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Evaluation of Octreotide LAR in Prevention of Chemotherapy-induced Diarrhea (LARCID)

Primary Purpose

Chemotherapy-induced Diarrhea

Status
Completed
Phase
Phase 3
Locations
Brazil
Study Type
Interventional
Intervention
Octreotide Long Acting Release
Standard Treatment
Sponsored by
Novartis Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Chemotherapy-induced Diarrhea focused on measuring Colorectal cancer, diarrhea, drug therapy, octreotide, fluorouracil, irinotecan, capecitabine, prevention

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria:

  1. Providing a written informed consent
  2. Age between 18 and 80 years;
  3. Histological diagnosis of colorectal cancer, presence of metastatic disease and no prior systemic therapy for metastatic disease (prior adjuvant therapy will be allowed if completed 6 months or longer before inclusion in the study);
  4. Indication of treatment, according to the judgment of the investigator, with a chemotherapy regimen containing either 5-FU, capecitabine, or irinotecan; any such regimen may also include oxaliplatin, bevacizumab, or cetuximab;
  5. A performance status of 0 or 1 according to the Eastern Cooperative Oncology Group (ECOG) scale
  6. Adequate organ function and lab values within specific ranges
  7. Female patients of childbearing potential must have a negative serum pregnancy test within 7 days prior to registration;
  8. Fertile patients (male or female) must agree to use an acceptable method of contraception to avoid pregnancy for the duration of the study and for 3 months after study termination;
  9. No prior use of octreotide in any formulation.

Exclusion criteria:

  1. Use of concomitant antineoplastic treatments, other than regimens containing either 5-FU, capecitabine, or irinotecan with or without oxaliplatin, bevacizumab, or cetuximab;
  2. Previous or concomitant need for radiotherapy to the abdomen or pelvis;
  3. Indication of treatment, according to the judgment of the investigator, with erlotinib, gefitinib, panitumumab, or other EGFR-inhibitors other than cetuximab;
  4. A second malignancy (except in situ carcinoma of the cervix, in situ carcinoma of the bladder, adequately treated basal-cell or squamous-cell carcinoma of the skin, or another malignancy treated more than 5 years prior to enrollment and without recurrence);
  5. Any type of condition leading to chronic diarrhea, including, but not limited to inflammatory bowel disease (e.g., ulcerative colitis and Crohn's disease), chronic diarrhea of presumed or confirmed infectious origin, and irritable bowel syndrome;
  6. Active or uncontrolled concurrent medical condition, including, but not limited to, unstable angina, congestive heart failure, coronary artery disease, hypertension, diabetes mellitus, and hyper- or hypothyroidism;
  7. Active and ongoing systemic infection;
  8. Serious uncontrolled psychiatric illness;
  9. Ongoing pregnancy or lactation;
  10. Female patients who are pregnant or lactating, or are of childbearing potential and would not practice a medically acceptable method for birth control;
  11. Lesions that have been irradiated cannot be included as sites of measurable disease. If the only measurable lesion was previously irradiated the patient cannot be included;
  12. Use of any investigational agent within 30 days prior to enrollment in the study or foreseen use of an investigational agent during the study;
  13. History of chronic (≥ 30 nonconsecutive days) use of laxatives;
  14. Concurrent use of antidiarrheal agents;
  15. Inability to comply with the study protocol.

Other protocol-defined inclusion/exclusion criteria may apply.

Sites / Locations

  • Biocâncer
  • CEPON-Centro de Pesquisas Oncologicas
  • Hospital Sao Lucas- Faculdade de Medicina da PUCRS
  • Clínica AMO
  • Nucleo de Oncologia da Bahia
  • Faculdade de Medicina do ABC
  • Hosital Alemão Oswaldo Cruz
  • Hospital A C Camargo/ Fundação Antonio Prudente
  • Hospital das Clínicas - FMUSP
  • Instituto Arnaldo Vieira de Carvalho - IAVC
  • UNIFESP

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Other

Arm Label

Octreotide Long Acting Release

Standard Treatment

Arm Description

Prevention of Chemotherapy Induced Diarrhea (CID)

Physician treatment of choice for chemotherapy induced diarrhea other than Octreotide LAR.

