Linaclotide Acetate in Preventing Colorectal Cancer in Healthy Volunteers
Primary Purpose
Colorectal Cancer, Healthy, no Evidence of Disease
Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
linaclotide acetate
placebo
pharmacological study
laboratory biomarker analysis
Sponsored by

About this trial
This is an interventional basic science trial for Colorectal Cancer
Eligibility Criteria
Inclusion Criteria:
- PRE-REGISTRATION INCLUSION CRITERIA
- Ability to understand and willingness to sign a written informed consent document and follow study procedures
- Willingness to abstain from grapefruit juice, alcohol, and concomitant medications during study
- Willingness to employ adequate contraception for men and women of childbearing potential; acceptable methods include double barrier methods, intrauterine device (IUD), postmenopausal status documented by serum follicle-stimulating hormone (FSH), and/or documentation of surgical sterilization
- Body mass index < 35 kg/m^2
- Willingness to provide blood and tissue specimens for research purposes
- REGISTRATION INCLUSION CRITERIA
- Participants must have normal organ function and have normal laboratory findings without clinically significant findings
- Satisfactory anesthesia and intestinal preparation, with no findings of advanced adenoma, chronic inflammation, or cancer
Exclusion Criteria:
- PRE-REGISTRATION EXCLUSION CRITERIA
- Previous personal history of advanced adenomas (>= 1 cm in maximal diameter, >= 3 in total number, villous morphology, or high-grade dysplasia) or colorectal cancer
- Family history of polyposis syndrome (e.g., familial adenomatous polyposis [FAP], hereditary non-polyposis colorectal cancer [HNPCC]) or colorectal cancer (first degree relatives younger than 60 years old)
- History of gastroparesis
- History of surgery involving the luminal gastrointestinal (GI) tract, including bariatric surgery
- History of celiac disease
- Inflammatory bowel disease (Crohn's disease, ulcerative colitis)
- Irritable bowel syndrome, chronic constipation, functional bowel disorders, or colonic motility disorder
- Any malignancy within 3 years of baseline; participants with a history of basal cell or squamous cell skin cancer may be enrolled at the discretion of the investigator
- Participants may not be receiving any other investigational agents
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to linaclotide
- History of difficulty with colonoscopy or abnormal colorectal anatomy
- Uncontrolled current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
- Pregnant or lactating women
- Use of laxatives more than 3 times per week
- Intestinal motility agents, histamine-2 inverse agonists (H-2 blockers), or proton pump inhibitors
- Current use of >= 5 cigarettes/day
- Current use of >= 3 alcoholic drinks/day
- Use anti-platelet agents within two weeks of anticipated colonoscopy
- Use of anti-coagulants within two weeks of anticipated colonoscopy
- History of bleeding/coagulation problems
- Prior intolerance of or contraindications for the use of sedation or anesthetic agents, which would prevent the safe use of sedation for colonoscopy; this includes allergies to eggs and soy products
- Any medical condition judged by the investigator to constitute a risk to safe participation
- REGISTRATION EXCLUSION CRITERIA
- Colonoscopic finding requiring clinical intervention
- Use of any illicit or illegal substances detected by urinary drug screen
- Inadequate pre-intervention bowel preparation, as determined by the study physician
Sites / Locations
- Thomas Jefferson University
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Placebo Comparator
Arm Label
Arm I (linaclotide acetate)
Arm II (placebo)
Arm Description
Participants receive linaclotide acetate PO QD on days 1-7.
Participants receive placebo PO QD on days 1-7.
Outcomes
Primary Outcome Measures
Dose of linaclotide acetate that produces a 60% response rate for cGMP levels in rectal tissue by radioimmunoassay (RIA)
The pharmacological effect is measured by the arithmetic difference in mean cGMP levels before and after 7 days of linaclotide acetate in biopsies from the colonoscopy. The mean cGMP value will be calculated based on 2 biopsies from the rectum assessed at each time point. The PD response is measured by the difference in mean cGMP levels after 7 days.
Secondary Outcome Measures
Incidence of adverse events associated with linaclotide acetate assessed using the Common Terminology Criteria for Adverse Events version 4.0
Summary statistics, frequency tables, and non-parametric tests will be used to describe the distributions of adverse events.
PD effect of linaclotide acetate on cGMP levels from the transverse colon to the cecum
Change in cGMP levels between all assigned doses, analyzed sequentially from the rectum, transverse colon, and cecum
Summary statistics and nonparametric tests will be used to compare the change in the cGMP levels between the different dose levels of linaclotide acetate and placebo.
