E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Glioblastoma multiforme - WHO grade IV First progression/recurrence |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10018337 |
E.1.2 | Term | Glioblastoma multiforme |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
Sunitinib will significantly increase the progression free survival rate at 6 months (PFS6) in patients with recurrent or progressive glioblastoma multiforme from 15% to 35%.
Primary endpoint: Progression Free Survival at 6 months (PFS6) |
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E.2.2 | Secondary objectives of the trial |
- Overall Survival (OS): Overall Survival at 12 months (OS12) - Progression Free Survival (PFS) - General Neuroradiological Studies: Objective Radiological Response (RR), Objective Radiological Response Rate (ORR), Objective Radiological Response Duration (ORD) - Extended Neuroradiological Studies: Normalization of tumor vessels, visible due to reduction of the tumor blood volume, relative vessel size, vascular permeability, tumor contrast enhancement and tumor edema (combined with a decrease of steroid usage and tumor edema related neurological symptoms) |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
[1] Patients present with a first recurrence or first progression of a histological confirmed primary supratentorial glioblastoma multiforme WHO Grade IV (Classification following WHO criteria). Note: Patients may be entered based on local pathology from the original diagnostic tumor specimen. For Translational Research Studies the original paraffin block - including sufficient tissue of the primary tumor - is required. Stereotactic biopsies or open biopsies of the primary GBM without sufficient tumor tissue are not feasible and the patients must not be enrolled in this study. [2] Patients with surgical resection of first tumor progression: Following standard therapy patients must have evidence of first tumor progression. In general, patients may have undergone prior surgical resection of the first tumor progression and will be eligible if the following conditions apply: Patients must have recovered from the effects of surgery To adequately asses the GBM before surgery and the extent of residual disease postoperatively, two MRIs scans have to be performed: The first MRI scan within 2 weeks before surgery to document a progressed or recurrent GBM The second MRI scan within 48 hours after surgery Note: Patients must be on a steroid dosage that has been stable for at least 5 days before MRI. If the 48-hour scan is performed more than 14 days prior to study enrollment, the scan needs to be repeated (third MRI scan), however, the <48 hour MRI is the baseline scan. Patients without surgical resection of first tumor progression: Patients must have evidence of first tumor progression following standard therapy as measured by a baseline MRI within 2 weeks prior to study enrollment (Macdonald criteria: e.g. tumor growth > 25% or new lesion). Note: Patients must be on a steroid dosage that has been stable for at least 5 days before MRI. If the steroid dose has increased between the date of imaging and enrollment, a new baseline MRI is required on a stable steroid dosage of at least 5 days duration. [3] Resolution of all acute toxic effects of prior therapy to grade ≤ 1 (except alopecia, see Protocol Attachment A.5) [4] Patients must have an ECOG performance status of 0-2 (refer to Protocol Attachment A.4) [5] Patients must be ≥ 18 years and ≤ 75 years of age, with a life expectancy of greater than 8 weeks [6] Patients must have adequate organ function as defined by the following criteria: Bone Marrow Reserve - Platelets ≥ 75.000/μL - Absolute Neutrophil Count (ANC) ≥ 1500/μL - Hemoglobin ≥ 10.0 g/dL Blood Coagulation - aPTT ≤ 1.5 times upper limit of normal (ULN) Hepatic Function - ASAT and ALAT ≤ 1.5 times ULN - ALP ≤ 2.5 times ULN - Total Serum Bilirubin < 1 times ULN Renal Function - Serum Creatinine ≤ 1.5 times ULN Metabolism - Serum Albumin ≥ 3.0 g/dL Heart Function - Left Ventricular Ejection Fraction (LVEF) ≥ 50% as measured by transthoracic echocardiogram (ECHO) All tests must be performed ≤ 3 days prior to study enrollment. Eligibility for hemoglobin count may be reached by transfusion [7] Signed and dated informed consent document by the patient, indicating that the patient has been informed of all the pertinent aspects of the trial prior to study enrollment [8] Willingness and ability of the patient to comply with scheduled visits, treatment plans, laboratory tests, and other study procedures
