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Optune Delivered Electric Field Therapy and Bevacizumab in Treating Patients With Recurrent or Progressive Grade 2 or 3 Meningioma

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ClinicalTrials.gov Identifier: NCT02847559
Recruitment Status : Recruiting
First Posted : July 28, 2016
Last Update Posted : September 20, 2019
Sponsor:
Collaborators:
NovoCure Ltd.
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Northwestern University

Brief Summary:
The purpose of this research study is to determine the effects bevacizumab (the study drug) combined with Optune (the study device) tumor treatment field therapy has on meningiomas. Bevacizumab is considered investigational because the US Food and Drug Administration (FDA) has not approved its use for the treatment of meningiomas. The study drug is a medication that blocks the growth of new blood vessels. It is thought that the study drug may interfere with the growth of new blood vessels and therefore might stop tumor growth, and possibly shrink the tumor by keeping it from receiving nutrients and oxygen supplied by the blood vessels. Optune is also considered investigational because the US FDA has not approved its use for the treatment of meningiomas. Optune is a device that the patient will wear and use for at least 18 hours of each day. It delivers alternating electrical current to the patient's brain tumor and by doing so interrupts a process called mitosis. Mitosis needs to occur in order for cell division to occur and allows tumors to grow. By slowing this process, we hypothesize that meningioma growth may also be slowed.

Condition or disease Intervention/treatment Phase
Anaplastic (Malignant) Meningioma Atypical Meningioma Grade II Meningioma Grade III Meningioma Recurrent Meningioma Supratentorial Meningioma Biological: Bevacizumab Procedure: Electric Field Therapy Device: NovoTTF-200A Device Procedure: Quality-of-Life Assessment Phase 2

Detailed Description:

PRIMARY OBJECTIVES:

I. To determine progression free survival (PFS) for 6 months (PFS-6) in patients with recurrent or progressive meningioma.

SECONDARY OBJECTIVES:

I. To determine overall survival (OS). II. To determine tumor response rate (TRR). III. To assess quality of life with treatment (QOL) using Functional Assessment of Cancer Therapy-Brain (FACT-Br) questionnaire.

OUTLINE:

Patients receive bevacizumab intravenously (IV) over 30-90 minutes on days 1 and 15 of courses 1-4. Beginning on day 1 of course 5, patients may choose to receive bevacizumab IV every 3 weeks or remain on the every 2-week schedule. Patients also undergo electric field therapy using Optune (formerly NovoTTF-200A System) daily over 18 hours. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for 2 years.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 27 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase 2, Single Arm, Multi-center, Open Label Trial Combining Optune With Concurrent Bevacizumab in the Setting of Recurrent or Progressive Meningioma
Study Start Date : August 2016
Estimated Primary Completion Date : September 2019
Estimated Study Completion Date : August 2020

Resource links provided by the National Library of Medicine

Drug Information available for: Bevacizumab

Arm Intervention/treatment
Experimental: Treatment (bevacizumab, electric field therapy)
Patients receive bevacizumab IV over 30-90 minutes on days 1 and 15 of courses 1-4. Beginning on day 1 of course 5, patients may choose to receive bevacizumab IV every 3 weeks or remain on the every 2-week schedule. Patients also undergo electric field therapy using Optune (formerly NovoTTF-200A System) daily over 18 hours. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
Biological: Bevacizumab
Given IV
Other Names:
  • Anti-VEGF
  • Anti-VEGF Humanized Monoclonal Antibody
  • Anti-VEGF rhuMAb
  • Avastin
  • Bevacizumab Biosimilar BEVZ92
  • Bevacizumab Biosimilar BI 695502
  • Immunoglobulin G1 (Human-Mouse Monoclonal rhuMab-VEGF Gamma-Chain Anti-Human Vascular Endothelial Growth Factor), Disulfide With Human-Mouse Monoclonal rhuMab-VEGF Light Chain, Dimer
  • Recombinant Humanized Anti-VEGF Monoclonal Antibody
  • rhuMab-VEGF

Procedure: Electric Field Therapy
Undergo electric field therapy using Optune device

Device: NovoTTF-200A Device
Undergo electric field therapy using Optune device
Other Names:
  • NovoTTF-200A
  • NovoTTF-200A System
  • NovoTTFields
  • NovoTumor Treatment Fields
  • Optune
  • Optune Device

Procedure: Quality-of-Life Assessment
Ancillary studies
Other Name: Quality of Life Assessment




Primary Outcome Measures :
  1. Progression Free Survival for 6 months (PFS-6) [ Time Frame: At 6 months ]
    Determine the efficacy of combination therapy of bevacizumab and Optune (TTF) as assessed by Progression Free Survival at 6 months


Secondary Outcome Measures :
  1. Overall Survival (OS) [ Time Frame: From time of registration to death, assessed up to 2 years ]
    OS will be defined from the time of registration to death and will be assessed for up to 2 years.

