The Evaluation of Curative Effect on Treatment of Tumor Above Thalidomide Combined With Megestrol

Prospective Clinical Study of the Effect of Thalidomide Combined With Megestrol Acetate on Lymphocyte, Inflammatory Factor Regulation and Nutritional Status in Patients With Advanced Malignant Tumors

To observe the effect of thalidomide combined with megestrol acetate on lymphocyte, inflammatory factor regulation and nutritional status in patients with advanced malignant tumors.

Study Overview

• Status: Unknown
• Conditions: Cancer, Therapy-Related
• Intervention / Treatment: Drug: Chemotherapy drugs; Drug: thalidomide and megestrol acetate; Other: optimal support treatment

Detailed Description

This study was to select 200 patients with advanced tumors with an estimated survival of ≥ 2 months. 50 patients were randomly assigned to each group. The patients were divided into chemotherapy group, chemotherapy combined with thalidomide and megestrol acetate group, The best supportive treatment group, the best supportive treatment combined with thalidomide and megestrol acetate group. The chemotherapy group and the best supportive treatment group were the control group. The combined group was administered continuously for 8 weeks according to thalidomide 100 mg qn po and megestrol acetate 0.16 qd po. Calculating the sum of the longest diameters of the target lesions from each patient before and 8 week after treatment. Patients in each group before treatment, 4th week, and 7th week were observed T cell subsets, B cell subsets, NK cell subsets and the expression of inflammatory cytokines. Through nutritional assessment Table (PG-SGA), Multidimensional Deficit Power Meter (MFSI-SF), Quality of Life Assessment Scale (EORTC QLQ-C30), Prognostic Assessment Form (GPS), Physical Status Assessment Form (ECOG) and lean body mass, upper arm muscle circumference and upper arm muscle area analysis of the effect of thalidomide combined with megestrol acetate on the nutritional status of patients with advanced cancer which reveal that thalidomide combined with megestrol acetate may improve the immune regulation and nutritional status of patients with advanced malignant tumors mechanism.

• Study Type: Interventional
• Enrollment (Anticipated): 200
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: yangwei w yang, master; Phone Number: 0755-82646002 13826524554; Email: junweiyang@163.com
• Study Contact Backup: Name: wenbin wb gao, doctor; Phone Number: 0755-82646002 13266778968; Email: drwenbingao@163.com

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 advanced malignant tumor confirmed by histopathology or cytology (hepatocarcinoma can be clinical diagnosis)
• Must be able to swallow pills
• The age of the tester ≥ 18 years old
• Gender is not limited
• Kamofsky score > 20 points
• Estimated survival period ≥ 2 months
• Childbearing age Women need negative pregnancy test
• Patients voluntarily sign informed consent and receive follow-up
• The tester can cooperate to observe adverse events and efficacy
• All of the above conditions can be included

Exclusion Criteria:

• Active upper digestive tract ulcers, obvious vomiting, chronic diarrhea, intestinal obstruction, malabsorption, etc; other patients have been known to affect drug absorption, distribution, metabolism or clearance
• 2 or more important organ dysfunction
• Thrombosis Embolism history, except for thrombosis caused by PICC
• Patients suspected of having a history of allergy to thalidomide tablets
• Any significant clinical and laboratory abnormalities that researchers believe affect safety evaluators, such as: uncontrollable activity Microbial infection, grade II or above peripheral neuropathy (NCI CTC AE v4.0), congestive heart failure, myocardial infarction within 6 months, chronic kidney disease, thyroid dysfunction etc, and acceptance may bring significant metabolic or weight changes Patients with clinical disposition
• Patients with mental disorders, affecting the efficacy of the assessor
• During the trial period and within 3 months after the end of the trial, the subject and his partner are not willing to contraception
• Any of the above can not be enrolled.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: chemotherapy group; the patients were recepted chemotherapy alone	Drug: Chemotherapy drugs; According to the NCCN Guidelines
EXPERIMENTAL: chemotherapy combined with TH and MG group; the patients were recepted chemotherapy combined with thalidomide and megestrol	Drug: thalidomide and megestrol acetate; The thalidomide and megestrol acetate administration groups were administered with thalidomide 100 mg qn po and megestrol acetate 0.16 qd po for 8 weeks; Other Names: optimal support treatment
EXPERIMENTAL: the best supportive treatment group; the patients were recepted the best supportive without chemotherapy	Other: optimal support treatment; Patients who cannot tolerate chemotherapy and other cancer treatments receive optimal support for 8 weeks
EXPERIMENTAL: the best supportive treatment combined with TH and MG group; the patients were recepted the best supportive combined with thalidomide and megestrol without chemotherapy	Drug: thalidomide and megestrol acetate; The thalidomide and megestrol acetate administration groups were administered with thalidomide 100 mg qn po and megestrol acetate 0.16 qd po for 8 weeks; Other Names: optimal support treatment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Imaging efficacy evaluation	Clinical response Based on the Response Evaluation Criteria Solid Tumors (RECIST), the therapeutic effect was divided into complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD). Investigators calculate the sum of the longest diameter of the target lesions from each patient by CT or MRI.	before and 8 week after treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Observing the expression of lymphocyte subsets	Patients were detected Lymphocyte subgroups of 2 ml peripheral blood by Flow cytometer (BD FACSCalibur), which inclunde the T cell subsets, NK cell subset, B cell subset(percentage)	before , the fourth and the seventh weeks of treatment
Observing the expression of inflammatory factors	2 ml of peripheral blood was taken from each patient. Flow cytometry was used to detect changes of inflammatory factor expression which include the IL-2, IL- 4, IL-5, IL-6, IL-9, IL-10, IL-13, IL-17A, IL-17F, IL-21, IL-22, IFN-γ and TNF-α(ug/ml)	before , the fourth and the seventh weeks of treatment
Nutritional assessment	Scored Patient-Generated Subjiective Global Assessment（PG-SGA）form was used in the present study. The total score of PG-SGA is summed by the following four subscale scores（A+B+C+D）. The first measurement score（A）is self-assessed by the subject and consists of the following four parts: Weight Table（0-4），Eating Situation Table（0-6），Symptom Table （0-22），Activity and Body Function Table（0-3）. The remaining three measurements are completed by trained registered clinical physicians， dieticians，and nurses: Scale of relationship between disease and nutritional needs（B）（0-6），Metabolic demand scale（C）（0-9），Physical examination scale（D）（0-24）. The scoring was controlled by one researcher (H.R). The lower scores represent a better outcome and the higher scores represent a worse outcome.	before , the fourth and the seventh weeks of treatment

