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TN-TC11G (THC+CBD) Combination With Temozolomide and Radiotherapy in Patients With Newly-diagnosed Glioblastoma (GEINOCANN)

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ClinicalTrials.gov Identifier: NCT03529448
Recruitment Status : Not yet recruiting
First Posted : May 18, 2018
Last Update Posted : May 31, 2019
Sponsor:
Collaborators:
Medical Cannabis Bike Tour
Voices Against Brain Cancer
Tilray
Information provided by (Responsible Party):
Grupo Español de Investigación en Neurooncología

Brief Summary:

Glioblastoma is the primary brain tumour with the worst prognosis: median survival is only 12 months despite the use of the most advanced treatments. In the past 10 years, survival in the treatment of this disease has not advanced significantly, with the postoperative standard being the administration of chemoradiotherapy with temozolomide, followed by 6 cycles of sequential chemotherapy with temozolomide.

Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD) have shown a clear synergistic antitumour effect with temozolomide and radiotherapy in preclinical glioma models. THC and CBD have a wide variety of biological effects by binding with and activating the type 1 and type 2 cannabinoid receptors (CB1 expressed in certain neuronal areas of the brain and CB2 expressed in the immune system and in glial cells). The activation of these receptors initiates a signalling pathway, called the endoplasmic reticulum stress response, which generates tumour cell autophagy by activating TRB3.

Given these data, the Spanish Group for Neuro-oncology (GEINO) proposes developing a phase Ib, open-label, multicenter, intrapatient dose-escalation clinical trial to assess the safety profile of the THC+CBD combination at a 1:1 ratio, adding temozolomide and radiotherapy in patients with newly-diagnosed glioblastoma.

The number of patients to be recruited is 30 over 6 months at 8 sites specialising in neuro-oncology.


Condition or disease Intervention/treatment Phase
Glioblastoma Drug: TN-TC11G Drug: Temozolomide Oral Product Radiation: Radiotherapy Phase 1 Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Intervention Model: Sequential Assignment
Intervention Model Description: Phase Ib, intra-patient dose escalation trial.
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase Ib, Open-label, Multicenter, Intrapatient Dose-escalation Clinical Trial to Assess the Safety Profile of the TN-TC11G (THC+CBD) Combination With Temozolomide and Radiotherapy in Patients With Newly-diagnosed Glioblastoma
Estimated Study Start Date : July 2019
Estimated Primary Completion Date : June 2020
Estimated Study Completion Date : June 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: TN-TC11G, radiotherapy and Temozolomide Oral Product

During Phase Ib, Four to seven weeks after surgical diagnosis, concurrent with radiotherapy (STUPP)

+ temozolomide (75mg/m2/day for 42 days) +TN-TC11G will be evaluated. During radiation therapy, temozolomide and TN-TC11G will be administered. This last, as the dose that have been selected previously, based on dose-titration period. Patient specific dose will remain until progresion of disease, unacceptable toxicity, non-compliance, consent withdrawal up to 2 years.

Drug: TN-TC11G

TN-TC11G dose will be gradually increased as follows:

Week 1: TN-TC11G: 0-0-5 mg (THC 5 mg + CBD 5 mg; in the mornings, 90 minutes after breakfast; in the afternoons, 90 minutes after lunch; in the evenings, 90 minutes after dinner).

Week 2: TN-TC11G: 5-0-5 mg Week 3: TN-TC11G: 5-5-5 mg Week 4: TN-TC11G: 5-5-10 mg Week 5: TN-TC11G: 5-5-15 mg Week 6: TN-TC11G: 10-10-15 mg Week 7: TN-TC11G: 10-10-20 mg. Week 8: TN-TC11G: 15-15-30 mg Week 9: TN-TC11G: 20-20-40 mg TN-TC11G will be administered daily at the relevant dose level according to the individual titration performed in the first 9 weeks of treatment. If there is any dose reduction, the reduced dose must be administered.


Drug: Temozolomide Oral Product

During RT, patients will receive Temozolomide (TMZ). All patients will be given TMZ at 75 mg/m2/d concurrently with RT for a maximum of 42 days.

