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Clonidine HCl MBT vs. Placebo to Prevent Chemoradiotherapy-Induced Severe Oral Mucositis in Oropharyngeal Cancer. (VOICE)

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ClinicalTrials.gov Identifier: NCT04648020
Recruitment Status : Recruiting
First Posted : December 1, 2020
Last Update Posted : April 13, 2021
Sponsor:
Information provided by (Responsible Party):
Monopar Therapeutics

Brief Summary:
This study is being performed to evaluate the effectiveness of a new drug, clonidine HCl MBT, to prevent the onset of severe oral mucositis (SOM) in patients with oropharyngeal cancer (OPC) who are being treated with chemoradiotherapy. OPC occurs on the back of the tongue or throat and is often treated by the use of chemoradiotherapy, where radiation is localized to these areas. Radiation to the OPC affected tissues causes the release of small proteins called cytokines that cause damage to the area surrounding the tumor including the oral cavity. This damage is characterized by the formation of mucositis which includes redness, pain and ulcers in the mouth and back of the throat. In addition, as more chemoradiation is administered to treat OPC, the inability to eat a solid diet (a Grade 3 mucositis) or to consume anything at all by mouth (a Grade 4 mucositis) occurs in many patients. Collectively, Grade 3 and Grade 4 mucositis is referred to as SOM. It is a frequent, debilitating side effect of chemoradiation in OPC that may cause patients to stop or interrupt their treatment, develop other side effects like the inability to swallow, or require the increased use of pain medications. OPC survivors who have successful treatment of their tumors often develop permanent swallowing, speaking and range of motion issues that may be linked back to the inability to eat and/or drink caused by SOM during their chemoradiotherapy treatment. Clonidine may inhibit the production of cytokines that cause SOM and clonidine HCl mucoadhesive buccal tablet (MBT) has been designed to deliver sustained high levels of clonidine in the oral cavity, potentially decreasing cytokine production and leading to a decrease in the incidence of SOM. Clonidine HCl MBT is a once per day treatment provided as a tablet that a patient may self-administer to the gums, where it sticks tightly to release clonidine over many hours. The primary objective of this Phase 2b/3 study is to evaluate whether clonidine HCl MBT is more effective than placebo MBT in decreasing the incidence of SOM.

Condition or disease Intervention/treatment Phase
Chemoradiotherapy-Induced Severe Oral Mucositis Drug: Clonidine HCl Mucoadhesive Buccal Tablet Drug: Placebo Mucoadhesive Buccal Tablet Phase 2 Phase 3

Detailed Description:
This is a sequential design Phase 2b/3 multicenter, randomized (1:1), double-blind, placebo-controlled, parallel group study to compare the efficacy and safety of clonidine HCl MBT to placebo MBT in the prevention of severe oral mucositis (SOM) in patients with oropharyngeal cancer (OPC) undergoing chemoradiotherapy (CRT). Best supportive care (BSC) will be allowed as per individual institutional practice with some exceptions as described in the inclusion and exclusion criteria. Eligible patients will be randomized to receive either clonidine MBT or placebo. Patients will be centrally randomized in a 1:1 ratio. The randomization will be stratified by p16 status (positive or negative). Randomized patients will be required to self-apply the study drug to the gum once a day in addition to BSC. The first application of MBT study drug will be performed on Day 1 of the CRT regimen. Each site will require the patient to follow the same local practice for BSC per Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) guidelines with some exceptions as described in the inclusion and exclusion criteria. Daily, self-administered MBT study drug will be continued once daily for the entire duration of CRT treatment; defined as from Day 1 of CRT until the last day of CRT (anticipated to be approximately 4-8 weeks depending on the patient's prescribed CRT plan). Patients will be recruited sequentially into either the Phase 2b or the Phase 3 part of the study. An interim analysis will be conducted when Phase 2b patients have either completed their CRT or discontinued from the study. The Data Monitoring Committee (DMC) will review the Phase 2b efficacy and safety data at the interim analysis and will make a recommendation on proceeding with the Phase 3 part of the study.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 260 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Supportive Care
Official Title: A Phase 2b/3, Multicenter, Randomized, Double-blind, Placebo-controlled Study Comparing the Efficacy and Safety of Clonidine Mucoadhesive Buccal Tablet to Placebo to Prevent Chemoradiotherapy-induced Severe Oral Mucositis in Patients With Oropharyngeal Cancer
Actual Study Start Date : February 11, 2021
Estimated Primary Completion Date : July 2023
Estimated Study Completion Date : June 2025

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Placebo Comparator: Placebo
Placebo Mucoadhesive Buccal Tablet given daily during chemoradiotherapy
Drug: Placebo Mucoadhesive Buccal Tablet
Placebo

