Trial record 13 of 34 for:    "hystrix-like ichthyosis with deafness" OR "Ichthyosis"

Imiquimod 3.75% Cream in Combination With Cryotherapy in the Treatment of Hypertrophic Actinic Keratoses

The recruitment status of this study is unknown because the information has not been verified recently.
Verified June 2011 by Frankel, Amylynne, M.D..
Recruitment status was  Recruiting
Sponsor:
Collaborator:
Graceway Pharmaceuticals, LLC
Information provided by:
Frankel, Amylynne, M.D.
ClinicalTrials.gov Identifier:
NCT01229319
First received: October 26, 2010
Last updated: June 21, 2011
Last verified: June 2011
  Purpose

Actinic keratoses (AK) are common cutaneous lesions associate with chronic ultraviolet radiation exposure. While most authorities consider AK as a pre-malignant lesion, some consider it as an incipient squamous cell carcinoma (SCC). In addition, the skin around clinically obvious AK lesions has been subject to the same chronic ultraviolet exposure, resulting in genetic damage and mutations, resulting in "field cancerization." Subclinical AKs may progress to clinical AKs, or even de novo invasive SCCs.

Among the current therapies for the treatment of AK are excisional surgery, cryosurgery, electrodessication and curettage, topical chemotherapy and light therapies. With cryotherapy, treated lesion clearance rates at 3 months post-treatment after double-freeze thaw cryotherapy has been reported to be around 76-88%; Overall lesion clearance rate at approximately 5 months post-cryosurgery has been reported to be 35-51%.

Imiquimod is a topical immune response modifier and a 5% formulation has been approved for the treatment of AKs in the US as a 2x/week for 16 week regimen and in Europe as a 3x/week for 4 week regimen for 1 or 2 courses of therapy. Topical imiquimod treatment may also reduce subclinical lesions in the treatment area, resulting in fewer "new" AK lesions developing over the same period of time when compared to focal treatment. In a comparison of cryosurgery versus imiquimod for the treatment of AKs, Krawtchenko et al reported initial complete clearance rates of 68 and 85% by clinical assessment, respectively. However, the treatment field sustained clearance rate was 4% versus 73%, respectively. Tan et al reported that while application of imiquimod or vehicle following cryosurgery resulted in comparable target AK clearance rates at 12 weeks of 79% versus 76%, respectively, the imiquimod group had fewer total AKs and fewer subclinical AKs.

Imiquimod cream at a concentration of 3.75% has been found in Phase 3 studies to be superior to placebo cream with respect to clearance of AKs using a regimen of up to 2 packets (250 mg of cream per packet, 500 mg total) applied daily to the entire face (approximately 200 cm2) for two 2-week treatment cycles separated by a 2-week no-treatment period. This study aims to examine the benefit of cryotherapy in combination with imiquimod 3.75% compared to cryotherapy alone.


Condition Intervention Phase
Actinic Keratosis
Drug: Cryotherapy alone to Left arm plus cryotherapy + imiquimod to Right arm
Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Investigator)
Primary Purpose: Treatment
Official Title: An Investigator-Initiated Study to Assess the Safety and Efficacy of Imiquimod 3.75% Cream When Used After Cryotherapy in the Treatment of Hypertrophic Actinic Keratoses (AK) on Dorsal Hands and Forearms

Resource links provided by NLM:


Further study details as provided by Frankel, Amylynne, M.D.:

Primary Outcome Measures:
  • Clearance of Actinic Keratoses [ Time Frame: 14 weeks ] [ Designated as safety issue: No ]
    AK lesion count, photography


Secondary Outcome Measures:
  • Local Skin Reactions (LSRs) [ Time Frame: 14 weeks ] [ Designated as safety issue: No ]

