Phase 2a Desipramine in Small Cell Lung Cancer and Other High-Grade Neuroendocrine Tumors

March 2, 2017 updated by: Joel Neal

A Phase 2a Intrapatient Dose Escalation Study of Desipramine in Small Cell Lung Cancer and Other High-Grade Neuroendocrine Tumors

Intrapatient dose escalation study of desipramine in subjects with small cell lung cancer (SCLC) and other high-grade neuroendocrine tumors.

Study Overview

Status

Terminated

Intervention / Treatment

Detailed Description

Participants will start desipramine by mouth nightly (QHS) for 6 weeks, with weekly dose escalation. Starting dose will be 25 to 75 mg. The desipramine dose will be escalated until the maximum dose of 450 mg is reached or a maximum safe dose per subject is established.

Dose level may be adjusted (decreased) based on cardiac or general adverse effects. desipramine level will be tapered if the subject experience disease progression, unless physician judges immediate suspension is in the subjects best interest.

Assessments will be conducted every 28 days, and will include ECGs, physicians and blood samples.

One partial and/or complete response will be sufficient to consider a larger clinical trial.

Study Type

Interventional

Enrollment (Actual)

6

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 Locations

    • California
      • Stanford, California, United States, 94305
        • Stanford University Cancer Institute

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:

  • Metastatic small-cell lung cancer
  • Metastatic high-grade neuroendocrine carcinoma of any organ system (high-grade defined by Ki-67 ≥ 20% and/or ≥ 20 mitoses/10 (HPF).
  • Received at least one line of prior chemotherapy treatment for metastatic disease.
  • Daily chemotherapy must be completed ≥ 2 weeks prior to registration
  • Weekly chemotherapy must be completed ≥ 2 weeks prior to registration
  • Chemotherapy every 2 weeks must be completed ≥ 3 weeks prior to registration
  • Chemotherapy every 3 weeks must be completed ≥ 4 weeks prior to registration
  • ECOG Performance Status 0 to 2
  • Measurable disease by RECIST 1.1 criteria
  • Age at least 18 years
  • Estimated life expectancy at least 3 months
  • Absolute neutrophil count ≥ 1,500/ mm³
  • Platelets ≥ 100,000/mm³
  • Hemoglobin ≥ 9 g/dL
  • Total bilirubin ≤ 1.5 mg/dL, OR ≤ 2 X ULN if tumor involves the liver
  • AST(SGOT)
  • ALT(SGPT) ≤ 3 X ULN
  • Creatinine ≤ 1.5 X ULN
  • Creatinine clearance ≥ 45 mL/min/1.73m²) for patients with creatinine levels above institutional normal
  • QT interval corrected using Fridericia's method (QTcF) < 450 msec (males) or < 470 msec (females)
  • PR < 240 msec
  • QRS < 100 msec
  • Brain metastases must be asymptomatic and have been adequately treated with radiation finishing at least 1 week prior to initiation of study treatment.
  • Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  • Clinically-significant ventricular arrhythmia including cardiac arrest
  • Myocardial infarction from coronary artery disease within 3 months of study enrollment
  • Implantable pacemaker or implantable cardioverter defibrillator
  • NYHA Class III or greater congestive heart failure
  • Other clinically-significant cardiac disorders
  • Family history of long QT syndrome.
  • Concomitant or expected treatment with strong inhibitors of cytochrome p450 CYP2D6, specifically including Bupropion; Fluoxetine; or Paroxetine (must be discontinued at least 2 weeks or 5-half lives prior to the initiation of desipramine, whichever is shortest, except fluoxetine which requires at least a 5-week washout period).
  • Use of medications known to increase risk of torsades de pointes, including Amiodarone; Arsenic trioxide; Astemizole; Azithromycin; Bepridil; Chloroquine; Chlorpromazine; Cisapride; Citalopram; Clarithromycin; Disopyramide; Dofetilide; Domperidone; Droperidol; Erythromycin; Flecainide; Halofantrine; Haloperidol; Ibutilide; Levomethadyl; Mesoridazine; Methadone; Moxifloxacin; Pentamidine; Pimozide; Probucol; Procainamide; Quinidine; Sotalol; Sparfloxacin; Terfenadine; Thioridazine; Vandetanib
  • Other anti-depressant or anti-psychotic medications including selective serotonin re-uptake inhibitors (SSRIs); other tricyclic, monoamine oxidase inhibitors (MAOIs); serotonin-norepinephrine reuptake inhibitors (SNRIs, typical or atypical anti-psychotic)
  • Metoclopramide (Reglan) because of increased risk of extrapyrimidal symptoms and neuroleptic malignant syndrome
  • Symptomatic orthostatic hypotension despite adequate volume resuscitation.
  • Medical history of narrow angle glaucoma
  • Bipolar disorder, ongoing or active within the last 5 years
  • Suicidal ideation, ongoing or active within the last 5 years
  • Suicide attempt, ongoing or active within the last 5 years
  • Pregnancy
  • Breastfeeding
  • Receiving any other investigational agents
  • Any other serious or unstable concomitant systemic disorder that in the opinion of the investigator is incompatible with the clinical study

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: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Desipramine HCl
Desipramine is a tricyclic antidepressant (TCA).
Desipramine is a tricyclic antidepressant (TCA). All patients will start off with a 25 mg dose by mouth nightly (QHS), increasing weekly for 6 weeks. The target dose level at 6 weeks is 450 mg (maximum dosage) or the maximum tolerated dose (MTD) for each subject.
Other Names:
  • Norpramin
  • Pertofrane
  • Desmethylimipramine

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Overall Response Rate (ORR)
Time Frame: 6 weeks
Overall response rate (ORR) was assessed as the number of patients who achieve either a partial (PR) or complete response (CR) measured by CT scans and Response Evaluation Criteria In Solid Tumors (RECIST 1.1) criteria, divided by the total number of patients treated on the study. CR: Disappearance of all target lesions, all non-target lesions, and no new lesion. PR: At least a 30% decrease in the sum of diameters of target lesions, no progression in non-target lesion, and no new lesion.
6 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Desipramine Maximum Dose
Time Frame: Up to 6 weeks
Assessed as the median per patient maximum dose (MD) using intra-patient dose escalation, and reported as the highest dose of desipramine administered continuously for 1 week or greater.
Up to 6 weeks
Median Serum Desipramine Levels During Treatment
Time Frame: Up to 6 weeks

Median serum desipramine levels during treatment is reported as the median of the maximum steady state serum concentration observed in all patients.

Therapeutic concentration of desipramine is 100 to 300 ng/mL, and toxic concentration is > 300 ng/mL.

Up to 6 weeks
Progression-free Survival (PFS), Median
Time Frame: Up to 5 years from enrollment to radiographic progression or drug discontinuation
Median PFS was defined as the time from randomization to disease progression (or death if the patient died before progression) calculated using the Kaplan-Meier method.
Up to 5 years from enrollment to radiographic progression or drug discontinuation
Median Overall Survival (OS)
Time Frame: From start of enrollment until death, no limit
Median overall survival was defined as time from enrollment to death from any cause calculated using the Kaplan-Meier method.
From start of enrollment until death, no limit

Collaborators and Investigators

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

Sponsor

Investigators

  • Principal Investigator: Joel W Neal, MD, PhD, Stanford University

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

October 1, 2012

Primary Completion (Actual)

May 1, 2014

Study Completion (Actual)

May 1, 2015

Study Registration Dates

First Submitted

October 29, 2012

First Submitted That Met QC Criteria

October 30, 2012

First Posted (Estimate)

November 1, 2012

Study Record Updates

Last Update Posted (Actual)

April 17, 2017

Last Update Submitted That Met QC Criteria

March 2, 2017

Last Verified

March 1, 2017

More Information

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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