E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
A type of newly diagnosed brain tumor named Glioblastoma
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E.1.1.2 | Therapeutic area | Diseases [C] - Cancer [C04] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 15.0 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10018336 |
E.1.2 | Term | Glioblastoma |
E.1.2 | System Organ Class | 10029104 - Neoplasms benign, malignant and unspecified (incl cysts and polyps) |
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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 |
• To demonstrate the superiority in overall survival (OS) when bevacizumab is added to temozolomide with radiotherapy followed by temozolomide for the treatment of patients with newly diagnosed glioblastoma
• To demonstrate the superiority in progression-free survival (PFS) as assessed by the investigator (using adapted MacDonald criteria) when bevacizumab is added to temozolomide with radiotherapy followed by temozolomide for the treatment of patients with newly diagnosed glioblastoma |
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E.2.2 | Secondary objectives of the trial |
• To compare PFS as assessed by an IRF between treatment arms
• To compare 1-year and 2-year survival rates between treatment arms
• To evaluate and compare the safety profile between treatment arms
• To compare health-related quality of life (EORTC QLQ-C30, BN20) between treatment arms
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
Full Title: A Neurocognitive function substudy of BO21990, a randomized, double blind, placebo controlled, multicenter Phase III trial of bevacizumab, temozolomide and radiotherapy, followed by bevacizumab and temozolomide versus placebo, temozolomide and radiotherapy followed by placebo and temozolomide in patients with newly diagnosed glioblastoma Objective: The purpose of this neurocognitive function substudy is to measure the possible effect of the study treatments on the neurocognitive function (whether the treatment will help to improve the neurocognitive deficits). BO21990-NCF, Version A, 04 Feb 2010 This substudy will be performed in a selected number of countries. |
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E.3 | Principal inclusion criteria |
1. Signed informed consent
2. Age greater than or equal to 18 years
3. Present with newly diagnosed supratentorial Glioblastoma (GBM) with a tissue diagnosis that has been established following either a surgical resection or biopsy. This includes treatment-naïve -(chemotherapy and radiotherapy)- patients with prior diagnosis of a lower grade astrocytoma that has been upgraded to a histologically verified GBM
4. Craniotomy or intracranial biopsy site must be adequately healed, free of drainage or cellulitis, and the underlying cranioplasty must appear intact at the time of randomisation. Study treatment should be initiated ≥ 28 days and ≤ 49 days following the last surgical procedure (including biopsy, surgical resection, wound revision, or any other major surgery involving entry into a body cavity)
5. WHO performance status ≤ 2
6. Patient must have at least 1 formalin fixed paraffin embedded tumour tissue block representative of glioblastoma available for pathology central review and analysis of MGMT status. If tumour block is not available or not of adequate quality, sufficient pathology material, representative of glioblastoma, must be available for central review.
7. Stable or decreasing corticosteroids dose within 5 days prior to randomization
8. Adequate hematological function:
• Absolute neutrophil count (ANC) ≥ 1.5 x 1'000'000'000/L
• Platelet count ≥ 100 x 1'000'000'000/L
• Haemoglobin ≥ 10 g/dL (may be transfused to maintain or exceed this level)
9. Adequate liver function
• Total bilirubin ≤ 1.5 x ULN
• AST and ALT ≤ 2.5 x ULN
10. Adequate renal function
•Creatinine ≤ 1.25 x ULN
• Urine dipstick for proteinuria < 2+. Patients discovered to have ≥ 2+ proteinuria on dipstick urinalysis at baseline should undergo a 24 hour urine collection and must demonstrate ≤ 1.0 g of protein in 24 hours
OR
• Urine protein/creatinine ratio (UPC) ≤ 1.0
11. International normalized ratio (INR) or PT (secs) and activated partial thromboplastin time (aPTT):
• in the abscence of therapeutic intent to anticoagulate the subject: INR≤1.5 or PT≤1.5 x ULN and aPTT≤1.5 x ULN
• in the presence of therapeutic intent to anticoagulate the subject: INR or PT and aPTTwithin therapeutic limits (according to the medical standard in the institution)
NOTE: Use of full-dose anticoagulants is permitted as long as the INR or aPTT is within therapeutic limits (according to the medical standard in the institution) and the patient has been on a stable dose of anticoagulants for at least two weeks before randomization. As per ASCO guidelines, LMWH should be the preferred approach
12. Willing and able to comply with the protocol as judged by the investigator
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E.4 | Principal exclusion criteria |
Disease and Treatment History
1. Evidence of recent hemorrhage on postoperative MRI of the brain. However, patients with clinically asymptomatic presence of hemosiderin, resolving hemorrhagic changes related to surgery, and presence of punctate hemorrhage in the tumor are permitted entry into the study
2. Previous centralized screening for MGMT status for enrolment into a clinical trial
3. Any prior chemotherapy (including carmustine-containing wafers (Gliadel®) or immunotherapy (including vaccine therapy) for glioblastomas and low grade astrocytomas
NOTE: 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) administered prior to surgery to aid in optimal surgical resection is not considered a chemotherapy agent
4. Any prior radiotherapy to the brain or prior radiotherapy resulting in a potential overlap in the radiation field
Bevacizumab related Exclusion Criteria
5. Inadequately controlled hypertension (defined as systolic blood pressure >150 mmHg and/or diastolic blood pressure >100 m Hg)
6. Prior history of hypertensive crisis or hypertensive encephalopathy
7. New York Heart Association (NYHA) Grade II or greater congestive heart failure (see Appendix 6)
8. History of myocardial infarction or unstable angina within 6 months prior to randomization
9. History of stroke or TIAs within 6 months prior to randomization
10.Significant vascular disease (e.g. aortic aneurysm requiring surgical repair or recent peripheral arterial thrombosis) within 6 months prior to randomization
11.History of ≥ grade 2 haemoptysis according to the NCI-CTC criteria within 1 month prior to randomization
12.Evidence of bleeding diathesis or coagulopathy (in the absence of therapeutic anticoagulation)
13.Major surgical procedure, open biopsy, intracranial biopsy, ventriculoperitoneal shunt or significant traumatic injury within 28 days prior to randomization
14.Core biopsy (excluding intracranial biopsy) or other minor surgical procedure within 7 days prior to randomization. Placement of a central vascular access device (CVAD) if performed within 2 days prior to bevacizumab/placebo administration
15.History of abdominal fistula or gastrointestinal perforation within 6 months prior to randomization
16.History of intracranial abscess within 6 months prior to randomization
17.Serious non-healing wound, active ulcer or untreated bone fracture
18.Pregnant or lactating females. NOTE: Serum pregnancy test to be assessed within 7 days prior to study treatment start
19.Fertile women < 2 years after last menstruation and men (surgically sterilized and of childbearing potential) unwilling or unable to use effective means of contraception (oral contraceptives, intrauterine contraceptive device, barrier method of contraception in conjunction with spermicidal jelly)
General Exclusion Criteria
20.Any other malignancy within 5 years prior to randomization, except for adequately controlled limited basal cell carcinoma of the skin, squamous carcinoma of the skin or carcinoma in situ of the cervix
21.Evidence of any active infection requiring hospitalization or IV antibiotics within 2 weeks prior to randomization
22.Patients who have any other disease, either metabolic or psychological, or who have any evidence on clinical examination or special investigations (including a laboratory finding) which gives reasonable suspicion of a disease or condition that contraindicates the use of the investigational drug, or that may affect the patient’s compliance with study requirements, or would place the patient at higher risk of potential treatment complications
23.Current or recent (within 30 days of enrollment) treatment with another investigational drug or participation in another investigational study
24. Known hypersensitivity to any excipients of bevacizumab formulation or to the chemotherapy regimen (temozolomide)
25.Any contraindication to temozolomide listed in the local label
26.Hypersensitivity to Chinese hamster ovary cell products or other recombinant human or humanized antibody
27.Unable to comply with the administration of the study treatment
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E.5 End points |
E.5.1 | Primary end point(s) |
• OS, defined as the time between randomization and death due to any cause. Patients without an event will be censored the last time they were known to be alive.
• PFS, as assessed by the investigator. PFS, defined as the time between randomization and disease progression (using adapted MacDonald Response Criteria) or death due to any cause. Patients without an event will be censored at the date of last follow up for progression. Patients with no post baseline follow up for progression will be censored at the day of randomization. For submission purposes in the United States, patients who receive non protocol specified anti-cancer therapy (NPT) will be censored at the last tumour assessment prior to receiving NPT. Also, only deaths occurring within 112 days (two tumour assessments) of the last tumour assessment will be counted as events
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Final OS analysis: when 683 of deaths events are registered (to achieve 80% power of the log rank test at a 2-sided overall 4% alpha level) - Final PFS: occurred on beginning of August 2012 |
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E.5.2 | Secondary end point(s) |
1) PFS, as assessed by an IRF.
2) 1-year and 2-year survival rates.
3) Safety profile.
4) Health-related quality of life |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1) occurred on beginning of August 2012
2) interim results on August 2012, final when 683 events are registered
3) interim results on August 2012, final when 683 events are registered
4) occurred on beginning of August 2012 |
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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 | Yes |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | Yes |
E.6.13.1 | Other scope of the trial description |
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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) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| Information not present in EudraCT |
E.8.4 | The trial involves multiple sites in the Member State concerned | Information not present in EudraCT |
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 | 66 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Belgium |
Canada |
Denmark |
France |
Germany |
Greece |
Hong Kong |
Israel |
Italy |
Japan |
Korea, Democratic People's Republic of |
Netherlands |
New Zealand |
Poland |
Portugal |
Romania |
Russian Federation |
Spain |
Sweden |
Switzerland |
Turkey |
United Kingdom |
United States |
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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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Following the final OS analysis, the end of the study will be defined as 90 days after the last patient has completed bevacizumab treatment (IMP), has switched to commercial bevacizumab, or has been enrolled into an extension study, whichever occurs first. The study may also be prematurely terminated by the sponsor. |
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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 | 5 |
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 | 5 |
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 |