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E.4 | Principal exclusion criteria |
[9] The patient is active participant in another clinical trial. [10] Exclusion of patients in the event of surgery for recurrence/progression within 1 week prior to study enrollment chemotherapy within 4 weeks prior to study enrollment treatment with more than one chemotherapy regime radiation therapy within 8 weeks to study enrollment evidence in baseline MRI of intratumoral or peritumoral hemorrhage deemed clinically significant by the treating physician (area of hemorrhage > 25% of tumor area) custody due to authorization by court or responsible authority. [11] Significant Co-Morbidities within 12 months prior to study enrollment myocardial infarction, severe/unstable angina pectoris, coronary/peripheral artery bypass graft, congestive heart failure pulmonary embolus cerebro-vascular accident including TIA (transient ischemic attack) [12] Significant Co-Morbidities at Baseline Evaluation Clinically significant ongoing cardiac dysrhythmias of grade ≥ 2, atrial fibrillation of any grade, QTc interval > 470 ms measured by electrocardiogram (ECG) Hypertension that cannot be controlled by medications (>150/100 mmHg despite optimal medical therapy) A known HIV (human immunodeficiency virus) or Hepatitis B/C infection or severe acute infection [13] Anticoagulation: Current treatment with therapeutic doses of Marcoumar / Sintrom excluding thrombosis prophylaxis with low dose Heparin. [14] Antiepileptic Drugs: Concurrent use of EIADs within 2 weeks of study enrollment (patients must discontinue EIAD treatment ≥ 14 days prior to study enrollment, refer to Section 4.2.2.2 and Protocol Attachment A.9) [15] Pregnancy, Breastfeeding and Non-Contraception Female patients who are pregnant or nursing Patients who are sexually active and unwilling or unable to use a medically acceptable method of contraception during the trial. Note: Female and male patients with reproductive potential have to use an approved contraceptive method (e.g., hormonal contraception, intrauterine device, condom with spermicide, etc.) during and for 3 months after discontinuation of study treatment. Female Patients with child-bearing age must have a negative serum pregnancy test ≤ 3 days prior to study enrollment. During study treatment pregnancy has to be excluded (serum pregnancy tests every 2 weeks until tumor progression). [16] Evidence of increased intracranial pressure midline shift > 5 mm distinct nausea and vomiting [17] Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that would impart excess risk associated with study participation or study drug administration, or which would make the patient inappropriate for entry into this study. The decision to enroll the patient in this study is in the judgment of the investigator. [18] Hypersensitivity to sunitinibmalate or any other ingredients of SUTENT |
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E.5 End points |
E.5.1 | Primary end point(s) |
Progression-free survival rate at 6 months (PFS6)
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | Yes |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | No |
E.8.1.1 | Randomised | Information not present in EudraCT |
E.8.1.2 | Open | Information not present in EudraCT |
E.8.1.3 | Single blind | Information not present in EudraCT |
E.8.1.4 | Double blind | Information not present in EudraCT |
E.8.1.5 | Parallel group | Information not present in EudraCT |
E.8.1.6 | Cross over | Information not present in EudraCT |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Information not present in EudraCT |
E.8.2.2 | Placebo | Information not present in EudraCT |
E.8.2.3 | Other | Information not present in EudraCT |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 4 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 9 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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The end of study is reached, when all patients have completed the planned observations including the post progression follow-up period, i.e. when the last enrolled patient has completed the sixth post-progression follow-up contact. Due to a possible 18 months recruitment phase and a period of about months of Sunitinib treatment until end of treatment (EOT), the entire study period will last about 2 years. |
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 0 |
E.8.9.1 | In the Member State concerned days | 0 |
E.8.9.2 | In all countries concerned by the trial years | 2 |
E.8.9.2 | In all countries concerned by the trial months | 0 |
E.8.9.2 | In all countries concerned by the trial days | 0 |