The RECSUR-study: Resection Versus Best Oncological Treatment for Recurrent Glioblastoma (ENCRAM 2302)

NCT ID: NCT06283927

Last Updated: 2024-02-28

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

RECRUITING

Total Enrollment

464 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-01-01

Study Completion Date

2028-01-01

Brief Summary

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Previous evidence has indicated that resection for recurrent glioblastoma might benefit the prognosis of these patients in terms of overall survival. However, the demonstrated safety profile of this approach is contradictory in the literature and the specific benefits in distinct clinical and molecular patient subgroups remains ill-defined. The aim of this study, therefore, is to compare the effects of resection and best oncological treatment for recurrent glioblastoma as a whole and in clinically important subgroups.

This study is an international, multicenter, prospective observational cohort study. Recurrent glioblastoma patients will undergo tumor resection or best oncological treatment at a 1:1 ratio as decided by the tumor board. Primary endpoints are: 1) proportion of patients with NIHSS (National Institute of Health Stroke Scale) deterioration at 6 weeks after surgery and 2) overall survival. Secondary endpoints are: 1) progression-free survival (PFS), 2) NIHSS deterioration at 3 months and 6 months after surgery, 3) health-related quality of life (HRQoL) at 6 weeks, 3 months, and 6 months after surgery, and 4) frequency and severity of Serious Adverse Events (SAEs) in each arm. Estimated total duration of the study is 5 years. Patient inclusion is 4 years, follow-up is 1 year.

The study has been approved by the Medical Ethics Committee (METC Zuid-West Holland/Erasmus Medical Center; MEC-2020-0812). The results will be published in peer-reviewed academic journals and disseminated to patient organisations and media.

Detailed Description

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This is an international, multicenter, prospective, cohort study. Eligible patients are operated or receive best oncological treatment with a 1:1 ratio with a sequential computer-generated random number as subject ID. Intraoperative mapping techniques and/or surgical adjuncts can be used in both treatment arms to ensure the safety of the resection (to minimize the risk of postoperative deficits).

Study patients undergo tumor re-resection or receive best oncological treatment and will undergo evaluation at presentation (baseline) and during the follow-up period at 6 weeks, 3 months, and 6 months postoperatively. Motor function will be evaluated using the NIHSS (National Institute of Health Stroke Scale) and MRC (Medical Research Council) scale. Language function will be evaluated using a standard neurolinguistic test-battery consisting of the Aphasia Bedside Check (ABC), Shortened Token test, Verbal fluency, Picture description and Object naming. This neurolinguistic test-battery is the result of a consensus between the participating centers. Cognitive function will be assessed using the Montreal Cognitive Assessment (MOCA). Overall patient functioning with be assessed with the Karnofsky Performance Scale (KPS) and the ASA (American Society of Anesthesiologists) physical status classification system for comorbidities. Health-related quality of life (HRQoL) will be assessed with the EQ-5D questionnaire and the EORTC QLQ-C30 and EORTC QLQ-BN20 questionnaires. Overall survival and progression-free survival will be assessed. We expect to complete patient inclusion in 4 years. The estimated duration of the study, including follow-up, will be 5 years.

The primary study objective is to evaluate the safety and efficacy of re-resection versus best oncological treatment (neurological morbidity and overall survival) in recurrent glioblastoma patients as expressed by NIHSS scores and survival data. Secondary study objectives are to study the overall progressive-free survival (PFS), long-term neurological morbidity (3 months and 6 months postoperatively), health-related quality of life (HRQoL), and Serious Adverse Events (SAEs) after resection versus best oncological treatment as expressed by progression on follow up MRI scans based on the RANO criteria24 for tumor progression; NIHSS scores, quality of life questionnaires (EORTC QLQ C30, EORTC QLQ BN20, EQ-5D), and registration of SAEs.

Patients will be recruited for the study from the neurosurgical or neurological outpatient clinic or through referral from general hospitals of the participating neurosurgical hospitals of the ENCRAM Research Consortium, located in Europe and the United States.

