ClinicalTrials.gg
RecruitingNCT06275919MIRAGEUpdated Sep 30, 2026

Regorafenib for Recurrent Meningioma (MIRAGE Trial)

A Phase 2 interventional study of Regorafenib 40 MG Oral Tablet and Local Standard of Care in Meningioma, Malignant, sponsored by Istituto Oncologico Veneto IRCCS. Recruiting at 20 sites in Italy. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-09-30.

Sponsored by Istituto Oncologico Veneto IRCCS · Phase 2, Interventional, and Treatment

From the registry’s dates

  • Started Sep 2024; still recruiting 2 years 1 month later.
Updated Sep 30, 2026Primary completion movedStudy completion moved+2 moreGo to Updates ↓
Phase
Phase 2
Study type
Interventional
Enrollment
104
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The focus of this study will be to investigate whether Regorafenib demonstrates antitumor activity against recurrent meningiomas.

Small trials and case series suggest clinical relevant activity of several VEGF inhibitors such as sunitinib, bevacizumab and valatinib reporting a 6m-PFS rate of 42-64%. Indeed, VEGF and VEGF receptors (VEGFR) are regularly overexpressed in meningiomas and can correlate with outcome.

Regorafenib inhibits angiogenic receptor tyrosine kinases (RTKs) and is highly selective for VEGFR1/2/3; moreover Regorafenib inhibits PDGFRB, FGFR1 and oncogenic intracellular signalling cascades involving c-RAF/RAF1 and BRAF highly expressed in meningiomas.

Noteworthy, Regorafenib showed antitumor activity in vitro and in vivo in a recent study; indeed, Regorafenib showed significant inhibition of meningioma cell motility and invasion and in vivo, mice with orthotopic meningioma xenografts showed a reduced volume of signal enhancement in MRI following Regorafenib therapy; this translated in a significantly increased overall survival time (p\<0.05) for Regorafenib treated mice.

Moreover, Regorafenib showed good efficacy in different cancer types, such as colorectal cancer, GIST, hepatocellular carcinoma and glioblastoma (REGOMA trial) , maintainingmaintaining a good quality of life.

02

Conditions studied

  • Meningioma, Malignant

Browse trials for

03

In context

Meningioma

255 studies on the registry are indexed under Meningioma; 85 are open to participants now.

This study's planned enrollment of 104 is above the median of 40 across 180 interventional studies indexed under Meningioma.

Browse Meningioma studies →

Lead sponsor

Istituto Oncologico Veneto IRCCS is the lead sponsor of 47 studies on the registry; 13 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Subject must understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted
  • Patients capable of taking oral medication
  • Subject is willing and able to adhere to the study visit schedule and other protocol requirements.
  • Histological diagnosis of meningioma according to the WHO 2021 classification
  • Radiologically documented progression of any existing tumor with an estimated planar growth >25% (bidirectional) in the last 12 months or appearance of new lesions
  • Ineligible for further surgery and/or radiotherapy
  • at least 1 (minimum 10 x 10mm) on baseline MRI
  • performance status (ECOG PS) of 0 to 1 (or ³70)
  • Male or female ≥ 18 years of age
  • Subjects must have of at least 6 months
  • Paraffin-embedded tumor tissue available (mandatory)
  • Dosage of dexamethasone or equivalent within 7 days prior the randomization ≤4mg/die
  • Stable or decreasing dosage of steroids for 7 days prior to the randomization.
  • Adequate cardiac function and adequate liver, renal and hematological function
  • Subject must have the following laboratory values at screening within 14 days before starting Regorafenib:
  • (ANC) ≥ 1.5 x 109/L without growth factor support for 7 days (14 days if subject received pegfilgrastim).
  • (Hgb) ≥10 g/dL
  • count (plt) ≥100x 109/L
  • Serum potassium concentration within normal range, or correctable with supplements
  • Serum glutamic oxaloacetic transaminase ()/aspartate aminotransferase (AST) and serum glutamate pyruvic transaminase (SGPT)/alanine aminotransferase (ALT) ≤ 3.0 x (ULN).
  • Serum total ≤ 1.5 x ULN
  • Serum creatinine ≤ 1.5 x ULN or measured (GFR) ≥ 50 mL/min/1.73 m2 using an exogenous filtration marker such as iohexol, inulin, 51Cr EDTA or 1125 iothalamate, or of ≥ 50 mL/min using Cockroft-Gault equation.
  • Serum albumin > 3.5 g/dL
  • PT (or ) and APTT within normal range
  • For women who are not (i.e., \< 2 years after last menstruation) or surgically sterile (absence of ovaries and/or uterus) and who are sexually active: agreement to use an adequate method of (oral contraceptives, intrauterine contraceptive device, or barrier method of contraception in conjunction with spermicidal jelly) during the Treatment period and for at least 6 months after the last dose of study drug.
  • For male patients who are partners of premenopausal women: agreement to use a barrier method of contraception during the Treatment period and for at least 6 months after the last dose of study drug.
  • Participants with type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to participate.
  • 19. Patients with measurable, progressive meningioma who received radiation therapy are potentially eligible but need to show evidence of progression at least 24 weeks from completion of radiation therapy.
  • 20. Possible prior use of bevacizumab in the treatment of radionecrosis (3-24 months after radiosurgery or radiotherapy; 5mg/kg q14w, 4-6 cycles)

