Radiotherapy Planning Using Fluciclovine PET in Patients With Newly Diagnosed Glioblastoma

NCT ID: NCT04840069

Last Updated: 2023-01-13

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: PHASE2
• Total Enrollment: 100 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-06-07
• Study Completion Date: 2024-03-30

Brief Summary

The purpose of the this study is to see if the use of a PET scan with 18F-fluciclovine (PET or Fluciclovine PET) in addition to the normal radiation planning imaging procedures (MRI and CT scan) will help determine the areas where the radiation therapy is to be delivered. It is also a goal of the study to determine if subjects live longer when treatment plans for radiation therapy are designed using a Fluciclovine PET scan, as well as MRI and CT scans. We will also collect information on if and where the tumor returns. Information on the side effects from the two different treatment planning imaging methods will also be collected. 18F-Fluciclovine is an FDA-approved radioactive diagnostic agent that is injected into the patient and then taken up by cancer cells, which can then be visualized with a PET/CT scan. 18F-Fluciclovine is FDA approved for the detection of recurrent prostate cancer, but is still investigational for the purposes of this study.

Detailed Description

The goal of this study is to see if the use of PET in planning radiotherapy can reduce these local failures.

Glioblastoma (GBM) is the most common primary malignant brain tumor. Newly diagnosed glioblastoma management includes maximum safe resection followed by radiotherapy with concurrent temozolomide, followed by maintenance temozolomide for 6 - 12 cycles. This postoperative chemoradiotherapy approach has resulted in a significant increase in median PFS (5.0 vs. 6.9 months) and OS (12.1 vs. 14.6 months) compared to radiotherapy alone (Stupp 2005). However, despite such multi-modality therapy, the median survival for GBM remains poor at approximately 15-16 months in contemporary series (Grossman, Ye et al. 2010, Gilbert, Wang et al. 2013 vs 2010).

Recently, a randomized trial of tumor-treating fields (TTF or Optune) plus temozolomide demonstrated the benefit of this treatment in newly diagnosed glioblastoma that led to FDA approval of the device (Stupp 2015, Stupp 2017). However despite these advances, most patients still have a poor prognosis with median survival of 16-21 months. Although adjuvant chemoradiotherapy has been shown to increase survival, a predominant pattern of failure remains local (Chan, Lee et al. 2002, Milano, Okunieff et al. 2010). Therefore, better therapeutic options are needed for this disease.

Conditions

Newly Diagnosed Glioblastoma

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

MRI-guided radiotherapy

Patients will undergo standard of care MRI-guided radiotherapy.

Group Type: NO_INTERVENTION

No interventions assigned to this group

MRI + Fluciclovine PET-guided radiotherapy

Patients will undergo MRI + Fluciclovine PET-guided radiotherapy

Group Type: EXPERIMENTAL

Fluciclovine PET guided Radiotherapy

Intervention Type: DRUG

PET+MRI Based There is no GTV\_5400. The GTV\_6000 will be defined as the surgical cavity inclusive of any remaining tumor enhancement and the hypermetabolic volume. CTV\_5400 will include the GTV\_6000 plus a margin of 1.0 cm which may be reduced around natural barriers to tumor growth such as the skull, ventricles, falx, etc. CTV\_5400 must also include the entirety of the GTV\_6000. There is no CTV\_6000. PTV\_5400 is the CTV\_5400 plus a geometric 3 mm expansion in all dimensions; PTV\_6000 is GTV\_6000 plus a geometric 3 mm expansion in all dimensions. PTV may extend beyond bony margins and the skin surface. The PTV\_5400 must contain the PTV\_6000. In the setting of multi-focal disease, the primary target volumes will be defined as above, but for satellite lesions, the GTV\_6000 will be defined as any tumor enhancement and hypermetabolic volume. There will be no CTV\_6000. PTV\_6000 will be defined as GTV\_6000 plus a geometric 3 mm expansion in all dimensions.

Interventions

Fluciclovine PET guided Radiotherapy

PET+MRI Based There is no GTV\_5400. The GTV\_6000 will be defined as the surgical cavity inclusive of any remaining tumor enhancement and the hypermetabolic volume. CTV\_5400 will include the GTV\_6000 plus a margin of 1.0 cm which may be reduced around natural barriers to tumor growth such as the skull, ventricles, falx, etc. CTV\_5400 must also include the entirety of the GTV\_6000. There is no CTV\_6000. PTV\_5400 is the CTV\_5400 plus a geometric 3 mm expansion in all dimensions; PTV\_6000 is GTV\_6000 plus a geometric 3 mm expansion in all dimensions. PTV may extend beyond bony margins and the skin surface. The PTV\_5400 must contain the PTV\_6000. In the setting of multi-focal disease, the primary target volumes will be defined as above, but for satellite lesions, the GTV\_6000 will be defined as any tumor enhancement and hypermetabolic volume. There will be no CTV\_6000. PTV\_6000 will be defined as GTV\_6000 plus a geometric 3 mm expansion in all dimensions.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Histological diagnosis of primary, newly diagnosed supratentorial, WHO grade IV glioma
• Greater than 18 years of age
• Karnofsky performance score greater than 70%
• Recovered from surgery and on a stable or tapering dose of corticosteroids
• Plan to undergo standard therapy with XRT 60Gy/30fx with TMZ followed by 6-12 cycles of maintenance TMZ within 6 weeks of surgery
• If woman of child bearing potential, negative serum pregnancy test. Patients must agree to take adequate pregnancy preventions for the length of the study.
• Life expectancy of at least 3 months
• Written study specific consent

Exclusion Criteria

• Previous treatment of glioma of any grade with bevacizumab or other molecular targeted therapies less than 6 months before MRI (and PET) used for radiotherapy planning
• Recurrent of multifocal malignant glioma
• Any sites of distant disease (for example drop metastases or leptomeningeal spread)
• Prior use of Gliadel wafers or any other intratumal or intracavity treatment
• Prior radiotherapy to the cranium, head and neck or other sites resulting in overlapping fields
• Molecular targeted therapies planned during radiotherapy
• Simultaneous participation in other interventional trials which could interfere with this trial or participation in a clinical trial within the last thirty days before patient's enrollment in current study.
• Inability to undergo an MRI or PET (Claustrophobia, non-MRI compatible pacemaker, known allergy to MRI contrast agent or fluciclovine tracer)
• Any pregnant or lactating patient
• Any prior malignancy within 3 years excluding carcinoma in-situ or early staged,localized basal or squamous cell skin cancers

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Barrow Neurological Foundation

OTHER

Sponsor Role: collaborator

Arizona Biomedical Research Commission (ABRC)

OTHER

Sponsor Role: collaborator

Blue Earth Diagnostics

INDUSTRY

Sponsor Role: collaborator

St. Joseph's Hospital and Medical Center, Phoenix

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

St. Joseph's Hospital and Medical Center

Phoenix, Arizona, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Phase 0 Navigator

Role: CONTACT

research@ivybraintumorcenter.org

602-406-8605

Facility Contacts

Phase 0 Navigator

Role: primary

research@ivybraintumorcenter.org

602-406-8605

Other Identifiers

090-20-16

Identifier Type: -

Identifier Source: org_study_id