  2. Tumor Response Rate (TRR) [ Time Frame: At baseline and every eight weeks, assessed up to 12 months ]
    Imaging (MRI or CT scan) will assess radiographic response in terms of complete response, partial response, stable disease, and progressive disease. The iRANO criteria will be used for response assessment.

  3. Quality of Life (QOL) with treatment using FACT-Br questionnaire [ Time Frame: At baseline, on Day 1 of every cycle, and 1 month after the last dose of study drug ]
    To assess QOL with treatment the Functional Assessment of Cancer Therapy-Brain version 4.0 (FACT-Br) questionnaire will be administered.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must have a histologic diagnosis of meningioma, World Health Organization (WHO) grade 2 or 3 (atypical or anaplastic)
  • Patient's tumor must have a supratentorial component
  • Patients must have measurable or non-measurable (evaluable) disease recurrence; recurrence must be documented by magnetic resonance imaging (MRI) or computed tomography (CT) scan
  • All patients must have developed recurrent disease/progression (evidence of recurrence to be established by MRI or CT scan with contrast; there is no limit to the number of relapses) after receiving all standard treatments, which must include the following:

    • Surgical resection, if possible;
    • Definitive radiation therapy for unresectable meningioma, or for recurrent meningioma after resection (Note: At registration, patients must be at least 28 days post-surgery, and must be at least 28 days post-radiation therapy, with resolution of related cytotoxicities down to grade 2)
  • Patients may have had previous systemic treatment regimens with the exception of bevacizumab (no limit to number of prior therapies); a 4 week wash-out period prior to registration is mandatory for all systemic treatments
  • Life expectancy of at least 12 weeks
  • Karnofsky performance status >= 60%
  • Patients must have adequate bone marrow, kidney, and liver function, (within 14 days prior to registration), defined as:
  • Absolute neutrophil count (ANC) >= 1500/uL (with/without growth factor)
  • Hemoglobin (Hgb) >= 9 g/dL (with/without transfusion)
  • Platelets >= 100,000/L
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x institutional upper limit of normal (ULN)
  • Total bilirubin =< 1.5 x institutional ULN
  • Serum creatinine =< 1.5 x institutional ULN
  • Females of child-bearing potential (FOCBP) and males with partners of childbearing potential must agree to use adequate contraception prior to study entry and for the duration of study treatment; should a female patient become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately; likewise, if the female partner of a male patient becomes pregnant or suspect she is pregnant, he should inform his treating physician immediately

NOTE: A FOCBP is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:

  • Has not undergone a hysterectomy or bilateral oophorectomy
  • Has had menses at any time in the preceding 12 consecutive months (and therefore has not been naturally postmenopausal for > 12 months)

    • FOCBP must have a negative serum or urine pregnancy test within 14 days prior to registration on study
    • Patients must have the ability to understand and the willingness to sign a written informed consent prior to registration on study
    • Patients must be able to comply with all protocol requirements

Exclusion Criteria:

  • Patients who have had major surgery or significant traumatic injury within 4 weeks prior to registration, patients who have not recovered from the side effects of any major surgery (defined as requiring general anesthesia), or patients that may require major surgery during the course of the study
  • Patients who have had minor surgical procedures (with the exception of the placement of porta cath or other central venous access) within 7 days prior to registration
  • Patients with infratentorial disease and spinal disease
  • Patients may not be receiving any other investigational agents; (i.e. 28-day washout period from prior investigational drug is required)
  • Patients may not receive any other anti-cancer therapies, within 28 days prior to registration and throughout the duration of this trial
  • Previous treatment with bevacizumab
  • Patients who have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to bevacizumab are not eligible
  • Patients with active implanted medical device, a skull defect (such as, missing bone with no replacement), a shunt or bullet fragments; examples of active electronic devices include deep brain stimulators, spinal cord stimulators, vagus nerve stimulators, pacemakers, defibrillators, and programmable shunts
  • Patients with known sensitivity to conductive hydrogels like the gel used on electrocardiogram (ECG) stickers or transcutaneous electrical nerve stimulation (TENS) electrodes
  • Patients with proteinuria within 14 days of registration as demonstrated by either: urine protein creatinine (UPC) ratio >= 1.0 at screening OR urine dipstick for proteinuria 2+ (patients discovered to have 2+ proteinuria on dipstick urinalysis at baseline should undergo a 24-hour urine collection, and must demonstrate =< 1 g of protein/24 hours to be eligible)
  • Patients with a serious non-healing wound, active ulcer, or untreated bone fracture
  • Patients with evidence of bleeding diathesis or significant coagulopathy (in the absence of therapeutic anticoagulation)
  • Patients with history of hematemesis or hemoptysis (defined as having bright red blood of 1/2 teaspoon or more per episode) within 28 days prior to registration
  • History of myocardial infarction or unstable angina within 6 months of registration
  • Inadequately controlled hypertension (defined as systolic blood pressure > 150 mmHg and /or diastolic blood pressure > 100 mmHg)
  • History of stroke or transient ischemic attack within 6 months prior to registration
  • Any prior history of hypertensive crisis or hypertensive encephalopathy
  • History of abdominal fistula or gastrointestinal perforation within 6 months prior to registration
  • Chronic, systemic treatment with immunosuppressive agents; patients who require a stable dose of corticosteroids for control of cerebral edema are eligible; topical or inhaled steroids are also allowed
  • Patients who have any severe and/or uncontrolled intercurrent medical conditions including, but not limited to any of the following, are not eligible:

