38 Participants Needed

Nivolumab + Radiosurgery for Recurrent Meningioma

Recruiting at 31 trial locations
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Breakthrough TherapyThis drug has been fast-tracked for approval by the FDA given its high promise

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, you cannot participate if you are currently using immunosuppressive medication, except for certain types like inhaled or topical steroids, or if you have had chemotherapy within 4 weeks before the study.

What data supports the effectiveness of the treatment Nivolumab + Radiosurgery for Recurrent Meningioma?

Research shows that stereotactic radiosurgery (a type of precise radiation treatment) is effective in controlling tumor growth in meningiomas, with tumor control rates over 85% for certain types. Additionally, stereotactic radiotherapy (a similar treatment) has been found to offer better tumor control and fewer side effects compared to stereotactic radiosurgery.12345

Is the combination of Nivolumab and radiosurgery safe for treating recurrent meningioma?

Stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) are generally safe for treating intracranial meningiomas, but SRS may lead to a higher risk of neurological issues and swelling compared to SRT. Further studies are needed to confirm these findings.15678

How does the treatment of Nivolumab + Radiosurgery for Recurrent Meningioma differ from other treatments?

This treatment is unique because it combines nivolumab, an immune checkpoint inhibitor that targets PD-1 to help the immune system attack cancer cells, with stereotactic radiosurgery (SRS), a precise form of radiation therapy. This combination aims to enhance the effectiveness of treatment for recurrent meningioma, a condition with limited standard treatment options.1591011

What is the purpose of this trial?

This trial studies how well nivolumab and stereotactic radiosurgery, with or without ipilimumab, work in treating patients whose grade II-III meningioma has returned. The treatment aims to boost the immune system to fight cancer and use precise radiation to shrink the tumor. Nivolumab and ipilimumab are immune checkpoint inhibitors that have shown promise in treating various cancers, including brain metastases from melanoma.

Research Team

JH

Jiayi Huang

Principal Investigator

Yale University Cancer Center LAO

Eligibility Criteria

Adults with Grade II-III meningioma that has returned after radiation therapy can join this trial. They must have a certain level of blood cells, normal organ function, and agree to use contraception if applicable. Pregnant or breastfeeding women, those on other trials, recent chemotherapy patients, individuals with severe allergies to similar drugs or active autoimmune diseases are excluded.

Inclusion Criteria

You have enough white blood cells in your body.
ECOG performance status =< 2 (Karnofsky >= 60%)
AST/ALT =< 2.5 x institutional ULN
See 22 more

Exclusion Criteria

You are currently taking part in other experimental treatments.
Chemotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to study entry
Residual toxicities > grade 1 from prior anti-cancer therapy
See 12 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Patients receive nivolumab and multi-fraction stereotactic radiosurgery, with or without ipilimumab, for up to 1 year

12 months
Regular visits every 2-4 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

100 days
Follow-up visits as needed

Treatment Details

Interventions

  • Ipilimumab
  • Nivolumab
  • Stereotactic Radiosurgery
Trial Overview The trial is testing the effectiveness and safe dosage of nivolumab combined with stereotactic radiosurgery for recurrent brain tumors (meningiomas), comparing results when used alone or alongside ipilimumab. These medications may help the immune system fight cancer by stopping tumor growth.
Participant Groups
2Treatment groups
Experimental Treatment
Group I: Cohort B (nivolumab, ipilimumab, radiosurgery)Experimental Treatment6 Interventions
Patients receive nivolumab IV over 30 minutes every 2 weeks for 12 doses (6 months) and then every 4 weeks for additional 6 months. Patients also receive ipilimumab IV over 90 minutes on day 1. Treatment with ipilimumab repeats every 6 weeks for 4 doses in the absence of disease progression or unacceptable toxicity. Patients undergo multi-fraction stereotactic radiosurgery on days 1, 3, and 5. Patients undergo brain MRI and blood sample collection throughout the study. Patients may also undergo ECHO as clinically indicated.
Group II: Cohort A (nivolumab, radiosurgery)Experimental Treatment5 Interventions
Patients receive nivolumab IV over 30 minutes on day 1. Cycles repeat every 28 days for up to 1 year in the absence of disease progression or unacceptable toxicity. Patients also undergo multi-fraction stereotactic radiosurgery on days 1, 3, and 5. Patients undergo brain MRI and blood sample collection throughout the study. Patients may also undergo ECHO as clinically indicated.

