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A Study Comparing Two Carboplatin Containing Regimens for Children and Young Adults With Previously Untreated Low Grade Glioma

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ClinicalTrials.gov Identifier: NCT02455245
Recruitment Status : Recruiting
First Posted : May 27, 2015
Last Update Posted : March 26, 2018
Sponsor:
Information provided by (Responsible Party):
Natasha Pillay Smiley, Ann & Robert H Lurie Children's Hospital of Chicago

Brief Summary:
This study is trying to learn and understand if the chemotherapy drug called carboplatin works as well as the standard therapy. The standard therapy for Low Grade Glioma (LGG) in children and young adults is using a combination of carboplatin and vincristine. Studies in children have shown that the use of carboplatin alone has promise of being just as effective for treating LGG as standard therapy. Additionally, this study will try to understand if treatment with carboplatin alone is associated with an improved quality of life for LGG patients and their families.

Condition or disease Intervention/treatment Phase
Low Grade Glioma Drug: Carboplatin Drug: Vincristine Phase 3

Detailed Description:

Low grade gliomas are the most common central nervous system (CNS) tumors in the pediatric population. They consist of a heterogeneous group of tumors that are classified as World Health Organization (WHO) grade I or II. This includes astrocytic, oligodendroglial, neuronal and mixed glial- neuronal tumors. The clinical behavior of these tumors varies according to location and histology. The cerebellum is the most common location for low grade gliomas, but they can also arise in the cerebrum, deep midline structures such as the hypothalamus, optic pathway and, less frequently, in the brainstem.

Although the etiology of most childhood LGG is unknown, patients with Neurofibromatosis type 1 (NF-1) are one rare group predisposed to developing CNS tumors. NF-1 is an inherited disorder that affects the nervous system, eyes and skin. In addition, children are at an increased risk for developing optic pathway and hypothalamic low grade gliomas. Fifteen to-20% of NF-1 patients will develop these tumors, and they account for up to 70% of the tumors seen in this location. In half of patients with NF-1 and an optic pathway tumor, the patients are not symptomatic and the mass is found incidentally. Many optic gliomas in NF-1 patients follow an indolent course and stabilize without intervention. Patients are most commonly treated when there is deterioration in their vision or a symptomatic increase in the tumor size. Although the event free survival (EFS) has been reported to be similar between NF1 and non-NF1 patients, overall survival is higher in NF1 patients.

Location, as it affects the extent of surgical resection, plays a key role in the prognosis of all patients with low grade gliomas. Complete surgical resection offers a 90% survival rate at 10 years with often no need for adjuvant chemotherapy or radiation. Unfortunately, a gross total resection is not always possible due to the location of the tumor and its proximity to vital structures in the brain. In patients with an incomplete resection, the 10 year EFS is up to 74% with radiation treatment. However, toxicity from radiation, especially in young children, is significant and includes neurocognitive delays, endocrinopathies, secondary malignancy, ototoxicity and vasculopathy. Therefore, most experts agree that the standard of care in young children is to treat low grade gliomas that require adjuvant therapy after surgical resection/biopsy, or whose tumors are not surgically resectable with chemotherapy first, in order to delay or avoid radiation. This is especially true in children with NF-1, where the risk of a secondary malignancy after radiation therapy can be as high as 50% in the lifetime of the child.


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Study Type : Interventional
Estimated Enrollment : 160 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase III Study Comparing Two Carboplatin Containing Regimens for Children and Young Adults With Previously Untreated Low Grade Glioma
Study Start Date : March 2015
Estimated Primary Completion Date : April 2020
Estimated Study Completion Date : April 2021

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: Carboplatine and Vincristine

Induction: 10 weeks of Carboplatin and Vincristine therapy. Carboplatin 175 mg/m2 give an an IV infusion weeks 1, 2, 3, 4, 7, 8, 9, 10. Vincristine 1.5mg/m2 (0.05 mg/kg if child less than 12 kg) (maximum dose 2.0 mg) give as an IV bolus infusion on weeks 1, 2, 3, 4, 5, 6, 7, 8, 9, 10.

Maintenance: Maintenance consists of 8, 6-week cycles of chemotherapy. It begins week 12 of Induction or when peripheral counts recover with ANC >1,000/µL and platelet count >100,000/µL. Each cycle will consist of 4 weekly doses of carboplatin, three weekly doses of vincristine (given concomitantly with the first 3 weeks of carboplatin), followed by two weeks of rest for a total of 6 weeks. Maintenance will continue for a total of 8 cycles.

Carboplatin 175 mg/m2 as an IV continuous infusion over 60 minutes on Week 1, 2, 3, 4 of each cycle. Vincristine 1.5 mg/m2 (0.05 mg/ kg for children <12 kg) (maximum dose 2.0 mg) IV bolus infusion on Week 1, 2, 3 of each cycle.

Drug: Carboplatin
Drug: Vincristine
Experimental: Carboplatin alone

Carboplatin is given once every four weeks, Each 4-week period is considered a cycle. Regimen B will last for 13 cycles which is equivalent to one year (52 weeks).

