Clinical trial • Phase IV • Oncology|Immunology

Pembrolizumab for Glioblastoma multiforme

Phase IV trial of Pembrolizumab for Glioblastoma multiforme.

Overview

Trial Therapeutic Area
Oncology|Immunology
Trial Disease
Glioblastoma multiforme
Trial Stage
Phase IV
Drug Modality
Monoclonal antibody

Key dates

Initial CTIS Submission Date
12-09-2024
First CTIS Authorization Date
05-11-2024

Trial design

Randomised, open-label, three arms: arm 1 — neoadjuvant pembrolizumab (2 doses, 200 mg each) plus adjuvant pembrolizumab (16 cycles q3w, 200 mg each) on top of standard chemo-radiotherapy (stupp protocol: radiotherapy 60 gy over 6 weeks, 2 gy per daily fraction mon-fri plus temozolomide 75 mg/m2 daily during radiotherapy and six cycles post-radiotherapy of 150-200 mg/m2 for 5 days in each 28-day cycle); arm 2 — neoadjuvant pembrolizumab (2 doses, 200 mg each) on top of standard stupp protocol (radiotherapy 60 gy + temozolomide 75 mg/m2 during radiotherapy and 6 cycles post-radiotherapy of 150-200 mg/m2 for 5 days each 28-day cycle); arm 3 — standard chemo-radiotherapy (stupp protocol) alone (radiotherapy 60 gy + temozolomide 75 mg/m2 during radiotherapy and 6 cycles post-radiotherapy of 150-200 mg/m2 for 5 days each 28-day cycle).-controlled Phase IV trial across 2 sites in Poland.

Randomised
Yes
Open Label
Yes
Comparator
Three arms: Arm 1 — neoadjuvant Pembrolizumab (2 doses, 200 mg each) plus adjuvant Pembrolizumab (16 cycles q3w, 200 mg each) on top of standard chemo-radiotherapy (Stupp protocol: radiotherapy 60 Gy over 6 weeks, 2 Gy per daily fraction Mon-Fri plus Temozolomide 75 mg/m2 daily during radiotherapy and six cycles post-radiotherapy of 150-200 mg/m2 for 5 days in each 28-day cycle); Arm 2 — neoadjuvant Pembrolizumab (2 doses, 200 mg each) on top of standard Stupp protocol (radiotherapy 60 Gy + Temozolomide 75 mg/m2 during radiotherapy and 6 cycles post-radiotherapy of 150-200 mg/m2 for 5 days each 28-day cycle); Arm 3 — standard chemo-radiotherapy (Stupp protocol) alone (radiotherapy 60 Gy + Temozolomide 75 mg/m2 during radiotherapy and 6 cycles post-radiotherapy of 150-200 mg/m2 for 5 days each 28-day cycle).
Target Sample Size
36
Trial Duration For Participant
942

Eligibility

Recruits 36 Trial indicates vulnerable population selection is true. Participants must be adults (Age ≥ 18 years and ≤ 70 years) and must provide a Signed Informed Consent Form. Subjects with "Any mental disorder that may affect patient's participation" or inability to understand the local language for QoL instruments are excluded. Informed consent is obtained from the participant (ICF document available; PL translations present). No procedures for parental consent or assent for minors are applicable because enrollment is restricted to adults..

Pregnancy Exclusion
Pregnant or lactating or intending to become pregnant during the study – women who are not postmenopausal (postmenopausal defined as ≥ 12 months of non-drug-induced amenorrhea) or surgically sterile must have a negative serum pregnancy test result within 2 weeks prior to initiation of study treatment
Vulnerable Population
Trial indicates vulnerable population selection is true. Participants must be adults (Age ≥ 18 years and ≤ 70 years) and must provide a Signed Informed Consent Form. Subjects with "Any mental disorder that may affect patient's participation" or inability to understand the local language for QoL instruments are excluded. Informed consent is obtained from the participant (ICF document available; PL translations present). No procedures for parental consent or assent for minors are applicable because enrollment is restricted to adults.

Inclusion criteria

  • {"criterion_text":"- Signed Informed Consent Form\n- For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use double barrier contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 120 days after the last immuno-PET imaging.\n- For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use double barrier contraceptive methods that result in a failure rate of < 1% per year during the treatment period and for at least 120 days after the last immuno-PET imaging.\n- Age ≥ 18 years\n- Age ≤70 years\n- Able to comply with the study protocol in the investigator’s judgment\n- Clinically and radiologically (contrast CT, full profile MRI – T1-weighted with or without contrast, T2-weighted, FLAIR, DWI, PWI, MR-spectroscopy) confirmed diagnosis of GBM, localized outside eloquent brain areas\n- Resectable tumor\n- Fully physically active ≥80 points in Karnofsky performance scale\n- Life expectancy of at least 3 months\n- Adequate organ function (confirmed within 1 weeks before enrollment):a) Hemoglobin ≥ 9g/dL , b) Absolute Neutrophils Count (ANC) ≥1.5×10^9/L, c) White Blood Cells (WBC) count ≥3×10^9/L, d) Platelets (PTL) ≥ 100×10^9/L, e) AST/ALT ≤2.5×ULN, f) Serum creatinine (S-Cr) ≤ ULN, g) Glomerular Filtration Rate (GFR) ≥50mL/min, h) Albumin ≥ LLN , i) Bilirubin ≤ 1.5 ULN (except patients with documented Gilbert’s Syndrome, who must present adequate level of direct bilirubin),j) International normalized ratio (INR) and activated partial thromboplastin time (aPTT) ≤ 1.5×ULN. (Elevation of INR and aPTT due to administration of anticoagulation drugs is not a contraindication for the enrollment. However, it must return to normal range prior to surgery)."}

