To test the effectiveness and safety of Optune® given concomitantly with radiation therapy (RT) and temozolomide (TMZ) in newly diagnosed GBM patients, compared to radiation therapy and temozolomide alone. In both arms, Optune® and maintenance temozolomide are continued following radiation therapy.
Optune® is a medical device that has been approved for the treatment of recurrent and newly diagnosed glioblastoma (GBM) by the Food and Drug Administration (FDA) in the United States. Optune® has obtained a CE mark in Europe for recurrent and newly diagnosed GBM. The current standard of care for GBM includes the addition of Optune® to maintenance temozolomide (TMZ), following the completion of radiation therapy (RT). The purpose of the current study is to test if the earlier introduction of Optune®, at the time of radiation therapy (which is given together with temozolomide), improves clinical outcomes compared to the standard of care. The study will randomize 950 subjects equally to one of two treatment arms: 1. Treatment arm I: Patients receive TTFields at 200 kHz to the brain using the Optune® System together with RT and TMZ, followed by maintenance TMZ concomitant with the Optune® treatment. 2. Treatment arm II: Patients receive RT and TMZ alone, followed by maintenance TMZ concomitant with TTFields at 200 kHz to the brain using the Optune®. All patients are to receive standard RT and TMZ treatment followed by maintenance TMZ chemotherapy and Optune® according to the current standard of care regimen. Optune® will continue until second disease progression per 2010 RANO Criteria unless any of the treatment discontinuation conditions described under criteria for patient withdrawal or termination are met. After surgery or biopsy, subjects that would like to participate will be required to submit samples of their tumor to a lab for testing. The results of this test will be used for randomization into the trial. If the subject is assigned to the treatment group that will start Optune® therapy during radiation therapy, Optune® therapy will begin within 10 days of enrolling in the study and no later than the first day of RT and TMZ treatment. After the initial visit, subjects will continue treatment at home, while pursuing normal daily routines. Subjects are required to use the device for at least 18 hours a day. Short breaks in treatment for personal hygiene and other personal needs is allowed. Total usage time will be recorded and provided to the site and sponsor. Subjects will be required to return to the clinic per the study protocol. After the second disease progression, subjects will return to the clinic for one final visit approximately 30 days after the last treatment with Optune® or after second disease progression, the latter of the two per protocol. After completing active participation in the study, subjects will be contacted once per month to answer basic questions about their health status.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
981
Optune® is a commercial, portable, battery-operated device intended for continuous home use, which delivers TTFields at a frequency of 200kHz to the brain by means of insulated transducer arrays. The Optune® device produces electric forces intended to disrupt cancer cell division. In treatment arm I, the patient starts Optune® concurrently with RT/TMZ for 6 weeks, followed by Optune® + TMZ until second disease progression. In treatment arm II, the patient starts RT/TMZ for 6 weeks, followed by Optune® + TMZ until second disease progression.
Overall Survival (OS)
Survival will be measured from the time of randomization until date patient is alive.
Time frame: 5 years
Progression Free Survival (PFS)
PFS will be measured from the date of randomization to the date of progression based on the 2010 RANO Criteria.
Time frame: 5 years
1- and 2-year survival rates
The analyses will be performed based on estimated proportions of patients who are on study at 12 and 24 months in both arms of the study.
Time frame: 5 years
Overall Radiological response (ORR)
The analyses will be performed based on the 2010 RANO criteria, and comparison between the rates of response.
Time frame: 5 years
Next progression-free survival (PFS2)
PFS2 will be measured from the time of randomization to second tumor progression.
Time frame: 5 years
Progression-free survival at 6 (PFS6) and 12 months (PFS12)
The analyses will be estimated proportions of patients who are progression-free at 6 and 12 months in both arms of the study.
Time frame: 5 years
Severity and frequency of adverse events
The analyses will be performed based on the incidence, severity, frequency of adverse events, and their association with study treatments.
Time frame: 5 years
Quality of Life EORTC Questionnaire
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The analyses will be assessed using the EORTC QLQ C-30 questionnaire with BN-20 (brain symptom) supplement.
Time frame: 5 years
The NANO scale
The Neurological assessment in Neuro-Oncology will be assessed using the NANO scale questionnaire and per the 2010 RANO criteria.
Time frame: 5 years