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Safety and Efficacy of Ingenol Mebutate 0.05% Gel When Used After Cryotherapy in the Hypertrophic Actinic Keratoses

Primary Purpose

Actinic Keratoses

Status
Completed
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Ingenol Mebutate
Cryotherapy
Sponsored by
Icahn School of Medicine at Mount Sinai
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Actinic Keratoses focused on measuring Actinic

Eligibility Criteria

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

Inclusion Criteria:

  • Adults at least 18 years old.
  • Subjects must be in good general health as confirmed by the medical history.
  • Subjects must be able to read, sign, and understand the informed consent
  • Prior to cryosurgery, subjects have at least 3 hypertrophic actinic keratoses on each dorsal hand.
  • Subject must be willing to forego any other treatments on the dorsum of the hands, including tanning bed use and excessive sun exposure while in the study.
  • Subject is willing and able to participate in the study as an outpatient, making frequent visits to the study center during the treatment and follow-up periods and to comply with all study requirements including concomitant medication and other treatment restrictions.
  • If subject is a female of childbearing potential she must have a negative urine pregnancy test result prior to study treatment initiation and must agree to use an approved method of birth control while enrolled in the study.

Exclusion Criteria:

  • Subjects with a history of melanoma anywhere on the body.
  • Subjects with an unstable medical condition as deemed by the clinical investigator.
  • Subjects with non-melanoma skin cancer on the dorsum of the hands.
  • Subjects with any dermatologic disease in the treatment area that may be exacerbated by the treatment proposed or that might impair the evaluation of AKs.
  • Subjects who have previously been treated with ingenol mebutate: on the dorsum of the hands in the past 6 months; or outside of the study area within the past 30 days.
  • Women who are pregnant, lactating, or planning to become pregnant during the study period.
  • Subjects who have experienced a clinically important medical event within 90 days of the visit (e.g., stroke, myocardial infarction, etc).
  • Subjects who have active chemical dependency or alcoholism as assessed by the investigator.
  • Subjects who have known allergies to any excipient in the study gel.
  • Subjects who are currently participating in another clinical study or have completed another clinical study with an investigational drug or device on the study area within 30 days prior to study treatment initiation.
  • Subjects who have received any of the following within 90 days prior to study treatment initiation:

    • interferon or interferon inducers
    • cytotoxic drugs
    • immunomodulators or immunosuppressive therapies (inhaled/ intranasal steroids are permitted)
    • oral or parenteral corticosteroids
    • topical corticosteroids if greater than 2 gm/day
    • any dermatologic procedures or surgeries on the study area (including any AK treatments)
  • Subjects who have used any topical prescription medications on the study area within 30 days prior to study treatment initiation.

Sites / Locations

  • Icahn School of Medicine at Mount Sinai

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Combination Therapy

Cryotherapy Alone

Arm Description

Cryotherapy followed by Ingenol Mebutate Gel

Cryotherapy only

Outcomes

Primary Outcome Measures

Safety of Combination Therapy vs Cryotherapy Alone
To evaluate the safety of cryotherapy plus ingenol mebutate on dorsal hands and compare it to the safety of cryotherapy alone looking at Adverse Events.

Secondary Outcome Measures

Change in Number of All Actinic Keratoses
To evaluate and compare the mean reduction in number of all AKs (hypertrophic and non-hypertrophic) on the dorsal hands of the combination cryotherapy- ingenol mebutate treated side vs. the cryotherapy alone side on Day 57 as compared to baseline
Change in Actinic Keratoses by Anatomic Site
To evaluate the number of AKs (both hypertrophic and non-hypertrophic) before therapy by anatomic site (dorsal hand) at Day 57 as compared to baseline

Full Information

First Posted
September 17, 2014
Last Updated
March 15, 2017
Sponsor
Icahn School of Medicine at Mount Sinai
Collaborators
LEO Pharma
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1. Study Identification

Unique Protocol Identification Number
NCT02251652
Brief Title
Safety and Efficacy of Ingenol Mebutate 0.05% Gel When Used After Cryotherapy in the Hypertrophic Actinic Keratoses
Official Title
An Investigator-Initiated Study to Assess the Safety and Efficacy of Ingenol Mebutate 0.05% Gel When Used After Cryotherapy in the Treatment of Hypertrophic Actinic Keratoses (AK) on Dorsal Hands
Study Type
Interventional

2. Study Status

Record Verification Date
March 2017
Overall Recruitment Status
Completed
Study Start Date
April 2013 (undefined)
Primary Completion Date
December 2014 (Actual)
Study Completion Date
August 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Icahn School of Medicine at Mount Sinai
Collaborators
LEO Pharma

