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Gene Therapy in Preventing Cancer in Patients With Premalignant Carcinoma of the Oral Cavity or Pharynx

Primary Purpose

Lip and Oral Cavity Cancer, Oropharyngeal Cancer, Stage 0 Lip and Oral Cavity Cancer

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ad5CMV-p53 gene
laboratory biomarker analysis
Sponsored by
National Cancer Institute (NCI)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Lip and Oral Cavity Cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Histologically confirmed mild to moderate dysplasia OR severe dysplasia/carcinoma in situ of the oral cavity or oral pharynx Clinically evident diffuse premalignant disease, defined by 1 of the following mucosal abnormalities: Extension between adjacent organ structures (e.g., lateral tongue, ventral tongue, and the floor of the mouth) Extensive surface area, including the entire ventral tongue or floor of the mouth or buccal mucosa, in a velvety "indiscreet" pattern Meets 1 of the following criteria: Previously treated with conventional treatment (e.g., radiotherapy or surgery) for a prior head and neck malignancy Failed biochemoprevention approaches for premalignant disease Failed other therapeutic approaches for premalignant disease No active squamous cell carcinoma of the head and neck Performance status - Karnofsky 70-100% Absolute granulocyte count at least 2,000/mm^3 Platelet count at least 100,000/mm^3 Bilirubin no greater than 1.0 mg/dL Creatinine no greater than 1.5 mg/dL No hypertension (baseline blood pressure 140/90 mm Hg or higher) Not pregnant or nursing Negative pregnancy test Fertile patients must use effective barrier contraception during and for 1 year after study participation HIV-1 negative No known contact with former tissue or organ transplantation recipients or individuals with severe immunodeficiency disease (acquired or congenital) during and for 28 days after study treatment No prior malignancy within the past 2 years except nonmelanoma skin cancer or aerodigestive cancer No active systemic viral, bacterial, or fungal infections requiring treatment No serious concurrent illness that would preclude study compliance and follow-up No psychological, familial, sociological, geographical, or other condition that would preclude study compliance and follow-up See Disease Characteristics More than 21 days since prior chemotherapy (42 days for mitomycin and nitrosoureas) No concurrent systemic chemotherapy No concurrent prednisone or the equivalent, including corticosteroids of more than 10 mg/day See Disease Characteristics More than 3 months since prior radiotherapy involving the lesion selected for this study No concurrent radiotherapy See Disease Characteristics More than 8 weeks since prior investigational agents No prior experimental therapy (i.e., oral, systemic, topical, or direct injection) for the lesion selected for treatment in this study No other concurrent immunosuppressive therapy No other concurrent investigational agents No concurrent aspirin dose greater than 175 mg/day

Sites / Locations

  • M D Anderson Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Treatment (Ad5CMV-p53 gene)

Arm Description

Phase I: Patients receive Ad5CMV-p53 gene by intramucosal injection into the area of the lesion followed at least 2 hours later by Ad5CMV-p53 gene as an oral rinse on day 1. Patients then receive Ad5CMV-p53 gene as an oral rinse twice daily on days 2-5. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of Ad5CMV-p53 gene as an oral rinse until the MTD is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Phase II: Patients receive treatment with intramucosal Ad5CMV-p53 gene as in phase I and Ad5CMV-p53 gene as an oral rinse at the MTD.

Outcomes

Primary Outcome Measures

Frequency of adverse events
Severity of adverse events graded using the CTCAE version 3.0
Maximum tolerated dose of Ad5CMV-p53 gene
Evaluated by the frequency and relationship of dose-limiting toxicities, if any, experienced by patients during dose escalation.
Pharmacodynamics evaluated by examining the injected precancerous lesion for induction of apoptosis and expression of the p53 protein
Presented using descriptive statistics, frequency tabulations, and graphical displays over time by treatment cohort.

Secondary Outcome Measures

Full Information

First Posted
July 8, 2003
Last Updated
January 22, 2013
Sponsor
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00064103
Brief Title
Gene Therapy in Preventing Cancer in Patients With Premalignant Carcinoma of the Oral Cavity or Pharynx
Official Title
Clinical Protocol for Wild Type p53 Gene Induction in Premalignancies of Squamous Epithelium of the Oral Cavity and Oral Pharynx Via an Adenoviral Vector [NCI Supplied Agent Ad-p53, (INGN 201) (Advexin®) NSC 683550, IND# 7135]
Study Type
Interventional

