Role of Antisecretory Factor in Curative Radiochemotherapy for Anal Carcinoma (SALFLAC)
A Randomized Phase 2 Double-blind Placebo-controlled Trial Investigating the Effect of Salovum™ and SPC-flakes on Radiochemotherapy Induced Toxicity in Curative Treatment of Anal Carcinoma
研究概览
详细说明
Curative RCT for AC is associated with considerable acute and long-term toxicity.
The acute toxicity derives from the combined effects of radiation and chemotherapy and is dominated by localized skin mucositis, diarrhoea and pain from radiation and nausea, fatigue, anemia/leukopenia, diarrhoea and general skin dryness from chemotherapy. These adverse effects are treated symptomatically with mostly modest effect and sometimes leads to the need for in-patient care and temporary stop of the RCT. Long-term toxicity is caused by radiation fibrosis and is dominated by impaired anal sphincter function leading to faeces incontinence, pelvic pain and reduced sexual function. Thus, new ways to efficiently counteract the RCT induced adverse effects are urgently needed.
Cholera induced diarrhoea, as well as other forms of diarrhoea-inducing agents, has been shown to elicit a stimulated, endogenous production of a protein, named "antisecretory factor" (ASF). This protein has been chemically characterized in detail. ASF acts by modulating secretion of water and ions but also counteracts inflammatory processes . ASF is also produced by hens fed on a diet of fermented grains or a specific diet of sugars and amino acids, leading to an accumulation of the ASF protein in the egg yolk. Spray dried yolk in the form of a powder is commercialized as Salovum registered by the EU authorities as "Food for specific medical purposes", i e is not adrug from a regulatory perspective.
Salovum rapidly increase the plasma (P-) ASF-concentration. Another way to increase ASF and, thus, to achieve benefit, is to induce its production/conversion by ingestion of oat flakes, specially processed (similar to malting) to contain the proper mix of sugars and amino acids. Such flakes are also commercially available (named SPC flakes) as "Food for specific medical purposes" and has been recommended or considered for a number of secretory pathological conditions, e g for treatment of Mb Meniére.
With this background the present study will investigate if induction of endogenous ASF by intake of SPC-flakes might be beneficial in AC patients to prevent RCT induced adverse events (AEs) and if administration of ASF from Salovum provides additional benefit (explorative).
研究类型
注册 (预期的)
阶段
- 不适用
联系人和位置
学习联系方式
- 姓名:Peter Nygren, MD
- 电话号码:+46704250719
- 邮箱:peter.nygren@igp.uu.se
参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Age ≥ 18 years.
- Histologically confirmed diagnosis of AC irrespective of tumour p16-status.
- Planned for curative RCT according to national care programme schedule B
- WHO performance status of 0 or 1.
- For patients planned for schedule C, they must be unsuitable for or not consenting to participation in the SWANCA trial.
- Able to understand study information and questionnaires and provide signed informed consent.
Exclusion Criteria:
- Patients with stoma.
- Contraindications to the investigational product, e g known or suspected hypersensitivity to the investigational products or expected inability to their use in accordance with the protocol.
- Contraindications to curative RCT in accordance with AC national care programme.
- Lack of suitability for participation in the study, e g expected difficulties to follow the protocol procedures, as judged by the investigator.
- Prior exposure to Salovum or SPC-flakes.
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:随机化
- 介入模型:并行分配
- 屏蔽:四人间
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
有源比较器:SPC-flakes with or without Salovum
SPC-flakes flat dose of 75 g/d divided in 2 - 4 doses started 5 days prior to start of RCT and continued during the RCT.
Salovum egg powder 4 g/sachet.
Four sachets, ie 16 g q 8 h for 5 days prior to start of RCT.
The appropriate amount of Salovum is mixed with 100 - 200 ml of suitable liquid, eg fruit juice, and ingested orally.
|
Salovum and SPC-flakes are foods approved for specific medical purposes.
|
安慰剂比较:SPC-flakes placebo with or without Salovum placebo
SPC-placebo flat dose of 75 g/d divided in 2 - 4 doses started 5 days prior to start of RCT and continued during the RCT.
Salovum placebo egg powder 4 g/sachet.
Four sachets, ie 16 g q 8 h for 5 days prior to start of RCT.