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Sequential therapy with cryosurgery and ingenol mebutate may optimize the treatment of hypertrophic AKs and also treat non-hypertrophic AKs in this anatomic location. Furthermore, use of ingenol mebutate will also be evaluated for potential treatment of subclinical lesions.
Detailed Description
The investigators plan to treat 30 subjects. Each qualifying subject will have at least 3 hypertrophic AKs, defined as more than 3mm in thickness, on each dorsal hand. Cryotherapy will be standardized in all patients and for all treated lesions: 1-2 sprays, 5 seconds each, with a 5 second interval. All subjects will be treated with the same cryo-spray. Following cryotherapy, subjects will be randomized to treat either their right or left dorsal hand with ingenol mebutate gel. The decision to treat the right vs. the left hand will be chosen by chance, like flipping a coin. Neither the subject nor the study doctor will choose what arm receives the ingenol mebutate gel. The study doctor will not know which arm is treated with ingenol mebutate, so the subject should not reveal that information to him or her at any time during the study. Subjects will treat the randomized dorsal hand with ingenol mebutate 0.05% gel starting on the same day as the cryotherapy (Day 0). Subjects will utilize the once daily for two days regimen. Subjects will be followed on day 4 after their initial visit, day 8, day 15, day 29, and day 57, with a two day window period.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Actinic Keratoses
Keywords
Actinic

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Combination Therapy
Arm Type
Active Comparator
Arm Description
Cryotherapy followed by Ingenol Mebutate Gel
Arm Title
Cryotherapy Alone
Arm Type
Active Comparator
Arm Description
Cryotherapy only
Intervention Type
Drug
Intervention Name(s)
Ingenol Mebutate
Other Intervention Name(s)
PEP005 Gel
Intervention Description
Ingenol mebutate 0.05% gel
Intervention Type
Procedure
Intervention Name(s)
Cryotherapy
Intervention Description
1-2 sprays, 5 seconds each, with a 5 second interval
Primary Outcome Measure Information:
Title
Safety of Combination Therapy vs Cryotherapy Alone
Description
To evaluate the safety of cryotherapy plus ingenol mebutate on dorsal hands and compare it to the safety of cryotherapy alone looking at Adverse Events.
Time Frame
Day 57
Secondary Outcome Measure Information:
Title
Change in Number of All Actinic Keratoses
Description
To evaluate and compare the mean reduction in number of all AKs (hypertrophic and non-hypertrophic) on the dorsal hands of the combination cryotherapy- ingenol mebutate treated side vs. the cryotherapy alone side on Day 57 as compared to baseline
Time Frame
Baseline and Day 57
Title
Change in Actinic Keratoses by Anatomic Site
Description
To evaluate the number of AKs (both hypertrophic and non-hypertrophic) before therapy by anatomic site (dorsal hand) at Day 57 as compared to baseline
Time Frame
Baseline and Day 57

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Adults at least 18 years old. Subjects must be in good general health as confirmed by the medical history. Subjects must be able to read, sign, and understand the informed consent Prior to cryosurgery, subjects have at least 3 hypertrophic actinic keratoses on each dorsal hand. Subject must be willing to forego any other treatments on the dorsum of the hands, including tanning bed use and excessive sun exposure while in the study. Subject is willing and able to participate in the study as an outpatient, making frequent visits to the study center during the treatment and follow-up periods and to comply with all study requirements including concomitant medication and other treatment restrictions. If subject is a female of childbearing potential she must have a negative urine pregnancy test result prior to study treatment initiation and must agree to use an approved method of birth control while enrolled in the study. Exclusion Criteria: Subjects with a history of melanoma anywhere on the body. Subjects with an unstable medical condition as deemed by the clinical investigator. Subjects with non-melanoma skin cancer on the dorsum of the hands. Subjects with any dermatologic disease in the treatment area that may be exacerbated by the treatment proposed or that might impair the evaluation of AKs. Subjects who have previously been treated with ingenol mebutate: on the dorsum of the hands in the past 6 months; or outside of the study area within the past 30 days. Women who are pregnant, lactating, or planning to become pregnant during the study period. Subjects who have experienced a clinically important medical event within 90 days of the visit (e.g., stroke, myocardial infarction, etc). Subjects who have active chemical dependency or alcoholism as assessed by the investigator. Subjects who have known allergies to any excipient in the study gel. Subjects who are currently participating in another clinical study or have completed another clinical study with an investigational drug or device on the study area within 30 days prior to study treatment initiation. Subjects who have received any of the following within 90 days prior to study treatment initiation: interferon or interferon inducers cytotoxic drugs immunomodulators or immunosuppressive therapies (inhaled/ intranasal steroids are permitted) oral or parenteral corticosteroids topical corticosteroids if greater than 2 gm/day any dermatologic procedures or surgeries on the study area (including any AK treatments) Subjects who have used any topical prescription medications on the study area within 30 days prior to study treatment initiation.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Gary Goldenberg, MD
Organizational Affiliation
Icahn School of Medicine at Mount Sinai
Official's Role
Principal Investigator
Facility Information:
Facility Name
Icahn School of Medicine at Mount Sinai
City
New York
State/Province
New York
ZIP/Postal Code
11370
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
27672408
Citation
Hashim PW, Nia JK, Singer S, Goldenberg G. An Investigator-initiated Study to Assess the Safety and Efficacy of Ingenol Mebutate 0.05% Gel When Used After Cryosurgery in the Treatment of Hypertrophic Actinic Keratosis on Dorsal Hands. J Clin Aesthet Dermatol. 2016 Jul;9(7):16-22. Epub 2016 Jul 1.
Results Reference
derived

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Safety and Efficacy of Ingenol Mebutate 0.05% Gel When Used After Cryotherapy in the Hypertrophic Actinic Keratoses

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