Cancer Associated Thrombosis and Isoquercetin (CATIQ) (CATIQ)

Randomized, Placebo-controlled, Double-blind Phase II/III Trial of Oral Isoquercetin to Prevent Venous Thromboembolic Events in Cancer Patients.

This research study is evaluating a drug called isoquercetin to prevent venous thrombosis (blood clots), in participants who have pancreas, non small cell lung cancer or colorectal cancer.

Study Overview

• Status: Completed
• Conditions: Thromboembolism of Vein VTE in Colorectal Cancer; Thromboembolism of Vein in Pancreatic Cancer; Thromboembolism of Vein in Non-small Cell Lung Cancer
• Intervention / Treatment: Drug: Isoquercetin

Detailed Description

• This research study is a Phase II/III clinical trial.

  --The goal of this trial is to evaluate if isoquercetin can prevent blood clots in patients with pancreas, non small cell lung cancer or colorectal cancer. In the Phase II part of this study, the investigators are looking for the dose of isoquercetin to reduce D-dimer and demonstrate safety.

• Phase III Endpoint and Treatment Plan

  • Primary Endpoint for Phase III portion of protocol: Cumulative incidence of VTE.
  • Following the completion of the phase II portion, enrolled patients will be randomized 1:1 to Arm C (isoquercetin) or Arm D (placebo). The dose for Arm C will be determined after evaluation of the Phase II portion of the trial. The protocol will be amended when the decision is made whether to proceed to Phase III and what dose to use for Arm C. The study will be double-blinded to treatment arm. Lower extremity ultrasound will be performed at 56 days. Baseline D-dimer and correlative labs will be drawn at Day 1 and at 56 days. Patients will be followed for survival after completion of 56 days.
  • At BIDMC, optional blood draw will be performed at time 0 and 4 hours following the first dose of study drug.

• Study Type: Interventional
• Enrollment (Actual): 64
• Phase: Phase 2; Phase 3

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90033
      • USC/Norris Comprehensive Cancer Center
    • Sacramento, California, United States, 95655
      • VA Northern California Health Care System
  • Connecticut
    • West Haven, Connecticut, United States, 06450
      • VA Connecticut Healthcare System
  • District of Columbia
    • Washington, District of Columbia, United States, 20422
      • Veterans Affair Medical Center
  • Maine
    • York, Maine, United States, 03909
      • York Hospital-Oncology Treatment Center
  • Massachusetts
    • Boston, Massachusetts, United States, 02215
      • Beth Israel Deaconess Medical Center
    • Boston, Massachusetts, United States, 02130
      • Boston VA Healthcare System
    • Waltham, Massachusetts, United States, 02138
      • Mount Auburn Hospital
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • Washington University in St. Louis
  • Rhode Island
    • Providence, Rhode Island, United States, 02908
      • Providence VA Medical Center
  • Vermont
    • White River Junction, Vermont, United States, 05009
      • White River Junction VA Medical Center

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:

• Participants must meet the following criteria on screening examination to be eligible to participate in phase 2 and 3 of the study:
• Participants must have histologically confirmed malignancy that is metastatic or currently unresectable.

• Eligible malignancies include:

  • Adenocarcinoma of the pancreas (currently unresectable or metastatic)
  • Colorectal (stage IV)
  • Non-small cell lung cancer (currently unresectable stage III or stage IV)
• Receiving or scheduled to receive first or second line chemotherapy (within 30 days of registration)
• Minimum age 18 years. Because limited dosing or adverse event data are currently available on the use of isoquercetin in participants <18 years of age, children are excluded from this study but will be eligible for future pediatric isoquercetin trials.
• Life expectancy of greater than 4 months.
• ECOG performance status ≤2 (see Appendix B ).
• Patient must be able to swallow capsules (phase III only)

• Participants must have preserved organ and marrow function as defined below:

  • Absolute neutrophil count ≥1,000/mcL
  • Platelets ≥ 90,000/mcL
  • PT and PTT ≤ 1.5 x upper limit of normal
  • Total bilirubin < 2.0 mg/dl
  • AST (SGOT)/ALT (SGPT) ≤ 2.5 X institutional upper limit of normal Creatinine < 2.0 mg/dl
• The effects of isoquercetin on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
• Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