At 4 weeks after RT completion, patients will start taking TMZ at 150 mg/m2/d for the first 5 days of a 28-day cycle. If first cycle is well tolerated, patients will receive TMZ at 200 mg/m2/d for the first 5 days of every subsequent 28-day cycle for another 5 cycles.

Other Name: Temozolomide

Radiation: Radiotherapy
All the patients will receive the Stupp regimen. The radiotherapy (RT) treatment will be administered in fractions of 1.8-2.0 Gy/day delivered 5 days/week to a total dose of 58-60 Gy. Radiotherapy will be delivered to the gross tumor volume with a 2-3 cm margin for the clinical target volume.
Other Name: STUPP




Primary Outcome Measures :
  1. THC-CBD Maximum tolerated dose [ Time Frame: 9 weeks ]
    After intra-patient dose escalation period, recommended dose of Glasdegib administeres with temozolamide during and after RT.

  2. Incidence of Treatment-Emergent Adverse Events [ Time Frame: 12 months ]
    Type and number or adverse events reported during THC-CBD treatment, based on the CTCAE reference criteria.


Secondary Outcome Measures :
  1. Antitumor activity of THC-CBD combination with temozolamide and radiotherapy [ Time Frame: 12 months ]
    Based on the tumor response in patients with measurable disease, after comparison of baseline characteristics and follow-up evaluations

  2. Overall survival [ Time Frame: 12 months ]
    Time between the start of treatment to death

  3. Progression free survival [ Time Frame: 12 months ]
    Time between the start of treatment and progression of disease

  4. Expression of Midkine [ Time Frame: 12 months ]
    Correlation of expression of midkine in peripheral blood and response to the experimental treatment.



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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Ability to understand and sign the informed consent document
  • Men or women ≥18 years and ≤70 years
  • Newly-diagnosed GB confirmed by biopsy or by resection in the 4-7 weeks before being registered in the trial.
  • Patients must have at least 15 slides without staining or a tissue block (frozen or paraffin-embedded) available from a previous biopsy or surgery (tumour sample previously archived).
  • Patients must have recovered from previous surgeries (time between surgery and inclusion in the study: 6 weeks).
  • Karnofsky Index ≥60%.
  • Adequate bone marrow reserve: haemoglobin ≥10 g/dL, WBC >3,000/mcL, absolute neutrophil count (ANC) ≥1,500 cells/μL, platelets ≥100,000 cells/μL.
  • Adequate liver function: Bilirubin <1.5 times the upper limit of normal (ULN); AST ≤2.5 x ULN
  • Creatinine clearance >60 ml/min/1.73 m2.
  • The study treatment's effects on the development of the human foetus are not known. For this reason, women of childbearing age and men must agree to use a suitable birth control method (hormonal, barrier, abstinence or surgical sterilisation) before inclusion in the study, for the duration of the study and for at least 3 months after completing the trial treatment. The definition of an effective method of birth control is based on the judgement of the principal investigator or their designee. If a woman is pregnant or there is suspicion that she might be pregnant while participating in the study, she must inform the trial doctor immediately. All women of childbearing age should have a negative pregnancy test (serum/urine) in the 2 weeks prior to the beginning of treatment.

Exclusion Criteria:

  • Presence of extracranial metastatic disease.
  • Any previous treatment for glioblastoma.
  • Patients who have had a Gliadel implant in the surgery.
  • Use of an enzyme-inducing antiepileptic drug. Patients receiving this type of drug must have a washout period of at least 7 days prior to study inclusion.
  • Previous abuse of cannabinoids.
  • Presence of any clinically significant gastrointestinal abnormality that may affect the intake, transit or absorption of the study drug, such as the inability to take medication in the form of oral tablets or solution.
  • Presence of any psychiatric or cognitive impairment that limits understanding or the signing of the informed consent and/or compromises compliance with the requirements of this protocol.
  • Significant or uncontrolled cardiovascular disease, including: 1. Myocardial infarction in the previous 12 months. 2. Uncontrolled angina in the previous 6 months. 3. Congestive heart failure in the previous 6 months. 4. Diagnosed or suspected congenital long QT syndrome. 5. History of ventricular arrhythmias of any clinically significant type (such as ventricular tachycardia, ventricular fibrillation or torsades de pointes). 6. QTc prolongation on an electrocardiogram prior to entry (>470 ms). 7. History of second- or third-degree heart block (these patients may be eligible if they carry pacemakers). 8. Heart rate <50/min on the baseline electrocardiogram. 9. Uncontrolled hypertension
  • Any patient with a history of significant cardiovascular disease, even if it is currently controlled, or who presents signs or symptoms that suggest impaired left ventricular function according to the investigator should have an assessment of left ventricular ejection fraction (LVEF) by ECCO or MUGA. If the LVEF in these circumstances is below the site's lower limit of normality or less than 50%, the patient will not be eligible.
  • History of any cancer, except in the following circumstances: Patients with a history of other malignancies are eligible if they have been disease-free for at least the last 3 years and if, in the investigator's opinion, there is a low risk of disease recurrence. People with the following cancers are eligible, even if they have been diagnosed and treated in the past 3 years: cervical carcinoma in situ and basal cell carcinoma.

Patients will not be eligible if there is evidence of another cancer that required therapy other than surgery in the past 3 years.


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): NCT03529448


Contacts
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Contact: Federico Nepote +34 93 434 44 12 investigacion@mfar.net
Contact: Verónica Roca +34 93 434 44 12 investigacion@mfar.net

Locations
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Spain
Institut Català d'Oncología L'Hospitalet Not yet recruiting
L'Hospitalet de Llobregat, Barcelona, Spain, 08908
Contact: Miguel Gil, M.D.       secretaria@geino.es   
Principal Investigator: Miguel Gil, M.D.         
Hospital Universitario Son Espases
Palma de Mallorca, Mallorca, Spain
Consorcio Hospitalario Provincial de Castellón Not yet recruiting
Castelló, Valencia, Spain, 12002
Contact: Ramón de las Peñas, M.D.       secretaria@geino.es   
Principal Investigator: Ramón de las Peñas, M.D.         
Hospital del Mar Not yet recruiting
Barcelona, Spain, 08003
Contact: Maria Martinez, M.D.       secretaria@geino.es   
Principal Investigator: María Martínez, M.D.         
Complejo Hospitalario Regional Virgen de las Nieves Not yet recruiting
Granada, Spain, 18004
Contact: Raquel Luque, MD       secretaria@geino.es   
Principal Investigator: Raquel Luque, M.D.         
Hospital Universitario 12 de Octubre Not yet recruiting
Madrid, Spain, 28041
Contact: Juan Sepúlveda       secretaria@geino.es   
Principal Investigator: Juan Sepúlveda, M.D.         
Hospital Regional Universitario de Malaga
Malaga, Spain
Hospital Clínico Universitario de Salamanca Not yet recruiting
Salamanca, Spain, 37007
Contact: Luis Miguel Navarro, M.D.       secretaria@geino.es   
Principal Investigator: Luis Miguel Navarro, M.D.         
Sponsors and Collaborators
Grupo Español de Investigación en Neurooncología
Medical Cannabis Bike Tour
Voices Against Brain Cancer
Tilray
Investigators
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Principal Investigator: Manuel Benavides, M.D., Ph.D. Hospital Universitario y Regional de Málaga y Virgen de la Victoria

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Responsible Party: Grupo Español de Investigación en Neurooncología
ClinicalTrials.gov Identifier: NCT03529448     History of Changes
Other Study ID Numbers: GEINO-1601
2016-003216-12 ( EudraCT Number )
First Posted: May 18, 2018    Key Record Dates
Last Update Posted: May 31, 2019
Last Verified: May 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Grupo Español de Investigación en Neurooncología:
Glioblastoma
Additional relevant MeSH terms:
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Glioblastoma
Astrocytoma
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Temozolomide
Antineoplastic Agents, Alkylating
Alkylating Agents
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents