Pilot Phase 2 Study Whole Brain Radiation Therapy With Simultaneous Integrated Boost for Patients With Brain Metastases
| Status: | Recruiting |
|---|---|
| Conditions: | Brain Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 2/28/2019 |
| Start Date: | July 6, 2017 |
| End Date: | March 31, 2020 |
| Contact: | Kathy Lauer |
| Email: | klauer@iuhealth.org |
| Phone: | 317-962-3172 |
A Pilot Phase 2 Study Evaluating Dose De-escalation in Whole Brain Radiation Therapy With Simultaneous Integrated Boost for Patients With Brain Metastases
This trial is a pilot, Phase 2, sequential two-cohort study designed to test two de-escalated
whole brain radiation therapy (WBRT) dose levels and assess their ability to maintain
acceptable in-brain distant control. The WBRT dose would decrease as the study moves forward,
both in terms of absolute value and equivalent dose in 2 Gray fractions (EQD2) (as determined
by the linear quadratic radiobiological model). The absolute value of the simultaneous
integrated boost (SIB) dose will change with each dose level because the number of fractions
delivered will depend on the WBRT dose. As such, the SIB dose will be manipulated such that
the EQD2 will remain essentially equivalent despite the difference in the number of fractions
delivered. This design will ensure that the only variable is the change in WBRT dose.
The concept is that WBRT with SIB would be expected to maximize both local and in-brain
distant control as has already been shown in studies exploring WBRT with SRS boost. However,
by itself WBRT with SIB does not address the concern over neurocognitive outcomes. Therefore,
investigators hypothesize that there is a lower WBRT dose threshold that will maintain
acceptable in-brain distant control, particularly in the setting of a SIB to gross lesions to
maintain treated lesion control. In addition, lower overall brain dose (including lower
hippocampal dose without specific hippocampal avoidance) may potentially improve
neurocognitive function. Investigators are also interested in evaluating treated lesion
control, overall survival, neurocognitive sequelae of therapy, quality of life, performance
status, and adverse effects of therapy. Biomarker identification for potential correlative
circulating tumor DNA and microRNA is an exploratory endpoint to generate data for future
prospective evaluation.
whole brain radiation therapy (WBRT) dose levels and assess their ability to maintain
acceptable in-brain distant control. The WBRT dose would decrease as the study moves forward,
both in terms of absolute value and equivalent dose in 2 Gray fractions (EQD2) (as determined
by the linear quadratic radiobiological model). The absolute value of the simultaneous
integrated boost (SIB) dose will change with each dose level because the number of fractions
delivered will depend on the WBRT dose. As such, the SIB dose will be manipulated such that
the EQD2 will remain essentially equivalent despite the difference in the number of fractions
delivered. This design will ensure that the only variable is the change in WBRT dose.
The concept is that WBRT with SIB would be expected to maximize both local and in-brain
distant control as has already been shown in studies exploring WBRT with SRS boost. However,
by itself WBRT with SIB does not address the concern over neurocognitive outcomes. Therefore,
investigators hypothesize that there is a lower WBRT dose threshold that will maintain
acceptable in-brain distant control, particularly in the setting of a SIB to gross lesions to
maintain treated lesion control. In addition, lower overall brain dose (including lower
hippocampal dose without specific hippocampal avoidance) may potentially improve
neurocognitive function. Investigators are also interested in evaluating treated lesion
control, overall survival, neurocognitive sequelae of therapy, quality of life, performance
status, and adverse effects of therapy. Biomarker identification for potential correlative
circulating tumor DNA and microRNA is an exploratory endpoint to generate data for future
prospective evaluation.
Primary Objective Evaluate two de-escalated whole brain radiation dose levels (in the setting
of simultaneous integrated boost to gross lesions) with respect to in-brain distant control
for brain metastases, defined as an in-brain failure rate outside of the planning target
volume at 6 months of < 20%.
Secondary Objectives
1. Evaluate treated lesion control at 6 months for brain metastases in the setting of a
predetermined total biologically effective SIB dose as determined by radiographic
progression within the planning target volume with fusion and overlay of follow-up MRIs.
