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Huachansu & Gemcitabine in Pancreatic Cancer

10 juli 2012 bijgewerkt door: M.D. Anderson Cancer Center

A Randomized, Placebo-controlled, Blinded Phase II Study of Huachansu & Gemcitabine in Pancreatic Cancer

This protocol is part of a larger grant funded by the NCI to create an international research center to study traditional Chinese medicine (TCM). All of the patients enrolled in this study will be treated at the Cancer Hospital, Fudan University, our sister institution in Shanghai, China. No patients will be seen at MDACC. This protocol will be overseen by the Fudan University Institutional Review Board (IRB00002408) which has Federal Wide Assurance through the U.S. Department of Health & Human Services (Approved: April 25, 2002). The research nurses have received training at MDACC and will receive regular oversight by MDACC personnel.

Primary End Point:

1. Determine the efficacy of huachansu as measured by progression free survival at 4 months.

Secondary End Points:

  1. Examine the feasibility and safety of treatment using huachansu in combination with gemcitabine in patients with pancreatic cancer.
  2. Determine clinical efficacy by other measures including tumor response, 6-month survival, and changes in quality of life (QOL) in patients with pancreatic cancer.
  3. Monitor patient blood levels of the three main cardiac glycosides that are in huachansu (bufalin, cinobufagin, and resibufogenin). This information will provide evidence to delineate the role of these cardiac glycosides in antitumor activity.

Studie Overzicht

Toestand

Voltooid

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

The Study Drugs:

HuaChanSu is a substance used in China to treat different types of cancer. One of the major elements of the substance is bufalin, which is an ingredient that has been shown to block the growth of tumor cells.

Gemcitabine is designed to disrupt the growth of cancer cells, which may cause cancer cells to die.

Screening:

Before you can receive study treatment, you will have "screening tests." These tests will help the study doctor decide if you are eligible to take part in this study. The following tests will be performed:

  • You will be asked questions about your medical history and any symptoms you may have now.
  • You will have a complete physical exam.
  • Your vital signs (temperature, heart rate, breathing rate, and blood pressure), height, and weight will be measured.
  • You will be asked how well you are able to perform the normal activities of daily living (a performance status evaluation).
  • You will have an electrocardiogram (ECG-a test that measures the electrical activity of the heart).
  • To check the status of the cancer, you will have computed tomography (CT) scan(s) and/or magnetic resonance imaging (MRI) scans of your abdomen, pelvis, and any other areas where there is disease.
  • You will complete a short questionnaire that will ask questions about your quality of life. This will take about 5 minutes to complete.
  • A traditional Chinese medicine diagnosis will also be done. This will include diagnosis by a study doctor. The doctor will take your pulse (heart rate), look at your tongue, and ask you a few questions about your health. The doctor will also use a heart-rate machine and take a photograph of your tongue. This will allow a more scientific check of your heart rate and tongue condition.
  • You will have blood (about 3 teaspoons) collected for routine safety tests. This routine blood draw will include a pregnancy test for women who are able to have children. To be eligible to take part in this study, the pregnancy test must be negative.
  • You will have 1 biopsy of your tumor tissue to check your cancer type. To collect a tumor tissue biopsy, an area where cancer is located is numbed with anesthetic, and a small amount of tumor tissue is withdrawn through a large needle.

Randomization:

If you are found to be eligible and decide to take part in this study, you may begin treatment.

The first 3 participants enrolled on this study will be given HuaChanSu and gemcitabine, to find out if this dose combination can be tolerated. After the first 3 participants are enrolled, all other participants will be randomly assigned (as in the toss of a coin) to receive HuaChanSu and gemcitabine or gemcitabine and the placebo. The first 20 participants have an equal chance of receiving HuaChanSu or placebo, but after that point, participants will have a better chance of being assigned to the group that is responding better to their study combination. All participants will receive the same dose level of gemcitabine, but you will not know if you are given HuaChanSu or placebo. However, this information can be found out if medically necessary.

