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A Clinical Trial of COX and EGFR Inhibition in Familial Polyposis Patients (FAPEST)

Primary Purpose

Adenomatous Polyposis Coli

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Erlotinib
Sulindac
Placebo A
Placebo B
Sponsored by
University of Utah
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Adenomatous Polyposis Coli focused on measuring Familial Adenomatous Polyposis, Attenuated Familial Polyposis

Eligibility Criteria

18 Years - 69 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients who are 18 years or older with a clinical or genetic diagnosis of FAP or attenuated FAP.
  • Presence of duodenal polyps with a sum of diameters ≥ 5mm.
  • Minimum of two weeks since any major surgery
  • WHO performance status ≤1
  • Adequate bone marrow function as show by: normal leukocyte count, platelet count ≥ 120 x 109/L, Hgb > 12 g/dL
  • Adequate liver function as shown by: normal serum bilirubin(≤ 1.5 Upper Limit Normal {ULN}) and serum transaminases (≤ 2.0 ULN)
  • Patient must discontinue taking any Nonsteroidal anti-inflammatory drugs (NSAIDS) within one month of treatment initiation.
  • Patients must be able to provide written informed consent.

Exclusion Criteria:

  • Prior treatment with any investigational drug within the preceding 4 weeks.
  • Malignancies within the past 3 years except for adequately treated carcinoma of the cervix or basal or squamous cell carcinomas of the skins.
  • Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study as determined by the Principal Investigator such as:

    1. Unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction ≤ 6 months prior to first study treatment, serious uncontrolled cardiac arrhythmia
    2. Severely impaired lung function
    3. Any active (acute or chronic) or uncontrolled infection/ disorders.
    4. Nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by the treatment with the study therapy
    5. Liver disease such as cirrhosis, chronic active hepatitis or chronic persistent hepatitis
  • Screening clinical laboratory values that indicate any of the following:

    1. anemia
    2. thrombocytopenia
    3. leucopenia
    4. elevations of transaminases greater than 2X ULN
    5. elevation of bilirubin > 1.5 X ULN
    6. alkaline phosphatase elevation > 1.5 X ULN
    7. increased creatinine, urinary protein, or urinary casts outside the clinically normal range.
  • Gastrointestinal bleeding (symptoms including dyspnea, fatigue, angina, weakness, malaise, melena, hematochezia, hematemesis, anemia or abdominal pain will require clinical assessment to rule out gastrointestinal bleeding).
  • Patient who is currently taking any anti-coagulation medication.
  • Women who are pregnant or breast feeding.
  • Patients with a known hypersensitivity to sulindac or erlotinib or to their excipients

Sites / Locations

  • Huntsman Cancer Institute

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Erlotinib and Sulindac

Placebo A and Placebo B

Arm Description

Erlotinib 75 mg per day in combination with sulindac 150 mg twice daily for 6 months.

Placebo capsules matching erlotinib active comparator (Placebo A) once daily and placebo capsules matching sulindac active comparator (Placebo B) twice daily for 6 months

Outcomes

Primary Outcome Measures

Change in Duodenal Polyp Burden From Baseline to 6 Months
A comparison between the Sulindac-erlotinib and Placebo arms of the change in polyp burden from a 10-centimeter segment of the duodenum, measured as the sum of the diameters of the polyps, in millimeters (mm), from the duodenal segment (6-month polyp burden minus baseline polyp burden).

Secondary Outcome Measures

Change in Duodenal Polyp Burden From Baseline to 6 Months in Classic Familial Adenomatous Polyposis (FAP) Participants
A comparison between the Sulindac-erlotinib and Placebo arm Classic FAP subgroups of the change in polyp burden from a 10-centimeter segment of the duodenum, measured as the sum of the diameters of the polyps, in millimeters (mm), from the duodenal segment (6-month polyp burden minus baseline polyp burden).
Change in Duodenal Polyp Burden From Baseline to 6 Months in Attenuated FAP Participants
A comparison between the Sulindac-erlotinib and Placebo arm Attenuated FAP subgroups of the change in polyp burden from a 10-centimeter segment of the duodenum, measured as the sum of the diameters of the polyps, in millimeters (mm), from the duodenal segment (6-month polyp burden minus baseline polyp burden).
Change in Number of Duodenal Polyps From Baseline to 6 Months
A comparison between the Sulindac-erlotinib and Placebo arms of the change in number of polyps in a 10-centimeter segment of the duodenum (6-month polyp count minus baseline polyp count).
Change in Number of Duodenal Polyps From Baseline to 6 Months in Classic FAP Participants
A comparison between the Sulindac-erlotinib and Placebo arm Classic FAP subgroups of the change in number of polyps in a 10-centimeter segment of the duodenum (6-month polyp count minus baseline polyp count)
Change in Number of Duodenal Polyps From Baseline to 6 Months in Attenuated FAP Participants
A comparison between the Sulindac-erlotinib and Placebo arm Attenuated FAP subgroups of the change in number of polyps in a 10-centimeter segment of the duodenum (6-month polyp count minus baseline polyp count)

Full Information

First Posted
August 3, 2010
Last Updated
May 10, 2016
Sponsor
University of Utah
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT01187901
Brief Title
A Clinical Trial of COX and EGFR Inhibition in Familial Polyposis Patients
Acronym
FAPEST
Official Title
Genetic Events Leading to APC-Dependent Colon Cancer in High-Risk Families; a Clinical Trial of COX and EGFR Inhibition in Familial Polyposis Patients
Study Type
Interventional

2. Study Status

Record Verification Date
May 2016
Overall Recruitment Status
Completed
Study Start Date
April 2010 (undefined)
Primary Completion Date
June 2014 (Actual)
Study Completion Date
July 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Utah
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to determine in a randomized, placebo-controlled, phase II trial if the combination of sulindac and erlotinib causes a significant regression of duodenal and colorectal adenomas in familial adenomatous polyposis (FAP) and attenuated FAP (AFAP) patients.
Detailed Description
This will be a single-center, phase-II, six-month-long, placebo-controlled, double blinded, randomized trial of the epidermal growth factor receptor (EGFR) inhibitor, erlotinib (Tarceva) and the cyclooxygenase (COX-2) inhibitor, sulindac in patients with familial adenomatous polyposis (FAP) or attenuated FAP. FAP is an autosomal dominant inherited colon cancer predisposition with a 100% risk of colon cancer in the absence of preventive care (endoscopy and surgery). Efficacious chemoprevention for duodenal adenomas is an unmet clinical need in FAP patients that would reduce the morbidity from duodenectomy and risk of duodenal adenocarcinoma. Currently the only Food and Drug Administration (FDA)-approved chemopreventive agent is celecoxib which results in a modest reduction of duodenal and colorectal polyps and is associated with cardiac toxicity at effective doses. If it can be shown that combinatorial inhibition of COX-2 and EGFR activity leads to successful regression in duodenal adenomatous polyps in FAP, it could be used as an effective chemopreventive regimen in FAP patients with duodenal adenomas or who have undergone surgical resection of duodenal adenomas or have many rectal adenomas. FAP and AFAP patients will be screened by endoscopy for presence of 5 or more duodenal polyps, then randomized to either A) erlotinib at 75 mg/day and sulindac at 150 mg/day or B) placebo for 6 months. The endpoint will be endoscopy at 6 months. Primary Aim : To determine if the combination of sulindac and erlotinib causes a significant regression of duodenal polyp burden at 6 mohths in FAP and attenuated FAP patients. Secondary Aim: To measure if combination of sulindac and erlotinib cause a reduction in total duodenal polyp count, and change in duodenal polyp burden or count stratified by genotype and initial polyp burden.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adenomatous Polyposis Coli
Keywords
Familial Adenomatous Polyposis, Attenuated Familial Polyposis

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
92 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Erlotinib and Sulindac
Arm Type
Active Comparator
Arm Description
Erlotinib 75 mg per day in combination with sulindac 150 mg twice daily for 6 months.
Arm Title
Placebo A and Placebo B
Arm Type
Placebo Comparator
Arm Description
Placebo capsules matching erlotinib active comparator (Placebo A) once daily and placebo capsules matching sulindac active comparator (Placebo B) twice daily for 6 months
Intervention Type
Drug
Intervention Name(s)
Erlotinib
Other Intervention Name(s)
Tarceva (NDA#021743)
Intervention Description
Tarceva oral tablets are conventional, immediate-release tablets containing erlotinib as the hydrochloride salt. Erlotinib(75mg)will be taken once daily for six months in combination with sulindac.
Intervention Type
Drug
Intervention Name(s)
Sulindac
Other Intervention Name(s)
Sulindac (ANDA#071891)
Intervention Description
Sulindac is a non-steroidal, anti-inflammatory indene derivative designed for the treatment of arthritic conditions. For this study, sulindac (150mg) will be taken twice daily in combination with erlotinib
Intervention Type
Drug
Intervention Name(s)
Placebo A
Other Intervention Name(s)
Erlotinib placebo
Intervention Description
Erlotinib (Tarceva) will provide a 25 mg identical placebo. This will be provided by the Division of Cancer Prevention at the NIH who will receive the drug and placebo from the manufacturer, OSI/Genentech. Dosage for Placebo A will be 75 mg a day for 6 months.
Intervention Type
Drug
Intervention Name(s)
Placebo B
Other Intervention Name(s)
Sulindac placebo
Intervention Description
Sulindac will be encapsulated in 150 mg doses along with an identical encapsulated Placebo B. One 150 mg capsules of Placebo B will be taken twice per day with meals (breakfast and supper).
Primary Outcome Measure Information:
Title
Change in Duodenal Polyp Burden From Baseline to 6 Months
Description
A comparison between the Sulindac-erlotinib and Placebo arms of the change in polyp burden from a 10-centimeter segment of the duodenum, measured as the sum of the diameters of the polyps, in millimeters (mm), from the duodenal segment (6-month polyp burden minus baseline polyp burden).
Time Frame
Baseline and 6 months
Secondary Outcome Measure Information:
Title
Change in Duodenal Polyp Burden From Baseline to 6 Months in Classic Familial Adenomatous Polyposis (FAP) Participants
Description
A comparison between the Sulindac-erlotinib and Placebo arm Classic FAP subgroups of the change in polyp burden from a 10-centimeter segment of the duodenum, measured as the sum of the diameters of the polyps, in millimeters (mm), from the duodenal segment (6-month polyp burden minus baseline polyp burden).
Time Frame
Baseline and 6 months
Title
Change in Duodenal Polyp Burden From Baseline to 6 Months in Attenuated FAP Participants
Description
A comparison between the Sulindac-erlotinib and Placebo arm Attenuated FAP subgroups of the change in polyp burden from a 10-centimeter segment of the duodenum, measured as the sum of the diameters of the polyps, in millimeters (mm), from the duodenal segment (6-month polyp burden minus baseline polyp burden).
Time Frame
Baseline and 6 months
Title
Change in Number of Duodenal Polyps From Baseline to 6 Months
Description
A comparison between the Sulindac-erlotinib and Placebo arms of the change in number of polyps in a 10-centimeter segment of the duodenum (6-month polyp count minus baseline polyp count).
Time Frame
Baseline and 6 months
Title
Change in Number of Duodenal Polyps From Baseline to 6 Months in Classic FAP Participants
Description
A comparison between the Sulindac-erlotinib and Placebo arm Classic FAP subgroups of the change in number of polyps in a 10-centimeter segment of the duodenum (6-month polyp count minus baseline polyp count)
Time Frame
Baseline and 6 months
Title
Change in Number of Duodenal Polyps From Baseline to 6 Months in Attenuated FAP Participants
Description
A comparison between the Sulindac-erlotinib and Placebo arm Attenuated FAP subgroups of the change in number of polyps in a 10-centimeter segment of the duodenum (6-month polyp count minus baseline polyp count)
Time Frame
Baseline and 6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
69 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients who are 18 years or older with a clinical or genetic diagnosis of FAP or attenuated FAP. Presence of duodenal polyps with a sum of diameters ≥ 5mm. Minimum of two weeks since any major surgery WHO performance status ≤1 Adequate bone marrow function as show by: normal leukocyte count, platelet count ≥ 120 x 109/L, Hgb > 12 g/dL Adequate liver function as shown by: normal serum bilirubin(≤ 1.5 Upper Limit Normal {ULN}) and serum transaminases (≤ 2.0 ULN) Patient must discontinue taking any Nonsteroidal anti-inflammatory drugs (NSAIDS) within one month of treatment initiation. Patients must be able to provide written informed consent. Exclusion Criteria: Prior treatment with any investigational drug within the preceding 4 weeks. Malignancies within the past 3 years except for adequately treated carcinoma of the cervix or basal or squamous cell carcinomas of the skins. Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study as determined by the Principal Investigator such as: Unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction ≤ 6 months prior to first study treatment, serious uncontrolled cardiac arrhythmia Severely impaired lung function Any active (acute or chronic) or uncontrolled infection/ disorders. Nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by the treatment with the study therapy Liver disease such as cirrhosis, chronic active hepatitis or chronic persistent hepatitis Screening clinical laboratory values that indicate any of the following: anemia thrombocytopenia leucopenia elevations of transaminases greater than 2X ULN elevation of bilirubin > 1.5 X ULN alkaline phosphatase elevation > 1.5 X ULN increased creatinine, urinary protein, or urinary casts outside the clinically normal range. Gastrointestinal bleeding (symptoms including dyspnea, fatigue, angina, weakness, malaise, melena, hematochezia, hematemesis, anemia or abdominal pain will require clinical assessment to rule out gastrointestinal bleeding). Patient who is currently taking any anti-coagulation medication. Women who are pregnant or breast feeding. Patients with a known hypersensitivity to sulindac or erlotinib or to their excipients
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Randall Burt, MD
Organizational Affiliation
University of Utah at Huntsman Cancer Institute
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Niloy J Samadder, MD
Organizational Affiliation
University of Utah at Huntsman Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Huntsman Cancer Institute
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84112
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
30012100
Citation
Sample DC, Samadder NJ, Pappas LM, Boucher KM, Samowitz WS, Berry T, Westover M, Nathan D, Kanth P, Byrne KR, Burt RW, Neklason DW. Variables affecting penetrance of gastric and duodenal phenotype in familial adenomatous polyposis patients. BMC Gastroenterol. 2018 Jul 16;18(1):115. doi: 10.1186/s12876-018-0841-8.
Results Reference
derived
PubMed Identifier
29423501
Citation
Samadder NJ, Kuwada SK, Boucher KM, Byrne K, Kanth P, Samowitz W, Jones D, Tavtigian SV, Westover M, Berry T, Jasperson K, Pappas L, Smith L, Sample D, Burt RW, Neklason DW. Association of Sulindac and Erlotinib vs Placebo With Colorectal Neoplasia in Familial Adenomatous Polyposis: Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol. 2018 May 1;4(5):671-677. doi: 10.1001/jamaoncol.2017.5431.
Results Reference
derived
PubMed Identifier
27002448
Citation
Samadder NJ, Neklason DW, Boucher KM, Byrne KR, Kanth P, Samowitz W, Jones D, Tavtigian SV, Done MW, Berry T, Jasperson K, Pappas L, Smith L, Sample D, Davis R, Topham MK, Lynch P, Strait E, McKinnon W, Burt RW, Kuwada SK. Effect of Sulindac and Erlotinib vs Placebo on Duodenal Neoplasia in Familial Adenomatous Polyposis: A Randomized Clinical Trial. JAMA. 2016 Mar 22-29;315(12):1266-75. doi: 10.1001/jama.2016.2522.
Results Reference
derived

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A Clinical Trial of COX and EGFR Inhibition in Familial Polyposis Patients

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