This is a Prospective Randomized Open Blinded Endpoint phase II clinical trial. The study will be adaptive: an interim analysis is planned after enrolment of 20 patients in each arm of treatment (WBRT and AGuIX® + WBRT), to select and continue the study with group(s) that present the best response rate to the experimental treatment (AGuIX® + WBRT). The main endpoint will be evaluated by a blinded endpoint committee.
The occurrence of brain metastases is a common event in the history of cancer and negatively affects the life expectancy of patients. Their incidence varies between 15 and 50% according to the histologic types. Surgery, stereotactic radiosurgery, radiotherapy and chemotherapy are the main treatments currently proposed. For patients with multiple brain metastases, whole brain radiation therapy (WBRT) remains the standard of care. However, the median overall survival is less than 6 months and new approaches need to be developed to improve treatment of these patients. In this context, the weak control of the disease comes from three main factors: the multiplicity of the brain lesions, the radioresistance of certain histologies and the poor distribution of cytotoxic agents in brain metastases. The use of radiosensitizing agents is here of great interest. The radiosensitizing agent chosen in this study is AGuIX®. It is a Gadolinium-chelated polysiloxane based nanoparticle developed by NH TherAguix company for its theranostic properties (radiosensitization and diagnosis by multimodal imaging). Preclinical studies have demonstrated the radiosensitizing effect of AGuIX® in vivo in 8 tumor models xenografted in rodents, and particularly in brain tumors.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
100
3 intravenous injection at 100mg/kg * D0: AGuIX® injection followed by MRI (within 7 days before commencement of WBRT) * Fr1: AGuIX® injection before the first radiation session * Fr6: AGuIX® injection before the sixth radiation session
30 Gy in 10 fractions of 3 Gy over 2-3 weeks
Institut Régional du Cancer
Montpellier, Occitanie, France
Institut Claudius Regaud Institut Universitaire du Cancer Toulouse Oncopole Radiothérapie
Toulouse, Occitanie, France
Centre Leon Berard Lyon
Lyon, Rhones Alpes, France
Best objective intracranial response rate - intent-to-treat
Evaluation of brain metastases response, according to RECIST v1.1 criteria (or modified RECIST) by MRI, with MRI centralized reading
Time frame: at 6 weeks
Best objective intracranial response rate - intent-to-treat
Evaluation of brain metastases response, according to RECIST v1.1 criteria (or modified RECIST) by MRI, with MRI centralized reading
Time frame: at 3 months
Evaluation of the quality of life
Quality of life test score EORTC QLQ C30
Time frame: at D0, 6 weeks, 3, 6, 9, 12 months
Evaluation of the quality of life
Quality of life test score EORTC QLQ BN20
Time frame: at day 0, 6 weeks, 3, 6, 9, 12 months
Neurocognitive evaluation
Neurocognitive test (MoCA)
Time frame: at Day 0, 6 weeks, 3, 6, 9, 12 months
Best objective intracranial response rate - per-protocol
Evaluation of brain metastases response on per-protocol population, according to RECIST v1.1 criteria (or modified RECIST), by MRI with centralized reading
Time frame: at 6 weeks and 3 months
Evaluation of the intracranial response rate
Evaluation of brain metastases response, according to RANO, to RECIST v1.1 criteria, and as the evolution of the sum of longest diameters (for all metastases with a sum of diameters \> 1cm), by MRI, at 6 weeks and 3, 6, 9 and 12 months
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Centre Hospitalier Annecy Genevois
Annecy, Rhones-Alpes, France
Centre Hospitalier Universitaire Grenoble-Alpes
Grenoble, Rhones-Alpes, France
CRLCC - Institut Bergonié
Bordeaux, France
Crlcc Francois Baclesse
Caen, France
Centre Georges François Leclerc
Dijon, France
Hospices Civils de Lyon-Hôpital Lyon Sud
Lyon, France
Hôpital Européen Georges Pompidou
Paris, France
...and 4 more locations
Time frame: for 12 months
Evaluation of individual metastasis response
Evaluation of individual brain metastasis response, for all metastases with the sum of diameters \> 1cm, by MRI rate
Time frame: at 6 weeks and 3, 6, 9 and 12 months
Intracranial progression-free survival
Evaluation of the time between the start of the treatment and the occurence of intracranial progression or neuriologic death
Time frame: at 12 months
Intracranial progression-free survival, brain survival
Death related to brain metastases progression
Time frame: at 12 months
Overall survival
Death
Time frame: at 12 months
Change in steroid dependence
Reporting of daily steroid dose
Time frame: at 6 weeks and 3, 6, 9 and 12 months
Incidence of adverse events
Reporting of adverse events by type, frequency and severity for both treatments (WBRT and AGuIX® + WBRT)
Time frame: at 6 weeks and 3, 6, 9 and 12 months
MRI study of the distribution of the product in brain metastases
MRI evaluation of contrast enhancement at D0 after AGuIX® injection
Time frame: Day 0