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Trial record 1 of 1 for:    NCT02414165
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The Toca 5 Trial: Toca 511 & Toca FC Versus Standard of Care in Patients With Recurrent High Grade Glioma (Toca5)

This study is currently recruiting participants.
Verified November 2017 by Tocagen Inc.
Sponsor:
ClinicalTrials.gov Identifier:
NCT02414165
First Posted: April 10, 2015
Last Update Posted: November 23, 2017
The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
Information provided by (Responsible Party):
Tocagen Inc.
  Purpose

This is a multicenter, randomized, open-label phase 2/3 study of Toca 511 and Toca FC versus standard of care that comprises Investigator's choice of single agent chemotherapy (lomustine or temozolomide) or bevacizumab administered to subjects undergoing resection for first or second recurrence (including this recurrence) of GBM or AA. Subjects meeting all of the inclusion and none of the exclusion criteria will be randomized prior to surgery in a 1:1 ratio to receive either Toca 511 and Toca FC (Experimental arm, Arm T) or control treatment with one option of standard of care (Arm SOC). Stratification will be done by IDH1 mutation status. A second stratification factor is based on the patient's Karnofsky Performance Score (KPS) (70-80 vs 90-100). Further, to account for potential differences in treatment choices for the control arm in regions, the trial will be stratified by geographical region during the randomization process.

Funding Source - FDA OOPD


Condition Intervention Phase
Glioblastoma Multiforme Anaplastic Astrocytoma Biological: Toca 511 Drug: Toca FC Drug: Lomustine Drug: Temozolomide Biological: Bevacizumab Phase 2 Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 2/3 Randomized, Open-Label Study of Toca 511, a Retroviral Replicating Vector, Combined With Toca FC Versus Standard of Care in Subjects Undergoing Planned Resection for Recurrent Glioblastoma or Anaplastic Astrocytoma

Resource links provided by NLM:


Further study details as provided by Tocagen Inc.:

Primary Outcome Measures:
  • To compare the overall survival (OS) of subjects treated with Toca 511 combined with Toca FC to subjects treated according to standard of care after tumor resection for recurrence of glioblastoma or anaplastic astrocytoma [ Time Frame: 30 December 2019 ]
    Time from randomization date to death due to any cause


Secondary Outcome Measures:
  • Durable Response Rate (CR or PR ≥ 24 weeks) [ Time Frame: 30 December 2019 ]
    The proportion of patients whose best response is either CR or PR lasting at least 24 weeks, according to modified RANO criteria

  • Durable Clinical Benefit Rate (CR or PR ≥ 24 weeks or SD ≥ 18 months) [ Time Frame: 30 December 2019 ]
    The proportion of subjects whose best overall response is either CR or PR lasting at least 24 weeks, or stable disease (SD) lasting at least 18 months, according to modified RANO criteria

  • Duration of Durable Response [ Time Frame: 30 December 2019 ]
    Time from documentation of durable response to disease progression or death due to disease progression

  • Overall Survival at 12 months [ Time Frame: 30 December 2019 ]
    Time from randomization date to death due to any cause


Estimated Enrollment: 380
Study Start Date: November 2015
Estimated Study Completion Date: March 2023
Estimated Primary Completion Date: December 2019 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Toca 511/Toca FC

Resection followed by administration of 4 mL Toca 511 (vocimagene amiretrorepvec). Toca 511 is administered by injection into the wall of the subject's tumor resection cavity on Day 1 (approximately 40 injections of 0.1 mL)

Toca FC is an extended-release formulation of flucytosine. Toca FC will be administered at 220 mg/kg/day orally for 7-day courses beginning at least 6 weeks after resection and repeated approximately every 6 weeks.