Exclusion criteria

Exclusion Criteria:

  • Prior antineoplastic therapy for meningioma
  • Subject incapacitated to understand and voluntarily sign an ICF prior to any study-related assessments/procedures being conducted
  • Are taking strong cytochrome P (CYP) inhibitors (eg, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telithromycin, voriconazole) or strong CYP3A4 inducers (eg, carbamazepine, phenobarbital, phenytoin, rifampin, St. John's Wort)
  • Are taking strong UGT1A9 inhibitors (e.g. mefenamic acid, diflunisal and niflumic acid)
  • Receiving additional, concurrent, active therapy for Meningioma outside of the trial.
  • Disease outside the brain (ie. spinal cord or bone or to a distant organ)
  • Candidate for urgent palliative intervention for primary disease (e.g., impending herniation) as judged by the Investigator
  • History of allergy or to any of the study treatments or any of their .
  • In the presence of therapeutic intent to anticoagulate the patient:, or PT and aPTT not within therapeutic limits (according to the medical standard in the institution)
  • Unable or unwilling to undergo brain MRI scans with intravenous (IV) gadolinium
  • History of another in the previous 3 years, with a disease-free interval of\< 3 years. Patients with prior history of in situ cancer or basal or squamous cell skin cancer are eligible.
  • Serious, non-healing wound, ulcer, bone fracture, or abscess.
  • Any cerebrovascular accident (including ) within the last 6 months prior to initiation of study treatment.
  • Have an ongoing infection with severity of Grade 2 or above ( 5.0)
  • Any hemorrhage or bleeding event that is ≥ Grade 3 based on the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Event (CTCAE), Grade 2 intracranial hemorrhage, or persistent thrombotic/embolic event within 4 weeks prior to the start of study medication.
  • Uncontrolled or severe cardiac disease (e.g., history of unstable angina, myocardial infarction, coronary stenting, or bypass surgery within the last 6 months prior to initiation of study treatment), symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia (including atrial flutter/fibrillation), requirement for inotropic support or use of devices for cardiac conditions (e.g.,pacemakers/defibrillators), or hypertension (participants with systolic blood pressure[BP] of > 160 mmHg or diastolic BP of > 100 mmHg despite optimal medical management are to be excluded).
  • History of interstitial lung disease, history of slowly progressive dyspnea and unproductive cough, sarcoidosis, silicosis, idiopathic pulmonary fibrosis, pulmonary hypersensitivity pneumonitis, or symptomatic pleural effusion.
  • Active, known, or suspected auto-immune disease, including systemic lupus erythematosus, Hashimotos thyroiditis, scleroderma, polyarteritis nodosa, or auto-immune hepatitis.
  • Known history of , (HIV), or active infection requiring treatment with antiviral therapy. Note: HIV testing is not required in the absence of clinical suspicion.
  • History of bleeding diathesis (irrespective of severity).
  • Uncontrolled intercurrent illness including (e.g., symptomatic ascites), but not limited to ongoing or active infection.
  • Persistent ≥ Grade 3 Lipase (> 2.0 - 5.0 x [ULN] with signs or symptoms; > 5.0 x ULN and asymptomatic).
  • Persistent proteinuria > 3.5 g/24 hours measured by urine protein creatinine ratio from a random urine sample (≥ Grade 3, CTCAE 5.0)
  • Have any malabsorbition condition
  • Any condition that could make the subject noncompliant with the study procedures and/or study requirements, as judged by the Investigator (for example: cognitive impairment, psychiatric illness, etc).
Terms in these criteria, in plain language(26)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Measurable disease

The amount of disease can be tracked with a defined measurement, so the study can see whether it shrinks or grows. It might be a tumour measured on a scan or, in some blood cancers such as myeloma, a marker measured in blood or urine.