2. Study Status

Record Verification Date
January 2013
Overall Recruitment Status
Completed
Study Start Date
June 2003 (undefined)
Primary Completion Date
August 2007 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
This phase I/II trial is studying the side effects and best dose of gene therapy and to see how well it works in preventing cancer in patients with premalignant carcinoma of the oral cavity or pharynx. Inserting the p53 gene into a person's tumor cells may improve the body's ability to kill the tumor cells
Detailed Description
OBJECTIVES: I. Determine the acute toxic effects of Ad5CMV-p53 gene administered as an oral rinse and as an intramucosal injection in patients with diffuse premalignant carcinoma of the oral cavity or oral pharynx. II. Determine the maximum tolerated dose of this drug in these patients. III. Determine the topical transduction efficiency of adenoviral-mediated wild type p53 gene transfer in patients treated with this drug. IV. Determine the efficacy of this drug in reversing the histology of oral premalignancies in these patients. V. Determine the distribution of transgenic protein within the area of the premalignant lesion in patients treated with this drug. OUTLINE: This is an open-label, dose-escalation study of Ad5CMV-p53 gene administered as an oral rinse. Phase I: Patients receive Ad5CMV-p53 gene by intramucosal injection into the area of the lesion followed at least 2 hours later by Ad5CMV-p53 gene as an oral rinse on day 1. Patients then receive Ad5CMV-p53 gene as an oral rinse twice daily on days 2-5. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of Ad5CMV-p53 gene as an oral rinse until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Phase II: Patients receive treatment with intramucosal Ad5CMV-p53 gene as in phase I and Ad5CMV-p53 gene as an oral rinse at the MTD. Patients are followed every 3 months for 1 year, every 6 months for 1 year, and then annually for 3 years. Patients then receive long-term follow-up annually for an additional 10 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Lip and Oral Cavity Cancer, Oropharyngeal Cancer, Stage 0 Lip and Oral Cavity Cancer, Stage 0 Oropharyngeal Cancer, Tongue Cancer

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1, Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
51 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Treatment (Ad5CMV-p53 gene)
Arm Type
Experimental
Arm Description
Phase I: Patients receive Ad5CMV-p53 gene by intramucosal injection into the area of the lesion followed at least 2 hours later by Ad5CMV-p53 gene as an oral rinse on day 1. Patients then receive Ad5CMV-p53 gene as an oral rinse twice daily on days 2-5. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of Ad5CMV-p53 gene as an oral rinse until the MTD is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Phase II: Patients receive treatment with intramucosal Ad5CMV-p53 gene as in phase I and Ad5CMV-p53 gene as an oral rinse at the MTD.
Intervention Type
Biological
Intervention Name(s)
Ad5CMV-p53 gene
Other Intervention Name(s)
Ad5CMV-p53, ADVEXIN, INGN-201
Intervention Description
Given intramucosally or as oral rinse
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Frequency of adverse events
Time Frame
Up to 15 years
Title
Severity of adverse events graded using the CTCAE version 3.0
Time Frame
Up to 15 years
Title
Maximum tolerated dose of Ad5CMV-p53 gene
Description
Evaluated by the frequency and relationship of dose-limiting toxicities, if any, experienced by patients during dose escalation.
Time Frame
6 months
Title
Pharmacodynamics evaluated by examining the injected precancerous lesion for induction of apoptosis and expression of the p53 protein
Description
Presented using descriptive statistics, frequency tabulations, and graphical displays over time by treatment cohort.
Time Frame
168 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically confirmed mild to moderate dysplasia OR severe dysplasia/carcinoma in situ of the oral cavity or oral pharynx Clinically evident diffuse premalignant disease, defined by 1 of the following mucosal abnormalities: Extension between adjacent organ structures (e.g., lateral tongue, ventral tongue, and the floor of the mouth) Extensive surface area, including the entire ventral tongue or floor of the mouth or buccal mucosa, in a velvety "indiscreet" pattern Meets 1 of the following criteria: Previously treated with conventional treatment (e.g., radiotherapy or surgery) for a prior head and neck malignancy Failed biochemoprevention approaches for premalignant disease Failed other therapeutic approaches for premalignant disease No active squamous cell carcinoma of the head and neck Performance status - Karnofsky 70-100% Absolute granulocyte count at least 2,000/mm^3 Platelet count at least 100,000/mm^3 Bilirubin no greater than 1.0 mg/dL Creatinine no greater than 1.5 mg/dL No hypertension (baseline blood pressure 140/90 mm Hg or higher) Not pregnant or nursing Negative pregnancy test Fertile patients must use effective barrier contraception during and for 1 year after study participation HIV-1 negative No known contact with former tissue or organ transplantation recipients or individuals with severe immunodeficiency disease (acquired or congenital) during and for 28 days after study treatment No prior malignancy within the past 2 years except nonmelanoma skin cancer or aerodigestive cancer No active systemic viral, bacterial, or fungal infections requiring treatment No serious concurrent illness that would preclude study compliance and follow-up No psychological, familial, sociological, geographical, or other condition that would preclude study compliance and follow-up See Disease Characteristics More than 21 days since prior chemotherapy (42 days for mitomycin and nitrosoureas) No concurrent systemic chemotherapy No concurrent prednisone or the equivalent, including corticosteroids of more than 10 mg/day See Disease Characteristics More than 3 months since prior radiotherapy involving the lesion selected for this study No concurrent radiotherapy See Disease Characteristics More than 8 weeks since prior investigational agents No prior experimental therapy (i.e., oral, systemic, topical, or direct injection) for the lesion selected for treatment in this study No other concurrent immunosuppressive therapy No other concurrent investigational agents No concurrent aspirin dose greater than 175 mg/day
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gary L. Clayman
Organizational Affiliation
M.D. Anderson Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
M D Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Gene Therapy in Preventing Cancer in Patients With Premalignant Carcinoma of the Oral Cavity or Pharynx

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