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GlioblastomaPhase 2ARISTOCRATNCT05629702

ARISTOCRAT: Blinded Trial of Temozolomide +/- Cannabinoids

A Phase 2 study testing Nabiximols and Temozolomide in people with Glioblastoma and Brain Tumor, run by University of Birmingham at 17 sites in United Kingdom.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

ARISTOCRAT is a phase II, multi-centre, double-blind, placebo-controlled, randomised trial to compare the cannabinoid Nabiximols with placebo in patients with recurrent MGMT methylated glioblastoma (GBM) treated with temozolomide (TMZ). Read more about this study

Who is it for?
Ages 16 years and older
Conditions the study is for
Glioblastoma, Brain Tumor, Cannabis
What is being tested?
Nabiximols and Temozolomide
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
122 participants
Where
17 sitesUnited Kingdom
Study dates
3 Feb 2023to 7 Oct 2027
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 16 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Histological diagnosis of MGMT promoter methylated, IDH wild type (WT) GBM with consistent local molecular pathology (repeat biopsy at recurrence is NOT required).
  • First recurrence of GBM planned for systemic treatment as determined by local Multidisciplinary Team (MDT), including agreement of a Consultant Neuro-Radiologist that imaging changes are most in keeping with recurrence and not pseudo-progression. Patients with a prior recurrence treated by surgical resection alone are eligible at time of first recurrence planned for systemic treatment.
  • Patients must have received initial first-line treatment with standard dose conventionally fractionated radiotherapy (i.e. 40 Gy in 15 fractions or 54-60 Gy in 28-33 fractions; other regimes may be considered in consultation with the ARISTOCRAT Trial Office) with concomitant and adjuvant TMZ.
  • A minimum of 3 cycles of adjuvant TMZ must have been received.
  • A minimum of Stable Disease (SD) (or Partial Response (PR)/Complete Response (CR)) at the end of first-line treatment (measured by Response Assessment for Neuro-Oncology (RANO) criteria).
  • ≥3 months since day 28 of the last cycle of TMZ.
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  • Karnofsky Performance Status ≥60.
  • Adequate hematologic, renal, and hepatic function within 14 days prior to randomisation:
  • Absolute neutrophil count (ANC) ≥1.5 x 109/L
  • Platelet count ≥100 x 109/L
  • Serum creatinine clearance (measured or calculated (using local standard practice)) >30ml/min
  • Total serum bilirubin ≤1.5 x upper limit of normal (ULN)
  • Liver transaminases <2.5 x ULN
  • If surgery has been performed for first recurrence, then the wound must be adequately healed and there must be residual enhancing disease on MRI within 21 days of surgery or new enhancement at later follow up deemed suitable for systemic treatment.
  • Recovered from previous treatment side-effects ≤ Grade 2.
  • If on systemic steroids, must be on stable (≥7 days) or decreasing dose of steroids.
  • Willing and able to provide trial-specific informed consent.
  • Willing and able to comply with trial requirements.
  • Age ≥16.
  • Able to start treatment within 28 days of randomisation.

Who cannot join

  • Pathology inconsistent with IDH WT GBM (e.g. patients with molecular features of PXA or BRAF mutation will be excluded).
  • Prior invasive malignancy (except non-melanoma skin cancer), unless disease free for a minimum of one year.
  • Prior treatment with stereotactic radiotherapy, brachytherapy or Convection Enhanced Delivery (CED) of any agent.
  • Prior treatment, apart from debulking surgery, for first recurrence of GBM.
  • Any active co-morbidity making patient unsuitable for trial treatment in the view of the Investigator.
  • Personal history of schizophrenia, other psychotic illness, severe personality disorder or other significant psychiatric diagnosis other than depression associated with their underlying glioma condition.
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  • Prior allergic reaction or significant toxicity (≥Grade 3 CTCAE) related to TMZ treatment.
  • Current or recent cannabis or cannabinoid-based medications within 28 days of randomisation and/or unwilling to abstain for the duration of the trial.
  • Women who are pregnant, breastfeeding or a woman of childbearing potential who is unwilling to use effective contraceptive methods during trial treatment and for 6 months after completion of trial treatment.
  • o Women of childbearing age must have a negative pregnancy test within 7 days prior to randomisation.
  • Men who are sexually active and unwilling/unable to use medically acceptable forms of contraception during trial treatment or for 6 months after completion of trial treatment.
  • Contra-indication to MRI or gadolinium.
  • Hereditary galactose intolerance, total lactase deficiency or glucose-galactose malabsorption.
  • Known hypersensitivity to cannabinoids or excipients of the IMP.
  • Known history of current or prior alcohol or drug dependence.
  • Known Hepatitis B (HBV), Cytomegalovirus (CMV) or opportunistic infection.
  • Has received a live vaccine within 28 days prior to randomisation.
  • Unable to administer oromucosal medication due to mucosal lesions or other issues.
  • Participation in another therapeutic clinical trial whilst taking part in this trial.
  • Any psychological, familial, sociological or geographical condition hampering protocol compliance.