Experimental: Clonidine HCl Mucoadhesive Buccal Tablet (MBT)
Clonidine HCl MBT given daily during chemoradiotherapy
Drug: Clonidine HCl Mucoadhesive Buccal Tablet
100 μg of clonidine per tablet
Other Name: Validive®




Primary Outcome Measures :
  1. The occurrence of SOM (Yes/No), defined as any reporting of World Health Organization (WHO) Grade 3-4 OM, from the first day to the last day of CRT [ Time Frame: From the first CRT treatment through the end of the study treatment period, which is estimated to be 7 weeks. ]
    The WHO mucositis grading scale will be used to assess the occurrence of SOM in this trial. The WHO grading scale grades OM from 0 to 4 according to severity of clinical observation and functional limitation, with Grade 4 = oral alimentation impossible, Grade 3 = Oral ulcers, liquid diet only, Grade 2 = Oral erythema, ulcers, solid diet tolerated, Grade 1 = Oral soreness, erythema, and Grade 0 = normal, no mucositis (no signs, no symptoms).



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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:

  1. Male/Female patients of ≥ 18 years of age. Patients with histologically or pathologically confirmed squamous cell carcinoma of the oropharynx (including tonsils or the base of tongue) at one or several sites.
  2. Patients treated with surgical resection of their primary tumor for localized or locally advanced disease T ≥ T0 and/or N ≥ N1 without distant metastasis (M0) (American Joint Committee on Cancer - AJCC 8th edition) and initiating adjuvant concurrent CRT within 8 weeks post-operatively. Unknown primary with node-positive disease confirmed to be Squamous Cell Carcinoma would be allowed or Patients who will be treated with definitive concurrent CRT for locally advanced disease T ≥ T0 and/or N ≥ N1 M0 (American Joint Committee on Cancer - AJCC 8th edition).
  3. Patients eligible to receive a continuous course of external fractionated irradiation [conventional or intensity modulated radiation therapy (IMRT)] based on a daily dosing of 1.8 to 2.2 Gy/day 5 days/week in combination with cisplatin monotherapy either every 3 weeks (100 mg/m2) or weekly cisplatin (40 mg/m2). Alternative treatment regimens are allowed only if cisplatin is contraindicated. The decision on which cisplatin regimen to use in combination with IMRT and study drug/placebo will be at the discretion of the investigator.
  4. Radiation plan must include delivery of a cumulative dose of 60-72 Gy. The oropharynx should receive at least 50 Gy.
  5. Patients with adequate laboratory values defined as:

    1. Absolute neutrophil count ≥ 1.5 × 109/L
    2. Platelet count ≥ 75 × 109/L
    3. Hemoglobin ≥ 9 g/dL
    4. Creatinine blood level ≤ 1.5 × upper limit of the normal range (ULN)
    5. Total bilirubin ≤ 1.5 × ULN; patients with Gilbert's Syndrome can be included if hyperbilirubinemia ≤ 3 × ULN
    6. Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3 × ULN
  6. Patients with Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. A performance status of 2 is allowed only if due to a patient's malignancy.
  7. Patients must provide written informed consent.
  8. Human Papillomavirus (HPV) status documented by immunohistochemical detection of p16 expression in the tumor.
  9. Negative serum pregnancy test for females of child-bearing potential at screening. A female is eligible to enter and participate in the study if the female is of non-child-bearing potential (i.e., physiologically incapable of becoming pregnant), including any female who has had a hysterectomy, a bilateral oophorectomy (ovariectomy), a bilateral tubal ligation, or is post-menopausal with a minimum of 1 year without menses.
  10. Males with female partners of child-bearing potential and females of child-bearing potential must agree to use effective contraception starting prior to the first day of study drug treatment and continuing for 3 months after the last dose of study drug MBT.
  11. Patients must be willing to complete questionnaires on a tablet, home computer, or paper form.

Exclusion Criteria:

  1. Patients with no tumor or lesion in the oropharynx.
  2. Prior induction chemotherapy for treatment of current malignancy.
  3. Patients with planned accelerated IMRT.
  4. Evidence of a concomitant other malignancy and/or any prior malignancy without complete remission in the last 2 years, except adequately treated basal or squamous cell carcinoma of the skin or in situ cervical cancer.
  5. Patients with OM at baseline, any other oral ulceration or active oral infection (e.g., aphthous ulcers, orofacial herpes). Patients with post-operative pain of the mouth or throat are eligible.
  6. Patients with known human immunodeficiency virus (HIV) seropositivity, known active Hepatitis B or C or known active tuberculosis.
  7. Patients with systolic blood pressure (BP) < 100 mmHg and/or diastolic BP < 50 mmHg.
  8. Patients with symptomatic cardiac dysrhythmia.
  9. Patients with recent (less than 6 months) acute cardiovascular diseases (i.e., stroke, myocardial infarction).
  10. Patients with any clinical condition, psychiatric condition, or prior therapy that, in the opinion of the investigator, would make the patient unsuitable for the study or unable to comply with study requirements and follow-up visits.
  11. Patients currently being treated with sultopride, clonidine hydrochloride (eg, Catapres®), pentoxifylline or pilocarpine.
  12. Patients intended to be treated specifically to prevent OM with any of the following:

    a. Bioadherent agents and mouthwashes: i. GelClair (consists of polyvinylpyrrolidone, hyaluronic acid, and glycyrrhetinic acid) ii. Sucralfate iii. Episil mouth spray iv. MuGard oral mucoadhesive v. Saforis (L-glutamine (topical)) b. Drug therapies and biologics: i. Amifostine (and similar free radical scavenger/antioxidant medications) ii. Palifermin (recombinant human keratinocyte growth factor-(KGF-1)) iii. Glutamine b. Interventional therapies i. Low level laser therapy (LLLT)

  13. Patients who are unable to tolerate oral diet and/or are feeding tube dependent at baseline.
  14. Patients receiving an approved or an investigational anti-cancer agent other than those specified in this study.
  15. Patients with a known hypersensitivity to clonidine or any of the MBT excipients.
  16. Women who are pregnant or breast-feeding.
  17. Patients whose medical, psychological or surgical conditions are unstable and may affect the study completion and/or compliance and/or the ability to give informed consent.
  18. Men and women of child-bearing age and their respective partners unwilling to use a highly effective contraception method during the study and for 3 months after the last administration of study drug.
  19. Patient who has participated in another clinical trial with an investigational drug in the last 30 days prior to randomization in the present clinical study.
  20. Subjects with orthostatic hypotension, defined by a decrease of systolic BP and/or diastolic BP above 20 mmHg when the patient stands up.
  21. Conditions including but not limited to COVID-19 which would confound the assessment of the effects and/or safety of study medication in the opinion of the investigator.

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): NCT04648020


Contacts
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Contact: Chief Scientific Officer (847) 469-1420 mazar@monopartx.com

Locations
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United States, Georgia
IACT Health (John B Amos Cancer Center) Recruiting
Columbus, Georgia, United States, 31904
Contact: Tenetta Holt    706-321-0495    tholt@iacthealth.com   
Principal Investigator: Douglas Ciuba, MD         
United States, Iowa
UnityPoint Health (Nassif Community Cancer Center) Recruiting
Cedar Rapids, Iowa, United States, 52403
Contact: Elizabeth Heineman, BSN, RN    319-369-7780    Elizabeth.Heineman@unitypoint.org   
Principal Investigator: Robert Isaak, MD         
Des Moines Oncology Research Association Recruiting
Des Moines, Iowa, United States, 50309
Contact: Missy Stravers    515-241-3305    mstravers@iora.org   
Principal Investigator: Arshin Sheybani, MD         
United States, Louisiana
East Jefferson General Hospital Recruiting
Metairie, Louisiana, United States, 70006
Contact: Kimberly Sutton    504-503-5368    kimberly.sutton@ejgh.org   
Contact: Sarah Perrin    504-503-6467    sperrin@ejgh.org   
Principal Investigator: Thomas Cosgriff, MD         
Sponsors and Collaborators
Monopar Therapeutics
Investigators
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Study Director: Mazar Chief Scientific Officer
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Responsible Party: Monopar Therapeutics
ClinicalTrials.gov Identifier: NCT04648020    
Other Study ID Numbers: MNPR-301-001
First Posted: December 1, 2020    Key Record Dates
Last Update Posted: April 13, 2021
Last Verified: December 2020

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Monopar Therapeutics:
Mucositis
Oropharyngeal Cancer
Clonidine
Chemoradiotherapy
Severe Oral Mucositis
Monopar
Oral Mucositis
Head and Neck Cancer
Oral Cavity
Oropharynx
Mouth Sores
Additional relevant MeSH terms:
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Oropharyngeal Neoplasms
Mucositis
Stomatitis
Gastroenteritis
Gastrointestinal Diseases
Digestive System Diseases
Mouth Diseases
Stomatognathic Diseases
Pharyngeal Neoplasms
Otorhinolaryngologic Neoplasms
Head and Neck Neoplasms
Neoplasms by Site
Neoplasms
Pharyngeal Diseases
Otorhinolaryngologic Diseases
Clonidine
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Antihypertensive Agents
Sympatholytics
Autonomic Agents
Adrenergic alpha-2 Receptor Agonists
Adrenergic alpha-Agonists
Adrenergic Agonists
Adrenergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action