Estimated Enrollment: 20
Study Start Date: October 2010
Estimated Study Completion Date: August 2011
Estimated Primary Completion Date: August 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: cryo + imiquimod to Left
Cryotherapy alone to Right arm plus cryotherapy + imiquimod 3.75% daily x 2 weeks on and 2 weeks off and 2 weeks on to Left arm
Drug: Cryotherapy alone to Left arm plus cryotherapy + imiquimod to Right arm
Cryotherapy alone to Left arm plus cryotherapy + imiquimod 3.75% daily x 2 weeks on and 2 weeks off and 2 weeks on to Right arm
Other Name: zyclara
Experimental: Cryo + imiquimod to Right
Cryotherapy alone to Left arm plus cryotherapy + imiquimod 3.75% daily x 2 weeks on and 2 weeks off and 2 weeks on to Right arm
Drug: Cryotherapy alone to Left arm plus cryotherapy + imiquimod to Right arm
Cryotherapy alone to Left arm plus cryotherapy + imiquimod 3.75% daily x 2 weeks on and 2 weeks off and 2 weeks on to Right arm
Other Name: zyclara

Detailed Description:

Actinic keratoses (AK) are common cutaneous lesions associate with chronic ultraviolet radiation exposure. Ultraviolet radiation produces local and systemic immunosuppression, mutations in the p53 tumor suppressor gene, and deoxyribonucleic acid pyrimidine covalent dimmers, each of which is believed to contribute to the dysplasia seen in AK. While most authorities consider AK as a pre-malignant lesion, some consider it as an incipient squamous cell carcinoma (SCC). The risk for progression to SCC for an individual AK is reportedly low but highly variable; however, as patients often have multplie AKs, the overall risk for progression over a lifetime can be significant; thus treatment of AKs is warranted. In addition, the skin around clinically obvious AK lesions has been subject to the same chronic ultraviolet exposure, resulting in genetic damage and mutations, resulting in "field cancerization." Subclinical AKs may progress to clinical AKs, or even de novo invasive SCCs.

Among the current therapies for the treatment of AK are excisional surgery, cryosurgery, electrodessication and curettage, topical chemotherapy and light therapies. With provider-administered devices, temperature utilized, times of contact, and other variations in administration, influence efficacy of treatment. Efficacy can be improved by increasing the freeze time, but this is often associated with greater discomfort, more severe skin necrosis, and increased risk of post-treatment hypopigmentation. In addition, as with other lesion-directed therapies, cryosurgery does not treat subclinical lesions in the surrounding skin. Treated lesion clearance rates at 3 months post-treatment after double-freeze thaw cryotherapy has been reported to be around 76-88%; however, new lesions in the treatment field were not included. Overall lesion clearance rate, including new subclinical lesions, at approximately 5 months post-cryosurgery has been reported to be 35-51%. There is limited information on long-term AK clearance rates after cryosurgery and those reports differ in their methods of calculation. In a study comparing cyrotherapy, imiquimod and 5-fluorouracil, at 12 months post cryotherapy 28% (7/25) had complete clearance of baseline lesions that had undergone cryotherapy, but only 4% (1/25) had complete clearance of the treatment field.

Imiquimod is a topical immune response modifier that activates the innate immune system via Toll-like receptor 7, as well as enhances the acquired immune system. A 5% topical formulation has been approved for the treatment of AKs in the US as a 2x/week for 16 week regimen and in Europe as a 3x/week for 4 week regimen for 1 or 2 courses of therapy. Topical imiquimod treatment may also reduce subclinical lesions in the treatment area, resulting in fewer "new" AK lesions developing over the same period of time when compared to focal treatment. In a comparison of cryosurgery versus imiquimod for the treatment of AKs, Krawtchenko et al reported initial complete clearance rates of 68 and 85% by clinical assessment, respectively. However, the treatment field sustained clearance rate was 4% versus 73%, respectively. Tan et al reported that while application of imiquimod or vehicle following cryosurgery resulted in comparable target AK clearance rates at 12 weeks of 79% versus 76%, respectively, the imiquimod group had fewer total AKs and fewer subclinical AKs.