Trial locations and contacts

17 sites in 1 country.

17 sites in 1 country

United Kingdom17 sites
  • Aberdeen Royal Infirmary, NHS Grampian

    Aberdeen, AB25 2ZN

  • Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust

    Birmingham, B15 2TH

  • Bristol Haematology & Oncology Centre, University Hospitals Bristol & Weston NHS Foundation Trust

    Bristol, BS2 8ED

  • Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust

    Cambridge, CB2 0QQ

  • Velindre Cancer Centre, Velindre University NHS Trust

    Cardiff, CF15 7QZ

  • Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust

    Hull, HU16 5JQ

  • St James's University Hospital, Leeds Teaching Hospitals NHS Trust

    Leeds, LS9 7TF

  • St Bartholomew's Hospital, Barts Health NHS Trust

    London, EC1A 7BE

  • Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust

    London, SE1 9RT

  • Charing Cross Hospital, Imperial College Healthcare NHS Trust

    London, W6 8RF

  • Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust

    Maidstone, ME16 9QQ

  • The Christie Hospital, The Christie NHS Foundation Trust

    Manchester, M20 4BX

  • Clatterbridge Cancer Centre, The Clatterbridge Cancer Centre NHS Foundation Trust

    Metropolitan Borough of Wirral, CH63 4JY

  • Mount Vernon Hospital, The Hillingdon Hospitals NHS Foundation Trust

    Northwood, Middlesex, HA6 2RN

  • City Hospital, Nottingham University Hospitals NHS Trust

    Nottingham, NG5 1PB

  • Churchill Hospital, Oxford University Hospitals NHS Foundation Trust

    Oxford, OX3 9DU

  • Derriford Hospital, University Hospitals Plymouth NHS Trust

    Plymouth, PL6 8DH

Other trials in United Kingdom

About this study

Official title: A Randomised Controlled Phase II Trial of Temozolomide With or Without Cannabinoids in Patients With Recurrent Glioblastoma

ARISTOCRAT is a phase II, multi-centre, double-blind, placebo-controlled, randomised trial to compare the cannabinoid Nabiximols with placebo in patients with recurrent MGMT methylated glioblastoma (GBM) treated with temozolomide (TMZ).

Read the detailed description

This is a phase II, multi-centre, double-blind, placebo-controlled, randomised trial to compare the cannabinoid Nabiximols (Sativex®) with placebo in patients with recurrent MGMT methylated glioblastoma treated with temozolomide (TMZ). The trial will randomise a target number of 120 patients on a 2:1 basis to receive either Nabiximols or Nabiximols-matched placebo, in combination with standard TMZ.

Patients will be followed up at 4-weekly assessments for a minimum of 52 weeks from the start of trial treatment or until death, whichever is sooner. MRI scanning will be performed at screening, week 10, week 22, week 30, then 3-monthly after commencing trial treatment as per standard practice.

The trial includes an initial feasibility study of 40 patients to confirm safety, compliance and achievability of planned target recruitment. There are no formal criteria for evaluation of feasibility but once 40 patients have been recruited, the independent Data Monitoring Committee will review the adverse event data, details on protocol treatment received, monthly recruitment rates and projected recruitment in order to make recommendations on trial continuation.

The original phase II trial design allowed potential expansion of recruitment into a phase III trial, should the emerging phase II results warrant this development; however, the trial was revised to a standard phase II design to lower the recruitment targets in 2025

The trial will be linked to the Tessa Jowell BRAIN MATRIX (TJBM) programme; utilising TJBM infrastructure, opening the same participating sites, and aligning the data collection and Quality of Life assessments already embedded in TJBM. This collaboration will allow data sharing within the platform thereby streamlining patient entry and provide additional oversight through TJBM. Patients recruited to TJBM who are potentially eligible for ARISTOCRAT may be identified and suggested to sites for consideration to the trial.

Being tested
Nabiximols, Temozolomide, Nabiximols-matched placebo
Keywords
cannabinoid, GBM, temozolomide, sativex, nabiximols, cannabis, glioblastoma, brain, recurrent
Medical subject headings
Glioblastoma, Brain Neoplasms, Marijuana Abuse, Recurrence