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Multidimensional deficient power assessment	Multidimensional deficient power assessment (MFSI-SF) was used in the present study. The MFSI-SF scale contains 30 subjects' subjective feelings，such as muscle soreness and memory loss. Subjects were scored according to the degree of each sensation (0-4). The MFSI-SF scale total score is the sum of each sensation score (0-120). The lower scores represent a better outcome and the higher scores represent a worse outcome.	before , the fourth and the seventh weeks of treatment
Quality of life assessment	Quality of Life Assessment Table (EORTC QLQ-C30) was used in the present study. The Quality of Life Assessment Table contains 28 subjects' subjective feelings and symptoms，such as tiredness and diarrhea within one week (A)，and two other indicators: health status，quality of life within one week (B). Subjects were scored according to the degree of each sensation (A 0-4) and (B 1-7). The Quality of Life Assessment Table is divided into two parts: the first part of the total score (0-112); the second part of the total scores (2-14). In the first part of the total scores: the lower scores represent a better outcome and the higher scores represent a worse outcome. In the second part of the total scores: the higher scores represent a better outcome and the lower scores represent a worse outcome.	before , the fourth and the seventh weeks of treatment
Prognostic assessment	The prognostic assessment by GPS scores which were calculated by detecting peripheral blood CRP and albumin from each tumor patients. GPS scores：CRP < 10 mg/l，albumin> 35g/l，GPS 0；CRP > 10 mg/l，albumin > 35 g/l，GPS 1；CRP > 10 mg/l，albumin < 35 g/l，GPS 2. The lower scores represent a better outcome and the higher scores represent a worse outcome.	before , the fourth and the seventh weeks of treatment
Performance status assessment	The performance status of patients with cancer is measured by the clinician through the ECOG score form (score:0-5)	before , the fourth and the seventh weeks of treatment
Lean body mass	Patient's waist circumference and weight were measured by trained registered clinical dietitians, and the measuring was controlled by one researcher (H.R). The researcher calculate lean body mass by measurements of waist circumference and body weight	before , the fourth and the seventh weeks of treatment
Upper arm muscle circumference and upper arm muscle area	Patient's upper arm circumference and triceps skinfold thickness were measured by trained registered clinical dietitians, and the measuring was controlled by one researcher (H.R). The researcher calculate Upper arm muscle circumference and upper arm muscle area by measurements of upper arm circumference and triceps skinfold thickness	before , the fourth and the seventh weeks of treatment

Collaborators and Investigators

• Sponsor: Shenzhen Fifth People's Hospital

Study record dates

Study Major Dates

• Study Start (ANTICIPATED): December 10, 2018
• Primary Completion (ANTICIPATED): October 10, 2020
• Study Completion (ANTICIPATED): June 10, 2021

Study Registration Dates

• First Submitted: August 25, 2018
• First Submitted That Met QC Criteria: December 12, 2018
• First Posted (ACTUAL): December 19, 2018

Study Record Updates

• Last Update Posted (ACTUAL): December 19, 2018
• Last Update Submitted That Met QC Criteria: December 12, 2018
• Last Verified: December 1, 2018

More Information

Terms related to this study

• Keywords: inflammatory cytokines; tumor; nutritional; thalidomide; megestrol acetate; lymphocyte
• Additional Relevant MeSH Terms: Neoplasms; Neoplasms, Second Primary; Physiological Effects of Drugs; Anti-Infective Agents; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Antineoplastic Agents, Hormonal; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Growth Inhibitors; Anti-Bacterial Agents; Leprostatic Agents; Contraceptive Agents, Hormonal; Contraceptive Agents; Reproductive Control Agents; Contraceptives, Oral; Contraceptive Agents, Female; Contraceptives, Oral, Synthetic; Contraceptives, Oral, Hormonal; Central Nervous System Stimulants; Appetite Stimulants; Thalidomide; Megestrol; Megestrol Acetate
• Other Study ID Numbers: shenzhenfifth 201807

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No