A Trial of Tadalafil in Patients With Squamous Cell Carcinoma of the Upper Aero Digestive Tract

A Phase II Trial of Tadalafil in Patients With Squamous Cell Carcinoma of the Upper Aero Digestive Tract

The purpose of this trial is to determine whether or not Cialis (tadalafil) administered to head and neck squamous cell cancer patients augments immune response.

Study Overview

• Status: Completed
• Conditions: Head and Neck Squamous Cell Carcinoma
• Intervention / Treatment: Other: Placebo Pill; Drug: Tadalafil

• Study Type: Interventional
• Enrollment (Actual): 45
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21205
      • Johns Hopkins Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 99 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Histologically confirmed, previously untreated invasive head and neck squamous cell carcinoma OR histologically confirmed not yet treated recurrent head and neck squamous cell carcinoma (must be at least 3 months after diagnosis and completion of treatment for primary disease or last recurrence).
2. Disease location amenable to biopsy in outpatient clinical setting or operative biopsy within routine accepted schedule and practice of clinical care
3. No medical contraindication to biopsy of target lesion.
4. ECOG performance status 0-1

5. Required laboratory data (to be obtained within 4 weeks of initiation):

   • Platelets > 75,000/mm³
   • Calculated Creatinine Clearance (CRCL)> 60 mL/min iii. Total serum bilirubin < 1.5 mg/dL.
   • No intercurrent illness likely to prevent protocol therapy or surgical resection
6. Patients with a history of a curatively treated malignancy must be disease-free and have a survival prognosis that exceeds five years.
7. Female patients must not be pregnant or breast feeding. A negative pregnancy test is required within 14 days of randomization for all women of childbearing potential.
8. Willingness and ability to give signed written informed consent.

Exclusion Criteria:

1. Known severe hypersensitivity to tadalafil or any of the excipients of this product
2. Patients who have a concurrent malignancy or a history of previous malignancy treated with curative therapy within the last 3 months (other than squamous/basal cell cancer of the skin or cervical cancer) who have a survival prognosis of < 5 years.
3. Treatment with a non-approved or investigational drug within 30 days before day 1 of trial treatment.
4. Incomplete healing from previous oncologic or other major surgery.
5. Pregnancy or breast feeding (women of childbearing potential).
6. As judged by the investigator, any evidence of severe or uncontrolled systemic disease (e.g., unstable or uncompensated respiratory, cardiac, hepatic, or renal disease).
7. Evidence of any other significant clinical disorder or laboratory finding that makes it undesirable for the subject to participate in the trial.
8. Current therapy with ketoconazole or oral antifungal therapy.
9. History of significant hypotensive episode requiring hospitalization.
10. A history of acute myocardial infarction within prior 3 months, uncontrolled angina,
11. Uncontrolled arrhythmia, or uncontrolled congestive heart failure
12. Age < 18

13. History of any of the following cardiac conditions:

    • Angina requiring treatment with long-acting nitrates.
    • Angina requiring treatment with short-acting nitrates within 90 days of planned tadalafil administration.
    • Unstable angina within 90 days of visit 1 (Braunwald 1989).
    • Positive cardiac stress test without documented evidence of subsequent, effective cardiac intervention.

14. History of any of the following coronary conditions within 90 days of planned tadalafil administration:

    • Myocardial Infarction.
    • Coronary artery bypass graft surgery.
    • Percutaneous coronary intervention (for example, angioplasty or stent placement).
    • Any evidence of heart disease (NYHA≥Class III as defined in Protocol Attachment LVHG.3) within 6 months of planned tadalafil administration
15. Current treatment with nitrates.
16. Current systemic treatment with a potent cytochrome P450 3A4 (CYP3A4) inhibitor such as ketoconazole or ritonavir.
17. Received treatment within the last 30 days with a drug or device that has not received regulatory approval for any indication at the time of Visit 1.
18. Prior chronic immune suppressive state (AIDS, immunosuppressive therapy).
19. History of hypotension and/or blindness during prior treatment with Tadalafil or other PDE-5 inhibitors.
20. prior history of non-arterial ischemic optic retinopathy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Placebo	Other: Placebo Pill; Placebo
Experimental: Tadalafil; Tadalafil 20 mg once per day	Drug: Tadalafil; 20 mg once daily for 10 - 14 days; Other Names: Cialis

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Immune Response After Tadalafil Administration	Median fold-change in immune response of T-cell expansion, delayed-type hypersensitivity reactions, CD4/CD69, CD8/CD69. A positive value indicates an increase in immune response.	Change from baseline to up to 14 days post-intervention

Collaborators and Investigators

• Sponsor: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
• Collaborators: National Cancer Institute (NCI)
• Investigators: Principal Investigator: Joseph Califano, MD, Johns Hopkins University

Publications and helpful links

General Publications

• Califano JA, Khan Z, Noonan KA, Rudraraju L, Zhang Z, Wang H, Goodman S, Gourin CG, Ha PK, Fakhry C, Saunders J, Levine M, Tang M, Neuner G, Richmon JD, Blanco R, Agrawal N, Koch WM, Marur S, Weed DT, Serafini P, Borrello I. Tadalafil augments tumor specific immunity in patients with head and neck squamous cell carcinoma. Clin Cancer Res. 2015 Jan 1;21(1):30-8. doi: 10.1158/1078-0432.CCR-14-1716. Erratum In: Clin Cancer Res. 2018 Dec 1;24(23):6100.

Study record dates

Study Major Dates

• Study Start (Actual): May 8, 2007
• Primary Completion (Actual): March 1, 2012
• Study Completion (Actual): March 1, 2012

Study Registration Dates

• First Submitted: May 5, 2009
• First Submitted That Met QC Criteria: May 6, 2009
• First Posted (Estimate): May 7, 2009

Study Record Updates

• Last Update Posted (Actual): June 11, 2019
• Last Update Submitted That Met QC Criteria: May 22, 2019
• Last Verified: May 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Neoplasms by Histologic Type; Neoplasms; Neoplasms by Site; Neoplasms, Glandular and Epithelial; Head and Neck Neoplasms; Neoplasms, Squamous Cell; Carcinoma; Carcinoma, Squamous Cell; Squamous Cell Carcinoma of Head and Neck; Molecular Mechanisms of Pharmacological Action; Vasodilator Agents; Urological Agents; Enzyme Inhibitors; Phosphodiesterase Inhibitors; Phosphodiesterase 5 Inhibitors; Tadalafil
• Other Study ID Numbers: J0813; 1R21CA135635-01 (U.S. NIH Grant/Contract); NA_00012749 (Other Identifier: JHM IRB)