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • NabiximolsDrug

    Also called Sativex

    Oromucosal spray

  • TemozolomideDrug

    Oral capsule

  • Nabiximols-matched placeboDrug

    Nabiximols-matched placebo oromucosal spray

Study groups in NCT05629702
Study groupRoleWhat they receive
Standard Temozolomide with NabiximolsExperimental* Temozolomide 150mg/m2 for cycle 1, increasing to 200mg/m2 for subsequent cycles, once daily for days 1-5, orally, at the start of each 28 day cycle, up to a maximum of 6 cycles. * Nabiximols up to 12 oromucosal sprays per day up to a maximum of 6 cycles; self titrated over days 1-14 in cycle 1.
Receives: Drug: Nabiximols; Drug: Temozolomide
Standard Temozolomide with Nabiximols-matched placeboPlacebo comparator* Temozolomide 150mg/m2 for cycle 1, increasing to 200mg/m2 for subsequent cycles, once daily for days 1-5, orally, at the start of each 28 day cycle, up to a maximum of 6 cycles. * Nabiximols-matched placebo up to 12 oromucosal sprays per day up to a maximum of 6 cycles; self titrated over days 1-14 in cycle 1.
Receives: Drug: Temozolomide; Drug: Nabiximols-matched placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Overall survival time (OS)

    To establish whether the addition of cannabinoids (Nabiximols) to standard TMZ treatment improves overall survival time (OS) in MGMT methylated recurrent GBM compared to the addition of placebo to TMZ.

    Measured: Time in whole days from date of randomisation to the date of death from any cause, assessed at a minimum of 12 months..

Secondary outcomes (4)
  1. Overall survival at 12 months (OS12) (and 6 and 24 months)

    Of particular clinical relevance is the overall survival at 12 months from date of randomisation, i.e. whether the participant is alive or not at that time point. Overall survival at 6 months and 24 months will also be of interest.

    Measured: 6, 12 and 24 months

  2. Progression-free survival time (PFS)

    Measured using Response Assessment for Neuro-Oncology (RANO) criteria at screening, weeks 10, 22, 30 then 3 monthly (as per standard of care) for up to a minimum of 52 weeks from the start of trial treatment. PFS includes radiological progression assessed in accordance with RANO criteria and clinical progression where radiological progression is not possible.

    Measured: Time in whole days from the date of randomisation to the date of the first documented evidence of disease progression or death (from any cause), whichever came first, assessed at a minimum of 12 months.

  3. Health-related quality of life (HRQoL) as assessed by EORTC QLQ-C30

    Generic Health-related quality of life (HRQoL) will be assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) consisting of function, symptom and global health status scales, scored 1-4 with lower scores indicating better outcomes..

    Measured: Baseline (Week 0), Week 8, Week 16, End of Treatment (Week 24)

  4. Adverse events

    Assessment of AEs according to the current NCI-CTCAE v5.0 criteria. Acute AE will be defined as those occurring up to 12 weeks post-end of treatment. Late AE will be defined as those occurring after 12 weeks post-end of treatment. The end of treatment will be the date of the final chemotherapy cycle.

    Measured: Baseline (Week 0), Week 4, Week 8, Week 12, Week 16, Week 20, End of Treatment (Week 24)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Nov 2022
  2. Study start3 Feb 2023
  3. Primary completion7 Oct 2027 (estimated)
  4. Study completion7 Oct 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
122 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05629702
Sponsor's protocol ID
RG_21-001
Other IDs
2021-005214-34, ISRCTN
Acronym
ARISTOCRAT
Status last verified
Oct 2026
First submitted
7 Nov 2022
Last updated
16 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Scientifically sound proposals from appropriately qualified researchers will be considered for data sharing. Requests should be made by returning a Data Sharing Request Form to newbusiness@trials.bham.ac.uk; this captures the research requirements, statistical analysis plan, and intended publication schedule. Requests will be reviewed by the Cancer Research UK Clinical Trials Unit (CRCTU) Directors in discussion with the Chief Investigator (CI), Trial Management Group (TMG) and independent Trial Steering Committee (TSC). They will consider the scientific validity of the request, qualifications of the researchers, views of CI, TMG and TSC, consent arrangements, practicality of anonymizing the requested data contractual obligations. If supportive of the request, and where not already obtained, Sponsor consent for data transfer will be sought before notifying applicants of the outcome. It is anticipated that applicants will be notified within 3 months of receipt of the original request.

Publications

  • Bhaskaran D, Savage J, Patel A, Collinson F, Mant R, Boele F, Brazil L, Meade S, Buckle P, Lax S, Billingham L, Short SC. A randomised phase II trial of temozolomide with or without cannabinoids in patients with recurrent glioblastoma (ARISTOCRAT): protocol for a multi-centre, double-blind, placebo-controlled trial. BMC Cancer. 2024 Jan 15;24(1):83. doi: 10.1186/s12885-023-11792-4.

    PubMed 38225549

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Nabiximols and Temozolomide in people with Glioblastoma and Brain Tumor, run by University of Birmingham at 17 sites in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 20 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 16 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 17 sites in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Overall survival time (OS) (time frame: Time in whole days from date of randomisation to the date of death from any cause, assessed at a minimum of 12 months..). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05629702, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Oct 2026.

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