Phase III Trial of Primary Radio- or Chemotherapy in Malignant Astrocytoma of the Elderly (Methusalem)

• ClinicalTrials.gov Identifier: NCT01502241
• Recruitment Status: Completed
• First Posted: December 30, 2011
• Last Update Posted: December 30, 2011
• Sponsor: Heidelberg University
• Information provided by (Responsible Party): Prof. Dr. Wolfgang Wick, Heidelberg University

Study Description

Brief Summary:

The study aims to optimize the treatment of elderly subjects (> 65) with anaplastic astrocytoma and glioblastoma. Current treatment policies tend to be no more than palliative. There is no consensus as to how radical the surgery should be. Involved-field radiotherapy is the treatment most likely to be accepted apart from supportive and palliative measures. The role of chemotherapy is barely defined. Study data available to date does not suggest that this patient population would benefit from combined radiochemotherapy. The aim of the study is to verify the hypothesis that first-line chemotherapy with one week on/one week off temozolomide is not inferior to extended-field radiotherapy in the first-line treatment of anaplastic astrocytoma and glioblastoma in the elderly (> 65 age group). The primary endpoint is median survival, as life expectancy is limited to several months. Secondary endpoints are response rates in both arms (CR, PR, MacDonald et al. 1990), median progression-free survival, 1-year and 2-year survival rates, definition of MGMT as molecular genetic prognostic or predictive markers, and quality of life. Theoretically, it should be possible to preserve quality of life in the first-line chemotherapy arm of the study.

Condition or disease	Intervention/treatment	Phase
Glioblastoma; Anaplastic Astrocytoma	Drug: Temozolomide; Radiation: Radiotherapy of the partial brain.	Phase 3

Detailed Description:

This study is a prospective, randomized Phase III intervention study. Following histological documentation of the diagnosis by biopsy or resection of an anaplastic astrocytoma or glioblastoma, patients will be randomized either to receive postoperative extended-field radiotherapy (arm A) or to receive postoperative chemotherapy with temozolomide (arm B). Randomization will be done for all sites at the CRO, Alcedis GmbH.

For patients intending to participate in the study, the procedure is as follows:

• Request a reference neuropathological review from the brain tumor reference center in Bonn (Prof. Dr. G. Reifenberger) through the local neuropathology department. This review need not be present at randomization because anaplastic astrocytoma and glioblastoma cases are eligible
• Contact: Prof. Dr. W. Wick, Dep. Neurooncology, National Center for Tumor Diseases and Neurology Clinic, University of Heidelberg, wolfgang.wick@med.uni-heidelberg.de or CRO: Alcedis, Giessen at Alcedis GmbH, I. Helm, Winchester Str. 2, 35394 Gießen, Tel.: 0641 944360, Fax: 0641 94436 70, E-mail: ihe@alcedis.de
• Provide written confirmation that the patient signed the ethics committee-approved consent form
• Submit the registration form and a copy of the EORTC-QLQ given in Annexes

In subjects with progressive or recurrent disease, the investigating site will verify whether specific tumor treatment is justified. If yes, chemotherapy with temozolomide is recommended in arm A, possibly after further surgery. Subjects in arm B will receive radiotherapy, possible after further surgery. As all-cause mortality is the primary endpoint, all therapeutic measures following first-line therapy should be documented.

If study treatment is discontinued (first-line therapy) because of progressive disease or if progression occurs after completion of study treatment, the pertinent images should be submitted to the reference center for neuroradiology in Tübingen for reference review.

The treatment modalities employed in the study are chemotherapeutic and radiotherapeutic procedures licensed in the Federal Republic of Germany for use in human subjects. Temozolomide is currently licensed for treating subjects with recurrent disease and since 2006 in newly diagnosed glioblastoma together with radiotherapy. The time allotted for the individual treatment sections is 6 weeks for radiotherapy, while chemotherapy will be continued until progression or unacceptable adverse effects occur. The precise chemotherapy sequence is shown in the protocol. The criteria for withdrawal from the study are defined in in the protocol. Four years is the period scheduled for recruiting all patients.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 412 participants
• Allocation: Randomized
• Intervention Model: Crossover Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Temozolomid (One Week on/One Week Off) Versus Strahlentherapie in Der Primärtherapie Anaplastischer Astrozytome Und Glioblastome Bei älteren Patienten: Eine Randomisierte Phase III-Studie (Methvsalem)
• Study Start Date: January 2005
• Actual Primary Completion Date: November 2010
• Actual Study Completion Date: November 2011

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Radiotherapy; 6 weeks standard partial brain treatment.	Radiation: Radiotherapy of the partial brain.; 60 Gy in 30 fractions à 2 Gy.
Experimental: Temozolomide; Temozolomide in a one week on/one week off schedule per Wick et al. 2004 and A. Wick et al. 2007	Drug: Temozolomide; 100 mg/m2 per day on seven out of fourteen days.

Outcome Measures

Primary Outcome Measures :

1. Overall survival [ Time Frame: 12 months ]
   The primary endpoint was overall survival, measured in days from surgery to death for any reason. Patients alive at the day of the last contact were censored.