    • Ongoing or active wound infection requiring concurrent systemic antibiotic treatment; there is no mandatory duration of time that a patient has to be off antibiotics, but the treating physician has to deem the infection as effectively treated prior to enrollment
    • Symptomatic congestive heart failure
    • Unstable angina pectoris
    • Cardiac arrhythmia (New York Heart Association [NYHA] criteria)
    • Psychiatric illness/social situations that would limit compliance with study requirements, prevent patient comprehension of the nature of, and risk associated with, the study
    • Any other illness or condition that the treating investigator feels would interfere with study compliance or would compromise the patient's safety or study endpoints
  • Female patients who are pregnant or nursing are not eligible

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): NCT02847559


Contacts
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Contact: Study Coordinator (312)695-1301 cancertrials@northwestern.edu

Locations
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United States, California
John Wayne Cancer Center at Providence St. John's Health Center Recruiting
Santa Monica, California, United States, 90404
Contact: Santosh Kesari, MD, PhD    310-829-8265      
Principal Investigator: Santosh Kesari, MD, PhD         
Stanford Cancer Center Neuro-Oncology Clinic Not yet recruiting
Stanford, California, United States, 94305
Contact: Seema Nagpal, MD    650-498-6000    snagpal@stanford.edu   
Principal Investigator: Seema Nagpal, MD         
United States, Florida
Miami Cancer Institute Recruiting
Miami, Florida, United States, 33176
Contact: Minesh P. Mehta, MD    786-596-2000      
Principal Investigator: Minesh P. Mehta, MD         
United States, Georgia
Piedmont Healthcare Recruiting
Atlanta, Georgia, United States, 30309
Contact: Erin Dunbar, MD    404-605-2050      
Principal Investigator: Erin Dunbar, MD         
United States, Illinois
Northwestern University Recruiting
Chicago, Illinois, United States, 60611
Contact: Priya Kumthekar, MD    312-503-1818    p-kumthekar@northwestern.edu   
Principal Investigator: Priya Kumthekar, MD         
Sub-Investigator: Jeffrey Raizer, MD         
Sub-Investigator: Karan Dixit, MD         
Sub-Investigator: Orin Bloch, MD         
Sub-Investigator: James P. Chandler, MD         
Northwestern University- Lake Forest Hospital Active, not recruiting
Lake Forest, Illinois, United States, 60045
Northwestern Medicine/ Cadence Health - CDH Recruiting
Winfield, Illinois, United States, 60190
Contact: Sean Grimm, MD    630-352-5450      
Principal Investigator: Sean Grimm, MD         
United States, Minnesota
Regions Hospital - Cancer Care Center Not yet recruiting
Saint Paul, Minnesota, United States, 55101
Contact: Richard A. Peterson, MD    651-254-3572    Richard.A.Peterson@HealthPartners.Com   
Principal Investigator: Richard A. Peterson, MD         
United States, Pennsylvania
University of Pennsylvania Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Arati S. Desai, MD    215-615-5858      
Principal Investigator: Arati S. Desai, MD         
Sponsors and Collaborators
Northwestern University
NovoCure Ltd.
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Priya Kumthekar, MD Northwestern University

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Responsible Party: Northwestern University
ClinicalTrials.gov Identifier: NCT02847559     History of Changes
Other Study ID Numbers: NU 16C02
STU00203030 ( CTRP (Clinical Trial Reporting Program) )
NU 16C02 ( Other Identifier: Northwestern University )
P30CA060553 ( U.S. NIH Grant/Contract )
NCI-2016-01026 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
First Posted: July 28, 2016    Key Record Dates
Last Update Posted: September 20, 2019
Last Verified: September 2019
Additional relevant MeSH terms:
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Meningioma
Neoplasms, Nerve Tissue
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Vascular Tissue
Meningeal Neoplasms
Central Nervous System Neoplasms
Nervous System Neoplasms
Neoplasms by Site
Nervous System Diseases
Bevacizumab
Antineoplastic Agents, Immunological
Endothelial Growth Factors
Antibodies
Immunoglobulins
Antibodies, Monoclonal
Antineoplastic Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Physiological Effects of Drugs
Growth Inhibitors
Immunologic Factors