2. Evaluate overall survival at 6 months for brain metastases in the setting of WBRT with
SIB.
3. Evaluate changes in neurocognitive function after WBRT with SIB in the following
domains: verbal learning and memory as assessed by the Hopkins Verbal Learning Test -
Revised (HVLT-R); memory, executive function, and higher order cognition as assessed by
the Groton Maze Learning Test; and working memory via either the Two Back Test or One
Back Test (depending on patient performance at baseline). All tests except the HVLT-R
are part of a custom battery designed with the help of CogState psychology staff and
will be delivered via the CogState platform.
4. Evaluate changes in health-related quality of life as assessed by the Functional
Assessment of Cancer Therapy with Brain Subscale (FACT-Br) after WBRT-SIB for brain
metastases.
5. Evaluate changes in performance status as assessed by the Karnofsky Performance Status
tool after WBRT-SIB for brain metastases.
6. Evaluate adverse events after WBRT-SIB for brain metastases according to current CTCAE
criteria and documented by the LENT-SOMA form.
of simultaneous integrated boost to gross lesions) with respect to in-brain distant control
for brain metastases, defined as an in-brain failure rate outside of the planning target
volume at 6 months of < 20%.
Secondary Objectives
1. Evaluate treated lesion control at 6 months for brain metastases in the setting of a
predetermined total biologically effective SIB dose as determined by radiographic
progression within the planning target volume with fusion and overlay of follow-up MRIs.
2. Evaluate overall survival at 6 months for brain metastases in the setting of WBRT with
SIB.
3. Evaluate changes in neurocognitive function after WBRT with SIB in the following
domains: verbal learning and memory as assessed by the Hopkins Verbal Learning Test -
Revised (HVLT-R); memory, executive function, and higher order cognition as assessed by
the Groton Maze Learning Test; and working memory via either the Two Back Test or One
Back Test (depending on patient performance at baseline). All tests except the HVLT-R
are part of a custom battery designed with the help of CogState psychology staff and
will be delivered via the CogState platform.
4. Evaluate changes in health-related quality of life as assessed by the Functional
Assessment of Cancer Therapy with Brain Subscale (FACT-Br) after WBRT-SIB for brain
metastases.
5. Evaluate changes in performance status as assessed by the Karnofsky Performance Status
tool after WBRT-SIB for brain metastases.
6. Evaluate adverse events after WBRT-SIB for brain metastases according to current CTCAE
criteria and documented by the LENT-SOMA form.
Inclusion Criteria
1. Age ≥ 18 at time of consent.
2. Ability to provide written informed consent and HIPAA authorization.
3. Pathological diagnosis of any solid tumor histology (from any site in the body).
4. Pathological or clinical (i.e., by imaging) diagnosis of brain metastatic tumor
lesions.
5. Total volume of lesions ≤ 30 cm3.
6. Maximum volume of largest lesion ≤ 5 cm3.
a. This volume limit would be equivalent to a largest diameter of about 2.1 cm,
assuming a perfect sphere.
7. Not a candidate for or eligible for but refused Gamma Knife radiosurgery.
Exclusion Criteria
1. Previous radiation to the brain, including WBRT or brain radiosurgery.
2. Life expectancy < 6 months (as estimated per ds-GPA).
3. Inability to comply with treatment per investigator discretion.
4. Inability to complete neurocognitive assessments per investigator discretion.
Of note, tumor lesion number is not an inclusion or exclusion criteria as we are using
volume-based criteria instead.
We found this trial at
3
sites
Indianapolis, Indiana 46202
Principal Investigator: Gordon A. Watson, MD, PhD
Phone: 317-962-3172
Click here to add this to my saved trials
Indianapolis, Indiana 46202
Principal Investigator: Gordon A. Watson, MD, PhD
Phone: 317-962-3172
Click here to add this to my saved trials
Indianapolis, Indiana 46202
Principal Investigator: Gordon A. Watson, MD, PhD
Phone: 317-962-3172
Click here to add this to my saved trials