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Trial of Eflornithine Plus Sulindac in Patients With Familial Adenomatous Polyposis (FAP)

This study is currently recruiting participants. (see Contacts and Locations)
Verified October 2014 by Cancer Prevention Pharmaceuticals, Inc.
Sponsor:
Information provided by (Responsible Party):
Cancer Prevention Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier:
NCT01483144
First received: November 21, 2011
Last updated: October 7, 2014
Last verified: October 2014
  Purpose

The purpose of this randomized, double-blind, Phase III trial is to determine if the combination of eflornithine plus sulindac is superior to sulindac or eflornithine as single agents in delaying time to the first occurrence of any FAP-related event. This includes: 1) FAP related disease progression indicating the need for excisional intervention involving the colon, rectum, pouch, duodenum and/or 2) clinically important events which includes progression to more advanced duodenal polyposis, cancer or death.


Condition Intervention Phase
Familial Adenomatous Polyposis
Drug: Eflornithine plus Sulindac
Drug: Eflornithine and Placebo
Drug: Sulindac and Placebo
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Treatment
Official Title: Phase III Trial of the Safety and Efficacy of Eflornithine Combined With Sulindac Compared to Eflornithine, Sulindac as Single Agents in Patients With Familial Adenomatous Polyposis

Resource links provided by NLM:


Further study details as provided by Cancer Prevention Pharmaceuticals, Inc.:

Primary Outcome Measures:
  • Delaying time to the 1st occurrence of any FAP-related event. [ Time Frame: 24 months from the start of treatment ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • presence or absence of an ODC polymorphism [ Time Frame: 24 months from the start of treatment ] [ Designated as safety issue: No ]
    evaluate the potentially effect modifying properties of an ornithine decarboyxlase (ODC) polymorphism on primary outcome

  • excretion of 4 urinary polyamines [ Time Frame: 24 months from the start of treatment ] [ Designated as safety issue: No ]
    evaluate the potentially effect modifying properties of 4 urinary polyamines on the primary outcome measure


Other Outcome Measures:
  • Analysis of adverse events and clinical laboratory abnormalities [ Time Frame: 24 months from the start of treatment ] [ Designated as safety issue: Yes ]
  • Pharmacokinetics (AUC, Cmax, Cmin, tmax, Css, CL) of eflornithine and sulindac [ Time Frame: pre-dose and 1, 2, 4, and 8 hours post-dose (5 time points at month 3) ] [ Designated as safety issue: No ]
  • Evaluate tissue and dietary polyamine levels [ Time Frame: 24 months from the start of treatment ] [ Designated as safety issue: No ]
  • Patient reported quality of life will be evaluated using health related quality of life questionnaires and patient utilities [ Time Frame: 24 months from the start of treatment ] [ Designated as safety issue: No ]
  • Evaluation of the time to the first FAP-related beneficent event [ Time Frame: 24 months from the start of treatment ] [ Designated as safety issue: No ]
  • An analysis of the components and subgroups included in the primary analysis and their contribution to the primary outcome [ Time Frame: 24 months from the start of treatment ] [ Designated as safety issue: No ]

Estimated Enrollment: 150
Study Start Date: October 2013
Estimated Study Completion Date: December 2016
Estimated Primary Completion Date: October 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Eflornithine plus Sulindac
Eflornithine 750 mg and Sulindac 150 mg
Drug: Eflornithine plus Sulindac
Eflornithine [250 mg tablet, three tablets (750 mg) orally once a day] and Sulindac [150 mg tablet, one tablet orally once a day] for 24 months
Active Comparator: Eflornithine plus Placebo
Eflornithine 750 mg and Placebo
Drug: Eflornithine and Placebo
Eflornithine [250 mg, three tablets (750 mg) orally once a day] and Placebo [one tablet orally once a day] for 24 months
Active Comparator: Sulindac plus Placebo
Sulindac 150 mg and Placebo
Drug: Sulindac and Placebo
Sulindac [150 mg tablet, one tablet orally once a day] and Placebo [three tablets orally once a day] for 24 months

  Eligibility

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

Inclusion Criteria:

  • Diagnosis of phenotypic classical FAP with disease involvement of the duodenum and/or colon/rectum/pouch.

    1. Genotype: APC mutation (with or without family history) required
    2. Classical FAP Phenotype: 100's to 1,000's of colorectal adenomatous polyps, usually appearing in teenage years
  • UGI endoscopy/LGI endoscopy (proctoscopy/colonoscopy) performed within 30 days of randomization.
  • Patients with an intact colon/rectum, except for clinical polyposis, and prophylactic surgery is being considered as a stratification site.
  • Rectal/pouch polyposis as a stratification site as follows:

    1. At least three years since colectomy with IRA/proctocolectomy with pouch, and demonstrating polyposis as defined by Stage 1, 2, 3, of the proposed InSiGHT 2011 Staging System (Appendix B) and summarized as follows:

      Stage 1: 10-25 polyps, all < 5 mm Stage 2: 10-25 polyps, at least one > 1 cm Stage 3: >25 polyps amenable to complete removal, or any incompletely removed sessile polyp, or any evidence of high grade dysplasia, even if completely removed. [Note: For staging purposes only.]

    2. For all subjects, any rectal/pouch polyps > 5 mm must be excised at "baseline".
  • Duodenal polyposis as a stratification site; one or more of the following:

    1. Current Spigelman Stage 3 or 4. (Refer to Appendix A for Modified Spigelman Score and Classification table).
    2. Prior surgical endoscopic intervention within the past six months for Spigelman Stage 3 or 4 that may have been down staged to Spigelman 1 or 2.
  • Hematopoietic Status (within 30 days prior to randomization):

    1. No significant hematologic abnormalities
    2. WBC at least 3,000/mm3
    3. Platelet count at least 100,000/mm3
    4. Hemoglobin at least 10.0 g/dL
    5. No history of clinical coagulopathy
  • Hepatic Status (within 30 days prior to randomization):

    1. Bilirubin no greater than 1.5 times ULN
    2. AST and ALT no greater than 1.5 times ULN
    3. Alkaline phosphatase no greater than 1.5 times ULN
  • Renal Status (within 30 days prior to randomization):

    a) Creatinine no greater than 1.5 times ULN

  • Hearing:

    a) No clinically significant hearing loss, defined in Section 6.2, number 9.

  • If female, neither pregnant nor lactating.
  • Negative pregnancy test if female of child-bearing potential. Fertile patients must use effective contraception*.
  • Absence of gross blood in stool; red blood on toilet paper only acceptable.
  • No discrete gastric or duodenal ulcer greater than 5 mm within the past year except Helicobacter pylori-related peptic ulcer disease treated with antibiotics.
  • No invasive malignancy within the past 5 years except resected non-melanomatous skin cancer, papillary thyroid cancer, or precancerous cervical dysplasia.
  • No other significant medical or psychiatric problems that would preclude study participation or interfere with capacity to give informed consent.
  • Use of 81-100 mg daily aspirin or up to 700 mg aspirin not more than once a week are eligible.
  • No concurrent warfarin, fluconazole, lithium, Pradaxa® or other direct thrombin inhibitors, Plavix®, cyclosporine, other NSAIDs (such as ibuprofen, aspirin, diflunisal), diuretics (furosemide and thiazides), DMSO, methotrexate, probenecid, propoxyphene hydrochloride, Tylenol® (acetaminophen) preparations containing aspirin or cytotoxic chemotherapy drugs.
  • Willingness to forego concurrent use of supplements containing omega-3 fatty acids, corticosteroids, non-steroidal anti-inflammatory drugs or other FAP directed drug therapy.
  • Able to provide informed consent and follow protocol requirements.

Exclusion Criteria:

  • Prior pelvic irradiation.
  • Patients receiving oral corticosteroids within 30 days of enrollment.
  • Treatment with other investigational agents in the prior 4 weeks.
  • Use of other non-steroidal anti-inflammatory drugs (such as ibuprofen) exceeding 4 days per month, in the prior 6 weeks.
  • Regular use of aspirin in excess of 700 mg per week.
  • Treatment with other FAP directed drug therapy (including sulindac or celecoxib, fish oil) within 12 weeks of study enrollment.
  • Hypersensitivity to cyclooxygenase-2 inhibitors, sulfonamides, NSAIDs, or salicylates; NSAID associated symptoms of gastritis.
  • Patients must not have cardiovascular disease risk factors as defined below:

    • Uncontrolled high blood pressure (systolic blood pressure > 150 mm Hg
    • Unstable angina
    • History of documented myocardial infarction or cerebrovascular accident
    • New York Heart Association Class III or IV heart failure
    • Known uncontrolled hyperlipidemia defined as LDL-C >= 190 mg/dL or triglycerides >= 500 mg/dL
  • Patients with significant hearing loss are not eligible for study participation defined as hearing loss that affects everyday life and/or for which a hearing aid is required.
  • Colon/rectum/pouch with high grade dysplasia or cancer on biopsy or a large polyp (>1 cm) not amenable to complete removal.
  • Duodenal cancer on biopsy.
  • Intra-abdominal desmoid disease, stage III or IV
  • Inability to provide informed consent.
  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: NCT01483144

Contacts
Contact: Alfred M Cohen, MD 520-908-7774 acohen@canprevent.com
Contact: Kathryn A Grenier, MT/MPA(HSA) 520-908-7774 kgrenier@canprevent.com

