骨転移緩和のための併用放射線療法とゾレドロン酸の安全性と有効性の研究
乳癌、前立腺癌および肺癌からの骨転移の緩和のための併用放射線療法およびゾレドロン酸の安全性と有効性を研究する第I相パイロット試験
調査の概要
詳細な説明
骨転移は、がん患者における播種性疾患の最初の徴候の 1 つです。 転移性疾患による骨格合併症には、(重度の)骨痛、運動障害、脊髄圧迫、病的骨折、および高カルシウム血症が含まれます。 放射線療法と手術は、骨転移の特定の局所治療の選択肢です。 化学療法、ホルモン療法、ビスフォスフォネートは、高カルシウム血症の有無にかかわらず骨転移の治療に使用される全身療法です。 乳房、前立腺、肺、骨髄腫などの骨に転移する傾向のあるがんは、破骨細胞と相互作用する能力を持っている可能性があります。 破骨細胞は特殊な骨細胞であり、酸とリソソーム酵素を分泌することによってミネラル化された骨を侵食します。 正常な骨のリモデリングでは、破骨細胞の骨吸収は造骨細胞の骨形成と結合し、平衡状態にあります。 悪性骨転移に伴う溶解性骨破壊は、腫瘍細胞が破骨細胞を刺激して骨を再吸収させる可溶性因子を合成および放出するために発生します。 破骨細胞の悪性活性化は、正常な骨リモデリングの破壊をもたらし、骨吸収と骨形成との間の平衡が骨吸収の増加に向かってシフトする。 この破骨細胞による骨吸収の相対的な増加は、骨の正味の損失をもたらします。
ゾレドロン酸 (Zometa®、CGP42446) は、ビスフォスフォネートとして知られる化合物のクラスのメンバーです。 ビスフォスフォネートは、破骨細胞の骨吸収を効果的に阻害します。 それらは、悪性腫瘍の高カルシウム血症、多発性骨髄腫に関連する溶解性骨疾患、および乳癌、前立腺癌、および肺癌に関連する溶解性骨転移と芽球性骨転移の混合の治療に治療効果があります。 臨床現場では、ゾレドロン酸が最も強力なビスフォスフォネートです。
従来、外照射放射線療法 (RT) は、骨転移の緩和のための主要な治療法です。 骨転移治療における RT の目的は、周囲の正常細胞を損傷することなく悪性細胞を根絶することです。 RT は通常、できるだけ多くの骨髄を節約するために、病変領域に行われます。 RT は、多発性骨髄腫の孤立性、溶解性、痛みを伴う骨病変、および乳房、前立腺、肺がんなどの固形腫瘍からの骨転移に適応し、骨折のリスクを防ぎ、痛みを和らげます。
この研究の目的は、乳がん、前立腺がん、または肺がん患者の骨転移に対する標準的な放射線療法と標準的なゾレドロン酸の併用の安全性と有効性を評価することです。 ゾレドロン酸は FDA 承認のアミノビスフォスフォネートの中で最も効果的であるため、この研究で使用するゾレドロン酸を選択しました。
研究の種類
入学 (実際)
段階
- フェーズ 1
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
包含基準:
- >18歳
- 生検で証明された乳がん、肺がん、および/または前立腺がん
- -放射線学的に診断された、または生検で証明された、放射線の兆候を伴う骨転移
- カルノフスキー パフォーマンス ステータス >60
- 少なくとも6か月の平均余命
- -血清クレアチニンレベル≤2.0mg / dLおよび計算されたクレアチニンクリアランス> 60 mL /分
- 白血球数≧3500/mm3
- ヘモグロブリン > 11 g/dl
- 血小板 > 100,000 / mm3
- 総ビリルビン < 2.5 mg/dl
除外基準:
- 妊娠中および授乳中の女性(乳がんおよび肺がん)
- -ホルモン療法が無作為化の3か月以内に開始された(前立腺がん)
- ビスフォスフォネートに対するアレルギー反応の既往
- -同時の腎毒性化学療法を受けている
- -治験薬を使用した別の臨床試験への参加、または過去30日以内に治験薬試験を完了
- 肝機能検査 > 正常値の 1.5 倍
- -無作為化の30日以内のIVカルシトニン投与
- 腎疾患の検査証拠
- -この研究で治療される骨転移の領域への以前のRT
- -現在経口またはIVビスフォスフォネート療法を受けている
- 腹水の存在
- 臨床的に重要な心電図変化
- 高カルシウム血症、病的骨折、または硬膜外脊髄圧迫
- 他臓器転移
- -Zometa®(ゾレドロン酸)または他のビスフォスフォネートに対する既知の過敏症
- 歯または顎骨(上顎または下顎)の感染を含む現在進行中の歯の問題;歯科または器具の外傷、または顎の骨壊死(ONJ)、口内の露出した骨、または歯科処置後の治癒の遅延の現在または以前の診断。
