Treatment of Radiation and Cisplatin Induced Toxicities With Tempol
Słowa kluczowe
Abstrakcyjny
Opis
One hundred and twenty (120) participants with head and neck cancer are scheduled to undergo combined radio- and chemotherapy (n = 120).
Nearly all (90% to 97%) participants receiving radiotherapy in the head and neck will develop some degree of mucositis. Of these participants treated with radiotherapy with or without chemotherapy, 34% to 43% will present severe mucositis. As a result, the participant's quality of life is affected, hospital admittance rates are higher, the use of total parenteral nutrition is increased and interruption of treatment is more frequent, all of which compromise tumor control. Mucositis causes 9% to 19% of chemotherapy and radiotherapy interruption.
A common chemotherapeutic agent used in head and neck cancer is Cisplatin. Cisplatin (cis- diamminedichloroplatinum(II), CDDP) is an antineoplastic drug used in the treatment of many cancers including testicular cancer, ovarian cancer, bladder cancer, head and neck cancer, esophageal cancer, small and non-small cell lung cancer, breast cancer, cervical cancer, stomach cancer, prostate cancer, brain tumors, neuroblastoma, sarcomas, multiple myeloma, melanoma, mesothelioma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, pancreatic cancer, and thyroid cancer. While toxicities include ototoxicity, gastrotoxicity, myelosuppression, and allergic reactions, the main dose-limiting side effect of cisplatin is nephrotoxicity followed by ototoxicity.
Tempol is a piperidine nitroxide. Nitroxides are a class of stable free radical compounds that have anti-oxidant activity protecting mammalian cells against numerous toxic agents including hydrogen peroxide, superoxide, and t-butyl hydroperoxide cytotoxicity. This anti-oxidant activity of Tempol has led to its investigation as a potential radioprotector and chemoprotectant. In radiation and chemotherapy, Tempol protects normal cells from radiation and cisplatin-induced damage; however, in cancerous or tumor cells, Tempol is reduced to its hydroxylamine form that does not and cannot protect the cells from radiation and cisplatin induced damage. This distinction is of particular importance in the setting of cancer treatment, in which both normal and tumor tissue is exposed to radiation and chemotherapy. Without using Tempol, both normal cells and cancer cells suffer from toxicity. Tempol is the only known compound to possess this functional duality. Because of Tempol's free-radical scavenging ability, this compound is able to prevent many of the toxicities associated with cisplatin and radiation treatment including the prevention of mucositis, nephrotoxicity, and ototoxicity.
The first group 60 participants will be randomized 1:1 to either Tempol 600 mg daily or placebo. Assuming that treatment is well tolerated but ≥20% of the participants in the active arm have grade 3 or 4 mucositis, a second group of 60 participants may be enrolled, and randomized 1:1 to receive either Tempol 1000 mg daily or placebo.
Throughout the treatment period, participants will take study medication twice daily on both chemo/radiation days and cancer treatment free days. On radiation/chemo days, participants will be instructed to take study medication 10 minutes before each proton therapy or radiation treatment (400 or 600 mg) and again in the evening (200 or 400 mg) no less than 6 hours following the first dose. Participants will begin to take study medication four (4) days before their scheduled cancer treatment. When proton therapy or radiation is not administered, participants will take the medication twice daily, 400 mg or 600 mg in the morning and 200 mg or 400 mg in the evening. On the day of radiation therapy, study medication will be administered within 10 minutes prior to each course of radiotherapy. Participants will be instructed to hold the solution in their mouth swishing for approximately 30 seconds and then swallow.