Locations
United States, Massachusetts
Dana Farber Cancer Institute Recruiting
Boston, Massachusetts, United States, 02215
Contact: Victoriana Curry    617-632-3354    fapstudy@dfci.harvard.edu   
Principal Investigator: Ramona Lim, M.D.         
Sub-Investigator: Sapna Syngal, M.D., M.P.H.         
United States, Michigan
University of Michigan Recruiting
Ann Arbor, Michigan, United States, 48109
Principal Investigator: Elena Stoffel, M.D., M.P.H.         
United States, Minnesota
Mayo Clinic Recruiting
Rochester, Minnesota, United States, 55905
Principal Investigator: Frank A. Sinicrope, M.D.         
United States, Missouri
Washington University Recruiting
St. Louis, Missouri, United States, 63110
Contact: Michelle Cusumano, RN    314-362-2646    cusumanom@wudosis.wustl.edu   
Contact: Bart Freer    314-3627494    bfreer@wustl.edu   
Principal Investigator: Paul E. Wise, M.D.         
United States, Ohio
Cleveland Clinic Recruiting
Cleveland, Ohio, United States, 44195
Principal Investigator: Carol Burke, M.D.         
Principal Investigator: James Church, M.D.         
United States, Texas
MD Anderson Cancer Center Recruiting
Houston, Texas, United States, 77030
Principal Investigator: Patrick M. Lynch, M.D., J.D.         
United States, Utah
University of Utah- Huntsman Cancer Institute Recruiting
Salt Lake City, Utah, United States, 84112
Contact: Michelle Done    800-650-9071    michelle.done@hci.utah.edu   
Principal Investigator: Jewel Sammader, MD         
Canada, Ontario
Zane Cohen Centre For Digestive Diseases Recruiting
Toronto, Ontario, Canada, M5T 3L9
Principal Investigator: Steve Gallinger, M.D., MSc         
Sub-Investigator: Robert Gryfe, M.D., Ph.D.         
Sub-Investigator: Zane Cohen, M.D.         
Germany
University Hospital Bonn Not yet recruiting
Bonn, Germany, 53105
Principal Investigator: Christian Strassburg, Prof         
Sub-Investigator: Gabriella Möslein, Prof. Dr. med         
Sub-Investigator: Robert Hüneburg, Dr         
Netherlands
Academic Medical Centre Recruiting
Amsterdam, Netherlands, 1100 DE
Principal Investigator: Evelien Dekker, MD/PhD         
Spain
Institut de Malalties Digestives Recruiting
Barcelona, Catalonia, Spain, 08036
Principal Investigator: Antoni Castells, MD         
Sub-Investigator: Francesc Balaguer, MD         
United Kingdom
Institute of Genetic Medicine Recruiting
Newcastle Upon Tyne, Tyne and Wear, United Kingdom, NEI 3BZ
Principal Investigator: Alex Henderson, MD         
Sponsors and Collaborators
Cancer Prevention Pharmaceuticals, Inc.
Investigators
Principal Investigator: Carol Burke, M.D. The Cleveland Clinic
Principal Investigator: James Church, M.D. The Cleveland Clinic
Principal Investigator: Sue Clark, M.D. St. Mark's Hospital
Principal Investigator: Robin Phillips, M.S. St. Mark's Hospital
  More Information

Additional Information:
No publications provided

Responsible Party: Cancer Prevention Pharmaceuticals, Inc.
ClinicalTrials.gov Identifier: NCT01483144     History of Changes
Other Study ID Numbers: CPP-FAP-310
Study First Received: November 21, 2011
Last Updated: October 7, 2014
Health Authority: United States: Food and Drug Administration
Canada: Health Canada
European Union: European Medicines Agency

Keywords provided by Cancer Prevention Pharmaceuticals, Inc.:
Familial Adenomatous Polyposis
Eflornithine
Sulindac

Additional relevant MeSH terms:
Adenomatous Polyposis Coli
Adenoma
Adenomatous Polyps
Colonic Diseases
Colonic Neoplasms
Colorectal Neoplasms
Digestive System Diseases
Digestive System Neoplasms
Gastrointestinal Diseases
Gastrointestinal Neoplasms
Genetic Diseases, Inborn
Intestinal Diseases
Intestinal Neoplasms
Intestinal Polyposis
Neoplasms
Neoplasms by Histologic Type
Neoplasms by Site
Neoplasms, Glandular and Epithelial
Neoplastic Syndromes, Hereditary
Eflornithine
Sulindac
Analgesics
Analgesics, Non-Narcotic
Anti-Infective Agents
Anti-Inflammatory Agents
Anti-Inflammatory Agents, Non-Steroidal
Antineoplastic Agents
Antiparasitic Agents
Antiprotozoal Agents
Antirheumatic Agents

ClinicalTrials.gov processed this record on November 23, 2014