Double-blind-randomized,Placebo Controlled Trial for Chemotherapy-associated Oral Mucositis Using Doxycycline Hyclate

March 15, 2010 updated by: Metropolitan Autonomous University

Phase 2 Double-blind, Randomized, Placebo Controlled Clinical Trial for the Prevention of Oral Mucositis Using Sub-microbial Doses of Doxycycline Hyclate in Patients With Acute Leukemia Receiving Induction Chemotherapy

Background. Mucositis is a complication of chemotherapy with no effective treatment. Aim.To evaluate the efficacy of sub-microbial doses of doxycycline hyclate in preventing the development of oral mucositis in patients with acute leukemia (AL) treated with induction chemotherapy.

Hypothesis. Doxycycline hyclate administration in sub-microbial dosage will reduce the incidence of oral mucositis in patients with AL who receive induction chemotherapy.

Methods. Double-blind, randomized, placebo-controlled clinical trial. At the Cancer National Institute (INCan), adult patients (> 18 years of age) with acute leukemia of recent diagnosis, scheduled to receive induction chemotherapy will be enrolled in the study. Written informed consent from the patients will be obtained preceding inclusion in the study.

At baseline and 3-times per week, during 21-days, patients will have an oral examination performed using the Oral Mucositis Assessment Scale (OMAS), oral pain, difficulty to swallow, and salivary flow measurements will be recorded.

A sample size of 164 subjects has been calculated, 74 subjects in each arm of the study. The primary end point of this study to evaluate the efficacy will be the proportion of patients treated with doxycycline or placebo without oral lesions associated with OM, during the 21 days of follow-up. Efficacy will be evaluated if the proportion of complete response (CR) is significantly higher than the proportion of events in the placebo group. Additional secondary endpoints will be the partial resolution of the oral lesions, the incidence of infections and the mortality in the study groups during the 21 days of follow-up. Results will be analyzed by using Chi-squared test and Wilcoxon-Mann-Whitney rank sum test.

Study Overview

Status

Unknown

Conditions

Intervention / Treatment

Detailed Description

Background. Mucositis is a complication of chemotherapy with no effective treatment.

Aim.To evaluate the efficacy of sub-microbial doses of doxycycline hyclate in preventing the development of oral mucositis in patients with acute leukemia (AL) treated with induction chemotherapy.

Hypothesis. Doxycycline hyclate administration in sub-microbial dosage will reduce the incidence of oral mucositis in patients with AL who receive induction chemotherapy.

Methods. Double-blind, randomized, placebo-controlled clinical trial. At the Cancer National Institute (INCan), adult patients (> 18 years of age) with acute leukemia of recent diagnosis, scheduled to receive induction chemotherapy will be enrolled in the study. Written informed consent from the patients will be obtained preceding inclusion in the study.

Stratification according to the type of acute leukemia (myeloblastic and lymphoblastic) will be done. Random number tables will be used with balance for every four subjects; coded boxes will be utilized to preserve double blinding. Patients will be randomly assigned to receive either a sub-microbial dose of doxycycline hyclate or placebo (50 mg per day), immediately before the initiation of induction chemotherapy and daily during the following 21 days after chemotherapy.

At baseline and 3-times per week, during 21-days, patients will have an oral examination performed using the Oral Mucositis Assessment Scale (OMAS). Also oral pain and difficulty to swallow will be recorded using a visual analogue scale. Also in each visit, salivary flow measurements (Schirmer's test modified version) will be done.

The OMAS system is a validated index that evaluates the severity of oral mucositis by measuring the degree of ulceration/pseudomembrane and erythema in nine sites of the oral mucosa (upper and lower lip, right and left inner cheek, right and left ventral and lateral tongue, floor of the mouth, soft palate/fauces and hard palate). At each site, erythema is evaluated using a 3-point scale (0=none, 1=mild/moderate, 2=severe), and ulceration/pseudomembrane formation is evaluated using a 4-point scale (0=none, 1=cumulative surface area <1 cm2, 2=cumulative surface area 1-3 cm2, 3=cumulative surface area >3 cm2). The value of OMAS will be obtained by summing the erythema and ulceration/pseudomembrane sub-scores at each site and then averaging these scores across the affected sites.

In order to rule out oral candidosis (OC), definitive diagnosis of OC requires the identification of pseudohyphae in exfoliative cytology samples stained with periodic acid Schiff. Likewise, the clinical diagnosis of herpes simplex virus (HSV) induced oral lesions will be confirmed by the virus-infected cells demonstrated in cytologic smears stained with Papanicolaou, and/or a clinical response to systemic antiviral therapy with acyclovir.