PD effect on cGMP levels (Stage II)
Changes in cGMP levels from baseline to day 6 will also be assessed using summary statistics and nonparametric tests.
Full Information
NCT ID
NCT01950403
First Posted
September 23, 2013
Last Updated
November 23, 2022
Sponsor
Mayo Clinic
Collaborators
National Cancer Institute (NCI)
1. Study Identification
Unique Protocol Identification Number
NCT01950403
Brief Title
Linaclotide Acetate in Preventing Colorectal Cancer in Healthy Volunteers
Official Title
Phase I, Randomized, Placebo-Controlled Trial of Linaclotide to Demonstrate Colorectal Bioactivity in Healthy Volunteers
Study Type
Interventional
2. Study Status
Record Verification Date
May 2018
Overall Recruitment Status
Completed
Study Start Date
September 2013 (Actual)
Primary Completion Date
April 28, 2016 (Actual)
Study Completion Date
February 22, 2018 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Mayo Clinic
Collaborators
National Cancer Institute (NCI)
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
This randomized phase I trial studies the side effects and best dose of linaclotide acetate in preventing colorectal cancer in healthy volunteers. Chemoprevention is the use of certain drugs to keep cancer from forming. The use of linaclotide acetate may prevent colorectal cancer.
Detailed Description
PRIMARY OBJECTIVES:
I. To assess the pharmacodynamic effect (PD) of linaclotide (linaclotide acetate) (single daily dose x 7 days, stage I cohort dose= 0.870 mg/day) on cyclic guanosine monophosphate (cGMP) levels, based on biopsy samples obtained pre- and post-intervention from the rectum, until an effect is documented.
SECONDARY OBJECTIVES:
I. To confirm the safety and tolerability of linaclotide. II. To assess the pharmacodynamic effect of linaclotide on cGMP levels, analyzed sequentially from the transverse colon to the cecum, if no cGMP effect was observed in the rectum for the primary endpoint.
III. To compare the change in the cGMP levels from baseline to day 7 between all the assigned doses of linaclotide (including placebo), analyzed sequentially from the rectum, transverse colon, and cecum.
IV. If the study proceeds to stage II, the pharmacodynamic effect of linaclotide on cGMP levels will be assessed from day 6 rectal biopsies (un-prepped).
TERTIARY OBJECTIVES:
I. To assess the pharmacodynamic effect of linaclotide on an additional pathway-specific biomarkers relevant to guanylate cyclase C (GCC) signaling (i.e., vasodilator-stimulated phosphoprotein [VASP] phosphorylation) and a marker of general proliferation (Ki67 expression), based on intestinal mucosa biopsy samples obtained by colonoscopy pre- and post-exposure at the anatomical location (rectum, transverse colon, or cecum) in which cGMP is elevated following linaclotide exposure.
OUTLINE: This is a dose-escalation study. Participants are randomized to 1 of 2 treatment arms.
ARM I: Participants receive linaclotide acetate orally (PO) once daily (QD) on days 1-7.
ARM II: Participants receive placebo PO QD on days 1-7.
After completion of treatment, participants are followed up for 21-51 days.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Colorectal Cancer, Healthy, no Evidence of Disease
7. Study Design
Primary Purpose
Basic Science
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
24 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Arm I (linaclotide acetate)
Arm Type
Experimental
Arm Description
Participants receive linaclotide acetate PO QD on days 1-7.
Arm Title
Arm II (placebo)
Arm Type
Placebo Comparator
Arm Description
Participants receive placebo PO QD on days 1-7.
Intervention Type
Drug
Intervention Name(s)
linaclotide acetate
Other Intervention Name(s)
Linzess, MD-1100 Acetate, MM-416775
Intervention Description
Given PO
Intervention Type
Other
Intervention Name(s)
placebo
Other Intervention Name(s)
PLCB
Intervention Description
Given PO
Intervention Type
Other
Intervention Name(s)
pharmacological study
Other Intervention Name(s)
pharmacological studies
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
laboratory biomarker analysis
Intervention Description
Correlative studies
Primary Outcome Measure Information:
Title
Dose of linaclotide acetate that produces a 60% response rate for cGMP levels in rectal tissue by radioimmunoassay (RIA)
Description
The pharmacological effect is measured by the arithmetic difference in mean cGMP levels before and after 7 days of linaclotide acetate in biopsies from the colonoscopy. The mean cGMP value will be calculated based on 2 biopsies from the rectum assessed at each time point. The PD response is measured by the difference in mean cGMP levels after 7 days.