Daktyle
| Ostatnia weryfikacja: | 09/30/2019 |
| Pierwsze przesłane: | 03/07/2018 |
| Szacowana liczba przesłanych rejestracji: | 03/26/2018 |
| Wysłany pierwszy: | 03/28/2018 |
| Ostatnia aktualizacja przesłana: | 10/02/2019 |
| Ostatnia opublikowana aktualizacja: | 10/06/2019 |
| Rzeczywista data rozpoczęcia badania: | 05/12/2019 |
| Szacowana data zakończenia podstawowej działalności: | 09/30/2020 |
| Szacowana data zakończenia badania: | 09/30/2021 |
Stan lub choroba
Interwencja / leczenie
Drug: Active 600 mg Tempol Solution
Drug: Placebo Solution
Faza
Grupy ramion
| Ramię | Interwencja / leczenie |
|---|---|
| Active Comparator: Active 600 mg Tempol Solution Patients will take 600 mg of Tempol a day for the duration of radiation treatment (6-8 weeks) | Drug: Active 600 mg Tempol Solution Investigational product is Tempol (4-hydroxy-2,2,6,6-tetramethylpiperidine-1-oxyl) oral solution. Tempol solution is an orange-colored, aqueous solution containing 7% Tempol along with xanthan gum, xylitol, aspartame, acesulfame potassium, sodium saccharin, alcohol, peppermint and wintergreen oils. |
| Placebo Comparator: Placebo Solution Patients will take placebo solution everyday for the duration of radiation treatment (6-8 weeks) | Drug: Placebo Solution The placebo contains the same excipients as the active product plus FD&C Yellow #6 for color matching. |
Kryteria kwalifikacji
| Wiek kwalifikujący się do nauki | 18 Years Do 18 Years |
| Płeć kwalifikująca się do nauki | All |
| Przyjmuje zdrowych wolontariuszy | tak |
| Kryteria | Inclusion Criteria: 1. Be ≥18 years of age with medically diagnosed squamous cell cancer of the head and neck (SCCHN); 2. Be scheduled to receive radiotherapy or proton therapy administered with a curative intent; 3. If female and of child bearing potential, be using an effective birth-control method with a history of reliability for the individual participant; 4. If male and of child bearing potential, adequate methods of contraception must be employed including use of condoms with spermicide. No sperm donation for 90 days until after the conclusion of the study; 5. Must be receiving cisplatin for chemotherapy; 6. Be properly informed of the nature and risks of the clinical investigation, comply with all clinical investigation-related procedures, and sign an Informed Consent Form prior to entering the clinical investigation; 7. Must have a score 2 or less on the ECOG performance status; 8. Participant life expectancy ≥ 6 months; and 9. Adequate baseline organ function (hematologic, liver, renal, nutritional and metabolic): Haematology: Absolute neutrophil count (ANC) ≥1.5 Hemoglobin ≥ 10 g/dL Platelets ≥ 100,000 per microliter of blood Hepatic: Total bilirubin ≤ 2 X (Upper limit normal) ULN Alanine amino transferase (ALT) and Aspartate aminotransferase (AST) ≤5 x ULN Renal: Serum creatinine ≤ ULN or, if > ULN calculated creatinine clearance (CrCl) ≥ 60 mL/min. Nutritional and metabolic: Urine Albumin < 3.0 mg/dl Exclusion Criteria: 1. Prior radiotherapy of the head and neck; 2. Have a clinically significant infection defined as any acute viral, bacterial or fungal infection, which requires specific therapy. Anti-infectious therapy must have been completed within 14 days of starting study treatment; 3. Be taking any non-approved therapy for oral mucositis, including β-carotene, tocopherol, laser irradiation, brushing the oral mucosa with silver-nitrate prophylactically, systemic TGF-β (transforming growth factor beta), or systemic KGF (keratinocyte growth factor) during or within 14 days of starting treatment; 4. Be taking mugard; 5. Be taking prostaglandins, pentoxifylline or leucovorin during or within 14 days of starting treatment; 6. Be rinsing with allopurinol, hydrogen peroxide, sucralfate, or chlorhexidine mouthwashes during or within 14 days of starting treatment; 7. Have had a recent, serious, non-malignant medical complication that, in the opinion of the investigator, makes the individual unsuitable for study participation; 8. Have used an investigational drug within 28 days of the initiation of study treatment; 9. Have a history of a positive blood test for HIV; 10. At the time of screening, having a significant active medical illness which, in the opinion of the investigator, would preclude completion of the study; 11. Participants with a treatment plan consisting of chemoradiation followed by further chemotherapy; 12. Participants with body weight less than 35 kg, 77 lbs; 13. Women who are pregnant or who are breastfeeding; 14. Participants with known intolerance to platin drugs; 15. History of insulin-dependent Diabetes Mellitus; and 16. Participants with Hepatitis B/C. |
Wynik
Podstawowe miary wyników
1. Mucositis [10 weeks]
Miary wyników wtórnych
1. Mucositis [10 weeks]
2. Nephrotoxicity [10 weeks]
3. Nephrotoxicity [10 weeks]
4. Mucositis [10 weeks]