The criteria or the study team say which measurement counts — having no tumour visible on a scan does not by itself rule you out.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Karnofsky performance status (KPS)

A 0–100 scale of how well someone can carry out everyday activities. 100 is no complaints and no signs of illness; 70 is able to look after yourself but not to work or keep up normal activity; 50 is needing considerable help and frequent medical care.

Studies often ask for 60 or 70 and above. Your doctor gives the score.

Life expectancy

The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

GFR and eGFR (kidney filtering)

GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².

Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

INR, PT and aPTT (clotting tests)

Blood tests of how long blood takes to clot. The INR is the prothrombin time (PT) put on a common scale; about 1 is usual for someone not taking a blood thinner.

Criteria often make an exception for people on a blood thinner such as warfarin, whose INR is raised on purpose.

Postmenopausal

Periods have stopped for good: usually no period for 12 months in a row without another medical reason, sometimes confirmed by a blood test (FSH).

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

CYP3A (CYP3A4) inhibitors and inducers

CYP3A is a group of enzymes, mainly CYP3A4, in the liver and gut that break down many medicines. Some medicines, supplements and foods (grapefruit, St John’s wort) slow them down or speed them up, which changes how much of a study drug stays in the body.

Studies list them so they can be avoided or switched; bring a list of everything you take, including supplements.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

Hypersensitivity

An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.

Excipients

The other ingredients in a medicine besides the active drug, such as fillers, colours or preservatives.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

TIA (transient ischaemic attack)

A “mini-stroke”: temporary stroke-like symptoms caused by reduced blood flow to part of the brain, spinal cord or eye, without signs of a new stroke on a scan.

Stroke symptoms need emergency care at once, even if they go away.

CTCAE grade

The US National Cancer Institute’s scale of how severe an adverse event is — any unwanted medical event during a study, such as a symptom, an illness or an abnormal test result, whether or not a treatment caused it. Whether it did is judged separately.

1
Mild.
2
Moderate.
3
Severe.
4
Life-threatening.
5
Death due to the event.

“Side effects of earlier treatment resolved to grade 1 or less” means they have settled to mild or gone.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

Hepatitis C tests

Hepatitis C is a virus that infects the liver. An HCV antibody test can stay positive after an infection has cleared (and is occasionally positive without one); an HCV RNA test shows whether the virus is there now.

After treatment, hepatitis C counts as cured when HCV RNA is still undetectable 12 weeks or more after the treatment ended. Studies often accept people cured this way.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
104 participants (estimated)

Study arms

  • Experimental
    Arm A (interventional arm)

    REGORAFENIB 40 mg tablets once daily (160 mg/die), 3 weeks on, 1 week off, until disease progression or unacceptable toxicity

    Drug: Regorafenib 40 MG Oral Tablet

  • Active comparator
    Arm B (control arm)

    Local Standard of Care until disease progression or unacceptable toxicity

    Drug: Local Standard of Care

Interventions

  • REGORAFENIB 40 mg tablets once daily (160 mg/die), 3 weeks on, 1 week off, until disease progression or unacceptable toxicity

  • DrugLocal Standard of Care

    In this setting there are not drugs with indication. Every site will treat patients as per their experience.

06

What researchers measure

Primary outcomes

  1. Progression free survival (PFS)

    The progression free survival (PFS) will be determined as the time from the date of enrolment to the date of disease progression determined using RANO criteria or to the date of death, whichever occurs first.

    Time frame: Up to 54 months

Secondary outcomes

  1. Overall survival (OS)

    The overall survival (OS) will be determined as the time from the date of enrolment to the date of death from any cause.

    Time frame: Up to 42 months

  2. Objective response rate (ORR)

    The objective response rate (ORR) will be defined as the percentage of patients with complete response (CR) and partial response (PR) determined using modified Macdonald criteria.

    Time frame: Up to 42 months

  3. Patient Reported Outcomes (PROs)

    Quality of life will be assessed by EORTC QLQ-C30 questionnaire.

    Time frame: Up to 42 months

  4. Patient Reported Outcomes (PROs)

    Quality of life will be assessed by the QLQBN20 questionnaire.