The imiquimod 5% formulation has limitations for the treatment of AKs. It is approved for the treatment of a small area of skin (25 cm2), uses a less than intuitive 2 times per week (2x/week) dosing schedule, and has a prolonged treatment period (16 weeks). Dosing more frequently than 3x/week with imiquimod 5% cream was not well tolerated in subjects with AK. Imiquimod cream at a concentration of 3.75% has been found in Phase 3 studies to be superior to placebo cream with respect to clearance of AKs using a regimen of up to 2 packets (250 mg of cream per packet, 500 mg total) applied daily to the entire face (approximately 200 cm2) for two 2-week treatment cycles separated by a 2-week no-treatment period.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Adults at least 18 years old.
  2. Subjects must be in good general health as confirmed by the medical history.
  3. Subjects must be able to read, sign, and understand the informed consent
  4. Prior to cryosurgery, subjects have at least 3 hypertrophic actinic keratoses on each dorsal hand/forearm.
  5. Subject must be willing to forego any other treatments on the dorsum of the hands and or/forearms, including tanning bed use and excessive sun exposure while in the study.
  6. Subject is willing and able to participate in the study as an outpatient, making frequent visits to the study center during the treatment and follow-up periods and to comply with all study requirements including concomitant medication and other treatment restrictions.
  7. If subject is a female of childbearing potential she must have a negative urine pregnancy test result prior to study treatment initiation and must agree to use an approved method of birth control while enrolled in the study.

Exclusion Criteria:

  1. Subjects with a history of melanoma anywhere on the body.
  2. Subjects with an unstable medical condition as deemed by the clinical investigator.
  3. Subjects with non-melanoma skin cancer on the dorsum of the hands or forearms.
  4. Subjects with any dermatologic disease in the treatment area that may be exacerbated by the treatment proposed or that might impair the evaluation of AKs.
  5. Subjects who have previously been treated with imiquimod: on the dorsum of the hands or forearms in the past 6 months; or outside of the study area within the past 30 days.
  6. Women who are pregnant, lactating, or planning to become pregnant during the study period.
  7. Subjects who have experienced a clinically important medical event within 90 days of the visit (e.g., stroke, myocardial infarction, etc).
  8. Subjects who have active chemical dependency or alcoholism as assessed by the investigator.
  9. Subjects who have known allergies to any excipient in the study cream.
  10. Subjects who are currently participating in another clinical study or have completed another clinical study with an investigational drug or device on the study area within 30 days prior to study treatment initiation.
  11. Subjects who have received any of the following within 90 days prior to study treatment initiation:

    • interferon or interferon inducers
    • cytotoxic drugs
    • immunomodulators or immunosuppressive therapies (inhaled/ intranasal steroids are permitted)
    • oral or parenteral corticosteroids
    • topical corticosteroids if greater than 2 gm/day
    • any dermatologic procedures or surgeries on the study area (including any AK treatments)
  12. Subjects who have used any topical prescription medications on the study area within 30 days prior to study treatment initiation.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01229319

Contacts
Contact: Gary S Goldenberg, MD 212-241-3288 garygoldenbergmd@gmail.com
Contact: Giselle Singer, BS 212-241-3288 giselle.singer@mssm.edu

Locations
United States, New York
Mount Sinai School of Medicine, Department of Dermatology, Clinical Trials Recruiting
New York, New York, United States, 10029
Contact: Amylynne J Frankel, MD    212-241-3288    amylynne.frankel@mssm.edu   
Contact: Giselle K Singer, BS    212-241-3288    giselle.singer@mssm.edu   
Principal Investigator: Gary S Goldenberg, MD         
Sponsors and Collaborators
Frankel, Amylynne, M.D.
Graceway Pharmaceuticals, LLC
Investigators
Principal Investigator: Gary S Goldenberg, MD Mount Sinai School of Medicine
  More Information

No publications provided

Responsible Party: Gary S Goldenberg, MD/Assistant Clinical Professor Dermatology and Dermatopathology, Mount Sinai School of Medicine
ClinicalTrials.gov Identifier: NCT01229319     History of Changes
Other Study ID Numbers: 10-0933
Study First Received: October 26, 2010
Last Updated: June 21, 2011
Health Authority: United States: Food and Drug Administration

Keywords provided by Frankel, Amylynne, M.D.:
actinic keratosis, keratocytic lesion, keratoses, cryotherapy, imiquimod

Additional relevant MeSH terms:
Ichthyosis
Hypertrophy
Keratosis
Keratosis, Actinic
Keratoacanthoma
Pathological Conditions, Anatomical
Skin Diseases
Precancerous Conditions
Neoplasms
Skin Abnormalities
Congenital Abnormalities
Infant, Newborn, Diseases
Imiquimod
Adjuvants, Immunologic
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Interferon Inducers

ClinicalTrials.gov processed this record on July 10, 2014