Secondary Outcome Measures :

1. Event-free survival [ Time Frame: 12 months ]
   Secondary efficacy end points included EFS. EFS was defined as time from surgery to first progression for patients with progression respectively to death for patients without progression. Patients without progression or death were censored at the day of the last contact. Univariate analysis of OS and EFS used Kaplan-Meier estimates21 and a Cox proportional hazard model for evaluating Hazard Ratios (HR) with 95%-confidence intervals and median OS and EFS with 95%-confidence intervals (CI).
2. Best response [ Time Frame: Within the first 8 months after surgery ]
   Response is assessed according MacDonald Criteria based on regular 3-monthly MRI.
3. Molecular prognostic or predictive biomarkers [ Time Frame: At 12 months ]
   Tumor tissue, fresh or paraffine-embedded, or DNA/RNA/proteins from tissue are analyzed for the status of known molecular parameters, e.g. MGMT, for a prognostic or predictive role. Further, newly discovered molecular parameters are assessed for their potential to predict outcome.

Eligibility Criteria

• Ages Eligible for Study: 65 Years and older (Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

• Histologically confirmed supratentorial anaplastic astrocytoma or glioblastoma
• Age > 65
• Karnofsky performance score > 60%
• Neutrophilic granulocyte count > 1500/µl
• Platelet count > 100 000/µl
• Hemoglobin > 10 g/dl
• Serum creatinine < 1.5 times the lab's upper normal limit
• AST or ALT < 3 times the lab's upper normal limit
• Alkaline phosphatase < 3 times the lab's upper normal limit
• No previous systemic chemotherapy
• No previous radiotherapy to the brain
• Written consent

Exclusion Criteria:

• Serious medical or neurological condition with a poor prognosis
• HIV infection
• Second cancer requiring radiotherapy or chemotherapy (contact the study coordinat if necessary)
• Hypersensitivity to temozolomide
• Conditions associated with regular vomiting that might affect oral administration of the drugs
• Psychological, familial, social or geographical circumstances with major implications for compliance with the study visit schedule
• Patient was taking part in other intervention studies within a month of starting this study

Contacts and Locations

Locations

Germany

University of Heidelberg

Heidelberg, Baden-Württemberg, Germany, 69120

University of Frankfurt

Frankfurt, Hessen, Germany, 60528

Charite Berlin

Berlin, Germany

University of Bochum

Bochum, Germany

University of Bonn

Bonn, Germany

University of Dresden

Dresden, Germany

University of Düsseldorf

Düsseldorf, Germany

University of Erlangen

Erlangen, Germany

University of Essen

Essen, Germany

University of Freiburg

Freiburg, Germany

University of Hamburg

Hamburg, Germany

University of Hannover II

Hannover, Germany

University of Hannover

Hannover, Germany

University of Homburg

Homburg, Germany

University of Kiel

Kiel, Germany

University of Leipzig

Leipzig, Germany

University of Mainz

Mainz, Germany

University of Heidelberg

Mannheim, Germany

University of Marburg

Marburg, Germany

University of Regensburg

Regensburg, Germany

University of Tübingen

Tübingen, Germany

University of Ulm

Ulm, Germany

Switzerland

University of Zurich

Zurich, Switzerland, 8091

Sponsors and Collaborators

Heidelberg University

Investigators

• Study Director: Michael Weller; University of Zurich
• Principal Investigator: Wolfgang Wick; Heidelberg University

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Wick A, Kessler T, Platten M, Meisner C, Bamberg M, Herrlinger U, Felsberg J, Weyerbrock A, Papsdorf K, Steinbach JP, Sabel M, Vesper J, Debus J, Meixensberger J, Ketter R, Hertler C, Mayer-Steinacker R, Weisang S, Bolting H, Reuss D, Reifenberger G, Sahm F, von Deimling A, Weller M, Wick W. Superiority of temozolomide over radiotherapy for elderly patients with RTK II methylation class, MGMT promoter methylated malignant astrocytoma. Neuro Oncol. 2020 Aug 17;22(8):1162-1172. doi: 10.1093/neuonc/noaa033.

Wick W, Platten M, Meisner C, Felsberg J, Tabatabai G, Simon M, Nikkhah G, Papsdorf K, Steinbach JP, Sabel M, Combs SE, Vesper J, Braun C, Meixensberger J, Ketter R, Mayer-Steinacker R, Reifenberger G, Weller M; NOA-08 Study Group of Neuro-oncology Working Group (NOA) of German Cancer Society. Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol. 2012 Jul;13(7):707-15. doi: 10.1016/S1470-2045(12)70164-X. Epub 2012 May 10.

• Responsible Party: Prof. Dr. Wolfgang Wick, Chairman and Director Neurooncology, Heidelberg University
• ClinicalTrials.gov Identifier: NCT01502241
• Other Study ID Numbers: NOA-08; 05-01 ( Registry Identifier: German Cancer Society )
• First Posted: December 30, 2011
• Last Update Posted: December 30, 2011
• Last Verified: December 2011

Keywords provided by Prof. Dr. Wolfgang Wick, Heidelberg University:

elderly; brain tumors; MGMT; chemotherapy; Newly diagnosed; patients > 65 years

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; Temozolomide; Antineoplastic Agents, Alkylating; Alkylating Agents; Molecular Mechanisms of Pharmacological Action; Antineoplastic Agents