Outcomes

Primary Outcome Measures

Percentage of Participants Developing Diarrhea (Grade 1 to 4)
The percentage of patients developing diarrhea (incidence of grade 1 to 4) during treatment, considering only the worst grade of diarrhea for each patient. Diarrhea was graded according to Common Toxicity Criteria where Grade 0=None, 1 = Increase of <4 stools/day over pretreatment, Grade 2 = Increase of 4-6 stools/day, or nocturnal stools, Grade 3 = Increase of ≥7 stools/day or incontinence; or need for parenteral support for dehydration and Grade 4= Physiologic consequences requiring intensive care; or hemodynamic collapse.

Secondary Outcome Measures

Number of Episodes of Diarrhea by Patient
Number of episodes of diarrhea is evaluated by patient diaries recorded on a daily basis.
Number of Episodes of Diarrhea by Patient by Cycle
Mean number of episodes of diarrhea is evaluated by patient diaries recorded by cycle. (cycle 1 to cycle 7.)
Percentage of Patients by Grade of Diarrhea
Grade (severity) of episodes of diarrhea is evaluated by patient diaries recorded on a daily basis by considering only worse grade of diarrhea for each patient. Diarrhea was graded according to Common Toxicity Criteria where Grade 0 = None, 1 = Increase of <4 stools/day over pretreatment, Grade 2 = Increase of 4-6 stools/day, or nocturnal stools, Grade 3 = Increase of ≥7 stools/day or incontinence; or need for parenteral support for dehydration and Grade 4= Physiologic consequences requiring intensive care; or hemodynamic collapse.
Percentage of Episodes by Grade
Grade (severity)of episodes of diarrhea is evaluated by patient diaries recorded on a daily basis by considering only worse grade of diarrhea for each patient. Diarrhea was graded according to Common Toxicity Criteria where Grade 1 = Increase of <4 stools/day over pretreatment, Grade 2 = Increase of 4-6 stools/day, or nocturnal stools, Grade 3 = Increase of ≥7 stools/day or incontinence;or need for parenteral support for dehydration and Grade 4= Physiologic consequences requiring intensive care; or hemodynamic collapse.
Percentage of Participants Who Need Chemotherapy Dose Reduction Due to Diarrhea
For patient, chemotherapy dose reduction due to diarrhea as counted each time it occurred. Chemotherapy dose reduction because of other adverse events related to chemotherapy was not considered.
Percentage of Participants Who Need Opioids for Control of Diarrhea
Percentage of Patients Hospitalized Due to Diarrhea
Percentage of Participants Who Need Intravenous Hydration for Control of Diarrhea
Percentage of Participants With Complete or Partial Response at Response Evaluation Criteria in Solid Tumors (RECIST)
Lesions that can be accurately measured in at least one dimension (longest diameter (LD) to be recorded) as > 20 mm with conventional techniques (CT, MRI) or as > 10 mm with spiral CT scan. All measurable lesions up to maximum of 5 lesions per organ and 10 lesions in total representative of all involved organs should be identified as target lesions and recorded and measured at baseline. Complete Response is defined as Disappearance of all target lesions. Partial Response is defined at least a 30% decrease in the sum of LD of target lesions taking as reference the baseline sum LD.
Change From Baseline in Quality of Life Measured by the Functional Assessment of Chronic Illness Therapy-Diarrhea (FACIT-D)
Quality of life (QoL) is evaluated using FACIT-D scale. FACIT-D is composed of 38 items, whose responses range from 0 to 4. The total FACIT-D score may range from 0 to 152. The 38 items compose five subscales, each evaluating a different component of the (QOL). For calculating the subscale score, some items are computed in a reverse fashion, so that higher FACIT-D scores indicate a better (QoL). Descriptive statistics (mean, standard deviation, median, minimum and maximum) are used to summarize FACIT-D scores (total and subscales) by study group at each time point.

Full Information

First Posted
December 21, 2007
Last Updated
April 13, 2015
Sponsor
Novartis Pharmaceuticals
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1. Study Identification

Unique Protocol Identification Number
NCT00582426
Brief Title
Evaluation of Octreotide LAR in Prevention of Chemotherapy-induced Diarrhea
Acronym
LARCID
Official Title
LARCID: Evaluation of Octreotide LAR in Prevention of Chemotherapy-induced Diarrhea
Study Type
Interventional

2. Study Status

Record Verification Date
April 2015
Overall Recruitment Status
Completed
Study Start Date
April 2008 (undefined)
Primary Completion Date
September 2010 (Actual)
Study Completion Date
September 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Novartis Pharmaceuticals

4. Oversight

5. Study Description

Brief Summary
This study will evaluate the efficacy of Octreotide LAR in preventing chemotherapy-induced diarrhea (with regimens that contain 5 fluorouracil, irinotecan and capecitabine)in patients with colorectal cancer.
Detailed Description
Eligible patients will have a diagnosis of colorectal cancer, and will be candidates to adjuvant chemotherapy or first-line chemotherapy for metastatic disease with a regimen containing fluorouracil, capecitabine and/or irinotecan. Eligible chemotherapy regimens include Irinotecan, Leucovorin (folinic acid), and Fluorouracil(IFL), Leucovorin, Fluorouracil, and Irinotecan (FOLFIRI), combinations of Irinotecan and Capecitabine, the Roswell Park regimen and the Mayo Clinic regimen, all of them without or with Oxaliplatin, Bevacizumab or Cetuximab. Patients receiving Erlotinib, or other Tyrosine-kinase, Epidermal Growth Factor Receptor (EGFR)-inhibitors, will not be eligible. The acute treatment for diarrhea will be left to physician's discretion in both groups. Patients in the control arm will be treated without Octreotide LAR. Patients in the experimental arm will receive the first dose of Octreotide LAR (30 mg) at chemotherapy initiation, in addition to a minimum of two more identical monthly doses of Octreotide LAR (with an interval of 28 days between them), until chemotherapy is discontinued or for a maximum of six doses of Octreotide LAR, whichever occurs first. Patient evaluation will be done at each cycle for efficacy and toxicity.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chemotherapy-induced Diarrhea
Keywords
Colorectal cancer, diarrhea, drug therapy, octreotide, fluorouracil, irinotecan, capecitabine, prevention

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
139 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Octreotide Long Acting Release
Arm Type
Experimental
Arm Description
Prevention of Chemotherapy Induced Diarrhea (CID)
Arm Title
Standard Treatment
Arm Type
Other
Arm Description
Physician treatment of choice for chemotherapy induced diarrhea other than Octreotide LAR.
Intervention Type
Drug
Intervention Name(s)
Octreotide Long Acting Release
Other Intervention Name(s)
Octreotide LAR, Sandostatin LAR
Intervention Description
Patients will receive the first dose of Octreotide LAR (30 mg) at chemotherapy initiation, in addition to a minimum of two more identical monthly doses of Octreotide LAR (with an interval of 28 days between them), until first-line chemotherapy is discontinued or for a maximum of six doses of Octreotide LAR, whichever occurs first.
Intervention Type
Other
Intervention Name(s)
Standard Treatment
Intervention Description
Physician treatment of choice for chemotherapy induced diarrhea other than Octreotide LAR.
Primary Outcome Measure Information:
Title
Percentage of Participants Developing Diarrhea (Grade 1 to 4)
Description
The percentage of patients developing diarrhea (incidence of grade 1 to 4) during treatment, considering only the worst grade of diarrhea for each patient. Diarrhea was graded according to Common Toxicity Criteria where Grade 0=None, 1 = Increase of <4 stools/day over pretreatment, Grade 2 = Increase of 4-6 stools/day, or nocturnal stools, Grade 3 = Increase of ≥7 stools/day or incontinence; or need for parenteral support for dehydration and Grade 4= Physiologic consequences requiring intensive care; or hemodynamic collapse.
Time Frame
6 month overall
Secondary Outcome Measure Information:
Title
Number of Episodes of Diarrhea by Patient
Description
Number of episodes of diarrhea is evaluated by patient diaries recorded on a daily basis.
Time Frame
6 months overall
Title
Number of Episodes of Diarrhea by Patient by Cycle
Description
Mean number of episodes of diarrhea is evaluated by patient diaries recorded by cycle. (cycle 1 to cycle 7.)
Time Frame
at each cycle (28 days per cycle)
Title
Percentage of Patients by Grade of Diarrhea
Description
Grade (severity) of episodes of diarrhea is evaluated by patient diaries recorded on a daily basis by considering only worse grade of diarrhea for each patient. Diarrhea was graded according to Common Toxicity Criteria where Grade 0 = None, 1 = Increase of <4 stools/day over pretreatment, Grade 2 = Increase of 4-6 stools/day, or nocturnal stools, Grade 3 = Increase of ≥7 stools/day or incontinence; or need for parenteral support for dehydration and Grade 4= Physiologic consequences requiring intensive care; or hemodynamic collapse.
Time Frame
6 months overall
Title
Percentage of Episodes by Grade
Description
Grade (severity)of episodes of diarrhea is evaluated by patient diaries recorded on a daily basis by considering only worse grade of diarrhea for each patient. Diarrhea was graded according to Common Toxicity Criteria where Grade 1 = Increase of <4 stools/day over pretreatment, Grade 2 = Increase of 4-6 stools/day, or nocturnal stools, Grade 3 = Increase of ≥7 stools/day or incontinence;or need for parenteral support for dehydration and Grade 4= Physiologic consequences requiring intensive care; or hemodynamic collapse.
Time Frame
6 months overall
Title
Percentage of Participants Who Need Chemotherapy Dose Reduction Due to Diarrhea
Description
For patient, chemotherapy dose reduction due to diarrhea as counted each time it occurred. Chemotherapy dose reduction because of other adverse events related to chemotherapy was not considered.
Time Frame
6 months overall
Title
Percentage of Participants Who Need Opioids for Control of Diarrhea
Time Frame
6 months overall
Title
Percentage of Patients Hospitalized Due to Diarrhea
Time Frame
6 months overall
Title
Percentage of Participants Who Need Intravenous Hydration for Control of Diarrhea
Time Frame
6 months overall
Title
Percentage of Participants With Complete or Partial Response at Response Evaluation Criteria in Solid Tumors (RECIST)
Description
Lesions that can be accurately measured in at least one dimension (longest diameter (LD) to be recorded) as > 20 mm with conventional techniques (CT, MRI) or as > 10 mm with spiral CT scan. All measurable lesions up to maximum of 5 lesions per organ and 10 lesions in total representative of all involved organs should be identified as target lesions and recorded and measured at baseline. Complete Response is defined as Disappearance of all target lesions. Partial Response is defined at least a 30% decrease in the sum of LD of target lesions taking as reference the baseline sum LD.
Time Frame
Day 56, Day 84, Day 112, Day 140, Day 168
Title
Change From Baseline in Quality of Life Measured by the Functional Assessment of Chronic Illness Therapy-Diarrhea (FACIT-D)
Description
Quality of life (QoL) is evaluated using FACIT-D scale. FACIT-D is composed of 38 items, whose responses range from 0 to 4. The total FACIT-D score may range from 0 to 152. The 38 items compose five subscales, each evaluating a different component of the (QOL). For calculating the subscale score, some items are computed in a reverse fashion, so that higher FACIT-D scores indicate a better (QoL). Descriptive statistics (mean, standard deviation, median, minimum and maximum) are used to summarize FACIT-D scores (total and subscales) by study group at each time point.
Time Frame
Baseline to Day 168

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: Providing a written informed consent Age between 18 and 80 years; Histological diagnosis of colorectal cancer, presence of metastatic disease and no prior systemic therapy for metastatic disease (prior adjuvant therapy will be allowed if completed 6 months or longer before inclusion in the study); Indication of treatment, according to the judgment of the investigator, with a chemotherapy regimen containing either 5-FU, capecitabine, or irinotecan; any such regimen may also include oxaliplatin, bevacizumab, or cetuximab; A performance status of 0 or 1 according to the Eastern Cooperative Oncology Group (ECOG) scale Adequate organ function and lab values within specific ranges Female patients of childbearing potential must have a negative serum pregnancy test within 7 days prior to registration; Fertile patients (male or female) must agree to use an acceptable method of contraception to avoid pregnancy for the duration of the study and for 3 months after study termination; No prior use of octreotide in any formulation. Exclusion criteria: Use of concomitant antineoplastic treatments, other than regimens containing either 5-FU, capecitabine, or irinotecan with or without oxaliplatin, bevacizumab, or cetuximab; Previous or concomitant need for radiotherapy to the abdomen or pelvis; Indication of treatment, according to the judgment of the investigator, with erlotinib, gefitinib, panitumumab, or other EGFR-inhibitors other than cetuximab; A second malignancy (except in situ carcinoma of the cervix, in situ carcinoma of the bladder, adequately treated basal-cell or squamous-cell carcinoma of the skin, or another malignancy treated more than 5 years prior to enrollment and without recurrence); Any type of condition leading to chronic diarrhea, including, but not limited to inflammatory bowel disease (e.g., ulcerative colitis and Crohn's disease), chronic diarrhea of presumed or confirmed infectious origin, and irritable bowel syndrome; Active or uncontrolled concurrent medical condition, including, but not limited to, unstable angina, congestive heart failure, coronary artery disease, hypertension, diabetes mellitus, and hyper- or hypothyroidism; Active and ongoing systemic infection; Serious uncontrolled psychiatric illness; Ongoing pregnancy or lactation; Female patients who are pregnant or lactating, or are of childbearing potential and would not practice a medically acceptable method for birth control; Lesions that have been irradiated cannot be included as sites of measurable disease. If the only measurable lesion was previously irradiated the patient cannot be included; Use of any investigational agent within 30 days prior to enrollment in the study or foreseen use of an investigational agent during the study; History of chronic (≥ 30 nonconsecutive days) use of laxatives; Concurrent use of antidiarrheal agents; Inability to comply with the study protocol. Other protocol-defined inclusion/exclusion criteria may apply.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Novartis Pharmaceuticals
Organizational Affiliation
Novartis Pharmaceuticals
Official's Role
Study Director
Facility Information:
Facility Name
Biocâncer
City
Belo Horizonte
Country
Brazil
Facility Name
CEPON-Centro de Pesquisas Oncologicas
City
Florianópolis
Country
Brazil
Facility Name
Hospital Sao Lucas- Faculdade de Medicina da PUCRS
City
Porto Alegre
Country
Brazil
Facility Name
Clínica AMO
City
Salvador
Country
Brazil
Facility Name
Nucleo de Oncologia da Bahia
City
Salvador
Country
Brazil
Facility Name
Faculdade de Medicina do ABC
City
Santo André
Country
Brazil
Facility Name
Hosital Alemão Oswaldo Cruz
City
São Paulo
Country
Brazil
Facility Name
Hospital A C Camargo/ Fundação Antonio Prudente
City
São Paulo
Country
Brazil
Facility Name
Hospital das Clínicas - FMUSP
City
São Paulo
Country
Brazil
Facility Name
Instituto Arnaldo Vieira de Carvalho - IAVC
City
São Paulo
Country
Brazil
Facility Name
UNIFESP
City
São Paulo
Country
Brazil

12. IPD Sharing Statement

Citations:
PubMed Identifier
24516038
Citation
Hoff PM, Saragiotto DF, Barrios CH, del Giglio A, Coutinho AK, Andrade AC, Dutra C, Forones NM, Correa M, Portella Mdo S, Passos VQ, Chinen RN, van Eyll B. Randomized phase III trial exploring the use of long-acting release octreotide in the prevention of chemotherapy-induced diarrhea in patients with colorectal cancer: the LARCID trial. J Clin Oncol. 2014 Apr 1;32(10):1006-11. doi: 10.1200/JCO.2013.50.8077. Epub 2014 Feb 10.
Results Reference
derived

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Evaluation of Octreotide LAR in Prevention of Chemotherapy-induced Diarrhea

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