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Glyburide vs Placebo as Prophylaxis Against Cerebral Edema in Patients Receiving Radiosurgery for Brain Metastases (GCC 1465)

Information source: University of Maryland
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Cerebral Edema; Brain Metastases

Intervention: Glyburide (Drug); Placebo (Other)

Phase: Phase 1/Phase 2

Status: Not yet recruiting

Sponsored by: University of Maryland

Overall contact:
Nancy Kennedy, RN, BSN, Phone: 410-328-2513, Email: nkennedy@umm.edu

Summary

Primary Objectives: Pilot Portion: To determine the feasibility and safety of administering oral glyburide to non-diabetic patients receiving stereotactic radiosurgery (SRS) for newly diagnosed brain metastases. Randomized Portion: To determine the number of patients with newly diagnosed brain metastases who have an increase in edema as measured on volumetric FLAIR imaging and the number of patients that require dexamethasone administration (or any corticosteroid administration with the purpose of treating cerebral edema) from the day of SRS to one month follow-up MRI in the group receiving glyburide versus placebo.

Clinical Details

Official title: A Pilot Study and Phase II Double Blind Placebo Controlled Randomized Trial Examining the Safety and Efficacy of Glyburide as Prophylaxis Against Cerebral Edema in Patients Receiving Radiosurgery for Brain Metastases

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator), Primary Purpose: Treatment

Primary outcome:

Pilot Portion: Occurrence of Dose Limiting Toxicities (DLTs) between the time of glyburide initiation and the time of the one month follow-up MRI.

Randomized Portion: Occurrence of edema increase and initiation of dexamethasone (or any corticosteroid administration with the purpose of treating cerebral edema) between the time of SRS and the time of the one month follow-up MRI.

Secondary outcome:

ktrans change as assessed at the time of SRS and the time of the one and three month post SRS MRI scans..

FLAIR ratio change as assessed at the time of SRS and the time of the one and three month post SRS MRI scans.

Time until dexamethasone initiation (or any corticosteroid administration with the purpose of treating cerebral edema) as measured between the time of SRS and the time of the one and three month post SRS MRI scans.

Incidence of CTCAE version 4.0 reportable toxicities of grades 2-5.

Incidence of CTCAE version 4.0 reportable toxicities of grades 1-2 Cardiac Disorders or Hepatobiliary Disorders.

Cerebral edema increase as measured on FLAIR volumetric imaging, defined from MRI taken at the time of SRS and the time of the one and three month post SRS MRI scans.

Absolute volume change of index tumor(s) that received radiosurgery as manually contoured by the radiation oncologist defined from T1 post gadolinium sequences at the time of SRS and the time of the one and three month post SRS MRI scans.

Detailed description: Many patients with cancer that has spread to the brain have side effects caused by swelling around the tumors. A common treatment for this swelling is a medicine called dexamethasone. Dexamethasone is a steroid. Long-term use of steroids has several known side effects. Recent studies have shown that a drug commonly used in to control high blood sugar in diabetes, called glyburide, can decrease brain swelling in patients with brain damage or stroke. Animal studies have shown that this drug may also reduce swelling from tumors in the brain. Researchers are interested in whether glyburide could treat brain swelling as well as dexamethasone with fewer side effects. This study is being done to see whether glyburide is safe to be used in patients without diabetes in combination with receiving SRS for brain metastases. This study will also find out if glyburide will decrease brain swelling in patients that get radiosurgery (SRS) for brain metastases. This study will also find out if taking glyburide will decrease the chance of needing steroids due to brain swelling that is causing symptoms. It is not yet known, but it is the investigators' hope that glyburide will both decrease brain swelling and lessen the chance of needing steroids.

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Patients with 1-10 newly diagnosed brain metastases.

- Subject must have cytologically or histologically confirmed malignancy (this is the

original malignancy, not the brain metastases).