A sample size of 164 subjects has been calculated, 74 subjects in each arm of the study. This estimate is based in the incidence of OM that is higher than 40% in patients with AL, and considering its reduction to half (20%), assuming an alpha value of 0.05 (one-sided) and a minimum statistical power of 0.80.

The efficacy primary end point of this study will be the proportion of patients treated with doxycycline or placebo without oral lesions associated with OM, in the 21 days of follow-up. Efficacy will be evaluated if the proportion of complete response (CR) is significantly higher than the proportion of events in the placebo group. Additional secondary endpoints will be the partial resolution of the oral lesions, the incidence of infections and the mortality in the study groups during the 21 days of follow-up.

Statistical analysis. Results will be analysed by using Chi-squared test and Wilcoxon-Mann-Whitney rank sum test.

Study Type

Interventional

Enrollment (Anticipated)

164

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Mexico
      • Mexico City, Mexico, 140180
        • Instituto Nacional de Cancerologia
        • Contact:
        • Principal Investigator:
          • Juan R Labardini-Mendez, MD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

16 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Adult patients (> 18 years of age) with acute leukemia of recent diagnosis,scheduled to receive induction chemotherapy.
  • Capacity to give written informed consent.
  • Ability to attend the follow-up visits.

Exclusion Criteria:

  • Patients with allergy or intolerance to tetracyclines
  • Patients with acute or chronic renal insufficiency (basal blood creatinine >1.9 mg/dl)
  • Patients with the contraindication for the oral administration of drugs.
  • Patients with active septic processes or considered resolved in less than 7 days before the start of chemotherapy.
  • Patients who required tetracycline administration in the 28 days previous to randomization.
  • Adult patients with acute leukemia schedule to undergo stem-cell transplantation in the following two weeks.
  • Adult patients with hematological cancer with previous radiotherapy that may affect the salivary glands.
  • Inability to authorize a written informed consent.

Exclusion criteria

  • Patients who start chemotherapy before 12 hours of the assigned treatment.
  • Patients who have received less than 10 doses (5 days) of the assigned treatment.
  • Requirement to receive ergot derivates.
  • Patients who require the administration of acitretin/isotretinoin/tretinoin
  • Patients that receive photosensitive drugs during the study period (hydroxyquinone/retinoids or methoxsalen)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Single Group Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: doxycycline hyclate
Patients will be randomly assigned to receive either a sub-microbial dose of doxycycline hyclate or placebo (50 mg per day), immediately before the initiation of induction chemotherapy and daily during the following 21 days after chemotherapy.
Drug: Doxycycline hyclate
Sub-microbial dose of Doxycycline hyclate or placebo (50 mg per day), immediately before the initiation of induction chemotherapy and daily during the following 21 days after chemotherapy.
Other Names:
  • Vibramycin
  • Doryx
  • Doxine

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Complete response
Time Frame: At baseline and 3-times per week, during 21-days after chemotherapy.
Complete response will be evaluated through the OMAS score.
At baseline and 3-times per week, during 21-days after chemotherapy.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Partial resolution of oral lesions, incidence of infections and mortality.
Time Frame: At baseline and 3-times per week, during 21-days after chemotherapy.
Partial response will be evaluated through the OMAS score. The incidence of infections and the mortality in the study groups during the 21 days of follow-up.To confirm the diagnosis of oral candidosis (OC), the identification of pseudohyphae in exfoliative cytology samples stained with periodic acid Schiff, will be necessary. The clinical diagnosis of herpes simplex virus (HSV) induced will be confirmed by the virus-infected cells demonstrated in cytologic smears stained with Papanicolaou, and/or a clinical response to systemic antiviral therapy with acyclovir.
At baseline and 3-times per week, during 21-days after chemotherapy.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Metropolitan Autonomous University

Collaborators

Instituto Nacional de Cancerologia de Mexico

Investigators

  • Study Director: Sergio Ponce de Leon, MD, Instituto Nacional de Ciencias Médicas y Nutrición

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

May 1, 2010

Primary Completion (Anticipated)

June 1, 2011

Study Completion (Anticipated)

February 1, 2013

Study Registration Dates

First Submitted

March 12, 2010

First Submitted That Met QC Criteria

March 15, 2010

First Posted (Estimate)

March 16, 2010

Study Record Updates

Last Update Posted (Estimate)

March 16, 2010

Last Update Submitted That Met QC Criteria

March 15, 2010

Last Verified

March 1, 2010

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • MetropolitanAU

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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