Time Frame
Baseline to 7 days
Secondary Outcome Measure Information:
Title
Incidence of adverse events associated with linaclotide acetate assessed using the Common Terminology Criteria for Adverse Events version 4.0
Description
Summary statistics, frequency tables, and non-parametric tests will be used to describe the distributions of adverse events.
Time Frame
Up to 51 days
Title
PD effect of linaclotide acetate on cGMP levels from the transverse colon to the cecum
Time Frame
Up to 7 days
Title
Change in cGMP levels between all assigned doses, analyzed sequentially from the rectum, transverse colon, and cecum
Description
Summary statistics and nonparametric tests will be used to compare the change in the cGMP levels between the different dose levels of linaclotide acetate and placebo.
Time Frame
Baseline to 7 days
Title
PD effect on cGMP levels (Stage II)
Description
Changes in cGMP levels from baseline to day 6 will also be assessed using summary statistics and nonparametric tests.
Time Frame
Up to 6 days
Other Pre-specified Outcome Measures:
Title
PD effect of linaclotide acetate on GCC signaling (i.e., VASP phosphorylation) and general proliferation (Ki67 expression)
Description
Summary statistics, frequency tables, non-parametric tests, and graphical methods will be used to describe the distributions of cGMP levels relative to linaclotide acetate dose levels and biomarkers. Linear and logistic regression models may also be used as appropriate.
Time Frame
Up to 7 days
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
PRE-REGISTRATION INCLUSION CRITERIA
Ability to understand and willingness to sign a written informed consent document and follow study procedures
Willingness to abstain from grapefruit juice, alcohol, and concomitant medications during study
Willingness to employ adequate contraception for men and women of childbearing potential; acceptable methods include double barrier methods, intrauterine device (IUD), postmenopausal status documented by serum follicle-stimulating hormone (FSH), and/or documentation of surgical sterilization
Body mass index < 35 kg/m^2
Willingness to provide blood and tissue specimens for research purposes
REGISTRATION INCLUSION CRITERIA
Participants must have normal organ function and have normal laboratory findings without clinically significant findings
Satisfactory anesthesia and intestinal preparation, with no findings of advanced adenoma, chronic inflammation, or cancer
Exclusion Criteria:
PRE-REGISTRATION EXCLUSION CRITERIA
Previous personal history of advanced adenomas (>= 1 cm in maximal diameter, >= 3 in total number, villous morphology, or high-grade dysplasia) or colorectal cancer
Family history of polyposis syndrome (e.g., familial adenomatous polyposis [FAP], hereditary non-polyposis colorectal cancer [HNPCC]) or colorectal cancer (first degree relatives younger than 60 years old)
History of gastroparesis
History of surgery involving the luminal gastrointestinal (GI) tract, including bariatric surgery
History of celiac disease
Inflammatory bowel disease (Crohn's disease, ulcerative colitis)
Irritable bowel syndrome, chronic constipation, functional bowel disorders, or colonic motility disorder
Any malignancy within 3 years of baseline; participants with a history of basal cell or squamous cell skin cancer may be enrolled at the discretion of the investigator
Participants may not be receiving any other investigational agents
History of allergic reactions attributed to compounds of similar chemical or biologic composition to linaclotide
History of difficulty with colonoscopy or abnormal colorectal anatomy
Uncontrolled current illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Pregnant or lactating women
Use of laxatives more than 3 times per week
Intestinal motility agents, histamine-2 inverse agonists (H-2 blockers), or proton pump inhibitors
Current use of >= 5 cigarettes/day
Current use of >= 3 alcoholic drinks/day
Use anti-platelet agents within two weeks of anticipated colonoscopy
Use of anti-coagulants within two weeks of anticipated colonoscopy
History of bleeding/coagulation problems
Prior intolerance of or contraindications for the use of sedation or anesthetic agents, which would prevent the safe use of sedation for colonoscopy; this includes allergies to eggs and soy products
Any medical condition judged by the investigator to constitute a risk to safe participation
REGISTRATION EXCLUSION CRITERIA
Colonoscopic finding requiring clinical intervention
Use of any illicit or illegal substances detected by urinary drug screen
Inadequate pre-intervention bowel preparation, as determined by the study physician
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Paul Limburg
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Thomas Jefferson University
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
12. IPD Sharing Statement
Learn more about this trial
Linaclotide Acetate in Preventing Colorectal Cancer in Healthy Volunteers
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