Trial Search Results

Memantine Hydrochloride and Whole-Brain Radiotherapy With or Without Hippocampal Avoidance in Reducing Neurocognitive Decline in Patients With Brain Metastases

This randomized phase III trial compares memantine hydrochloride and whole-brain radiotherapy with or without hippocampal avoidance in reducing neurocognitive decline in patients with cancer that has spread from the primary site (place where it started) to the brain. Whole brain radiotherapy (WBRT) is the most common treatment for brain metastasis. Unfortunately, the majority of patients with brain metastases experience cognitive (such as learning and memory) deterioration after WBRT. Memantine hydrochloride may enhance cognitive function by binding to and inhibiting channels of receptors located in the central nervous system. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Using radiation techniques, such as intensity modulated radiotherapy to avoid the hippocampal region during WBRT, may reduce the radiation dose to the hippocampus and help limit the radiation-induced cognitive decline. It is not yet known whether giving memantine hydrochloride and WBRT with or without hippocampal avoidance works better in reducing neurocognitive decline in patients with brain metastases.

Stanford is currently accepting patients for this trial.

Lead Sponsor:

NRG Oncology

Collaborator: National Cancer Institute (NCI)

Intervention(s):

  • Other: Cognitive Assessment
  • Radiation: Intensity-Modulated Radiation Therapy
  • Drug: Memantine Hydrochloride
  • Other: Quality-of-Life Assessment
  • Radiation: Whole-Brain Radiotherapy
  • Radiation: Whole-Brain Radiotherapy

Phase:

Phase 3

Eligibility


Inclusion Criteria:

   - PRIOR TO STEP 1 REGISTRATION:

   - Brain metastases outside a 5-mm margin around either hippocampus must be visible on
   contrast-enhanced magnetic resonance imaging (MRI) performed =< 21 days prior to Step
   1 registration; an allowed exception, regarding ability to image brain metastases,
   would be that patients who had undergone radiosurgery or surgical resection and are
   planning adjuvant WBRT do not have to have visible disease but do need a pre-surgery
   MRI or computed tomography (CT) scan demonstrating brain metastases; however, the
   brain metastases could not have been within 5 mm of either hippocampus

   - Patients must have a gadolinium contrast-enhanced three-dimensional spoiled gradient
   (SPGR), magnetization-prepared rapid gradient echo (MP-RAGE), or turbo field echo
   (TFE) axial MRI scan with standard axial and coronal gadolinium contrast-enhanced
   T1-weighted sequence and axial T2/FLAIR sequence acquisitions; to yield acceptable
   image quality, the gadolinium contrast-enhanced three-dimensional SPGR, MP-RAGE, or
   TFE axial MRI scan should use the smallest possible axial slice thickness not
   exceeding 1.5 mm; the associated coronal and sagittal contrast-enhanced T1 sequences
   can be up to 2.5 mm in slice thickness; this MRI must be obtained =< 21 days prior to
   step 1 registration; the vendor specific MRI protocols are available for download from
   the Alzheimer's Disease Neuroimaging Initiative (ADNI)

   - Patients must provide study-specific informed consent prior to registration

   - PRIOR TO STEP 2 REGISTRATION:

   - The following baseline neurocognitive assessments must be completed prior to Step 2
   registration: HVLT-R, TMT, and COWA; the neurocognitive assessment will be uploaded
   into the NRG RAVE System for evaluation by Dr. Wefel; once the upload is complete, a
   notification will be sent to proceed to Step 2; NOTE: completed baseline
   neurocognitive assessments can be uploaded at the time of Step 1 registration

   - Pathologically (histologically or cytologically) proven diagnosis of solid tumor
   malignancy within 5 years prior to Step 2 registration

   - History and physical examination within 28 days prior to Step 2 registration

   - Karnofsky performance status of >= 70 within 28 days prior to Step 2 registration

   - Serum creatinine =< 3 mg/dL (265 umol/L) and creatinine clearance >= 30 ml/min

   - Blood urea nitrogen (BUN) within institutional upper limit of normal (e.g. < 20 mg/dL)

   - Total bilirubin =< 2.5 mg/dL (43 umol/L)

   - Patients may have had prior therapy for brain metastasis, including radiosurgery and
   surgical resection; patients must have completed prior therapy by at least 14 days
   prior to Step 2 for surgical resection and 7 days for radiosurgery

   - Negative serum pregnancy test (in women of childbearing potential) =< 14 days prior to
   Step 2; women of childbearing potential and men who are sexually active must practice
   adequate contraception while on study

   - Patients who are primary English or French speakers are eligible

Exclusion Criteria:

   - Prior external beam radiation therapy to the brain or whole brain radiation therapy

   - Planned cytotoxic chemotherapy during the WBRT only; patients may have had prior
   chemotherapy

   - Radiographic evidence of hydrocephalus or other architectural distortion of the
   ventricular system, including placement of external ventricular drain or
   ventriculoperitoneal shunt

   - Severe, active co-morbidity defined as follows:

      - Unstable angina and/or congestive heart failure requiring hospitalization within
      the last 6 months

      - Transmural myocardial infarction within the last 6 months

      - Acute bacterial or fungal infection requiring intravenous antibiotics at the time
      of registration

      - Chronic obstructive pulmonary disease exacerbation or other acute respiratory
      illness precluding study therapy at the time of registration

      - Severe hepatic disease defined as a diagnosis of Child-Pugh class B or C hepatic
      disease

      - Renal tubular acidosis or metabolic acidosis

      - Human immunodeficiency virus (HIV) positive with cluster of differentiation (CD)4
      count < 200 cells/microliter; note that patients who are HIV positive are
      eligible, provided they are under treatment with highly active antiretroviral
      therapy (HAART) and have a CD4 count >= 200 cells/microliter within 30 days prior
      to registration; Note also that HIV testing is not required for eligibility for
      this protocol

   - Pregnant or lactating women, or women of childbearing potential and men who are
   sexually active and not willing/able to use medically acceptable forms of
   contraception

   - Prior allergic reaction to memantine (memantine hydrochloride)

   - Current alcohol or drug abuse (may exacerbate lethargy/dizziness with memantine)

   - Intractable seizures while on adequate anticonvulsant therapy—more than 1 seizure per
   month for the past 2 months

   - Patients with definitive leptomeningeal metastases

   - Patients with brain metastases from primary germ cell tumors, small cell carcinoma,
   unknown primary, or lymphoma

   - Contraindication to magnetic resonance (MR) imaging such as implanted metal devices or
   foreign bodies

   - Contraindication to gadolinium contrast administration during MR imaging, such as
   allergy or insufficient renal function

   - Current use of (other N-methyl D-aspartate [NMDA] antagonists) amantadine, ketamine,
   or dextromethorphan

Ages Eligible for Study

18 Years - N/A

Genders Eligible for Study

All

Now accepting new patients

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Yeon Koo
650-721-4069
Recruiting