Supra-early Post-Surgery Chemotherapy in the Treatment on GBM Patients

A Clinical Study of Supra-early Post-Surgery Chemotherapy Plus Standard TEMODAL® Regimen Versus Standard TEMODAL® Regimen in the Treatment on Patients With Newly Diagnosed Glioblastoma Multiforme

The primary purpose of the study is to evaluate the efficacy and safety of supra-early post-surgery chemotherapy versus standard TEMODAL® regimen in treatment of patients with newly diagnosed glioblastoma multiforme. The secondary purpose is to assess the efficacy of supra-early post-surgery chemotherapy in release brain edema.

Glioblastoma (GBM) is the most common primary malignant brain tumor. Despite great efforts have been devoted to promoting the treatment effect, GBM remains one of the most lethal tumors concurrent with poor prognosis and inevitable recurrence. The standard treatment protocol for GBM includes surgical resection, radiotherapy and temozolomide (TMZ) based chemotherapy. TMZ, an alkylating agent, has been proved to be efficient to control tumor growth after surgery and gradually has been recognized in routine clinical course for GBM. In a pivotal clinical trial published in 2005, GBM patients received concomitant TMZ and radiotherapy followed by 6 periods of adjuvant TMZ chemotherapy had a median survival of 14.6 months and 5-year survival rate of 9.8%, which has been regarded as a landscape in treatment history of GBM. To date, this regimen remains the standard protocol for newly diagnosed GBM patients. However, the optimal timing of initiation of TMZ or radiotherapy remains unclear. Our previous study showed 75mg per square meter of body surface per day (mg/m2/d) of TMZ chemotherapy alone was effective to control post-operative edema caused by tumor cell infiltration in primary GBM patients. The result suggested anti-cancer agents such as TMZ may be a useful regimen to control tumor cell regrowth after operation. Therefore, we conducted this prospective clinical trial to testify the hypothesis that supra-early initiation of TMZ chemotherapy in newly diagnosed GBM patients is effective to control tumor growth after tumor resection and therefore improve patients'clinical outcome.

Inclusion Criteria:

1. Patients with prior histological confirmation of newly diagnosed primary glioblastoma multiforme in supratentorial cerebral hemisphere.

2. Gross total resection or partial resection (imaging) >70%.

3. Chemo-radiotherapy to be expected from Week 5 (Day 29) after surgery.

4. Age >=18 and <=70 years.

5. Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2.

6. Life expectancy >=9 months.

7. Laboratory test values must satisfy the following criteria:

   1. absolute neutrophil count >=1.5 x 10^9/L;
   2. platelet count >=100 x 10^9/L;
   3. hemoglobin >=80 g/L;
   4. blood urea nitrogen and creatinine < 1.5 x upper limit of normal value (ULN);
   5. total bilirubin and direct bilirubin < 1.5 x ULN;
   6. alanine aminotransferase and aspartate aminotransferase < 3 x ULN;
   7. alkaline phosphatase < 2 x ULN.

8. Patients must be willing to provide written informed consent.

9. Patients of child-bearing potential (including female subjects and the female partners of male subjects) must use an effective method of contraception.

Exclusion Criteria:

1. Patients without prior histological confirmation of primary glioblastoma multiforme.
2. Patient with previous or current malignancies at other sites.
3. Patient who received chemotherapy, radiotherapy for study indication, or other medications for antitumor indication prior to surgery.
4. Patient with recurrent or multiple malignant glioma (including gliomatosis cerebri).
5. Patient with metastatic lesions at the subtentorial or outside of calvaria.
6. Patient who received chemotherapy or radiotherapy sensitizers for head or neck tumor.
7. Patient who received radiotherapy at head or neck which leads to radiotherapy domain overlapping.
8. Frequent vomiting or medical condition that could interfere with oral medication intake (eg, partial bowel obstruction).
9. Known human immunodeficiency virus (HIV)-positive or acquired immune deficiency syndrome (AIDS)-related illness.
10. Woman who is pregnant or breastfeeding.
11. Patient with a history of hypersensitivity to temozolomide or other analogic alkylating agents.
12. Patient with severe myelosuppression
13. Patient with any other conditions under which investigators think the subject is not suitable for enrolment, such like having known that the subject may not have good compliance.