Study Treatment:

Before the study drug infusions begin, you will be fitted with a peripherally-inserted central catheter (PICC) by a specially trained nurse. A PICC is a tube that is inserted into a vein, either in your arm or under the collarbone, to make it easier to give you gemcitabine with or without HuaChanSu. This is an outpatient procedure. You will be given a separate consent form for the insertion of the PICC. It will explain the risks of the procedure and how to take care of the PICC. Your doses of gemcitabine and either HuaChanSu or a placebo (a saline [salt water] solution that looks like HuaChanSu but has no effects) will be given through the PICC while you are on this study.

  • HuaChanSu (or placebo) will be given as a 2-hour continuous (nonstop) infusion through the PICC. You will receive the 2-hour dose 5 days a week (5 days in a row each time) for 3 weeks. This will be followed by 1 week of not receiving the drug.
  • Gemcitabine will be given through a needle in a vein over 30 minutes on Days 1, 8, and 15, followed by 1 week where no study drug is given. Each 4-week treatment period is called a study "cycle."

PK Testing:

During Cycle 1 only, you will have extra blood (about 1 teaspoon each time) collected at various time points for pharmacokinetic (PK) testing. PK testing measures the amount of study drug in the body at different time points. PK blood samples will be drawn 4 times over a 24-hour period on Day 1 and then once each on Days 7, 14, and 21.

Study Tests:

Before each new cycle, you will be asked questions about your current health, and you will have a complete physical exam. Your vital signs and weight will be measured. You will have a performance status evaluation. You will complete a questionnaire about your quality of life. The questionnaire will take about 5 minutes to complete. You will also have blood (about 3 teaspoons) drawn for routine safety tests.

On Days 8 and 15 of each cycle, you will also have blood (about 3 teaspoons) drawn for routine safety tests.

Every 8 weeks (starting in Cycle 3), to check the status of the cancer, you will have CT and/or MRI scan(s) of your abdomen, pelvis, and any other areas where there is disease.

Length of Study Participation:

You may continue to receive more cycles of treatment, as long as the cancer does not get worse and intolerable side effects do not occur.

You will be taken off this study if the cancer gets worse, intolerable side effects occur, new information shows that the treatment is not right for you, you are not able to follow the study rules, the study is stopped, or you decide to leave the study for any reason. If you are thinking about leaving the study, please tell your study doctor, so that you may be told how to end treatment safely as well as what other treatment options are available.

End-of-Treatment Visit:

You will be asked to have a final study visit 4 weeks after your last dose of study drugs. During this visit, you will have the following tests and procedures performed:

  • You will have blood (about 3 teaspoons) drawn for routine safety tests.
  • You will be asked questions about your medical history.
  • You will have a complete physical exam, and your vital signs and weight will be measured.
  • You will have a performance status evaluation.
  • You will complete a questionnaire about your quality of life.
  • To check the status of the cancer, you will have computed tomography (CT) scan(s) and/or magnetic resonance imaging (MRI) scans of your abdomen, pelvis, and any other areas where there is disease (if these were not performed close to the time that you stopped study treatment).

This is an investigational study. HuaChanSu is a commercially available medication that is approved by the Chinese FDA for the treatment of pancreatic cancer. Gemcitabine is approved by the Chinese FDA for the treatment of pancreatic cancer. In this study, the combination of these drugs is being used for research only.

Up to 80 patients will take part in this study. All will be enrolled at Fudan University Cancer Hospital.

Studietype

Ingrijpend

Inschrijving (Werkelijk)

80

Fase

  • Fase 2

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

  • China
      • Shanghai, China
        • Cancer hospital Fudan University

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar en ouder (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

Inclusion Criteria:

  1. Histologically/cytologically confirmed unresectable (locally advanced or stage IV) pancreatic adenocarcinoma.
  2. Karnofsky Performance Status > 60 (see Appendix H for definition)
  3. Measurable disease by RECIST criteria must be present. Bone scan abnormalities alone will not be accepted as measurable disease. Lytic lesions seen on plain radiographs will not be accepted as measurable disease but will be evaluated in conjunction with bone scan abnormalities. Pure blastic bone metastases will not be accepted as measurable disease. Pleural or peritoneal effusions will not be accepted as measurable disease. Irradiated lesions are not considered measurable.
  4. Patients must not be pregnant. Serum beta-HCG will be checked in all premenopausal patients.
  5. Patients must have adequate organ functions reflected by the laboratory criteria below: Granulocytes >1,500/uL; Hemoglobin >/= 8.0 gm/dL; Platelets > 100,000/uL; Serum creatinine < 2.0 mg/dL; Bilirubin < 1.5 mg/dL; SGPT < 3 x normal; Alk Phos < 3 x normal; Calcium </=11.0 mg/dL
  6. Age >/=18
  7. Patients must not have received any prior chemotherapy. Prior exposure to Traditional Chinese Medicine is allowed provided that at least one week washout time is given prior to initiation of experimental treatment.
  8. Concomitant bisphosphonates are allowed for patients with bone metastases.
  9. Patients with jaundice must have a biliary drainage decompression operation before recruitment.
  10. Ability to understand and the willingness to sign a written informed consent.
  11. Prior local therapy, e.g., TACE or radiation, is allowed provided that at least 4 weeks washout time is given.

Exclusion Criteria:

  1. Known central nervous system involvement and leptomeningeal disease
  2. Other serious illness or condition including cardiac disease including congestive heart failure (New York Heart Association Classification III or IV), active HIV infection/HIV disease, psychiatric disorders.
  3. Known allergies to the huachansu or toad skin products.
  4. Concurrent infection requiring intravenous antibiotics.
  5. Pregnant or lactating women.
  6. Prior treatment with systemic chemotherapy.

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Dubbele

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Experimenteel: Gemcitabine + HuaChanSu
Gemcitabine 1,000 mg/m2 once a week for 3 weeks then 1 week off + HuaChanSu 20 mL/m2 for total 500 mL given as a 2 hour infusion, 5 days a week for 3 weeks then one week off (28 Day Cycle).
Geneesmiddel: Gemcitabine
1,000 mg/m2 once a week for 3 weeks then 1 week off (28 Day Cycle).
Andere namen:
  • Gemzar
  • Gemcitabine Hydrocholoride
Geneesmiddel: HuaChanSu
20 mL/m2 for total 500 mL given as a 2 hour infusion, 5 days a week for 3 weeks then one week off (28 Day Cycle).
Andere namen:
  • HCS
Experimenteel: Gemcitabine + Placebo
Gemcitabine 1,000 mg/m2 once a week for 3 weeks then 1 week off (28 Day Cycle) + Placebo 500 ml saline only administered as a 2 hour infusion by central line.
Geneesmiddel: Gemcitabine
1,000 mg/m2 once a week for 3 weeks then 1 week off (28 Day Cycle).
Andere namen:
  • Gemzar
  • Gemcitabine Hydrocholoride
Geneesmiddel: Placebo
500 ml saline only administered as a 2 hour infusion by central line.

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Progression Free Survival at 4 Months
Tijdsspanne: 4 Months
Number of participants without disease progression four months following treatment.
4 Months

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Median Overall Survival
Tijdsspanne: Up to 4 Years
Median participants overall survival defined as date of study entry until death, or censored to last known date of survival, reported in days.
Up to 4 Years

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

M.D. Anderson Cancer Center

Medewerkers

National Cancer Institute (NCI)

Onderzoekers

  • Hoofdonderzoeker: Chris Garrett, MD, UT MD Anderson Cancer Center

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Nuttige links

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 juni 2007

Primaire voltooiing (Werkelijk)

1 juli 2012

Studie voltooiing (Werkelijk)

1 juli 2012

Studieregistratiedata

Eerst ingediend

3 februari 2009

Eerst ingediend dat voldeed aan de QC-criteria

3 februari 2009

Eerst geplaatst (Schatting)

5 februari 2009

Updates van studierecords

Laatste update geplaatst (Schatting)

12 juli 2012

Laatste update ingediend die voldeed aan QC-criteria

10 juli 2012

Laatst geverifieerd

1 juli 2012

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • 2006-0948

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

product vervaardigd in en geëxporteerd uit de V.S.

Nee

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .

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Voorwaarden

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Geneesmiddelinterventies

Voedingssupplementen

Sponsor / medewerkers

Locaties

3
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