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Bevacizumab for Treatment of Recurrent Respiratory Papillomatosis (RRP)

Primary Purpose

Recurrent Respiratory Papillomatosis

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Avastin® (bevacizumab)
Saline
Sponsored by
Massachusetts General Hospital
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Recurrent Respiratory Papillomatosis

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female patients with dysphonia that have been diagnosed with Recurrent Respiratory Papillomatosis (RRP) of the vocal folds
  • Age between 18 and 60 years old
  • Female patients must be surgically sterilized, postmenopausal, or employ adequate contraception. Criteria for menopause are surgical menopause (hysterectomy, oophorectomy) or age > 45 years with absence of menses for greater than 12 months and an elevated serum Hormone, follicle-stimulating (FSH) (> 25 mIU/mL). Tubal ligation with menses within the past 12 months is not considered to be surgical sterilization.
  • Have bilateral glottal papillomatosis (i.e., involving both the right and left vocal folds)
  • Willing and able to comply with the investigational nature of the study and able to communicate well with investigators.
  • Ability to comprehend and willingness to provide written informed consent in accordance with institutional and regulatory guidelines.

Exclusion Criteria:

  • Have known sensitivity to bevacizumab
  • Have been treated systemically with bevacizumab within 4 months (approximately 6 half-lives).
  • Have hematocrits < 30, elevated PT or PTT levels more than 1.2 X the upper limit of normal (ULN) or absolute platelet counts below the lower limit of normal (LLN).
  • Have absolute neutrophil counts below 1500
  • Have urine dipsticks positive for ≥3+ proteinuria will have spot urine collections and those patients with urine protein to urine creatinine ratios greater than 1.5.
  • Have a history of congestive heart failure, angina that remains symptomatic despite medications, myocardial infarction or coronary artery disease-related procedure within the past 6 months (including angioplasty, stent placement, bypass graft surgery) or who have prosthetic heart valves.
  • Have significant uncontrolled hypertension (systolic blood pressure above 160 and/or diastolic blood pressure above 100).
  • Have had surgeries within 1 month of enrollment or who have un-healed surgical incisions at screening.
  • Have a history of thromboembolic events, gastro-intestinal (GI) ulcer or bleeding, or with a history of wound dehiscence.
  • Female patients that are pregnant, nursing or plan to nurse during the up to 18 months of treatment period.
  • Patients with a history of bleeding disorders, documented platelet dysfunction, current use of anti-platelet drugs, or abnormal prothrombin time (PT) or activated partial thromboplastin timea (PTT) laboratory values as defined in number 3 above.

Sites / Locations

  • Massachusetts General Hospital

Outcomes

Primary Outcome Measures

The Primary Activity Variable Was the Recurrence of Recurrent Respiratory Papillomatosis (RRP) in Bevacizumab Treated and the Un-treated Vocal Fold in the Same Patient During and at the End of the 6-month Treatment Period.
Prior to each treatment,the area of reappearance of disease was measured and the % change from baseline was calculated. The change was then added to the % change from the previous treatment to generate a cumulative total % change of reappearance of RRP from baseline. The additive nature of this parameter resulted in % greater than 100% if the area of vocal fold affected by the RRP increased over the baseline measurement.

Secondary Outcome Measures

Full Information

First Posted
November 13, 2009
Last Updated
December 18, 2012
Sponsor
Massachusetts General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT01020747
Brief Title
Bevacizumab for Treatment of Recurrent Respiratory Papillomatosis (RRP)
Official Title
A Pilot Study to Evaluate the Effects of Antiangiogenic Factor as an Adjunct Treatment After Photoangiolysis in Patients With Bilateral Recurrent Respiratory Papillomatosis of the Vocal Fold
Study Type
Interventional

2. Study Status

Record Verification Date
December 2012
Overall Recruitment Status
Completed
Study Start Date
November 2009 (undefined)
Primary Completion Date
March 2011 (Actual)
Study Completion Date
March 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Massachusetts General Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This phase I single center open labeled study is planned to assess the safety and tolerability of bevacizumab for treating patients with bilateral Recurrent Respiratory Papillomatosis (RRP). Approximately 20 patients will receive bevacizumab directly injected into the vocal folds. Patients who enroll in the protocol will be injected with bevacizumab in one vocal fold that represents the more diseased of the two folds. A sham injection with saline will be administered to the other vocal fold as the control. This therapy will be administered once every 6 ± 1 week for 6 months, with the same vocal fold selected for the initial treatment always getting the drug injection. The investigator will also treat lesions by laser photoangiolysis of both vocal folds using the 532 nm potassium-titanyl-phosphate (KTP) laser.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Recurrent Respiratory Papillomatosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Actual)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
Avastin® (bevacizumab)
Other Intervention Name(s)
Avastin®
Intervention Description
Bevacizumab injections (~7.5-12.5mg in 0.3 - 0.5 c.c.) into diseased vocal folds in conjunction with 532 nm pulsed-KTP laser photoangiolysis, administered every 6 ±1 weeks, for a total of 5 treatments. No patient will have an injection volume exceed 0.5 cc. for any single treatment. If initial results indicate a benefit, as described below, an extension of the active treatment period will be permitted up to a total treatment duration of 18 months.
Intervention Type
Drug
Intervention Name(s)
Saline
Intervention Description
A sham injection with saline (0.3-0.5 cc) has been administered to the other vocal fold as the control. This therapy will be administered once every 6 ± 1 week for 6 months, with the same vocal fold selected for the initial treatment always getting the drug injection.
Primary Outcome Measure Information:
Title
The Primary Activity Variable Was the Recurrence of Recurrent Respiratory Papillomatosis (RRP) in Bevacizumab Treated and the Un-treated Vocal Fold in the Same Patient During and at the End of the 6-month Treatment Period.
Description
Prior to each treatment,the area of reappearance of disease was measured and the % change from baseline was calculated. The change was then added to the % change from the previous treatment to generate a cumulative total % change of reappearance of RRP from baseline. The additive nature of this parameter resulted in % greater than 100% if the area of vocal fold affected by the RRP increased over the baseline measurement.
Time Frame
6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female patients with dysphonia that have been diagnosed with Recurrent Respiratory Papillomatosis (RRP) of the vocal folds Age between 18 and 60 years old Female patients must be surgically sterilized, postmenopausal, or employ adequate contraception. Criteria for menopause are surgical menopause (hysterectomy, oophorectomy) or age > 45 years with absence of menses for greater than 12 months and an elevated serum Hormone, follicle-stimulating (FSH) (> 25 mIU/mL). Tubal ligation with menses within the past 12 months is not considered to be surgical sterilization. Have bilateral glottal papillomatosis (i.e., involving both the right and left vocal folds) Willing and able to comply with the investigational nature of the study and able to communicate well with investigators. Ability to comprehend and willingness to provide written informed consent in accordance with institutional and regulatory guidelines. Exclusion Criteria: Have known sensitivity to bevacizumab Have been treated systemically with bevacizumab within 4 months (approximately 6 half-lives). Have hematocrits < 30, elevated PT or PTT levels more than 1.2 X the upper limit of normal (ULN) or absolute platelet counts below the lower limit of normal (LLN). Have absolute neutrophil counts below 1500 Have urine dipsticks positive for ≥3+ proteinuria will have spot urine collections and those patients with urine protein to urine creatinine ratios greater than 1.5. Have a history of congestive heart failure, angina that remains symptomatic despite medications, myocardial infarction or coronary artery disease-related procedure within the past 6 months (including angioplasty, stent placement, bypass graft surgery) or who have prosthetic heart valves. Have significant uncontrolled hypertension (systolic blood pressure above 160 and/or diastolic blood pressure above 100). Have had surgeries within 1 month of enrollment or who have un-healed surgical incisions at screening. Have a history of thromboembolic events, gastro-intestinal (GI) ulcer or bleeding, or with a history of wound dehiscence. Female patients that are pregnant, nursing or plan to nurse during the up to 18 months of treatment period. Patients with a history of bleeding disorders, documented platelet dysfunction, current use of anti-platelet drugs, or abnormal prothrombin time (PT) or activated partial thromboplastin timea (PTT) laboratory values as defined in number 3 above.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Steven M Zeitels, MD
Organizational Affiliation
Massachusetts General Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02114
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
6836297
Citation
Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983 Apr 29;220(4596):524-7. doi: 10.1126/science.6836297.
Results Reference
background
PubMed Identifier
10406310
Citation
Armstrong LR, Derkay CS, Reeves WC. Initial results from the national registry for juvenile-onset recurrent respiratory papillomatosis. RRP Task Force. Arch Otolaryngol Head Neck Surg. 1999 Jul;125(7):743-8. doi: 10.1001/archotol.125.7.743.
Results Reference
background
PubMed Identifier
16458968
Citation
Avery RL, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA, Giust MJ. Intravitreal bevacizumab (Avastin) for neovascular age-related macular degeneration. Ophthalmology. 2006 Mar;113(3):363-372.e5. doi: 10.1016/j.ophtha.2005.11.019. Epub 2006 Feb 3.
Results Reference
background
PubMed Identifier
17585283
Citation
Burns JA, Zeitels SM, Akst LM, Broadhurst MS, Hillman RE, Anderson R. 532 nm pulsed potassium-titanyl-phosphate laser treatment of laryngeal papillomatosis under general anesthesia. Laryngoscope. 2007 Aug;117(8):1500-4. doi: 10.1097/MLG.0b013e318064e869.
Results Reference
background
PubMed Identifier
11568620
Citation
Dedo HH, Yu KC. CO(2) laser treatment in 244 patients with respiratory papillomas. Laryngoscope. 2001 Sep;111(9):1639-44. doi: 10.1097/00005537-200109000-00028.
Results Reference
background
PubMed Identifier
7488368
Citation
Derkay CS. Task force on recurrent respiratory papillomas. A preliminary report. Arch Otolaryngol Head Neck Surg. 1995 Dec;121(12):1386-91. doi: 10.1001/archotol.1995.01890120044008.
Results Reference
background
PubMed Identifier
16409133
Citation
Folkman J. Angiogenesis. Annu Rev Med. 2006;57:1-18. doi: 10.1146/annurev.med.57.121304.131306.
Results Reference
background
PubMed Identifier
12090703
Citation
Franco RA Jr, Zeitels SM, Farinelli WA, Anderson RR. 585-nm pulsed dye laser treatment of glottal papillomatosis. Ann Otol Rhinol Laryngol. 2002 Jun;111(6):486-92. doi: 10.1177/000348940211100603.
Results Reference
background
PubMed Identifier
16854824
Citation
Fung AE, Rosenfeld PJ, Reichel E. The International Intravitreal Bevacizumab Safety Survey: using the internet to assess drug safety worldwide. Br J Ophthalmol. 2006 Nov;90(11):1344-9. doi: 10.1136/bjo.2006.099598. Epub 2006 Jul 19.
Results Reference
background
PubMed Identifier
15175435
Citation
Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, Berlin J, Baron A, Griffing S, Holmgren E, Ferrara N, Fyfe G, Rogers B, Ross R, Kabbinavar F. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med. 2004 Jun 3;350(23):2335-42. doi: 10.1056/NEJMoa032691.
Results Reference
background
PubMed Identifier
17244226
Citation
Kernt M, Neubauer AS, Kampik A. Intravitreal bevacizumab (Avastin) treatment is safe in terms of intraocular and blood pressure. Acta Ophthalmol Scand. 2007 Feb;85(1):119-20. doi: 10.1111/j.1600-0420.2006.00819.x. No abstract available.
Results Reference
background
PubMed Identifier
17257126
Citation
Meert AP, Feoli F, Martin B, Ninane V, Sculier JP. Angiogenesis in preinvasive, early invasive bronchial lesions and micropapillomatosis and correlation with EGFR expression. Histopathology. 2007 Feb;50(3):311-7. doi: 10.1111/j.1365-2559.2007.02610.x.
Results Reference
background
PubMed Identifier
6291043
Citation
Mounts P, Shah KV, Kashima H. Viral etiology of juvenile- and adult-onset squamous papilloma of the larynx. Proc Natl Acad Sci U S A. 1982 Sep;79(17):5425-9. doi: 10.1073/pnas.79.17.5425.
Results Reference
background
PubMed Identifier
11568590
Citation
Parsons DS, Bothwell MR. Powered instrument papilloma excision: an alternative to laser therapy for recurrent respiratory papilloma. Laryngoscope. 2001 Aug;111(8):1494-6. doi: 10.1097/00005537-200108000-00030. No abstract available.
Results Reference
background
PubMed Identifier
15895784
Citation
Rahbar R, Vargas SO, Folkman J, McGill TJ, Healy GB, Tan X, Brown LF. Role of vascular endothelial growth factor-A in recurrent respiratory papillomatosis. Ann Otol Rhinol Laryngol. 2005 Apr;114(4):289-95. doi: 10.1177/000348940511400407.
Results Reference
background
PubMed Identifier
15470443
Citation
Ratner M. Genentech discloses safety concerns over Avastin. Nat Biotechnol. 2004 Oct;22(10):1198. doi: 10.1038/nbt1004-1198. No abstract available.
Results Reference
background
PubMed Identifier
18952553
Citation
Sachdev JC, Jahanzeb M. Evolution of bevacizumab-based therapy in the management of breast cancer. Clin Breast Cancer. 2008 Oct;8(5):402-10. doi: 10.3816/CBC.2008.n.048.
Results Reference
background
PubMed Identifier
16006276
Citation
Shehab N, Sweet BV, Hogikyan ND. Cidofovir for the treatment of recurrent respiratory papillomatosis: a review of the literature. Pharmacotherapy. 2005 Jul;25(7):977-89. doi: 10.1592/phco.2005.25.7.977.
Results Reference
background
PubMed Identifier
16603955
Citation
Spaide RF, Laud K, Fine HF, Klancnik JM Jr, Meyerle CB, Yannuzzi LA, Sorenson J, Slakter J, Fisher YL, Cooney MJ. Intravitreal bevacizumab treatment of choroidal neovascularization secondary to age-related macular degeneration. Retina. 2006 Apr;26(4):383-90. doi: 10.1097/01.iae.0000238561.99283.0e.
Results Reference
background
PubMed Identifier
8842481
Citation
Steinberg BM, DiLorenzo TP. A possible role for human papillomaviruses in head and neck cancer. Cancer Metastasis Rev. 1996 Mar;15(1):91-112. doi: 10.1007/BF00049489.
Results Reference
background
PubMed Identifier
949157
Citation
Strong MS, Vaughan CW, Cooperband SR, Healy GB, Clemente MA. Recurrent respiratory papillomatosis: management with the CO2 laser. Ann Otol Rhinol Laryngol. 1976 Jul-Aug;85(4 Pt 1):508-16. doi: 10.1177/000348947608500412.
Results Reference
background
PubMed Identifier
17674014
Citation
Wu L, Martinez-Castellanos MA, Quiroz-Mercado H, Arevalo JF, Berrocal MH, Farah ME, Maia M, Roca JA, Rodriguez FJ; Pan American Collaborative Retina Group (PACORES). Twelve-month safety of intravitreal injections of bevacizumab (Avastin): results of the Pan-American Collaborative Retina Study Group (PACORES). Graefes Arch Clin Exp Ophthalmol. 2008 Jan;246(1):81-7. doi: 10.1007/s00417-007-0660-z. Epub 2007 Aug 3.
Results Reference
background
Citation
Zeitels, S.M. (2001). In Atlas of Phonomicrosurgery and Other Endolaryngeal Procedures for Benign and Malignant Disease (San Diego).
Results Reference
background
Links:
URL
http://www.gene.com/gene/products/information/oncology/avastin
Description
Avastin package insert and information from the Genentech website.
URL
http://www.rrpwebsite.org/
Description
International RRP ISA site
URL
http://www.rrpf.org/
Description
RRP Foundation website

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Bevacizumab for Treatment of Recurrent Respiratory Papillomatosis (RRP)

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