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Phase IIa Desipramine in Small Cell Lung Cancer and Other High-Grade Neuroendocrine Tumors

This study has been terminated.
(Lack of efficacy)
Information provided by (Responsible Party):
Joel Neal, Stanford University Identifier:
First received: October 29, 2012
Last updated: July 2, 2015
Last verified: July 2015
Intrapatient dose escalation of desipramine. Start at 75 mg daily. Increase by 75 mg weekly to maximum of 450 mg daily. Taper desipramine upon disease progression, unacceptable toxicity or patient withdrawal from study.

Condition Intervention Phase
Small Cell Lung Cancer
Drug: desipramine
Phase 2

Study Type: Interventional
Study Design: Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase IIa Intrapatient Dose Escalation Study of Desipramine in Small Cell Lung Cancer and Other High-Grade Neuroendocrine Tumors

Resource links provided by NLM:

Further study details as provided by Stanford University:

Primary Outcome Measures:
  • Overall Response Rate (ORR): Number of patients who achieve either a partial or complete response divided by the total number of patients treated on the study as measured by CT scans and RECIST 1.1 criteria. [ Time Frame: At baseline and every 8 weeks up to 3 years. ]

Enrollment: 6
Study Start Date: October 2012
Study Completion Date: December 2014
Primary Completion Date: May 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm 1
Desipramine Arm
Drug: desipramine

Detailed Description:

Primary Objective:

To determine the overall response rate (ORR) of small cell lung cancer and high-grade neuroendocrine tumors in patients during treatment with desipramine.

Secondary Objectives:

  • To determine the progression-free survival (PFS) and overall survival (OS).
  • To perform exploratory blood biomarker analysis of PCSK1 and ROBO1 in patients enrolled on this trial.
  • To measure safety of desipramine using type, frequency and severity of adverse event reactions reported according to CTCAE v4.0
  • To measure tolerability using the incidence of adverse events (AEs) leading to desipramine delay or discontinuation
  • To establish the MTD of desipramine in each patient by adhering to an intrapatient dose escalation schema
  • To measure serum desipramine levels during treatment

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

Inclusion Criteria:

  • Metastatic small-cell lung cancer -or- Metastatic high-grade neuroendocrine carcinoma of any organ system (high-grade defined by Ki-67 >= 20% and/or >= 20 mitoses/10 (HPF).
  • Received at least one line of prior chemotherapy treatment for metastatic disease. After progression on first-line chemotherapy, disease does not have to have progressed on subsequent lines of therapy to enroll on trial.
  • Completed previous treatment in greater than or equal to the following times prior to initiation of study treatment:

    • Chemotherapy administered in a daily schedule must be completed >= 2 weeks prior to registration;
    • Chemotherapy administered in a weekly schedule must be completed >= 2 weeks prior to registration;
    • Chemotherapy administered in a 2-weekly schedule must be completed >= 3 weeks prior to registration;
    • Chemotherapy administered in a 3-weekly schedule must be completed >= 4 weeks prior to registration.
  • ECOG Performance Status 0-2
  • Measurable disease by RECIST 1.1 criteria
  • Age at least 18 years-old otherwise no age, gender/race-ethnic restrictions
  • At least 3 months estimated life expectancy.
  • Laboratory tests within the following parameters:

    • Absolute neutrophil count >= 1,500/ mm3
    • Platelets >= 100,000/mm3
    • Hemoglobin >= 9 g/Dl
    • Total bilirubin <= 1.5 mg/dL
    • AST(SGOT) and ALT(SGPT) <= 3 X ULN (Stanford: AST(SGOT) ULN 60, ALT (SGPT) ULN 80).
    • Creatinine <=1.5 X ULN (Stanford: ULN 1.1) -or- Calculated (See Appendix F for Cockgroft-Gault formula) measured creatinine clearance >= 45 mL/min/1.73m2 (normalized to BSA) for patients with creatinine levels above institutional normal
  • ECG demonstrating all of the following:

    • QT interval corrected using Fridericia's method (QTcF) <450 msec (males) or <470 msec (females) (see Appendix E for Fredericia's criteria).
    • PR <240 msec
    • QRS <100 msec
  • Brain metastases are allowed, but must be asymptomatic and have been adequately treated with radiation finishing at least 1 week prior to initiation of study treatment.
  • Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  • Cardiac disorders including the following:

    • Clinically significant ventricular arrhythmia including cardiac arrest
    • Myocardial infarction from coronary artery disease within 3 months of study enrollment
    • Implantable pacemaker or implantable cardioverter defibrillator
    • NYHA Class III or greater congestive heart failure
  • Family history of long QT syndrome.
  • Concomitant or expected treatment with any of the following prohibited study medications. Any prohibited drugs must be discontinued at least 2 weeks or 5-half lives prior to the initiation of desipramine, whichever is shortest (except fluoxetine, because of long half life, will need a at least a 5 week washout period). (see appendix C and D for lists of prohibited drugs)
  • Medications that prolong the QT interval and are known to increase risk of torsades de pointes (see appendix D for excluded drugs)
  • Strong inhibitors of cytochrome p450 CYP2D6 (see appendix C)
  • Other anti-depressant or anti-psychotic including a SSRI, other tricyclic, MAOI, SNRI, typical or atypical anti-psychotic
  • Metoclopramide (Reglan) because of increased risk of Extrapyrimidal Symptoms and Neuroleptic Malignant Syndrome
  • Symptomatic orthostatic hypotension despite adequate volume resuscitation.
  • Medical history of narrow angle glaucoma
  • Any of the following known psychiatric conditions, diagnosed by a psychiatrist, either ongoing or active within the last 5 years:

    • Bipolar disorder
    • Suicidal ideation
    • Suicide attempt
  • Patients who are pregnant or breastfeeding. Female subjects of childbearing potential must have a negative pregnancy test prior to enrollment and practice acceptable methods of birth control to avoid pregnancy. Male subjects must also practice acceptable methods of birth control to prevent pregnancy of a partner.
  • No other Investigational Agents allowed while on this trial.
  • Any other serious or unstable concomitant systemic disorder that in the opinion of the investigator is incompatible with the clinical study
  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 identifier: NCT01719861

United States, California
Stanford University Cancer Institute
Stanford, California, United States, 94305
Sponsors and Collaborators
Joel Neal
Principal Investigator: Joel Neal Stanford University
  More Information

Responsible Party: Joel Neal, Assistant Professor, Stanford University Identifier: NCT01719861     History of Changes
Other Study ID Numbers: VAR0087
25491 ( Other Identifier: Stanford IRB )
Study First Received: October 29, 2012
Last Updated: July 2, 2015

Additional relevant MeSH terms:
Lung Neoplasms
Neuroendocrine Tumors
Carcinoid Tumor
Small Cell Lung Carcinoma
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Lung Diseases
Respiratory Tract Diseases
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms, Nerve Tissue
Neoplasms, Glandular and Epithelial
Carcinoma, Bronchogenic
Bronchial Neoplasms
Antidepressive Agents, Tricyclic
Antidepressive Agents
Psychotropic Drugs
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Adrenergic Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Adrenergic Agents
Neurotransmitter Agents processed this record on March 22, 2017