- 最近(6週間以内)または予定されている歯科または顎の手術(抜歯、インプラントなど)
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:非ランダム化
- 介入モデル:単一グループの割り当て
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
実験的:1
ゾレドロン酸と放射線療法
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ベースラインでは、ゾレドロン酸 4 mg を 15 分かけて静注。
4 週間ごとに 6 か月間、放射線療法 30 Gy を 10 分割(最初の 2 週間は週 5 回)
|
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
時間枠 |
---|---|
PET-CT
時間枠:ベースラインと 6 か月
|
ベースラインと 6 か月
|
二次結果の測定
結果測定 |
時間枠 |
---|---|
X線、ベースライン
時間枠:3ヶ月、6ヶ月
|
3ヶ月、6ヶ月
|
身体検査
時間枠:Radiaton Oncology - 訪問 1、14、17
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Radiaton Oncology - 訪問 1、14、17
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身体検査
時間枠:腫瘍内科 - 訪問 1、13、17
|
腫瘍内科 - 訪問 1、13、17
|
協力者と研究者
出版物と役立つリンク
一般刊行物
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乳がんの臨床試験
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Tianjin Medical University Cancer Institute and...Guangxi Medical University; Sun Yat-sen University; Chinese PLA General Hospital; The First Affiliated... と他の協力者完了
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Jonsson Comprehensive Cancer CenterNational Cancer Institute (NCI); Highlight Therapeutics積極的、募集していない平滑筋肉腫 | 悪性末梢神経鞘腫瘍 | 滑膜肉腫 | 未分化多形肉腫 | 骨の未分化高悪性度多形肉腫 | 粘液線維肉腫 | II期の体幹および四肢の軟部肉腫 AJCC v8 | III期の体幹および四肢の軟部肉腫 AJCC v8 | IIIA 期の体幹および四肢の軟部肉腫 AJCC v8 | IIIB 期の体幹および四肢の軟部肉腫 AJCC v8 | 切除可能な軟部肉腫 | 多形性横紋筋肉腫 | 切除可能な脱分化型脂肪肉腫 | 切除可能な未分化多形肉腫 | 軟部組織線維肉腫 | 紡錘細胞肉腫 | ステージ I 後腹膜肉腫 AJCC (American Joint Committee on Cancer) v8 | 体幹および四肢の I 期軟部肉腫 AJCC v8 | ステージ... およびその他の条件アメリカ
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michal roll募集外科的切除 | この研究の目的は、光線力学療法の有効性を評価することです。 | 術後のデスモイド腫瘍患者の臨床転帰に対する補助療法イスラエル
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Massachusetts General HospitalStand Up To Cancer募集
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Roswell Park Cancer InstituteAIM ImmunoTech Inc.完了エストロゲン受容体陰性 | HER2/Neu陰性 | プロゲステロン受容体陰性 | トリプルネガティブ乳がん | 解剖学的ステージ IV 乳がん AJCCアメリカ