A Clinical Study to Improve Brain Function and Quality of Life of Patients With Newly Diagnosed Brain Tumors (Gliomas).
Status:
Recruiting
Trial end date:
2029-03-31
Target enrollment:
Participant gender:
Summary
Oligodendrogliomas in the novel edition of the Central Nervous System (CNS) World Health
Organization (WHO) classification are now molecularly defined by isocitrate dehydrogenase
(IDH)1 or IDH2 mutations and 1p/19q co-deletion. The prognosis of these molecularly defined
tumors is to be determined in new series since survival data from older histology-based
studies and population-based registries are confounded by the inclusion of 20-70% not
molecularly matching subsets. Also, the optimal treatment is a matter of ongoing
investigations. An extensive, but safe surgery is associated with improved outcome as is the
addition of chemotherapy with procarbazine, CCNU (lomustine), and vincristine (PCV) to the
partial brain radiotherapy (RT). However, the exact timing of postsurgical therapy especially
for tumors of the WHO grade II and acknowledging some variability in grading as well as the
choice of chemotherapy, temozolomide instead of PCV (CODEL: NCT00887146 randomizing CNS WHO
grade 2 and 3 oligodendrogliomas to chemoradiation(CHRT)therapy with PCV or with
temozolomide) or the need for primary radiotherapy RT are subjects of clinical studies
(POLCA: NCT02444000 randomizing patients with newly diagnosed CNS WHO grade 3
oligodendrogliomas to standard CHRT with PCV or PCV alone). Given the young age of patients
with CNS WHO grade 2 and 3 oligodendrogliomas and the relevant risk of neurocognitive,
functional and quality-of-life impairment with the current aggressive standard of care
treatment, chemoradiation with PCV, of the tumor located in the brain optimizing care is the
major challenge.
NOA-18/IMPROVE CODEL aims at improving qualified overall survival (qOS) for adult patients
with CNS WHO grade 2 and 3 oligodendrogliomas by randomizing between standard chemoradiation
with up to six six-weekly cycles with PCV and six six-weekly cycles with lomustine and
temozolomide (CETEG), thereby delaying radiotherapy (RT) and adding the chemoradiotherapy
(CHRT) concept at progression after initial radiation-free chemotherapy, allowing for an
effective salvage treatment and delaying potentially deleterious side effects. QOS represents
a new concept and is defined as OS without functional and/or cognitive and/or quality of life
(QOL) deterioration regardless whether tumor progression or toxicity is the main cause.
Phase:
Phase 3
Details
Lead Sponsor:
University Hospital Heidelberg
Collaborators:
Ruhr University of Bochum Universitätsmedizin Mannheim