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Randomized Controlled Trial of Talc Instillation In Addition To Daily Drainage Through a Tunneled Pleural Catheter to Improve Rates of Outpatient Pleurodesis in Patients With Malignant Pleural Effusion

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ClinicalTrials.gov Identifier: NCT04792970
Recruitment Status : Recruiting
First Posted : March 11, 2021
Last Update Posted : March 8, 2022
Sponsor:
Information provided by (Responsible Party):
Duke University

Brief Summary:
The purpose of this study is to compare the experiences of subjects who drain malignant (cancerous) pleural effusions (fluid) from around their lung(s) in a more frequent manner using a talc instilled via tunneled pleural catheter combined with daily drainage and those subjects who drain this fluid in a daily standard manner.

Condition or disease Intervention/treatment Phase
Malignant Pleural Effusion Drug: Talc Phase 4

Detailed Description:

Study Activities: Patients will be randomized to either the standard daily drainage group or the talc instilled via tunneled pleural catheter combined with standard daily drainage group. Patients will complete questionnaires regarding their health. If you are randomized to the talc group, you will receive talc infused through the tunneled pleural catheter. If you are randomized to the standard daily drainage group, you will not receive any additional therapy. Patients will complete a drainage diary for everyday they drain fluid which will provide information on drainage volume, fluid color, pain, and complications. At 30 days and 90 days post randomization, patients will return to clinic for follow-up, at which time they will have a physical exam, chest x-ray, and complete questionnaires regarding their health.

Risks/Safety Issues: Risks associated with talc include fever and pain. Less likely risks associated with talc include infection, dyspnea, hypoxemia, pneumonia, unilateral pulmonary edema, hemoptysis, pulmonary emboli, and bronchopleural fistula.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 152 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Randomized Controlled Trial of Talc Instillation In Addition To Daily Drainage Through a Tunneled Pleural Catheter to Improve Rates of Outpatient Pleurodesis in Patients With Malignant Pleural Effusion - The ASAP II Trial
Actual Study Start Date : March 18, 2021
Estimated Primary Completion Date : May 2024
Estimated Study Completion Date : May 2024

Arm Intervention/treatment
Active Comparator: Talc instilled via tunneled pleural catheter combined with standard daily drainage
This arm consists of eligible participants who are randomized to the Talc arm and would receive Talc therapy instilled into the pleural catheter.
Drug: Talc
All patients randomized to the Talc arm will receive Talc therapy through the pleural catheter.

No Intervention: Standard daily drainage
This arm consists of eligible participants who are randomized to control group and would not receive any intervention.



Primary Outcome Measures :
  1. Percentage of cohort undergoing accelerated pleurodesis [ Time Frame: 90 Days ]
    To assess the talc instilled via tunneled pleural catheter combined with daily drainage to induce accelerated pleurodesis in patients with malignant pleural effusion compared to standard daily drainage, measured by a patient reported daily drainage diary


Secondary Outcome Measures :
  1. Change in Dyspnea as measured by questionnaire [ Time Frame: Baseline, 30 days, 90 Days ]
    To assess Dyspnea Measurements

  2. Change in Qualify-of-Life as measured by questionnaire [ Time Frame: Baseline, 30 days, 90 Days ]
    To assess Qualify-of-Life Measurements



Information from the National Library of Medicine

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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 or female, at least 18 years of age, inclusive.
  2. Subject has a symptomatic MPE requiring intervention. For an effusion to be defined as malignant, at least one of the following must be true:

    1. There is histocytological confirmation of pleural malignancy
    2. The effusion is an exudate (per Light's criteria) in the context of histocytologically proven malignancy elsewhere, with no other clear cause for fluid identified.
  3. Subject has a history of at least 1 ipsilateral pleural effusion causing dyspnea that responded to thoracentesis where the lung expanded and the dyspnea was improved.
  4. Subject is willing and able to provide written informed consent.
  5. Subject is willing and able to meet all study requirements, including follow-up visits and receiving study-related telephone calls.
  6. Subject has sufficient pleural fluid to allow safe insertion of an IPC.
  7. Subject has negative pregnancy test if appropriate.
  8. Subject or caregiver is able to perform home drainage of the pleural effusion (a caregiver can be a friend, family member, or paid healthcare professional).

Exclusion Criteria:

  1. Subject has significant trapped lung, or a proximal bronchial obstruction which is likely to lead to trapped lung. For a subject to be eligible for this study, two separate study center clinicians must agree that there is no significant trapped lung on the same CXR using visual estimation (reference guide). The CXR used to make this decision must have been performed ≤30 days preceding the consent form being signed, and must have been performed preferably on the same day, but no more than 7 calendar days after tunneled pleural catheter insertion. Significant trapped lung is deemed present if any 1 of the following criteria is met:

    1. A CXR shows hydropneumothorax other than small (< 1 cm between chest wall and pleural line) apical pneumothoraces.
    2. A CXR shows ≥20% of the affected hemithorax to be free of the expected lung parenchymal markings and there is no suggestion of pleural fluid.
    3. A CXR shows ≥20% of the affected hemithorax to be occupied with pleural fluid AFTER a pleural aspiration which resulted in symptoms suggestive of trapped lung (e.g., chest pain or cough).
  2. Subject has a Karnofsky score <50, or a World Health Organization (WHO)/ Eastern Cooperative Oncology Group (ECOG) performance status ≥3. Subjects who have a performance status of 3 may be considered for the study if the removal of their fluid would likely improve their performance score by 1 or more.
  3. Subject is pregnant, planning to become pregnant, or is lactating.
  4. Subject has a history of empyema.
  5. Subject has a history of chylothorax.
  6. Subject has an uncorrected coagulopathy.

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): NCT04792970


Contacts
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Contact: Jessica Shier 919-684-9139 jessica.shier@duke.edu

Locations
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United States, North Carolina
Duke University Medical Center Recruiting
Durham, North Carolina, United States, 27710
Contact: Jessica Shier    919-684-9139    jessica.shier@duke.edu   
Principal Investigator: Scott Shofer         
Sponsors and Collaborators
Duke University
Investigators
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Principal Investigator: Scott Shofer Duke University
Publications:
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Responsible Party: Duke University
ClinicalTrials.gov Identifier: NCT04792970    
Other Study ID Numbers: Pro00107258
First Posted: March 11, 2021    Key Record Dates
Last Update Posted: March 8, 2022
Last Verified: February 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Pleural Effusion, Malignant
Pleural Effusion
Pleural Diseases
Respiratory Tract Diseases
Pleural Neoplasms
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Neoplasms