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Oral Bicarbonate as Adjuvant for Pain Reduction in Patients With Tumor Related Pain

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT01846429
Recruitment Status : Terminated (Drugs unavailable. Study did not progress to Phase 2.)
First Posted : May 3, 2013
Last Update Posted : June 4, 2015
Sponsor:
Collaborator:
Reliable Cancer Therapies
Information provided by (Responsible Party):
H. Lee Moffitt Cancer Center and Research Institute

Study Description
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Brief Summary:

The purpose of this study is to:

  • Determine how well people tolerate sodium bicarbonate taken by mouth in higher doses than those usually given for heartburn.
  • Determine if sodium bicarbonate can reduce cancer-related pain.

Condition or disease Intervention/treatment Phase
Tumor Cancer Pain Malignant Solid Tumor Unresectable Malignant Neoplasm Hematologic Malignancy Multiple Myeloma Lymphoma Neoplasm Metastasis Drug: Sodium Bicarbonate Phase 1

Detailed Description:

Single institution Phase I/II study of sodium bicarbonate in combination with standard medical management for patients with moderate to severe tumor related pain.

Patients with metastatic solid malignancies and patients with hematologic malignancies with moderate to severe tumor related pain on a stable opioid regimen will be the subjects of this study.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 9 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: A Phase I/II Study of Oral Bicarbonate as Adjuvant for Pain Reduction in Patients With Tumor Related Pain
Study Start Date : September 2013
Actual Primary Completion Date : December 2014
Actual Study Completion Date : May 2015

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Sodium Bicarbonate Treatment
A 3+3 design for Phase I component and a two staged design for Phase II were to be used. Treatment: Sodium Bicarbonate Capsules (900 mg).
 Drug: Sodium Bicarbonate
Cohort 1 patients will take 10 capsules/day; cohort 2 patients will take 20 capsules/day; cohort 3 patients will take 30 capsules/day and cohort 4 patients will take 40 capsules/day. Cohort 2 - 4 patients will begin at the cohort 1 dose and dose escalate to their respective cohort doses in order to prevent any side effects associated with alkalosis. Dose escalation will occur at a rate of 10 capsules/week.


Outcome Measures
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Primary Outcome Measures :
  1. Phase I - Maximum Tolerated Dose (MTD) [ Time Frame: 4 weeks per participant ]

    To evaluate the safety (Phase I) of oral Sodium bicarbonate capsules as an adjuvant pain reliever in patients with tumor related moderate to severe pain.

    To determine the maximum tolerated dose (MTD) of oral sodium bicarbonate capsules for patients with tumor related moderate to severe pain.


  2. Phase II - Percent of Participants With Desired Response [ Time Frame: 4 weeks per participant ]

    Evaluate the efficacy (Phase II) of oral Sodium Bicarbonate capsules as an adjuvant pain reliever in patients with tumor related moderate to severe pain.

    Percent of patients with greater than 30% improvement in pain intensity by visual assessment scale at 4 weeks compared to baseline without a corresponding increase in opioid regimen. The response rate with 95% Clopper-Pearson confidence interval will be reported.



Secondary Outcome Measures :
  1. Pain Measurement Ranking [ Time Frame: 4 weeks per participant ]
    Pain will be rated by the participant using a visual assessment scale (VAS) on a 0 to 10 scale. Mild Pain (1-4), Moderate Pain (5-6), Severe Pain (7-10). The change in pain between baseline and 4 weeks after treatment as measured by the VAS will be assessed using two-sided one-sample t-test or Wilcoxon signed-rank test, depending on whether normality assumption holds.

  2. Quality of Life (QOL) [ Time Frame: 4 weeks per participant ]
    Quality of life will be assessed using the Memorial Symptom Assessment Scale (MSAS) and Brief Pain Inventory (BPI). The change in score between baseline and 4 weeks after treatment will be compared using two-sided one-sample t-test or Wilcoxon signed-rank test, as appropriate.