Biological: Toca 511
Toca 511 consists of a purified retroviral replicating vector encoding a modified yeast cytosine deaminase (CD) gene. The CD gene converts the antifungal 5-flurocytosine (5FC) to the anticancer drug 5-FU in cells that have been infected by the Toca 511 vector.
Other Names:
  • vocimagene amiretrorepvec
  • RRV
  • retroviral replicating vector
Drug: Toca FC
Toca FC is an extended-release formulation of flucytosine and is supplied as 500 mg tablets
Other Names:
  • flucytosine
  • 5-FC
  • 5-fluorocytosine
Active Comparator: Lomustine, Temozolomide, or Bevacizumab

Investigator selects one of the following:

Bevacizumab: Beginning 6 weeks after tumor resection, bevacizumab will be administered by IV infusion at 10 mg/kg and repeated every 2 weeks. Refer to the prescribing information and to institutional guidelines for details on the administration procedure.

Lomustine: Beginning 6 weeks after tumor resection, lomustine will be administered as a single oral dose of 110 mg/m2 and repeated every 6 weeks. Refer to the prescribing information and to institutional guidelines for details regarding the administration procedure.

Temozolomide: Beginning 6 weeks after tumor resection, temozolomide will be administered per 1 of 2 options:

  • at a dose of 50 mg/m2 PO once daily continuously, or
  • at an initial dose of 150 mg/m2 IV or PO once daily for 5 consecutive days per 28-day treatment cycle that may be raised to 200 mg/ m2 once daily for 5 consecutive days in the following 28-day treatment cycles
Drug: Lomustine
Other Names:
  • CCNU
  • CeeNU
Drug: Temozolomide
Other Name: Temodar
Biological: Bevacizumab
Other Name: Avastin

  Eligibility

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Ages Eligible for Study:   18 Years to 75 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Subject has given written informed consent
  2. Subject is between 18 years old and 75 years old, inclusive
  3. Subjects must have histologically proven GBM or AA and:

    1. Must have received first-line multimodal therapy with surgery followed by temozolomide (unless MGMT promoter unmethylated) and radiation (subjects with GBM must have received temozolomide and radiation concurrently)
    2. Must be in first or second recurrence (including this recurrence)
    3. Recurrence must be confirmed by diagnostic biopsy with local pathology review or contrast-enhanced MRI. If first recurrence of GBM is documented by MRI, an interval of at least 12 weeks after the end of prior radiation therapy is required unless there is either: i) histopathologic confirmation of recurrent tumor, or ii) new enhancement on MRI outside of the radiotherapy treatment field
  4. Subjects must have measurable disease preoperatively, defined as at least 1 contrast-enhancing lesion, with 2 perpendicular measurements of at least 1 cm, as per RANO criteria
  5. Subjects must be at least 4 weeks post last dose of temozolomide
  6. Prior gamma knife, stereotactic radiosurgery, or other focal high-dose radiotherapy is allowed but the subject must have either histopathologic confirmation of recurrent tumor, or new enhancement on MRI outside of the radiotherapy treatment field
  7. Based on the pre-operative evaluation by neurosurgeon, the subject is a candidate for ≥ 80% resection of enhancing region
  8. IDH mutation status of the primary tumor must be available or tumor samples must be available for pre randomization testing
  9. Laboratory values adequate for patient to undergo surgery, including:

    • Platelet count ≥ 60,000/mm3
    • Hgb ≥ 10 g/dL
    • Absolute neutrophil count (ANC) ≥ 1,500/mm3
    • Absolute lymphocyte count (ALC) ≥ 500/mm3
    • Adequate liver function, including:

      • Total bilirubin ≤ 1.5 x ULN (unless has Gilbert's syndrome)
      • ALT ≤ 2.5 x ULN f. Estimated glomerular filtration rate of at least 50 mL/min by the Cockcroft Gault formula
  10. Women of childbearing potential (≥12 months of non-therapy-induced amenorrhea or surgically sterile) must have had a negative serum pregnancy test within the past 21 days and must use a birth control method in addition to barrier methods (condoms).
  11. Subject or subject's partner is willing to use condoms for 12 months after receiving Toca 511 or until there is no evidence of the virus in his/her blood, whichever is longer.
  12. The subject has a KPS ≥ 70
  13. The subject is willing and able to abide by the protocol

Exclusion Criteria:

  1. History of more than 2 prior recurrences (including this recurrence) of GBM or AA
  2. History of other malignancy, unless the patient has been disease free for at least 5 years. Adequately treated basal cell carcinoma or squamous cell skin cancer is acceptable regardless of time, as well as localized prostate carcinoma or cervical carcinoma in situ after curative treatment
  3. Histologically confirmed oligodendroglioma or mixed glioma
  4. Known 1p/19q co deletion
  5. A contrast enhancing brain tumor that is any of the following:

    • Multi focal (defined as 2 separate areas of contrast enhancement measuring at least 1 cm in 2 planes that are not contiguous on either fluid attenuated inversion recovery (FLAIR) or T2 sequences);
    • Associated with either diffuse subependymal or leptomeningeal dissemination; or
    • > 5 cm in any dimension
  6. The subject has or had any active infection requiring systemic antibiotic, antifungal or antiviral therapy within the past 4 weeks
  7. The subject has any bleeding diathesis, or must take anticoagulants, or antiplatelet agents, including nonsteroidal anti inflammatory drugs (NSAIDs), at the time of the scheduled resection that cannot be stopped for surgery
  8. The subject is human immunodeficiency virus (HIV) positive
  9. The subject has a history of allergy or intolerance to flucytosine
  10. The subject has a gastrointestinal disease that would prevent him or her from being able to swallow or absorb flucytosine
  11. The subject received cytotoxic chemotherapy within the past 4 weeks (6 weeks for nitrosoureas) of the planned surgery date
  12. The subject received any investigational treatment within the past 30 days or prior immunotherapy or antibody therapy within the past 45 days.
  13. The subject is pregnant or breast feeding
  14. The subject intends to undergo treatment with the Gliadel® wafer at the time of this surgery or has received the Gliadel® wafer < 30 days from W1D1 (surgery)
  15. The subject has received bevacizumab for their disease unless in the context of primary therapy for newly diagnosed glioma
  16. For subjects planned to potentially receive bevacizumab, they have no evidence of uncontrolled hypertension (defined as a blood pressure of ≥ 150 mm Hg systolic and/or ≥ 100 mm Hg diastolic on medication) or active GI perforation
  17. The subject has received systemic dexamethasone continuously at a dose > 8 mg/day for 8 weeks prior to the date of the screening assessment
  18. Severe pulmonary, cardiac or other systemic disease, specifically:

    • New York Heart Association > Grade 2 congestive heart failure within 6 months prior to study entry, unless asymptomatic and well controlled with medication
    • Uncontrolled or significant cardiovascular disease, clinically significant ventricular arrhythmia (such as ventricular tachycardia, ventricular fibrillation, or Torsades des pointes), clinically significant pulmonary disease (such as ≥ Grade 2 dyspnea, according to CTCAE 4.03)
    • Subjects who have any other disease, either metabolic or psychological, which as per Investigator assessment may affect the subject's compliance or place the subject at higher risk of potential treatment complications
  Contacts and Locations
Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02414165


Contacts
Contact: Justine Walker, MD 858-412-8445 jwalker@tocagen.com
Contact: Mary Lovely, PhD, RN 858-412-8473 mlovely@tocagen.com

  Show 67 Study Locations
Sponsors and Collaborators
Tocagen Inc.
Investigators
Principal Investigator: Timothy Cloughesy, MD University of California, Los Angeles
  More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Tocagen Inc.
ClinicalTrials.gov Identifier: NCT02414165     History of Changes
Other Study ID Numbers: Tg 511-15-01
FD-R-5732 ( Other Grant/Funding Number: FDA OOPD )
First Submitted: April 3, 2015
First Posted: April 10, 2015
Last Update Posted: November 23, 2017
Last Verified: November 2017

Keywords provided by Tocagen Inc.:
Recurrence

Additional relevant MeSH terms:
Glioblastoma
Astrocytoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Bevacizumab
Temozolomide
Dacarbazine
Lomustine
Flucytosine
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors
Antineoplastic Agents
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antifungal Agents
Anti-Infective Agents
Antimetabolites