Study to Assess Epidural Resiniferatoxin for the Treatment of Intractable Pain Associated With Advanced Cancer

A Multicenter, Phase 2 Study to Assess the Safety and Efficacy of Epidural Resiniferatoxin for the Treatment of Intractable Pain Associated With Advanced Cancer

This Phase 2 study assesses the safety and efficacy of a single injection of Resiniferatoxin versus placebo for the treatment of intractable advanced cancer pain.

Study Overview

• Status: Suspended
• Conditions: Pain; Pain, Intractable; Pain Cancer
• Intervention / Treatment: Drug: Resiniferatoxin; Drug: Placebo

Detailed Description

This is a global multicenter, randomized Phase 2 study for subjects with advanced cancer experiencing intractable pain to assess the safety and efficacy of a single epidural injection of Resiniferatoxin versus vehicle control. Additional subjects who elect to not enroll but are willing to be followed will comprise a Concurrent Control Group. Subjects will be followed for twelve months.

• Study Type: Interventional
• Enrollment (Estimated): 120
• Phase: Phase 2

Contacts and Locations

• Study Contact: Name: Mike Royal, MD; Phone Number: 4146 8582034100; Email: mroyal@sorrentotherapeutics.com

Study Locations

• United States
  • California
    • La Jolla, California, United States, 92037
      • Altman Clinical and Translational Research Institute (ACTRI)
  • Florida
    • Gainesville, Florida, United States, 32610
      • University of Florida
  • Oregon
    • Portland, Oregon, United States, 97239
      • Oregon Health & Science University
  • Texas
    • Bellaire, Texas, United States, 77401
      • HD Research

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Histologically or cytologically confirmed advanced cancer
• Targeted pain area of involvement that is at or below the lower thoracic or chest level down to lower extremities, attributed to the cancer
• If pain is present in other areas, able to differentiate pain in the target area is the primary source of pain
• Intractable pain that has not responded to standard therapies
• Be opioid tolerant, defined as an average daily opioid consumption > 30 mg oral morphine equivalent dose during the screening and which has been stable for the month prior to screening
• Have a Karnofsky Performance Scale score ≥ 50 at Screening
• In the Investigator's opinion, a reasonable expectation that the subject will be able to complete the study
• Able to comply with the study procedures and give informed consent
• Willing to follow contraception guidelines

Exclusion Criteria:

• Be undergoing or have plans to undergo changes to current cancer treatment from D-7 through M3
• Had an implantation of intrathecal pump or spinal cord stimulator less than 6 weeks prior to D1 or planning to undergo such a placement during the study prior to M3
• Have leptomeningeal metastases in the lumbar area
• Unless approachable via the caudal route, have the level of intended epidural injection within site of prior lumbar spine surgical procedures that could disrupt the epidural space or otherwise impair ability of the injection to reach nerves
• Has evidence of a non-correctable coagulopathy or hemostasis problem including a low platelet count, prothrombin time, abnormal PT or PTT, or on anticoagulant or antiplatelet therapies before and during investigational product (IP) administration
• Have evidence or history of bleeding disorder or disseminated intravascular coagulation, any recent hemorrhage or bleeding event within 4 weeks prior to D1
• Have abnormal neutrophil or serum creatinine
• Is febrile or has other evidence of infection within 24 hours of D1
• Has recently been diagnosed as COVID-19 positive or evidence of active infection. The subject may participate if full recovery has occurred with a negative RT-PCR test (any EUA cleared test) at least 1 week prior to D1
• Has an allergy or hypersensitivity to TRPV1 agonists, bupivacaine, radiographic contrast agents, fentanyl, hydromorphone, or morphine
• Pregnant at Screening or planning on becoming pregnant or currently breastfeeding
• Has an intrathecal shunt, increased intracranial pressure or evidence of brain pathology as determined by symptoms, history, physical examination, and/or magnetic resonance imaging (MRI)
• Is unable or distinguish the target pain from any additional loci of pain at screening
• Non-study related minor surgical procedure ≤ 2 days or major surgical procedure ≤ 7 days prior to screening and must be sufficiently recovered and stable prior to D1
• Has not recovered from toxicities from previous cancer treatment, including chemotherapy, hormone therapy, immunotherapy, radiotherapy or bisphosphonates. Participants are not eligible if they have received such therapy within the month prior to D1
• Non-study related minor surgical procedure ≤ 5 days or major surgical procedure ≤ 21 days prior to enrollment. In all cases, subjects must be sufficiently recovered and stable prior to IP administration on D1
• Arterial thrombi, myocardial infarction, admission for unstable angina, within 3 months prior to screening
• Clinically significant electrocardiogram abnormalities
• Have any medical condition that could adversely impact subject's participation or safety or interfere with pain assessments
• Participation in another investigational trial during the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Resiniferatoxin; 15 mcg, 20 mcg, or 25 mcg in 2mL injected once into the epidural space	Drug: Resiniferatoxin; Resiniferatoxin is a compound purified from natural sources; Other Names: RTX
Placebo Comparator: Placebo; 2mL injected once into the epidural space	Drug: Placebo; Vehicle solution
No Intervention: Concurrent Control; No intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assess the incidence of any treatment-emergent adverse events of epidural Resiniferatoxin (RTX) [safety and tolerability]	To assess the safety of epidural RTX including incidence and severity of any short-term and long-term treatment-emergent adverse events (TEAEs) using the Common Terminology Criteria for Adverse Events (CTCAE) criteria	Baseline through study completion at up to approximately 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assess efficacy of RTX on pain associated with advanced cancer	To assess efficacy of each epidural RTX dose in comparison to control groups on the subject's intractable pain due to advanced cancer using the Brief Pain Inventory, Short Form (BPI-SF) score (1-10, with 10 associated with worse pain)	Baseline through study completion at up to approximately 12 months
Assess RTX effect on quality of life	To assess the efficacy of each epidural RTX dose in comparison to control groups on the quality of life using Treatment Helpfulness Questionnaire score (graded 1-7, with 7 being most helpful)	Baseline through study completion at up to approximately 12 months
Assess RTX effect on opioid consumption	To assess the effect of each epidural RTX dose on opioid consumption, measuring the average reduction compared to baseline of daily opioid consumption, calculated as an oral morphine equivalent dose	Baseline through study completion at up to approximately 12 months

Collaborators and Investigators

• Sponsor: Sorrento Therapeutics, Inc.
• Investigators: Study Director: Mike Royal, MD, Sorrento Therapeutics, Inc.

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2025
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: September 17, 2021
• First Submitted That Met QC Criteria: October 3, 2021
• First Posted (Actual): October 5, 2021

Study Record Updates

• Last Update Posted (Actual): March 18, 2024
• Last Update Submitted That Met QC Criteria: March 14, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: pain; cancer pain; advanced cancer pain; resiniferatoxin; RTX
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pain, Intractable
• Other Study ID Numbers: RTX-CAP-201

Drug and device information, study documents

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