• Participants may not be receiving any other study agents.
• Participants with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
• Prior history of documented venous thromboembolic event within the last 2 years (excluding central line associated events whereby patients completed anticoagulation).
• Active bleeding or high risk for bleeding (e.g. known acute gastrointestinal ulcer)
• History of significant hemorrhage (requiring hospitalization or transfusion) outside of a surgical setting within the last 24 months
• Familial bleeding diathesis
• Known diagnosis of disseminated intravascular coagulation (DIC)
• Currently receiving anticoagulant therapy
• Current daily use of aspirin (>81mg daily), Clopidogrel (Plavix), cilostazol (Pletal), aspirin-dipyridamole (Aggrenox) (within 10 days) or considered to use regular use of higher doses of non-steroidal anti-inflammatory agents as determined by the treating physician (e.g ibuprofen > 800 mg daily or equivalent).
• Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
• Known intolerance of niacin or ascorbic acid (including known G6PD deficiency)
• Pregnant women are excluded from this study because isoquercetin is a PDI inhibitor with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk of adverse events in nursing infants secondary to treatment of the mother with isoquercetin, breastfeeding should be discontinued if the mother is treated with isoquercetin. These potential risks may also apply to other agents used in this study.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cohort A - Isoquercetin; -- Cohort A: 500 mg, Once daily, 28 days - For both cohorts A and B, lower extremity ultrasound will be performed at 56 days. Baseline D-dimer and correlative labs will be drawn at Day 1 and at 56 days. Patients will be followed for survival after completion of 56 days.	Drug: Isoquercetin; Other Names: quercetin-3-O-glucoside; 482-35-9
Experimental: Cohort B - Isoquercetin; --Cohort B: 1000 mg, Once daily, 28 days - For both cohorts A and B, lower extremity ultrasound will be performed at 56 days. Baseline D-dimer and correlative labs will be drawn at Day 1 and at 56 days. Patients will be followed for survival after completion of 56 days.	Drug: Isoquercetin; Other Names: quercetin-3-O-glucoside; 482-35-9

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent Change in D-dimer Value	D-dimer concentrations will be compared for each patient at day 0 and day 56 by a paired-t test analysis. Analysis will be performed on an intention to treat basis for patients who undergo randomization and completed the baseline and day 56 D-dimer assessments.	Baseline, 56 Day

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Hemorrhage	Investigating the safety of isoquercetin in cancer patients	study visits until day 56
Cumulative Incidence of VTE at 56 Days	To investigate the cumulative incidence of VTE according to tissue factor bearing microparticle status (and isoquercetin randomization).	56 days

Collaborators and Investigators

• Sponsor: Jeffrey Zwicker, MD
• Collaborators: National Heart, Lung, and Blood Institute (NHLBI); Quercegen Pharmaceuticals
• Investigators: Principal Investigator: Jeffrey Zwicker, MD, Beth Israel Deaconess Medical Center

Publications and helpful links

General Publications

• Zwicker JI, Schlechter BL, Stopa JD, Liebman HA, Aggarwal A, Puligandla M, Caughey T, Bauer KA, Kuemmerle N, Wong E, Wun T, McLaughlin M, Hidalgo M, Neuberg D, Furie B, Flaumenhaft R; CATIQ Investigators11. Targeting protein disulfide isomerase with the flavonoid isoquercetin to improve hypercoagulability in advanced cancer. JCI Insight. 2019 Feb 21;4(4):e125851. doi: 10.1172/jci.insight.125851. eCollection 2019 Feb 21.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2015
• Primary Completion (Actual): December 1, 2018
• Study Completion (Actual): October 22, 2019

Study Registration Dates

• First Submitted: May 13, 2014
• First Submitted That Met QC Criteria: July 17, 2014
• First Posted (Estimate): July 21, 2014

Study Record Updates

• Last Update Posted (Actual): March 3, 2021
• Last Update Submitted That Met QC Criteria: February 11, 2021
• Last Verified: February 1, 2021

More Information

Terms related to this study

• Keywords: Venous Thromboembolic Events in Cancer Patients; Thromboembolism of Vein in Colorectal Cancer; Thromboembolism of Vein in Pancreatic Cancer; Thromboembolism of Vein in Non-small Cell Lung Cancer
• Additional Relevant MeSH Terms: Digestive System Diseases; Cardiovascular Diseases; Vascular Diseases; Respiratory Tract Diseases; Neoplasms; Lung Diseases; Neoplasms by Site; Endocrine System Diseases; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Endocrine Gland Neoplasms; Respiratory Tract Neoplasms; Thoracic Neoplasms; Carcinoma, Bronchogenic; Bronchial Neoplasms; Embolism and Thrombosis; Colonic Diseases; Intestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Lung Neoplasms; Pancreatic Diseases; Carcinoma, Non-Small-Cell Lung; Colorectal Neoplasms; Pancreatic Neoplasms; Thromboembolism; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Protective Agents; Antioxidants; Quercetin
• Other Study ID Numbers: 14-114