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Cisplatin Induced Kidney Toxicity (ACCENT)

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT04442516
Recruitment Status : Recruiting
First Posted : June 22, 2020
Last Update Posted : July 2, 2021
Canadian Institutes of Health Research (CIHR)
London Health Sciences Centre
Provincial Health Services Authority
Information provided by (Responsible Party):
Michael Zappitelli, The Hospital for Sick Children

Brief Summary:

Cisplatin (CisP) is a chemotherapeutic agent used to treat head and neck and lung cancer in adults and over 15 different pediatric cancers. Despite its known toxicity, CisP is still widely used as a first line chemotherapy as it is so effective. Nephrotoxicity is one of the most common adverse effects of CisP, occurring in 20-50% of patients. It manifests as acute kidney injury (AKI) typically within the first few days of exposure and is associated with short and long-term morbidity. Furthermore, AKI diagnosis is only possible once kidney damage has progressed to functional impairment, when mitigation strategies are ineffective. Tests that could predict AKI risk pre-emptively or diagnose early-stage AKI before functional loss would be very impactful, affording opportunities for prevention or early intervention to mitigate CisP nephrotoxicity, reduce morbidity and improve health outcomes.

The field of metabolomics seeks to identify patterns of small molecules (metabolites) involved in cell or tissue metabolism related to disease states, or patient factors like lifestyle and genetics. Plasma and urine are ideal for sampling the metabolome, which can identify at-risk patients and reveal disease-related changes earlier than existing diagnostic methods do.

In CisP-treated children and adults from across Canada, we will identify urine and plasma metabolite profiles a) prior to CisP dosing that predict CisP AKI risk, and b) shortly after dosing to identify early-stage nephrotoxicity, before clinical signs of AKI are detectable. Our identified biomarkers will allow individualization of CisP treatment based on the level of nephrotoxicity risk and the design of trials to mitigate the progression and complications of CisP nephrotoxicity.

Condition or disease Intervention/treatment
Acute Kidney Injury Cancer Other: Questionnaire, sampling of blood, urine and saliva

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Study Type : Observational
Estimated Enrollment : 600 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: A Canadian Study of Cisplatin mEtabolomics and NephroToxicity
Actual Study Start Date : August 12, 2020
Estimated Primary Completion Date : April 1, 2026
Estimated Study Completion Date : December 31, 2028

Resource links provided by the National Library of Medicine

Drug Information available for: Cisplatin

Group/Cohort Intervention/treatment
Adults receiving Cisplatin as part of their cancer therapy Other: Questionnaire, sampling of blood, urine and saliva
We are following patients who are receiving Cisplatin as part of their cancer therapy.

Children receiving Cisplatin as part of their cancer therapy Other: Questionnaire, sampling of blood, urine and saliva
We are following patients who are receiving Cisplatin as part of their cancer therapy.

Primary Outcome Measures :
  1. To identify patterns of metabolites and specific metabolites prior to and shortly after CisP treatment that predict AKI risk and identify the onset of AKI early (discovery cohort). [ Time Frame: 8+ years ]

Secondary Outcome Measures :
  1. To independently validate our findings and develop a precision medicine algorithm using metabolites to predict patients at high risk for developing CisP AKI (validation cohort). [ Time Frame: 8+ years ]

Biospecimen Retention:   Samples With DNA
Urinary and plasma metabolites and saliva or blood sample for DNA.

Information from the National Library of Medicine

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Ages Eligible for Study:   3 Months and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Child Cohort. We already performed these study procedures on 159 children in the "ABLE" study, a 12-centre cohort study.Eligibility criteria and data/samples collected on these patients during their initial CisP treatment are almost identical to the present study. The cohort diagnoses include neuroblastoma, medulloblastoma, osteosarcoma, germ cell tumour, hepatoblastoma, and other cancers. Data and specimens from the pediatric study subjects in the ABLE study who were recruited during their first CisP infusion (about half) will be included in the current study. The remaining children (to reach a target of 300) will be recruited over 3 years from the following centres: McGill, UBC, SickKids, U. Manitoba and UWO. Adult Cohort. 300 adults (18 years of age or older) initiating CisP (≥75 mg/m2) treatment for head/neck or lung cancers will be recruited to participate in this study from PMH (Toronto), UBC and UWO over 2 years. Over 500 new patients/year are available across all sites.

Inclusion Criteria:

  • Adult participants: Initiating treatment with CisP (≥75 mg/m2) for head/neck or lung cancers at one of the Adult participating sites; 18 years of age or older.
  • Paediatric participants: Initiating treatment with CisP for any cancer diagnosis at one of the Pediatric participating sites; greater than 3 months of age.
  • All participants: Consent to participate in the study.

Exclusion Criteria:

  • Diagnosis of chronic kidney disease (CKD) at baseline (glomerular filtration rate <60 mL/min/1.73m2, determined by chart review of either formal glomerular filtration rate testing, 24 hour creatinine creatinine clearance of age-appropriate serum creatinine-based estimated glomerular filtration rate equations; past kidney transplant)
  • Previous use of any nephrotoxic drugs included on the provided Excluded Nephrotoxic Medications list in the two weeks prior to initiation of CisP treatment
  • Previous use of CisP
  • Previous radiotherapy (total body irradiation or abdominal radiation only) in the last 1 month prior to study
  • Previous hematopoietic stem cell transplant
  • Any chronic or acute health condition that the investigator feels would render the patient inappropriate for this study, including but not limited to significant uncontrolled cardiorespiratory, hepatic, infectious, or renal disease at the discretion 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 identifier (NCT number): NCT04442516

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Contact: Michael Zappitelli, MD 416-813-7654 ext 304077
Contact: Jasmine Lee, MSc 416-813-7654 ext 309010

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Canada, ONT
London Health Sciences Centre Recruiting
London, ONT, Canada, N6A 5W9
Contact: Kathie Baer, MSc    (519) 685-8500 ext 54524   
Contact: Robin Sachdeva, PhD   
Sub-Investigator: Sara Kuruvilla, MD         
Sponsors and Collaborators
The Hospital for Sick Children
Canadian Institutes of Health Research (CIHR)
London Health Sciences Centre
Provincial Health Services Authority
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Michael Zappitelli, Clinician Scientist, The Hospital for Sick Children Identifier: NCT04442516    
Other Study ID Numbers: CisP Metabolomics
First Posted: June 22, 2020    Key Record Dates
Last Update Posted: July 2, 2021
Last Verified: June 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Acute Kidney Injury
Renal Insufficiency
Kidney Diseases
Urologic Diseases