University of Kansas Medical Center

Conditions

• Glioblastoma, IDH-Wildtype
• MGMT-Unmethylated Glioblastoma

Eligibility

Eligible Ages

Over 18 Years

Eligible Sex

All

Accepts Healthy Volunteers

No

Criteria

Inclusion Criteria:

- PRIOR TO STEP 1 REGISTRATION:

- No known IDH mutation. (If tested before step 1 registration, patients known to have
IDH mutation in the tumor on local or other testing are ineligible and should not be
registered).

- Availability of formalin-fixed paraffin-embedded (FFPE) tumor tissue block and
hematoxylin and eosin (H&E) stained slide to be sent for central pathology review
for confirmation of histology and MGMT promoter methylation status. Surgical
resection is required; stereotactic biopsy alone is not allowed because it will not
provide sufficient tissue for MGMT analysis. Note that tissue for central pathology
review and central MGMT assessment must be shipped to the New York University (NYU)
Center for Biospecimen Research and Development (CBRD) on or before postoperative
calendar day 30. If tissue cannot be shipped by postoperative calendar day 30, then
patients may NOT enroll on this trial as central pathology review will not be
complete in time for the patient to start treatment no later than 8 weeks following
surgery. Results of central pathology review and central MGMT analysis will
generally be completed within 10 business days of receipt of tissue. Results will be
entered by the central lab directly into Rave. Note: In the event of an additional
tumor resection(s), tissue must be shipped within 30 days of the most recent
resection and the latest resection must have been performed within 30 days after the
initial resection.

- Negative urine or serum pregnancy test (in persons of childbearing potential) within
14 days prior to Step 1 registration. Childbearing potential is defined as any
person who has experienced menarche and who has not undergone surgical sterilization
(hysterectomy or bilateral oophorectomy) or who is not postmenopausal.

- No known leptomeningeal disease or metastatic disease outside the brain.

- Age ≥ 18

- Because neurocognitive testing is the primary goal of this study, patients must be
proficient in English or French Canadian.

- Karnofsky Performance Status ≥ 70

- Hemoglobin ≥ 10 g/dl (Note: the use of transfusion or other intervention to achieve
hemoglobin (Hgb) ≥ 10.0 g/dl is acceptable)

- Leukocytes ≥ 2,000/mm^3 OR absolute neutrophil count ≥ 1,500/mm^3

- Platelets ≥ 100,000/mm^3

- Creatinine clearance (CrCl) ≥ 50 mL/min

- Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN)

- Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT]) and
alanine aminotransferase (ALT)(serum glutamic pyruvate transaminase [SGPT]) ≤ 3 x
ULN

- No prior cranial radiation therapy that would result in overlap of radiation therapy
fields.

- No previous therapy for GBM except surgery, laser interstitial thermal therapy
(LITT) or Gliadel wafer.

- Note: 5-aminolevulinic acid (ALA)-mediated fluorescence-guided resection (FGR)
photodynamic therapy (PDT) or fluorescein administered prior to/during surgery
to aid resection is not exclusionary and is not considered a chemotherapy or
intracerebral agent.

- No history of unstable angina requiring hospitalization in the last 3 months

- No history of myocardial infarction within the last 3 months

- New York Heart Association Functional Classification II or better (NYHA Functional
Classification III/IV are not eligible) (Note: Patients with known history or
current symptoms of cardiac disease, or history of treatment with cardiotoxic
agents, should have a clinical risk assessment of cardiac function using the New
York Heart Association Functional Classification)

- No active infection currently requiring IV antibiotic management

- No chronic obstructive pulmonary disease exacerbation or other acute respiratory
illness precluding study therapy

- No movement disorder that could impede ability to lie still with an immobilization
mask for approximately 40 minutes

- No significant sensory deficits (i.e., blindness, mutism) that would prohibit
participation of NCF testing

- No history of allergic reaction attributed to compounds of similar chemical or
biological composition to temozolomide

- PRIOR TO STEP 2 REGISTRATION:

- The following baseline neurocognitive tests must be completed within 28 days prior
to Step 2 registration: (Hopkins Verbal Learning Test - Revised [HVLT-R], Trail
Making Test [TMT], Controlled Oral Word Association [COWA]). The neurocognitive
tests will be uploaded into RAVE for evaluation by Dr. Wefel. The following scores
must be obtained for patient eligibility: HVLT-R Total Recall > 5, HVLT-R Delayed
Recall > 3, HVLT-R Delayed Recognition > -10, TMT Part A . 2738, TMT Part B . 3724,
COWA . 12. Central review of the Neurocognitive tests will be completed in Rave
within 3 business days after the upload is completed. Users with the Rave clinical
research associate (CRA) role will be able to view the results in Rave. The CRA must
confirm that the results are available and meet eligibility requirements prior to
proceeding with Step 2 Registration.

- NOTE: Completed baseline neurocognitive tests can be uploaded at the time of
Step 1 registration.