The appropriate amount of Salovum placebo is mixed with 100 - 200 ml of suitable liquid, eg fruit juice, and ingested orally.
|
Salovum and SPC-flakes are foods approved for specific medical purposes.
|
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Incidence of diarrhoea, fecal urgency, anal skin toxicity/mucositis and anal pain CTCAEv5.0 ≥ grade 2 during and up to 6 months after RCT. Anal skin toxicity/mucositis is to be verified by photos.
大体时间:Through study completion, approximately 6 months
|
Treatment related toxicity
|
Through study completion, approximately 6 months
|
次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Incidence and severity of other AEs according to CTCAEv5.0 during and up to 6 months after RCT.
大体时间:Through study completion, approximately 6 months
|
Other treatment related toxicity
|
Through study completion, approximately 6 months
|
Change from baseline in patient reported hQoL and abdominal symptoms assessed by EORTC QLQ- 30 and the ANL27 subscale questionnaires as well as the Bristol Stool Form Scale.
大体时间:Through study completion, approximately 6 months
|
PROMS
|
Through study completion, approximately 6 months
|
Increase in plasma (P)-ASF concentration from baseline to the day of start of RCT and to the end of treatment.
大体时间:Days -1, 6 and 42
|
Pharmacodynamic outcome and compliance check
|
Days -1, 6 and 42
|
Relationships between P-ASF concentration, biomarkers reflecting inflammation and adverse events.
大体时间:Through study completion, approximately 6 months
|
Biomarker assessments
|
Through study completion, approximately 6 months
|
Differences in primary and secondary endpoints between Salovum and placebo subgroups.
大体时间:Through study completion, approximately 6 months
|
Assessment of added value of Salovum
|
Through study completion, approximately 6 months
|
Tumour response rate according to RECIST v1.1 and clinical examination at 2, 3 (radiology) and 6 months after stop of RCT.
大体时间:Through study completion, approximately 6 months
|
Assessment of benefit, if any, from study products on clinical outcome
|
Through study completion, approximately 6 months
|
Disease free and overall survival at 3 and 6 months after stop of RCT.
大体时间:At 3 and 6 months after stop of treatment
|
Assessment of benefit, if any, from study products on clinical outcome
|
At 3 and 6 months after stop of treatment
|
其他结果措施
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Incidence of AEs CTCAEv5.0 grade ≥ 2 considered probably related to investigational products/placebo.
大体时间:Through study completion, approximately 6 months
|
Adverse effects from study products
|
Through study completion, approximately 6 months
|
合作者和调查者
出版物和有用的链接
一般刊物
- Ulgheri C, Paganini B, Rossi F. Antisecretory factor as a potential health-promoting molecule in man and animals. Nutr Res Rev. 2010 Dec;23(2):300-13. doi: 10.1017/S0954422410000193. Epub 2010 Aug 5.
- Laurenius A, Wangberg B, Lange S, Jennische E, Lundgren BK, Bosaeus I. Antisecretory factor counteracts secretory diarrhoea of endocrine origin. Clin Nutr. 2003 Dec;22(6):549-52. doi: 10.1016/s0261-5614(03)00057-8.
- Johansson E, Jennische E, Lange S, Lonnroth I. Antisecretory factor suppresses intestinal inflammation and hypersecretion. Gut. 1997 Nov;41(5):642-5. doi: 10.1136/gut.41.5.642.
- Cinausero M, Aprile G, Ermacora P, Basile D, Vitale MG, Fanotto V, Parisi G, Calvetti L, Sonis ST. New Frontiers in the Pathobiology and Treatment of Cancer Regimen-Related Mucosal Injury. Front Pharmacol. 2017 Jun 8;8:354. doi: 10.3389/fphar.2017.00354. eCollection 2017.
- Lonnroth I, Lange S. Purification and characterization of the antisecretory factor: a protein in the central nervous system and in the gut which inhibits intestinal hypersecretion induced by cholera toxin. Biochim Biophys Acta. 1986 Aug 6;883(1):138-44. doi: 10.1016/0304-4165(86)90144-3.
- Eriksson A, Shafazand M, Jennische E, Lange S. Effect of antisecretory factor in ulcerative colitis on histological and laborative outcome: a short period clinical trial. Scand J Gastroenterol. 2003 Oct;38(10):1045-9. doi: 10.1080/00365520310005064.
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