- A diagnostic contrast-enhanced MRI of the brain must be performed within 60 days

prior to registration. The contrast-enhancing intraparenchymal brain tumor must be well circumscribed and must have a maximum diameter of ≤ 4. 0 cm in any direction on the enhanced scan. If multiple lesions are present and one lesion is at the maximum diameter, the other(s) must not exceed 3. 0 cm in maximum diameter.

- History and physical with neurological examination, height, and weight within 14 days

prior to registration

- No dexamethasone use (or any other corticosteroid use with the purpose of treating

cerebral edema) starting 3 days prior to the treatment planning MRI. Patients may be tapered to meet this criterion if deemed safe by the treating physician.

- Women of child-bearing potential (e. g. not post-menopausal or permanently sterilized

women) must have a negative pregnancy test obtained within 14 days prior to registration. This is to prevent potential harm to the fetus by glyburide and radiotherapy.

- CBC with differential and CMP obtained within 14 days prior to registration and

meeting the following requirements:

- Creatinine Clearance ≥ 50 mL/min.

- Total Bilirubin < 1. 5 x the upper limit of normal (ULN).

- ALT and AST ≤ 2. 5 x ULN.

- Glucose ≥ 80 mg/dL.

- Hemoglobin ≥ 7 mg/dL.

- Absolute Neutrophil Count > 100 cells/mm3.

- For the Randomized Portion only: Subject must have at least 2 of the following risk

factors: {For the Pilot Portion, it is not required that patients have the risk factors mentioned in Inclusion Criteria 9.}

- Melanoma/Renal Cell Carcinoma Primary Histology.

- Pretreatment Edema/Tumor ratio (≥ 35: 1) as contoured on a baseline MRI

obtained at most 60 days prior to registration. Patients are allowed to have Whole Brain Radiotherapy (WBRT) or corticosteroid use between the time of pretreatment MRI and SRS (as long as the corticosteroids can be safely tapered at least 3 days prior to the treatment planning MRI and WBRT is at least 4 days prior to registration).

- Greater than 40 pack year history of smoking cigarettes.

- Whole Brain Radiotherapy at least 4 days and no more than 1 year prior to

registration.

- RPA Class III.

Exclusion Criteria:

- Known sulfonylurea treatment within 7 days prior to registration. Sulfonylureas

include glyburide/glibenclamide (Diabeta, Glynase); glyburide plus metformin (Glucovance); glimepiride (Amaryl); repaglinide (Prandin); nateglinide (Starlix); glipizide (Glucotrol, GlibeneseR, MinodiabR); gliclazide (DiamicronR); tolbutamide (Orinase, Tolinase); and glibornuride (Glutril).

- Leptomeningeal metastases.

- Known allergy to sulfa or specific allergy to sulfonylurea drugs.

- Use of VEGF inhibitors within 10 days prior to registration.

- Patients receiving an investigational drug within 10 days prior to registration

- Allergy to gadolinium.

- Type 1 diabetes mellitus or Type 2 diabetes mellitus actively receiving treatment.

- Cognitive impairment that precludes a patient from acting as his or her own agent to

provide informed consent.

- Concurrent use of Bosentan.

- Any major medical illnesses or psychiatric impairments that in the treating

physician's opinion will prevent administration or completion of protocol therapy.

- Pregnant or breast feeding women due potential damage to the fetus

- Patients treated on any other therapeutic clinical protocols within 10 days prior to

registration or during participation in the study.

- Inability to undergo MRI or SRS (e. g. due to safety reasons such as presence of a

pacemaker).

- Deemed by the treating physician to be unable to eat regular meals.

Locations and Contacts

Nancy Kennedy, RN, BSN, Phone: 410-328-2513, Email: nkennedy@umm.edu

Ummc Msgcc, Baltimore, Maryland 21201, United States
Additional Information

Starting date: August 2015
Last updated: August 10, 2015

Page last updated: August 23, 2015

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