Ipilimumab is already approved in United States, European Union for the following indications:

🇺🇸
Approved in United States as Yervoy for:
  • Advanced melanoma
  • Stage III unresectable melanoma
  • Stage IV metastatic melanoma
🇪🇺
Approved in European Union as Yervoy for:
  • Advanced melanoma
  • Stage III unresectable melanoma
  • Stage IV metastatic melanoma

Find a Clinic Near You

Who Is Running the Clinical Trial?

National Cancer Institute (NCI)

Lead Sponsor

Trials
14,080
Recruited
41,180,000+

Findings from Research

A systematic review of 1736 patients showed that stereotactic radiotherapy (SRT) provides better radiographic tumor control and a lower risk of neurological worsening compared to stereotactic radiosurgery (SRS) in treating intracranial meningiomas.
SRS was associated with a significantly higher risk of immediate symptomatic edema and clinical neurological decline, indicating that while both treatments are safe, SRT may be the more effective option for long-term management.
Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis.Fatima, N., Meola, A., Pollom, EL., et al.[2020]
Stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) effectively controlled aggressive Grade I and II meningiomas, with 3-year progression-free survival rates of 100% for Grade I and 83% for Grade II tumors.
However, Grade III meningiomas showed poor outcomes, with a 3-year progression-free survival rate of 0%, indicating that these malignant tumors are less responsive to SRS and SRT treatments.
Stereotactic radiation treatment for recurrent nonbenign meningiomas.Mattozo, CA., De Salles, AA., Klement, IA., et al.[2022]
A study of 297 patients treated with Linac-based fractionated stereotactic radiotherapy (FSRT) for intracranial meningiomas showed high progression-free survival (PFS) rates of 92.3% at 3 years, 87% at 5 years, and 84.1% at 10 years, indicating that FSRT is an effective treatment option.
Patients who received adjuvant radiotherapy had significantly better PFS rates compared to those who underwent primary radiotherapy, and the treatment was generally safe, with less acute toxicity observed in patients receiving normofractionated radiotherapy compared to hypofractionated radiotherapy.
Linac-based stereotactic radiotherapy and radiosurgery in patients with meningioma.Kaul, D., Budach, V., Wurm, R., et al.[2022]

References

Stereotactic radiosurgery versus stereotactic radiotherapy in the management of intracranial meningiomas: a systematic review and meta-analysis. [2020]
Stereotactic radiation treatment for recurrent nonbenign meningiomas. [2022]
Linac-based stereotactic radiotherapy and radiosurgery in patients with meningioma. [2022]
Long-term Experience of LINAC Single-Dose Radiosurgery for Skull Base Meningiomas: A Retrospective Single-Center Study of 241 Cases. [2023]
Stereotactic radiosurgery for WHO grade I meningiomas. [2022]
Single-fraction radiosurgery for presumed intracranial meningiomas: efficacy and complications from a 22-year experience. [2022]
Outcomes of radiation-induced meningiomas treated with stereotactic radiosurgery. [2023]
Single dose versus fractionated stereotactic radiotherapy for meningiomas. [2022]
Fractionated radiotherapy and radiosurgery of intracranial meningiomas. [2018]
10.United Statespubmed.ncbi.nlm.nih.gov
Radiosurgery for malignant meningioma: results in 22 patients. [2022]
Regression of intracranial meningioma following treatment with nivolumab: Case report and review of the literature. [2018]
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