Study of Imatinib Mesylate in Combination With Hydroxyurea Versus Hydroxyurea Alone as an Oral Therapy in Patients With Temozolomide Resistant Progressive Glioblastoma

Novartis

Status and phase: Completed; Phase 3

Conditions: Glioblastoma Multiforme; Astrocytoma

Treatments: Drug: Imatinib mesylate; Drug: Hydroxyurea

Study type: Interventional

Funder types: Industry

Identifiers

NCT00154375

CSTI571BDE40

Details and patient eligibility

About

This is a Phase III study comparing Imatinib mesylate and hydroxyurea combination therapy with hydroxyurea monotherapy in patients with temozolomide resistant progressive glioblastoma.

Enrollment: 240 patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Signed informed consent prior to initiation of any study procedure.
• Patients >= 18 years of age.
• Histological confirmed diagnosis of glioblastoma multiforme / astrocytoma World Health Organization (WHO) grade IV by a reference pathologist
• Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1 or 2.
• Adequate hepatic, renal and bone marrow function as defined by the following: total bilirubin < 1.5 x Upper Limit of Normal (ULN), ALT and AST < 2.5 x ULN, creatinine < 1.5 x ULN, absolute neutrophil count > 1.5 x109/L, platelets > 100 x109/L and hemoglobin > 10 g/dL.
• Female patients of childbearing potential with a negative pregnancy test within 7 days of initiation of study drug dosing. Postmenopausal women must be amenorrheic for at least 12 months to be considered of non-childbearing potential. Male and female patients of reproductive potential who agree to employ an effective barrier method of birth control throughout the study, and for up to 3 months following discontinuation of study drug.
• Life expectancy of >3 months.
• MRI available every 6 weeks for disease management
• No intercerebral inflammation
• Irradiation therapy 54 to 62 gy finished or less according to national standard
• Chemotherapy at least 1 temozolomide containing regimen finished, no established chemotherapy regiment available and progression under chemotherapy or in between 6 months following the last chemotherapy.
• Leucocytes > 2.500/µl, to be controlled once a week
• Thrombocytes > 80.000/µl, to be controlled once a week
• Ensured compliance
• Patients who had a second or third resection after disease progression cannot be included earlier than 2 weeks following the resection. MRI should be performed not later than 72 h post operation. If patients are to be included later than 4 weeks after the resection, a new baseline MRI must be performed.

Exclusion criteria

• Female patients who are pregnant or breast-feeding.
• Patients who have been treated with any investigational agent(s) within 28 days of the first day of administration of study drug.
• Patients with uncontrolled medical disease such as diabetes mellitus, thyroid dysfunction, neuropsychiatric disorders, infection, angina or Grade 3 or 4 cardiac problems as defined by the New York Heart Association Criteria.
• Patients with other malignant disorders.
• Patient with acute or known chronic liver disease (i.e., chronic active hepatitis, cirrhosis).
• Patients who are known to be HIV positive (no specific tests are required for confirmation of eligibility).
• Expected incompliance according to treatment, treatment diary and examination schedule
• Not confirmed histological diagnosis glioblastoma multiforme/astrocytoma WHO grade IV
• Other drugs with potential cytostatic main or side effect
• No or inadequate chemotherapy or irradiation therapy
• Patients without hematological recovery after previous chemotherapy who have been treated with Chemotherapy within 28 days of the first day of administration of study drug.

Other protocol-specific inclusion /exclusion criteria may apply.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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240 participants in 2 patient groups

Imatinib mesylate + hydroxyurea (HU)

Experimental group

Description:

Imatinib was supplied as 100 mg and 400 mg tablets. Patients in the combination arm were instructed to take a daily oral imatinib dose of 600 mg (600 mg at lunch time) and a daily oral hydroxyurea (HU) dose of 1000 mg (500 mg twice daily; in the morning and at bed time). Every 6 weeks after randomization based on assessment of therapeutic response, either patients continued with above mentioned dosing regimen or switched to receive a daily dose of 800 mg imatinib with 1000 mg HU. Patients were instructed to split the intake, taking 400 mg imatinib with 500 mg HU in the morning, then the same in the evening.

Treatment:

Drug: Hydroxyurea

Drug: Imatinib mesylate

Hydroxyurea alone

Active Comparator group

Description:

1500 mg/day of HU given as 500 mg 3 times daily. Every 6 weeks after randomization and based on assessment of therapeutic response, the patients were either switched to combination arm or continued in monotherapy arm of hydroxyurea.

Treatment:

Drug: Hydroxyurea