Improvement of Functional Outcome for Patients With Newly Diagnosed Grade 2 or 3 Glioma With Co-deletion of 1p/19q - IMPROVE CODEL: the NOA-18 Trial

Status: Recruiting
Location: See all (19) locations...
Intervention Type: Radiation, Drug
Study Type: Interventional
Study Phase: Phase 3
SUMMARY

Oligodendrogliomas in the novel edition of the Central Nervous System (CNS) World Health Organization (WHO) classification are now molecularly defined by isocitrate dehydrogenase (IDH)1 or IDH2 mutations and 1p/19q co-deletion. The prognosis of these molecularly defined tumors is to be determined in new series since survival data from older histology-based studies and population-based registries are confounded by the inclusion of 20-70% not molecularly matching subsets. Also, the optimal treatment is a matter of ongoing investigations. An extensive, but safe surgery is associated with improved outcome as is the addition of chemotherapy with procarbazine, CCNU (lomustine), and vincristine (PCV) to the partial brain radiotherapy (RT). However, the exact timing of postsurgical therapy especially for tumors of the WHO grade 2 and acknowledging some variability in grading as well as the choice of chemotherapy, temozolomide instead of PCV (CODEL: NCT00887146 randomizing CNS WHO grade 2 and 3 oligodendrogliomas to chemoradiation(CHRT)therapy with PCV or with temozolomide) or the need for primary radiotherapy RT are subjects of clinical studies (POLCA: NCT02444000 randomizing patients with newly diagnosed CNS WHO grade 3 oligodendrogliomas to standard CHRT with PCV or PCV alone). Given the young age of patients with CNS WHO grade 2 and 3 oligodendrogliomas and the relevant risk of neurocognitive, functional and quality-of-life impairment with the current aggressive standard of care treatment, chemoradiation with PCV, of the tumor located in the brain optimizing care is the major challenge. NOA-18/IMPROVE CODEL aims at improving qualified overall survival (qOS) for adult patients with CNS WHO grade 2 and 3 oligodendrogliomas by randomizing between standard chemoradiation with up to six six-weekly cycles with PCV and six six-weekly cycles with lomustine and temozolomide (CETEG), thereby delaying radiotherapy (RT) and adding the chemoradiotherapy (CHRT) concept at progression after initial radiation-free chemotherapy, allowing for an effective salvage treatment and delaying potentially deleterious side effects. QOS represents a new concept and is defined as OS without functional and/or cognitive and/or quality of life (QOL) deterioration regardless whether tumor progression or toxicity is the main cause.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• Histologically confirmed, newly diagnosed CNS WHO grade 2 or 3 glioma.

• Tumor carries an isocitrate dehydrogenase (IDH) mutation (determined by immunohistochemistry (IHC) and/or deoxyribonucleic acid (DNA) sequencing).

• Tumor is co-deleted for 1p/19q (determined by copy number variations, fluorescence in situ hybridization (FISH), multiplex ligation-dependent probe amplification (MLPA) or other appropriate methods).

• Biopsy (with sufficient tissue for molecular pathology) or resection.

• Age: ≥18 years.

• Karnofsky Performance status (KPI) ≥60%.

• Life expectancy \>6 months.

• Availability of formalin-fixed paraffin-embedded (FFPE) or fresh-frozen tissue and ethylenediamine tetraacetic acid (EDTA) blood for biomarker research.

• Standard magnetic resonance imaging (MRI) ≤ 72 h post-surgery according to the present national and international guidelines.

⁃ Craniotomy or intracranial biopsy site must be adequately healed.

⁃ ≥ 2 weeks and ≤ 3 months from surgery without any interim radio- or chemotherapy or experimental intervention.

⁃ Willing and able to comply with regular neurocognitive and health-related quality of life tests/questionnaires.

⁃ Indication for postsurgical cytostatic/-toxic therapy.

⁃ Written Informed consent.

⁃ Female patients with reproductive potential have a negative pregnancy test (serum or urine) within 6 days prior to start of therapy. Female patients are surgically sterile or agree to use adequate contraception during the period of therapy and 6 months after the end of study treatment, or women have been postmenopausal for at least 2 years.

⁃ Male patients are willing to use contraception

Locations
Other Locations
Germany
Charité, University Medicine Berlin, Neurosurgery
RECRUITING
Berlin
Knappschaftskrankenhaus Bochum GmbH, Neurology Clinic
RECRUITING
Bochum
University Hospital Bonn, Neurology Clinic
RECRUITING
Bonn
Chemnitz Hospital, Neurosurgery
RECRUITING
Chemnitz
University Hospital Cologne, Neurosurgery
RECRUITING
Cologne
University Hospital Duesseldorf, Neurooncology
RECRUITING
Düsseldorf
University Hospital Frankfurt, Neurooncology
RECRUITING
Frankfurt
University Hospital Göttingen, Neurosurgery
RECRUITING
Göttingen
University Hospital Heidelberg, Department of Neurooncology
RECRUITING
Heidelberg
University Hospital Saarland, Neurosurgery
RECRUITING
Homburg
University Hospital of Jena, Neurosurgery
RECRUITING
Jena
University Hospital Leipzig, Radiation Therapy
RECRUITING
Leipzig
University Hospital Mannheim, Neurology Clinic
RECRUITING
Mannheim
University Clinic Muehlenkreis, Minden
RECRUITING
Minden
University Hospital rechts der Isar, Radiation Oncology
RECRUITING
Munich
University Hospital Regensburg, Neurology Clinic
RECRUITING
Regensburg
Helios Hospital Schwerin, Neurosurgery
RECRUITING
Schwerin
University Hospital Tuebingen, Neurooncology
RECRUITING
Tübingen
University Hospital Wuerzburg, Neurosurgery
RECRUITING
Würzburg
Contact Information
Primary
Wolfgang Wick, Prof. Dr.
wolfgang.wick@med.uni-heidelberg.de
+49 6221 56
Backup
Antje Wick, PD Dr.
antje.wick@med.uni-heidelberg.de
+49 6221 56
Time Frame
Start Date: 2021-04-07
Estimated Completion Date: 2031-03-31
Participants
Target number of participants: 406
Treatments
Active_comparator: RT PCV
Radiotherapy (RT) for over approximately 5-6 weeks:~* at 50.4/54 Gy in 1.8 Gy fractions for grade 2 and~* at 59.4 Gy in 1.8 Gy fractions for grade 3 gliomas~PCV cycles are 6 weeks long and given as:~* Day 1: Lomustine (CCNU) at 110 mg/m2 body surface orally,~* Days 8/29: Vincristine 1.4 mg/m2 i.v. (capped at 2 mg),~* Days 8-21: Procarbazine 60 mg/m2 orally (capped at 100 mg).
Experimental: CETEG
Six 42-day cycles of lomustine plus temozolomide according to the commonly used regimen:~* Day 1: Lomustine (CCNU) at 100 mg/m2~* Days 2-6: Temozolomide at 100 mg/m2 (cycles 1) and in 50 mg/m2 steps to 200 mg/m2 from cycle 2 on dependent on hematological toxicity
Sponsors
Collaborators: Ruhr University of Bochum, Universitätsmedizin Mannheim
Leads: University Hospital Heidelberg

This content was sourced from clinicaltrials.gov

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