α-TEA in Advanced Cancer

Phase I Study of Alpha-tocopheryloxyacetic Acid (α-TEA) in Patients With Advanced Cancer

The goal of this study is to find the highest dose of α-TEA that can be given to patients safely, to identify potential side effects of α-TEA, and to measure the amount of α-TEA in patients' blood.

Additional goals of this study are to monitor the effect on tumors, to check for specific immune cells circulating in the blood, and to see if there are certain features of tumors that make it possible to predict the response to α-TEA.

Study Overview

• Status: Completed
• Conditions: Metastatic Sarcoma; Metastatic Carcinoma; Metastatic Lymphoma
• Intervention / Treatment: Drug: 2.4 mg/kg α-TEA; Drug: 4.8 mg/kg α-TEA; Drug: 8.0 mg/kg α-TEA; Drug: 9.6 mg/kg α-TEA; Drug: 12 mg/kg α-TEA; Drug: 16.8 mg/kg α-TEA; Drug: 19.2 mg/kg α-TEA; Drug: 22.3 mg/kg α-TEA; Drug: 26.8 mg/kg α-TEA

Detailed Description

This is a dose-escalation study in which doses ranging from 2.4 mg/kg to 26.8 mg/kg of α-TEA will be tested.

The main clinical objectives of this phase I two-stage dose-escalation trial will be to characterize α-TEA related toxicity, determine the maximum tolerated dose, and pharmacokinetics of α-TEA in humans. Tumor response and exploratory immunological monitoring will also be performed. Specifically, we will determine the frequency of circulating peripheral T cell subset populations including CD4+, CD8+ T cells and their activation status (central memory, effector cells) and regulatory T cells (CD4/CD25/Foxp3). Exploratory monitoring to assess tumor apoptosis and serum cytokine levels will also be performed to gain additional insight on the influence of α-TEA on the immune response and tumor. An assessment of the immunoscore in patients with tumor amenable to biopsy will also provide hypothesis-generating data on the influence of α-TEA on the tumor microenvironment.

• Study Type: Interventional
• Enrollment (Actual): 17
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Oregon
    • Clackamas, Oregon, United States, 97015
      • Providence Oncology & Hematology Care Clinic- Southeast
    • Newberg, Oregon, United States, 97132
      • Providence Oncology & Hematoloty Care Clinic- Newberg
    • Oregon City, Oregon, United States, 97045
      • Providence Oncology & Hematology Care Clinic- Willamette Falls
    • Portland, Oregon, United States, 97213
      • Providence Oncology & Hematology Care Clinic- Eastside
    • Portland, Oregon, United States, 97225
      • Providence Oncology & Hematology Care Clinic- Westside

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Patients with measurable or evaluable metastatic carcinoma, sarcoma or lymphoma who have malignancy refractory or progressed after therapy and for whom no other standard (non-experimental) therapy exists or who have declined available standard therapy, with potential to induce cure, remission or enhanced survival. Either histologic or cytologic diagnosis is acceptable of the primary cancer, or clinical evidence of metastasis.
• Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, or 2.
• Age 18 years or above.
• Laboratory values (performed within 28 days prior to enrollment) within protocol specified range.
• Confirmed radiographic and/or serum marker showing cancer progression after at least one systemic therapy for metastatic disease.
• Ability to give informed consent and comply with the protocol. Patients with a history of psychiatric illness must be judged able to understand the investigational nature of the study and the risks associated with the therapy.
• No active bleeding.
• No coagulopathy (INR <1.5, PT <16 seconds, PTT < 38 seconds) at baseline.
• Anticipated lifespan greater than 12 weeks.
• Ability to swallow capsules
• Women of childbearing potential must have a negative pregnancy test and must avoid becoming pregnant while on α-TEA and for 4 weeks after the last dose of α-TEA. Men must avoid fathering a child while on α-TEA and for 4 weeks after the last dose of α-TEA.

Exclusion Criteria:

• Active serious infection that could affect treatment.
• Coagulopathy or need for anti-coagulation therapy.
• Malabsorbtion state such as ulcerative colitis, previous surgical resection of > 20% of intestine or stomach.
• History of or active atrial fibrilliationfibrillation or supraventricular tachycardia
• Cardiac ejection fraction less than the lower limit of normal on echocardiography
• Right atrial enlargement on echocardiography
• Active cardiac ischemia. Patients with a history of ischemia ameliorated with stent placement or coronary artery bypass grafting and who have no evidence of ischemia by exercise or physiological stress testing are eligible.
• History of or active congestive heart failure
• Patients with tumor that has invaded vagal nerve, carotid bodies, mediastinal structures, pericardium or myocardium.
• Abnormal thyroid function, or euthyroid, but are on medication for thyroid disorders
• Need for chronic high dose maintenance oral steroids. Stable treatment with prednisone ≤ 10 mg daily (or a biologically-equivalent dose of another steroid) is allowed. Patients who require brief courses of steroids to manage allergic reaction to intravenous contrast used in radiographic studies are eligible. Patients requiring steroids for management of CNS metastatic disease are not eligible.
• Surgery or severe trauma within 4 weeks of study entry (minimally invasive procedures acceptable).
• Active brain metastatic disease. Patients with brain metastases who have been treated with surgery, gamma-knife radiosurgery or radiation and no radiographic progression for at least 4 weeks and off steroids are eligible.
• Any medical or psychiatric condition that in the opinion of the PI would preclude compliance with study procedures.
• Vitamin E supplements
• QTc greater than 450 msec at baseline (calculated using Bazett's formula), sick-sinus syndrome or other active cardiac disease.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

9

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: 2.4 mg/kg α-TEA; Patients will receive oral α-TEA 2.4 mg/kg daily for the first 14 days of a 28 day cycle.	Drug: 2.4 mg/kg α-TEA; Patients receive oral α-TEA 2.4 mg/kg daily for the first 14 days of a 28 day cycle.
Experimental: 4.8 mg/kg α-TEA; Patients will receive oral α-TEA 4.8 mg/kg daily for the first 14 days of a 28 day cycle.	Drug: 4.8 mg/kg α-TEA; Patients will receive oral α-TEA 4.8 mg/kg daily for the first 14 days of a 28 day cycle.
Experimental: 8.0 mg/kg α-TEA; Patients will receive oral α-TEA 8.0 mg/kg daily for the first 14 days of a 28 day cycle.	Drug: 8.0 mg/kg α-TEA; Patients will receive oral α-TEA 8.0 mg/kg daily for the first 14 days of a 28 day cycle.
Experimental: 9.6 mg/kg α-TEA; Patients will receive oral α-TEA 9.6 mg/kg daily for the first 14 days of a 28 day cycle.	Drug: 9.6 mg/kg α-TEA; Patients will receive oral α-TEA 9.6 mg/kg daily for the first 14 days of a 28 day cycle.
Experimental: 12 mg/kg α-TEA; Patients will receive oral α-TEA 12 mg/kg daily for the first 14 days of a 28 day cycle.	Drug: 12 mg/kg α-TEA; Patients will receive oral α-TEA 12 mg/kg daily for the first 14 days of a 28 day cycle.
Experimental: 16.8 mg/kg α-TEA; Patients will receive oral α-TEA 16.8 mg/kg daily for the first 14 days of a 28 day cycle.	Drug: 16.8 mg/kg α-TEA; Patients will receive oral α-TEA 16.8 mg/kg daily for the first 14 days of a 28 day cycle.
Experimental: 19.2 mg/kg α-TEA; Patients will receive oral α-TEA 19.2 mg/kg daily for the first 14 days of a 28 day cycle.	Drug: 19.2 mg/kg α-TEA; Patients will receive oral α-TEA 19.2 mg/kg daily for the first 14 days of a 28 day cycle.
Experimental: 22.3 mg/kg α-TEA; Patients will receive oral α-TEA 22.3 mg/kg daily for the first 14 days of a 28 day cycle.	Drug: 22.3 mg/kg α-TEA; Patients will receive oral α-TEA 22.3 mg/kg daily for the first 14 days of a 28 day cycle.
Experimental: 26.8 mg/kg α-TEA; Patients will receive oral α-TEA 26.8 mg/kg daily for the first 14 days of a 28 day cycle.	Drug: 26.8 mg/kg α-TEA; Patients will receive oral α-TEA 26.8 mg/kg daily for the first 14 days of a 28 day cycle.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants with Adverse Events	Patients are seen in clinic 7 times over a 28-day period. Patients will have 6 physical exams and meet with a research nurse 5 times for evaluation of any potential drug-related toxicities. In addition, blood will be drawn 7 times for complete blood counts and metabolic panel to check for hematological toxicities. After 28 days, a review of all safety data will determine whether the dose will be increased for subsequent patients.	28 Days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Adverse Events Possibly Caused by α-TEA	Patients are seen in clinic 7 times over a 28-day period. Patients will have 6 physical exams and meet with a research nurse 5 times for evaluation of any potential drug-related toxicities. In addition, blood will be drawn 7 times for complete blood counts and metabolic panel to check for hematological toxicities. This information will be used to identify toxicities of α-TEA and characterize the safety profile.	28 days
Blood serum levels of α-TEA	Patients will have 11 blood draws over 28 days for evaluation of pharmacokinetics. High-performance liquid chromatography (HPLC) and mass spectrometry detection (MSD) will be used to determine serum drug levels of α-TEA using blood samples collected just before the first dose of α-TEA and 1, 4, 8, and 24 hours after the first dose. Additional samples will be drawn just before the α-TEA dose on Days 2, 5, 8, 15, 22, and 29.	28 days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Tumor burden from baseline to 28 days	Imaging exams (CT, MRI, PET, bone scan, or ultrasound) will be done before treatment and after 28 days to evaluate response to treatment. Imaging modality will be determined by the treating physician.	28 Days
Change in Activity and Proliferation of Circulating T cell Sub-Populations	Blood will be drawn at before treatment and on days 8 and 29 to identify the type and proportion of circulating T cell subsets.	28 days
Change in the Number of Tumor-Infiltrating T cells from Baseline to 35 days	Patients who agree to an optional biopsy and have a subcutaneous or lymph node metastatic site amenable to a simple biopsy procedure will be included in this analysis to evaluate the number of tumor-infiltrating T cells.	35 days

Collaborators and Investigators

• Sponsor: Providence Health & Services
• Investigators: Principal Investigator: Brendan Curti, MD, Providence Cancer Center, Earle A. Chiles Reserach Institute at the Robert W. Franz Cancer Center

Publications and helpful links

Helpful Links

• Providence Cancer Center

Study record dates

Study Major Dates

• Study Start (Actual): August 4, 2014
• Primary Completion (Actual): December 11, 2017
• Study Completion (Actual): May 8, 2018

Study Registration Dates

• First Submitted: July 13, 2014
• First Submitted That Met QC Criteria: July 14, 2014
• First Posted (Estimate): July 16, 2014

Study Record Updates

• Last Update Posted (Actual): August 17, 2018
• Last Update Submitted That Met QC Criteria: August 16, 2018
• Last Verified: August 1, 2018

More Information

Terms related to this study

• Keywords: metastatic; refractory; progressive
• Additional Relevant MeSH Terms: Neoplasms, Connective and Soft Tissue; Neoplasms by Histologic Type; Neoplasms; Sarcoma
• Other Study ID Numbers: 14-043A

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO