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Testing the Effects of Oxybutynin for the Treatment of Hot Flashes in Men Receiving Hormone Therapy for Prostate Cancer

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ClinicalTrials.gov Identifier: NCT04600336
Recruitment Status : Recruiting
First Posted : October 23, 2020
Last Update Posted : August 26, 2021
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Alliance for Clinical Trials in Oncology

Brief Summary:
This phase II trial compares the effect of oxybutynin versus placebo for reducing hot flashes in men receiving androgen deprivation (hormone) therapy for the treatment of prostate cancer . Androgen deprivation therapy decreases testosterone and other androgens through medications or surgical removal of the testicles. Relative to placebo, low- or high-dose oxybutynin may reduce hot flashes in men receiving androgen deprivation therapy.

Condition or disease Intervention/treatment Phase
Prostate Carcinoma Drug: Oxybutynin Chloride Drug: Placebo Administration Other: Quality-of-Life Assessment Other: Questionnaire Administration Phase 2

Detailed Description:

The primary and secondary objectives of the study:

PRIMARY OBJECTIVE:

I. To assess the effects of two doses of oxybutynin chloride (oxybutynin) on hot flash scores relative to placebo.

SECONDARY OBJECTIVES:

I. To assess study accrual rates and compliance with the therapy. II. To characterize the safety and adverse event profile of two doses of oxybutynin in the study population.

III. To evaluate the consistency of the results across the various methods used to evaluate the efficacy of oxybutynin (i.e., hot flash scores versus hot flash frequencies, mean differences versus 50% or greater reduction since baseline, single day versus full week to define patients' baseline hot flash scores).

IV. To compare patient-reported quality of life and hot flash interference, as measured by the Hot Flash Related Daily Interference Scale (HFRDIS), across arms.

V. To compare other changes in patient symptoms, as measured by the Symptom Experience Questionnaire, across arms.

OUTLINE: Patients are randomized to 1 of 4 arms in a 2:2:1:1 ratio according to the dynamic allocation scheme.

ARM A: Patients receive low-dose oxybutynin chloride orally (PO) twice daily (BID) on days 8-49 (6 weeks) in the absence of unacceptable toxicity.

ARM B: Patients receive high-dose oxybutynin chloride PO BID on days 8-49 (6 weeks) in the absence of unacceptable toxicity.

ARM C: Patients receive low-dose placebo PO BID on days 8-49 (6 weeks). After 6 weeks, patients may cross over to Arm A per physician discretion.

ARM D: Patients receive high-dose placebo PO BID on days 8-49 (6 weeks). After 6 weeks, patients may cross over to Arm B per physician discretion.

There will be a 6-week follow-up for Arm C and Arm D patients who participate in the optional crossover phase.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 87 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Supportive Care
Official Title: A Randomized, Double-Blind, Placebo-Controlled Phase II Study of Oxybutynin Versus Placebo for the Treatment of Hot Flashes in Men Receiving Androgen Deprivation Therapy
Actual Study Start Date : July 30, 2021
Estimated Primary Completion Date : February 2023
Estimated Study Completion Date : March 2023

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arm Intervention/treatment
Experimental: Arm A (low-dose oxybutynin)
Patients receive low-dose oxybutynin chloride (2.5 mL twice daily) PO BID on days 8-49 (6 weeks) in the absence of unacceptable toxicity.
Drug: Oxybutynin Chloride
Given PO

Other: Quality-of-Life Assessment
Ancillary studies

Other: Questionnaire Administration
Ancillary studies

Experimental: Arm B (high-dose oxybutynin chloride)
Patients receive high-dose oxybutynin chloride (5.0 mL twice daily) PO BID on days 8-49 (6 weeks) in the absence of unacceptable toxicity.
Drug: Oxybutynin Chloride
Given PO

Other: Quality-of-Life Assessment
Ancillary studies

Other: Questionnaire Administration
Ancillary studies

Placebo Comparator: Arm C (low-dose placebo)
Patients receive a low-dose placebo (2.5 mL twice daily) PO BID on days 8-49 (6 weeks). After 6 weeks, patients may cross over to Arm A per physician discretion.
Drug: Placebo Administration
Given PO

Other: Quality-of-Life Assessment
Ancillary studies

Other: Questionnaire Administration
Ancillary studies

Placebo Comparator: Arm D (high-dose placebo)
Patients receive a high-dose placebo (5.0 mL twice daily) PO BID on days 8-49 (6 weeks). After 6 weeks, patients may cross over to Arm C per physician discretion.
Drug: Placebo Administration
Given PO

Other: Quality-of-Life Assessment
Ancillary studies

Other: Questionnaire Administration
Ancillary studies




Primary Outcome Measures :
  1. Patient-reported hot flash scores [ Time Frame: Baseline up to 6 weeks post-randomization ]
    Using patients' hot flash diaries, daily hot flash scores will be determined by multiplying the frequency of each defined hot flash grade by the severity and summing the values over a 24-hour period. Weekly hot flash scores will be computed by averaging these hot flash scores across 7 days. A mixed model will be estimated that includes baseline and weekly hot flash scores across the 6-week treatment period. Estimates from the mixed model will be used to construct 90% confidence intervals for mean differences in hot flash score reduction from baseline to 6 weeks between the oxybutynin and placebo arms (i.e., Arm A versus Arms C and D combined; Arm B versus Arms C and D combined). Contrasts estimated via the mixed model will involve a two-sided t-test with alpha = .10. At 6 weeks, the proportion of patients who experience a 50% or greater reduction in hot flash scores since baseline will be compared across the oxybutynin and placebo arms using Fisher's exact test or logistic regression.


Secondary Outcome Measures :
  1. Patient-reported hot flash frequency [ Time Frame: Baseline up to 6 weeks post-randomization ]
    Weekly hot flash frequencies will be determined by patients' hot flash diaries. A mixed model will be estimated that includes baseline and weekly hot flash frequencies across the 6-week treatment period. The mixed model and subsequent contrasts will account for the observed distribution of weekly hot flash frequencies. At 6 weeks, the proportion of patients who experience a 50% or greater reduction in hot flash frequency since baseline will be compared across the oxybutynin and placebo arms using Fisher's exact test or logistic regression. Consistency of the results will be assessed across the various methods used to evaluate the efficacy of oxybutynin in this trial (i.e., hot flash scores versus hot flash frequencies, mean differences versus 50% or greater reduction since baseline, single day versus full week to define patients' baseline hot flash scores).

  2. Incidence of adverse events [ Time Frame: Baseline up to 12 weeks post-randomization ]
    Grade 3 or higher adverse events will be assessed by the National Cancer Institute's Common Terminology Criteria for Adverse Events, version 5.0 and summarized by arm.

  3. Patient-reported symptoms [ Time Frame: Baseline and at the end of each week of treatment, assessed up to 6 weeks post-randomization ]
    Patient-reported symptoms will be assessed by the Symptom Experience Questionnaire. A mixed model will be estimated that includes baseline and weekly patient-reported symptoms across the 6-week treatment period. Estimates from the mixed model will be used to construct 90% confidence intervals for mean differences in patient-reported symptoms between the oxybutynin and placebo arms (i.e., Arm A versus Arms C and D combined; Arm B versus Arms C and D combined) at 6 weeks. Contrasts estimated via the mixed model will involve a two-sided t-test with alpha = .10.

  4. Patient accrual [ Time Frame: Up to 2 years ]
    The time required to accrue 87 patients will be reported.

  5. Treatment adherence rates [ Time Frame: Up to 2 years ]
    Treatment adherence rates will be calculated by dividing the number of patients who completed treatment per protocol by the number of patients who started treatment. Treatment adherence rates will be summarized by arm.

  6. Patient-reported quality of life: scale [ Time Frame: Baseline and at the end of each week of treatment, assessed up to 6 weeks post-randomization ]
    A mixed model will be estimated that includes patients' scores on the Hot Flash Related Daily Interference Scale (HFRDIS) across the 6-week treatment period. Estimates from the mixed model will be used to construct 90% confidence intervals for mean differences in patient-reported quality of life between the oxybutynin and placebo arms (i.e., Arm A versus Arms C and D combined; Arm B versus Arms C and D combined) at 6 weeks. Contrasts estimated via the mixed model will involve a two-sided t-test with alpha = .10.

  7. Patient-reported hot flash interference [ Time Frame: Baseline and at the end of each week of treatment, assessed up to 6 weeks post-randomization ]
    A mixed model will be estimated that includes patients' scores on the Hot Flash Related Daily Interference Scale (HFRDIS) across the 6-week treatment period. Estimates from the mixed model will be used to construct 90% confidence intervals for mean differences in patient-reported hot flash interference between the oxybutynin and placebo arms (i.e., Arm A versus Arms C and D combined; Arm B versus Arms C and D combined) at 6 weeks. Contrasts estimated via the mixed model will involve a two-sided t-test with alpha = .10.



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

Inclusion Criteria:

  • Men who are currently receiving androgen deprivation therapy (ADT) for the treatment of prostate cancer. ADT is defined by a history of orchiectomy, or ongoing usage of gonadotropin-releasing hormone agonists or antagonists. Men receiving next generation androgen axis inhibitor therapies including abiraterone, enzalutamide, apalutamide, and darolutamide are eligible
  • Patients must be on a stable dose of all hormone-directed therapies for at least 28 days prior to registration and must not be planning to discontinue this therapy for at least 42 days following registration. Patients receiving radiation therapy during the study period are eligible
  • Eligible patient must have bothersome hot flashes for >= 14 days prior to registration, defined by an occurrence of >= 28 times per week and of sufficient severity to cause the patient to seek therapeutic intervention
  • Life expectancy of greater than 6 months
  • Eastern Cooperative Oncology Group (ECOG) performance status - 0, 1, or 2
  • In order to complete the mandatory patient-completed measures, participants must be able to speak and/or read English

Exclusion Criteria:

  • No current use or future planned use of any of the following agents during the study period: drugs that are not Food and Drug Administration (FDA) approved for use in humans, androgens, estrogens, progesterone analogs, gabapentin, selective serotonin reuptake inhibitor (SSRI)/serotonin and norepinephrine reuptake inhibitor (SNRI) anti-depressants, cholinergic agonists, cholinesterase inhibitors, or complementary/alternative medicine taken for the purpose of managing hot flashes. Prior use of these agents is permitted as long as they are discontinued before registration
  • No current or prior use of oxybutynin
  • Patients with a history of any of the following contraindications to oxybutynin are not eligible: gastroparesis or gastrointestinal obstructive disorders; significant gastric reflux symptoms not controlled by medication; ulcerative colitis; narrow-angle glaucoma; urinary retention requiring indwelling or intermittent self-catheterization within the prior 6 months; hypersensitivity to oxybutynin or any other components of the product; current uncontrolled hyperthyroidism; uncontrolled coronary artery disease or a history of myocardial infarction within the prior 12 months; New York Heart Association (NYHA) class II-IV congestive heart failure; symptomatic cardiac arrhythmias; current uncontrolled hypertension; myasthenia gravis; or dementia

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): NCT04600336


Contacts
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Contact: Bradley J. Stish, MD 507-538-6120 stish.bradley@mayo.edu

Locations
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United States, Iowa
Iowa Methodist Medical Center Recruiting
Des Moines, Iowa, United States, 50309
Contact: Site Public Contact    515-241-6727      
Principal Investigator: Joshua Lukenbill         
Medical Oncology and Hematology Associates-Des Moines Recruiting
Des Moines, Iowa, United States, 50309
Contact: Site Public Contact    515-282-2921      
Principal Investigator: Joshua Lukenbill         
Sponsors and Collaborators
Alliance for Clinical Trials in Oncology
National Cancer Institute (NCI)
Investigators
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Study Chair: Bradley J. Stish, MD Mayo Clinic
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Responsible Party: Alliance for Clinical Trials in Oncology
ClinicalTrials.gov Identifier: NCT04600336    
Other Study ID Numbers: A222001
UG1CA189823 ( U.S. NIH Grant/Contract )
NCI-2020-07169 ( Registry Identifier: NCI Clinical Trial Reporting Program )
First Posted: October 23, 2020    Key Record Dates
Last Update Posted: August 26, 2021
Last Verified: August 2021

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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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Prostatic Neoplasms
Hot Flashes
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Prostatic Diseases
Oxybutynin
Parasympatholytics
Autonomic Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Muscarinic Antagonists
Cholinergic Antagonists
Cholinergic Agents
Neurotransmitter Agents
Molecular Mechanisms of Pharmacological Action
Urological Agents