Carboplatin 560 mg/m2 (or 19 mg/kg for children weighing less than 12 kg) IV over 1 hour every 4 weeks

Drug: Carboplatin



Primary Outcome Measures :
  1. Progression-free survival [ Time Frame: 3 years ]

Secondary Outcome Measures :
  1. Number of participants who experience improved quality of life as assessed by a Quality of Life questionnaire. [ Time Frame: week-6, week-12, month-6, month-12 ]
  2. Tumor response rate of each regimen, assessed by magnetic resonance imaging (MRI) [ Time Frame: 3 years ]
  3. Number of participants who experience toxicity on each regimen [ Time Frame: 3 years ]
  4. Number of B-Raf proto-oncogene, serine/threonine kinase (BRAF) mutations that have an association with clinical outcomes. [ Time Frame: 3 years ]
  5. Number of aberrations found through whole exome and ribonucleic acid (RNA) sequencing that coordinate with a clinical outcome. [ Time Frame: 3 years ]


Information from the National Library of Medicine

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Ages Eligible for Study:   up to 21 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Tumor Diagnosis: Low grade gliomas
  • Patients must be less than 21 years of age at study entry.
  • Central nervous system tumor. Patients with primary spinal cord lesions. Patients with metastatic disease are also allowed.
  • No previous therapy for the tumor with the exception of corticosteroids and surgery.
  • Performance status:Karnofsky Performance Scale (KPS for > 16 yrs of age) or Lansky Performance Score (LPS for ≤ 16 years of age) ≥ 50 assessed within two weeks prior to registration
  • Seizure disorder should be well controlled.
  • Normal organ and marrow function
  • Female patients of childbearing potential must not be pregnant or breast-feeding. Female patients who have menstruated and are of childbearing potential must have a negative serum or urine pregnancy test prior to enrollment.
  • Patients of childbearing or child fathering potential must be willing to use a medically acceptable form of birth control, which includes abstinence, while being treated on this study and for 6 months after the last drug administration.
  • Ability of subject or parent/guardian to understand and the willingness to sign a written informed consent/assent document. Informed consent/assent must be signed prior to registration on this study.
  • Tissue blocks or slides must be sent. If tissue is unavailable, the study chair must be notified prior to enrollment.

Exclusion Criteria:

  • Patients who are receiving any other investigational or chemotherapeutic agents will be excluded.
  • Patients with known inability to return for follow-up visits or obtain follow-up studies required to assess for toxicity to therapy.
  • Patients with Subepenydmal Giant Cell Astrocytomas are excluded. Patients with intrinsic brainstem tumors of the pons will be excluded from the study.
  • History of hypersensitivity reactions attributed to compounds of similar chemical or biologic composition to platinum based chemotherapy.
  • Patients with uncontrolled inter-current illness are excluded.
  • Females who are pregnant or breast feeding are excluded.

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): NCT02455245


Contacts
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Contact: Laura Kane 312.227.4860 lakane@luriechildrens.org
Contact: Kevin Ritt 312.227.4861 kritt@luriechildrens.org

Locations
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United States, Arizona
Phoenix Children's Hospital Recruiting
Phoenix, Arizona, United States, 85016
Contact: Amy Rosenfield, MD         
Contact: Courtney Hemphill    602.933.4649    Chemphill@phoenixchildrens.com   
United States, California
Rady Children's Hospital Not yet recruiting
San Diego, California, United States, 92123
Contact: John Crawford, MD         
Contact: Mehrzad Milburn, RN, BSN, CCRC    858.966.8155    mmilburn@rchsd.org   
United States, Connecticut
Yale University Recruiting
New Haven, Connecticut, United States, 06520
Contact: Asher M Marks, MD         
Contact: Jennifer Paquette, RN, BSN    203.785.5505    jennifer.paquette@yale.edu   
United States, Illinois
Ann & Robert H. Lurie Children's Hosptial of Chicago Recruiting
Chicago, Illinois, United States, 60611
Contact: Laura Kane    312-227-4860    lakane@luriechildrens.org   
Contact: Kevin Ritt    312.227.4861    kritt@luriechildrens.org   
United States, Indiana
St. Vincent Peyton Manning Children's Hospital Recruiting
Indianapolis, Indiana, United States, 46260
Contact: Jessica Goodman, MD         
Contact: Rachael Limbach, LPN    317.338.9825    Rachael.Limbach@stvincent.org   
United States, Maryland
The Johns Hopkins Hospital Recruiting
Baltimore, Maryland, United States, 21287
Contact: Ken Cohen, MD         
Contact: Tammy Scott, RN, OCN    410.614.5990    scottta@jhmi.edu   
United States, Massachusetts
Dana-Farber Cancer Institute Recruiting
Boston, Massachusetts, United States, 02115
Contact: Mark W Kieran, MD         
Contact: Lianne Greenspan    617.632.6740    Lianne_Greenspan@DFCI.HARVARD.EDU   
United States, Minnesota
Children's Hospitals and Clinics of Minnesota - Minneapolis Recruiting
Minneapolis, Minnesota, United States, 55404
Contact: Anne E Bendel, MD         
Contact: Michelle Allard    612.813.5913    Michelle.Allard@childrensmn.org   
United States, Ohio
Nationwide Children's Hospital Recruiting
Columbus, Ohio, United States, 43205
Contact: Diana S Osorio, MD         
Contact: Bridget Hoskins, CRA    614.722.3654    bridget.hoskins@nationwidechildrens.org   
United States, Wisconsin
American Family Children's Hospital Recruiting
Madison, Wisconsin, United States, 53792
Contact: Neha Patel, MD    608-263-6200      
Contact: Jenny Weiland, CCRP, MT    608.890.8070    jlweiland@pediatrics.wisc.edu   
Sponsors and Collaborators
Natasha Pillay Smiley
Investigators
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Principal Investigator: Natasha Pillay Smiley, DO Attending

Publications:

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Responsible Party: Natasha Pillay Smiley, Attending, Ann & Robert H Lurie Children's Hospital of Chicago
ClinicalTrials.gov Identifier: NCT02455245     History of Changes
Other Study ID Numbers: LGG 14C03
First Posted: May 27, 2015    Key Record Dates
Last Update Posted: March 26, 2018
Last Verified: March 2018
Additional relevant MeSH terms:
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Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Carboplatin
Vincristine
Antineoplastic Agents
Antineoplastic Agents, Phytogenic
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action