- Note: Patients whose neurocognitive test scores do not meet the criteria above
will not be eligible for the study and will be reported as ineligible due to
"Failure to meet Neurocognitive testing criteria" on Step 2 registration.

- Pathology proven diagnosis of IDH-wildtype glioblastoma with unmethylated MGMT
promoter confirmed by central pathology review. IDH mutation testing by at least one
method (such as immunohistochemistry for IDH1 R132H) must be performed as part of
standard of care and no mutation must be found (i.e. IDH-wildtype). (If a mutation
is identified then the patient will be ineligible and must be registered as
ineligible at Step 2.)

- Central pathology review will generally be completed within 10 business days of
receipt of the tissue. Users with the Rave CRA role will be able to view the
results in Rave. It must be confirmed that the results are available and meet
eligibility requirements prior to proceeding with Step 2 Registration.

- Note: Patients with tissue that is insufficient or inadequate for analysis, has
failed MGMT testing, or has indeterminate or methylated MGMT promoter are
excluded and will be reported as a "central pathology review failure" on step 2
registration.

Recruiting Locations

Study Contact

Detailed Description

PRIMARY OBJECTIVE: I. To determine whether TMPRT concurrently with TMZ can significantly improve time to neurocognitive function (NCF) failure compared to standard radiation therapy (RT) with temozolomide for patients with MGMT-unmethylated GBM. SECONDARY OBJECTIVES: I. To determine whether TMPRT can significantly improve time to NCF failure for the subset of older patients (age ≥ 65) with MGMT-unmethylated GBM. II. To evaluate between arm differences in NCF across time. III. To evaluate whether TMPRT prolongs overall survival (OS) compared to the control arm. IV. To determine if progression free survival (PFS) is prolonged after TMPRT compared to the control arm. V. To determine if TMPRT improves quality of life (QoL), compared to the control arm, as measured by the Functional Assessment of Cancer Therapy - Brain (FACT-Br) Total Score. VI. To determine if TMPRT improves patient-reported cognitive outcome (PRCO) compared to the control arm, as measured by the Functional Assessment of Cancer Therapy - Brain Cognitive Index (FACT-Br- CI). VII. To determine the impact of TMPRT on longitudinal changes in frailty after treatment compared to the control arm, as measured by the Deficit Accumulation Frailty Index (DAFI) derived from the Practical Geriatric Assessment (PGA). VIII. To evaluate if TMPRT reduces toxicity compared to the control arm. EXPLORATORY OBJECTIVES: I. To evaluate the impact of TMPRT on functional, social, and emotional QoL compared to the control arm, as measured by the FACT-Br. II. To evaluate the impact of TMPRT on longitudinal changes of specific geriatric assessment subscales compared to the control arm, as measured by the PGA. III. To evaluate the impact of TMPRT on treatment burden during RT compared to the control arm, as measured by the FACT-Br Physical Wellbeing subscale (FACT-Br PWB). IV. To investigate if TMPRT results in less white matter injury on post-treatment magnetic resonance imaging (MRI). V. To collect blood samples for future translational studies. VI. To correlate NCF with QoL and frailty. VII. To determine if baseline NCF, QoL, and frailty are associated with OS. VIII. To correlate adverse events with baseline frailty and specific geriatric assessment subscales. IX. To determine the concordance between institutional and central MGMT promoter status. OUTLINE: Patients are randomized to 1 of 2 arms. ARM 1: CONCURRENT TREATMENT (CYCLE 1): Patients receive standard RT over 12-15 minutes daily, 5 days a week, for 3 or 6 weeks. Patients also receive temozolomide orally (PO) once daily (QD) on days 1-21 or 1-42. Cycle 1 treatment continues for 21 or 42 days in in the absence of disease progression or unacceptable toxicity. ADJUVANT TREATMENT (CYCLES 2+): Approximately 1 month after completion of standard RT, patients receive temozolomide PO QD on days 1-5 of each cycle. Cycles repeat every 28 days for 6 cycles in the absence of disease progression or unacceptable toxicity. ARM 2: CONCURRENT TREATMENT (CYCLE 1): Patients receive TMPRT, delivered as 10-13 "pulses" over 30-40 minutes each with a 3 minute break in between, 5 days a week for 3 or 6 weeks. Patients also receive temozolomide PO QD on days 1-21 or 1-42. Cycle 1 treatment continues for 21 or 42 days in in the absence of disease progression or unacceptable toxicity. ADJUVANT TREATMENT (CYCLES 2+): Approximately 1 month after completion of standard RT, patients receive temozolomide PO QD on days 1-5 of each cycle. Cycles repeat every 28 days for 6 cycles in the absence of disease progression or unacceptable toxicity. All patients also undergo computed tomography (CT) or MRI scans, as well as optional blood sample collection throughout the trial. After completion of study treatment, patients are followed at months 1, 3, 5, 7, 9, and 12, then annually for 4 years.