75mg/m2/day from the day of start of radiotherapy to the last day of radiotherapy, then, after one month rest at 200mg/m2/day for five consecutive days for 12 cycles (28 days cycle).

Intervention Type DRUG

Radiotherapy

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

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

1. Written informed consent from parents/legal representative, patient, and age-appropriate assent before any study-specific screening procedures are conducted according to local, regional or national guidelines
2. Age at inclusion: \>/= 3 to \<18 years of age
3. Patients should be able and willing to comply with study visits and procedures as per protocol.
4. Patients must be affiliated to a social security system or beneficiary of the same according to local requirements
5. Sexually active females of childbearing potential must have a negative serum pregnancy test within 24 hours prior to initiation of treatment. Sexually active women of childbearing potential must agree to use acceptable and appropriate contraception during the study and for at least 5 months after the last study treatment administration. Sexually active males patients (and their female partner) must agree to use condom during the study and for at least 7 months after the last study treatment administration.
6. Newly diagnosed non-brainstem WHO grade III and IV HGG and neuroglial tumors; gliomatosis cerebri or diffuse glioma, metastatic malignant glial tumors, multifocal gliomas and bithalamic gliomas are eligible for the study. Diffuse midline gliomas with H3K27M mutation are not eligible. Anaplastic ganglioglioma and anaplastic pleomorphic astrocytoma will be eligible.
7. Local histological diagnosis after either stereotactic biopsy or surgical procedure has been confirmed centrally by a designated reference pathologist.
8. Able to commence trial treatment within 6 weeks following the last major surgery.
9. Adequate Bone Marrow Function : Hemoglobin \>/= 10 g/dL (transfusion independent), Neutrophil count \>/= 1.0 x 10\^9/L.

Platelet count \>/= 1.0 x 10\^9/L (transfusion independent)
10. Absence of Coagulation Disorder
11. Adequate Liver Function : AST \</= 2.5x institutional ULN for age, ALT \</= 2.5x institutional ULN for age, Total Bilirubin \</= 1.5x institutional ULN for age
12. Adequate Renal Function : Serum creatinine must be \</= 1.5x ULN for age, absence of clinically significant proteinuria as defined by a screening early morning urine (first sample) dipstick urinalysis of \</= 2

Exclusion Criteria

1. Any disease or condition that contraindicates the use of the study medication/treatment (for TMZ, see the approved product labelling) or places the patient at an unacceptable risk of experiencing treatment related complications.
2. Patients should not be on high-dose steroids (ie \> 1mg/kg) before study entry; doses should be stable for at least two weeks or decreasing.
3. Low probability of protocol compliance.
4. Radiological evidence of surgically related intracranial bleeding (excluding asymptomatic, resolving hemorrhagic changes associated with recent surgery and the presence of punctuate hemorrhage in the tumor).
5. Subjects with concommitant second malignancies are excluded unless a complete remission is achieved as it is empirically determined based on the malignancy and treatment provided prior to study entry and no additional therapy is required or anticipated to be required during the study period.
6. Previous cranial irradiation.
7. Any known auto-immune disease, previous or ongoing.
8. Known chronic inflammatory digestive disease, previous or ongoing.
9. Chronic asthma receiving corticotherapy, even only with inhalation.
10. Vaccinated with live attenuated vaccines within 4 weeks of the first dose of study drug
11. Pregnant or breastfeeding women
12. Known hypersensitivity to any component of the products (study drug or ingredients)
13. Clinically significant, uncontrolled heart disease (including history of any cardiac arrhythmias, e.g., ventricular, supraventricular, nodal arrhythmias, or conduction abnormality within 12 months of screening).
14. Patients who are currently receiving another investigational drug or anticancer agent
15. Patient who have an uncontrolled infection
16. Patient with known human immunodeficiency virus (HIV) / AIDS infection or acute / chronic Hepatitis B or C
Minimum Eligible Age

3 Years

Maximum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Gustave Roussy, Cancer Campus, Grand Paris

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Gustave Roussy

Villejuif, Val De Marne, France

Site Status

CHU Angers

Angers, , France

Site Status

Centre Oscar Lambret

Lille, , France

Site Status

Centre Léon Bérard

Lyon, , France

Site Status

Institut Curie

Paris, , France

Site Status

CHU Hautepierre

Strasbourg, , France

Site Status

Hôpital des enfants

Toulouse, , France

Site Status

Countries

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France

Other Identifiers

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2019/2797

Identifier Type: OTHER

Identifier Source: secondary_id

2018-002688-24

Identifier Type: -

Identifier Source: org_study_id