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Patients must have metastatic or unresectable solid malignancy or hematologic malignancy (multiple myeloma or lymphoma) and must have moderate to severe tumor related pain visual assessment scale (VAS)>4) on a stable or no opioid regimen (at least 3 days of an opiate regimen). VAS score should be greater than 4 at screening to be eligible.
  • No planned palliative surgery, palliative radiotherapy for at least 4 weeks. However prior radiotherapy, and surgery is allowed and not limited to the number of procedures and courses. Concomitant chemotherapy with agents indicated in protocol guidelines (Tables 10 and 11B, Appendix IV) is allowed.
  • No evidence of neurologic or psychiatric compromise which in the opinion of the investigator will interfere with completion of study assessments
  • Age greater than 18 years and able to understand and sign the informed consent document
  • Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status less than 3.
  • A female patient and a male patient's female partner, of childbearing potential, must agree to use 2 adequate barrier methods of contraception to prevent pregnancy or to abstain from heterosexual activity throughout the study, starting from Visit 1, while receiving protocol-specified medication, and for 1 month after stopping the medication.

Exclusion Criteria:

  • Patients with neuropathy and/or neuropathic pain as the only pain syndrome are not eligible.
  • Patients with only chronic non-malignant pain are not eligible.
  • Patients with renal insufficiency (creatinine > 2.5mg/dL) are excluded.
  • Patients with history of congestive heart failure or pulmonary artery hypertension will be excluded.
  • Patients with uncontrolled hypertension (systolic pressure >160, diastolic pressure >100) despite maximal antihypertensive therapy
  • Patients unable to ingest sodium bicarbonate capsules (such as patients with dysphagia or severe nausea)
  • Patients with ECOG performance status 3 or higher
  • Patients with acute leukemia, myelodysplastic syndrome, and chronic myeloid leukemia are not eligible.
  • Pregnant or lactating patients are not eligible.
  • Patients with known allergy to sodium bicarbonate or patients with preexisting renal or acid base disorders for which sodium bicarbonate is contraindicated (such as metabolic alkalosis, severe congestive heart failure, hypernatremia, and hypocalcemia (see above))
  • Patients with severe ongoing infections which places the patients at increased risks from therapy in the opinion of the investigator
  • Patients receiving concomitant chemotherapy with agents indicated in protocol guidelines (Tables 10 and 11B, Appendix IV) or target therapy intended to prolong life within 2 weeks of starting the study drug
  • Patients receiving experimental therapy within 2 weeks of starting study treatment
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01846429


Locations
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United States, Florida
H. Lee Moffitt Cancer Center and Research Institute
Tampa, Florida, United States, 33612
Sponsors and Collaborators
H. Lee Moffitt Cancer Center and Research Institute
Reliable Cancer Therapies
Investigators
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Principal Investigator: Amit Mahipal, M.D. H. Lee Moffitt Cancer Center and Research Institute
More Information
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Additional Information:

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Responsible Party: H. Lee Moffitt Cancer Center and Research Institute
ClinicalTrials.gov Identifier: NCT01846429    
Other Study ID Numbers: MCC-17136
First Posted: May 3, 2013    Key Record Dates
Last Update Posted: June 4, 2015
Last Verified: June 2015
Keywords provided by H. Lee Moffitt Cancer Center and Research Institute:
cancer
pain fibers
acid levels
tumor related pain
cancer related pain
sodium bicarbonate
pain reliever
 metastatic
unresectable
solid malignancy
hematologic malignancy
multiple myeloma
lymphoma
Additional relevant MeSH terms:
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Neoplasms
Multiple Myeloma
Neoplasm Metastasis
Hematologic Neoplasms
Cancer Pain
Neoplasms by Histologic Type
Lymphoproliferative Disorders
Immunoproliferative Disorders
Immune System Diseases
Neoplasms, Plasma Cell
Hemostatic Disorders
 Vascular Diseases
Cardiovascular Diseases
Paraproteinemias
Blood Protein Disorders
Hematologic Diseases
Hemorrhagic Disorders
Neoplastic Processes
Pathologic Processes
Neoplasms by Site
Pain
Neurologic Manifestations