Exclusion criteria

  • {"criterion_text":"- Any active concomitant malignancy, except: a. Locally treated basal or squamous cell carcinoma b. Cervical carcinoma in situ c. Breast cancer in situ d. Bladder cancer in situ e. Low grade prostate cancer (under observation with PSA level in normal range)\n- History of tuberculosis\n- Any mental disorder that may affect patient's participation\n- Any drug or psychoactive substance dependence\n- Evidence of significant uncontrolled concomitant disease that could affect compliance with the protocol\n- Treatment with any other investigational agent or participation in another clinical trial with therapeutic intent within 28 days prior to study treatment initiation\n- Major surgical procedure within 4 weeks prior to study enrollment or anticipation of need for a major surgical procedure during the course of the study other than for diagnosis\n- Any live vaccination within 30 days before enrollment\n- Any active immunosuppressive systemic infection including history of human immunodeficiency virus (HIV) infection\n- Body mass index (BMI) ≥ 35 kg/m2\n- Pregnant or lactating or intending to become pregnant during the study – women who are not postmenopausal (postmenopausal defined as ≥ 12 months of non-drug-induced amenorrhea) or surgically sterile must have a negative serum pregnancy test result within 2 weeks prior to initiation of study treatment\n- Any previous systemic cancer treatment, including, but not limited to: a. Radiotherapy b. Brachytherapy for brain tumor c. Chemotherapy d. Carmustine wafer treatment (Gliadel®) e. Any immune checkpoint inhibitor therapy or any anticancer vaccination\n- Any condition that the patient's physician determines to be detrimental to the patient participating in this study; including any clinically important deviations from normal clinical laboratory values or concurrent medical events\n- Inability to understand the local language for use of the patient QoL instruments\n- Tumor other than glioblastoma grade 4 IDH-wildtype, astrocytoma grade 3 or 4 IDH-mutant identified in post-surgery histopathology.\n- Presence of 1p19q codeletion\n- Hypersensitivity or allergy to any substance with similar action mechanism to Pembrolizumab, Atezolizumab, Temozolomide, other monoclonal antibodies or contrast agents\n- Any active immunosuppressive systemic therapy (except corticosteroids less or equal to 12mg of dexamethasone equivalent; the dose of dexamethasone should be kept as low as possible throughout the whole duration of this trial)\n- Any active autoimmune disease or systemic therapy for autoimmune disease within 2 years before enrollment\n- History of any immunodeficiency\n- Active infection\n- Significant cardiovascular disease, such as New York Heart Association cardiac disease ≥ Class III, myocardial infarction within 3 months, coronary artery disease, unstable arrhythmias or unstable angina\n- Active liver disease, hepatitis, HBV or HCV infection"}

Endpoints

Primary endpoints

  • {"endpoint_text":"- Safety and tolerability – incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs) related and unrelated with Pembrolizumab","definition_or_measurement_approach":"Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs) related and unrelated to Pembrolizumab (safety and tolerability assessment)."}
  • {"endpoint_text":"- Patient-Reported Outcomes to evaluate health status and Quality of Life (QoL) instruments for patients with GBM:  Eastern Cooperative Oncology Group (ECOG) status - Karnofsky Performance Status (KPS), - EORTC: QLQ-BN20 (brain), and QLQ-C30 (general cancer questionnaire).","definition_or_measurement_approach":"Patient-reported instruments and clinical performance scales: ECOG status, Karnofsky Performance Status (KPS), EORTC QLQ-BN20 and QLQ-C30 questionnaires to evaluate health status and QoL."}

Recruitment

Planned Sample Size
36
Recruitment Window Months
40
Consent Approach
Signed informed consent is required from each participant (adult participants only; Age ≥ 18). Subject information and informed consent form document is listed (L1_ICF_PL_redacted) and protocol translations into Polish are present. No assent procedures for minors are applicable because minors are excluded.

Geography

Total Number Of Sites
2
Total Number Of Participants
36

Poland

Earliest CTIS Part Ii Submission Date
25-09-2024
Latest Decision Or Authorization Date
21-11-2025
Processing Time Days
422
Number Of Sites
2
Number Of Participants
36

Sites

Site Name
Wojewódzki Szpital Specjalistyczny nr 5 im. św. Barbary w Sosnowcu
Department Name
Oddzial Kliniczny Neurochirurgii Katedry Neurochirurgii
Contact Person Name
Wojciech Kaspera
Contact Person Email
wkaspera@sum.edu.pl
Site Name
Narodowy Instytut Onkologii Im. Marii Sklodowskiej-Curie Panstwowy Instytut Badawczy
Department Name
III Klinika Radioterapii i Chemioterapii
Contact Person Name
Wojciech Kaspera
Contact Person Email
wkaspera@sum.edu.pl

Sponsor

Primary sponsor

Full Name
Medical University Of Silesia Katowice Poland
Organisation Type
Educational Institution
Country Of Registered Address
Poland

Third parties

  • {"country":"Poland","full_name":"Clinical Consulting Sp. z o.o.","duties_or_roles":"1,10,12,5,6,7,8,9","organisation_type":"Pharmaceutical company"}

Investigational products

Investigational Product Name
KEYTRUDA 25 mg/mL concentrate for solution for infusion
Active Substance
Pembrolizumab
Modality
Monoclonal antibody
Routes Of Administration
Intravenous infusion
Route
Intravenous infusion
Authorisation Status
Marketing authorisation present (EU/1/15/1024/002)
Starting Dose
200 mg
Dose Levels
200 mg
Frequency
Neoadjuvant: 2 doses (day 4 and day 18); Adjuvant (arm 1): 16 cycles every 3 weeks (q3w) 200 mg each; Adjuvant none for arms 2/3 beyond SoC
Maximum Dose
200 mg per infusion
Combination Treatment
Yes

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