    Time frame: Up to 42 months

  5. Toxicity during treatment

    Toxicity during the treatment will be recorded and graded according to the NCI Common Terminology Criteria for Adverse Events (CTCAE) v.5.

    Time frame: Up to 42 months

  6. Disease control rate (DCR)

    The disease control rate (DCR) will be defined as the percentage of patients with complete response (CR), partial response (PR) and stable disease (SD) determined using modified Macdonald criteria.

    Time frame: Up to 42 months

07

Study locations

15 of 20 sites recruiting
08

References and documents

Publications

  • Bosio A, Cerretti G, Padovan M, Del Bianco P, Polano M, Mandruzzato S, Indraccolo S, Manara R, Librizzi G, Caccese M, Corra M, Maccari M, Lonardi S, De Salvo GL, Lombardi G. Regorafenib versus local standard of care in patients with grade 2-3 meningioma no longer eligible for loco-regional treatments: a phase II randomized controlled trial (the MIRAGE study). Trials. 2025 Aug 4;26(1):268. doi: 10.1186/s13063-025-08997-2. PubMed 40759981 ↗

Individual participant data

Plan to share: Undecided

09

Updates

1 registry update since Sep 25, 2026
Sites
3 sites added
Show 3 added (3 Italy)
  • Ospedale Santa Maria Annunziata · Bagno a Ripoli, Italy
  • Centro di Riferimento Oncologico di Aviano (CRO), IRCCS · Aviano, Italy
  • Azienda Ospedaliera di Perugia · Perugia, Italy
Sep 30, 2026
Primary completion
Dec 2026→Dec 2028
Sep 30, 2026
Study completion
Mar 2027→Mar 2029
Sep 30, 2026
Primary outcomes
1 time frame changed
What changed in the outcomes
  • Time frameProgression free survival (PFS)Up to 36 months → Up to 54 months
Sep 30, 2026
Secondary outcomes
6 time frame changed
What changed in the outcomes
  • Time frameOverall survival (OS)Up to 30 months → Up to 42 months
  • Time frameObjective response rate (ORR)Up to 30 months → Up to 42 months
  • Time framePatient Reported Outcomes (PROs)Up to 30 months → Up to 42 months
  • Time framePatient Reported Outcomes (PROs)#2Up to 30 months → Up to 42 months
  • Time frameToxicity during treatmentUp to 30 months → Up to 42 months
  • Time frameDisease control rate (DCR)Up to 30 months → Up to 42 months
Sep 30, 2026
Show all 1 update
  1. Sep 30, 2026
    3 sites added
    Show 3 added (3 Italy)
    • Ospedale Santa Maria Annunziata · Bagno a Ripoli, Italy
    • Centro di Riferimento Oncologico di Aviano (CRO), IRCCS · Aviano, Italy
    • Azienda Ospedaliera di Perugia · Perugia, Italy
    Primary completion Dec 2026→Dec 2028
    Study completion Mar 2027→Mar 2029
    Primary outcomes 1 time frame changed
    What changed in the outcomes
    • Time frameProgression free survival (PFS)Up to 36 months → Up to 54 months
    Secondary outcomes 6 time frame changed
    What changed in the outcomes
    • Time frameOverall survival (OS)Up to 30 months → Up to 42 months
    • Time frameObjective response rate (ORR)Up to 30 months → Up to 42 months
    • Time framePatient Reported Outcomes (PROs)Up to 30 months → Up to 42 months
    • Time framePatient Reported Outcomes (PROs)#2Up to 30 months → Up to 42 months
    • Time frameToxicity during treatmentUp to 30 months → Up to 42 months
    • Time frameDisease control rate (DCR)Up to 30 months → Up to 42 months
    + 1 other change: verification date

From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗

10

Registry details

Key details

Study ID
NCT06275919
Lead sponsor
Istituto Oncologico Veneto IRCCS
Collaborators
Bayer
Responsible party
Sponsor
First posted
Feb 23, 2024
Start date
Sep 23, 2024
Primary completion
Dec 2028 (estimated)
Completion
Mar 2029 (estimated)
Last update
Sep 30, 2026

Study contacts

Gian Luca De Salvo, MD
Contact
gianluca.desalvo@iov.veneto.it
049 8215704 ext. +39
Giuseppe Lombardi, MD
principal investigator · Istituto Oncologico Veneto IOV IRCCS

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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