Conditions

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Glioblastoma Glioblastoma Multiforme Glioblastoma, IDH-wildtype Glioblastoma Multiforme of Brain Glioblastoma Multiforme, Adult Recurrent Glioblastoma Astrocytoma, Malignant Astrocytoma of Brain

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Re-resection

Resection of the recurrent tumor

Re-resection

Intervention Type PROCEDURE

Resection of the recurrent tumor

Best oncological treatment

Best oncological treatment consisting of re-challenge temozolomide, re-irradiation, experimental therapy, or best supportive care

Temozolomide

Intervention Type DRUG

Re-challenge Temozolomide chemotherapy

Lomustine

Intervention Type DRUG

Second line chemotherapy with Lomustine

Re-irradiation

Intervention Type RADIATION

Re-irradiation with single dose, fractionated, or hypofractionated radiation of the recurrent tumor

Experimental therapy

Intervention Type PROCEDURE

Experimental phase I therapy with oncolytic virotherapy or immunotherapy (this list is not exhaustive)

Best supportive care

Intervention Type OTHER

Best supportive care, focused on alleviating symptoms

Interventions

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Re-resection

Resection of the recurrent tumor

Intervention Type PROCEDURE

Temozolomide

Re-challenge Temozolomide chemotherapy

Intervention Type DRUG

Lomustine

Second line chemotherapy with Lomustine

Intervention Type DRUG

Re-irradiation

Re-irradiation with single dose, fractionated, or hypofractionated radiation of the recurrent tumor

Intervention Type RADIATION

Experimental therapy

Experimental phase I therapy with oncolytic virotherapy or immunotherapy (this list is not exhaustive)

Intervention Type PROCEDURE

Best supportive care

Best supportive care, focused on alleviating symptoms

Intervention Type OTHER

Other Intervention Names

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Immunotherapy Oncolytic virotherapy

Eligibility Criteria

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Inclusion Criteria

1. Age ≥18 years and ≤90 years
2. Tumor recurrence according to the RANO criteria of a previously diagnosed glioblastoma based on the WHO 2021 classification for glioma
3. The tumor is suitable for resection (according to neurosurgeon)
4. Written informed consent

Exclusion Criteria

1. Tumors of the cerebellum, brainstem, or midline
2. Medical reasons precluding MRI (e.g., pacemaker)
3. Inability to give written informed consent
4. Secondary high-grade glioma due to malignant transformation from low-grade glioma
5. Clinical data unavailable for the newly diagnosed setting
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Haaglanden Medical Centre

OTHER

Sponsor Role collaborator

Universitaire Ziekenhuizen KU Leuven

OTHER

Sponsor Role collaborator

University Hospital Heidelberg

OTHER

Sponsor Role collaborator

Technical University of Munich

OTHER

Sponsor Role collaborator

Insel Gruppe AG, University Hospital Bern

OTHER

Sponsor Role collaborator

Massachusetts General Hospital

OTHER

Sponsor Role collaborator

University of California, San Francisco

OTHER

Sponsor Role collaborator

Jasper Gerritsen

OTHER

Sponsor Role lead

Responsible Party

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Jasper Gerritsen

Dr.

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Jasper Gerritsen, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Erasmus Medical Center

Locations

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University of California, San Francisco

San Francisco, California, United States

Site Status RECRUITING

Massachusetts General Hospital

Boston, Massachusetts, United States

Site Status RECRUITING

University Hospital Leuven

Leuven, , Belgium

Site Status RECRUITING

University Hospital Heidelberg

Heidelberg, , Germany

Site Status RECRUITING

Technical University Munich

Munich, , Germany

Site Status NOT_YET_RECRUITING

Erasmus MC

Rotterdam, South Holland, Netherlands

Site Status RECRUITING

Medical Center Haaglanden

The Hague, South Holland, Netherlands

Site Status RECRUITING

Inselspital Universitätsspital Bern

Bern, , Switzerland

Site Status NOT_YET_RECRUITING

Countries

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United States Belgium Germany Netherlands Switzerland

Central Contacts

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Jasper Gerritsen, MD PhD

Role: CONTACT

31107036130

Arnaud Vincent, MD PhD

Role: CONTACT

31107034211

Facility Contacts

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Mitchel Berger, MD PhD

Role: primary

Brian Nahed, MD PhD

Role: primary

Steven De Vleeschouwer, MD PhD

Role: primary

Christine Jungk, Dr. med.

Role: primary

Arthur Wagner, MD

Role: primary

Arnaud Vincent, MD PhD

Role: primary

+31639428949

Jasper Gerritsen, MD

Role: backup

+31629119553

Marike Broekman, MD PhD

Role: primary

+31639758253

Philippe Schucht, MD PhD

Role: primary

Other Identifiers

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MEC-2020-0812-5

Identifier Type: -

Identifier Source: org_study_id

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