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Randomized, Phase II Clinical Trial of Sulforaphane in Bladder Cancer Chemoprevention

Primary Purpose

Bladder Cancer, Bladder Tumor, Urothelial Carcinoma

Status
Withdrawn
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Sulforaphane Administration
Placebo Administration
Standard of Care Surgery
Sponsored by
H. Lee Moffitt Cancer Center and Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Bladder Cancer focused on measuring primary bladder tumor, non-muscle invasive bladder tumor, muscle invasive bladder tumor, sulforaphane, chemoprevention

Eligibility Criteria

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

Inclusion Criteria:

  • Men and women; age ≥18 years; evidence of non-muscle invasive or muscle invasive primary bladder tumor (urothelial carcinoma +/- variant histology) discovered on cystoscopy or radiologic imaging performed within 60 days of randomization; with no evidence of distant metastases; planned Transurethral Resection+B21 (TURBT), cystoscopy with biopsies or cystectomy (total or partial);
  • Absent prior pelvic radiation; normal organ function;
  • Absent neoadjuvant chemotherapy (refusal or ineligibility); (the participant may have prior intravesical treatment exposure (including Bacillus Calmette-Guerin (BCG), mitomycin, gemcitabine, valrubicin, docetaxel, etc.) for bladder cancer (BC) (excluding primary bladder radiation therapy) provided that treatment was completed greater than 30 days prior to the patient's randomization visit);
  • Non-smokers (urinary cotinine tested);
  • Agree to restrict dietary sources of Sulforaphane (SFN) to 3 or 5 servings/week and abstain from consuming SFN supplements beginning three days prior to start of study and throughout duration of the study;
  • Eastern Cooperative Oncology Group (ECOG) performance status 0-2;
  • Willing to discontinue current vitamin/mineral supplement use and substitute with a standard multivitamin supplement provided for the study;
  • Willing to use an effective method of contraception, if the partner is of child-bearing age, while on study;
  • Willing to comply with proposed visit and treatment schedule;
  • Able to understand and willing to sign a written informed consent document;
  • Participants must have normal organ and marrow function.

Exclusion Criteria:

  • Evidence of other cancers (excluding non-melanoma skin cancer) or metastatic disease;
  • Prior pelvic radiation; concurrent systemic chemotherapy for any other cancer, excluding non-melanoma skin cancer;
  • Any treatment for the bladder tumor other than intravesical therapy;
  • Prior treatment with a known histone deacetylase inhibitor (including but not limited to valproic acid, suberoylanilide hydroxamic acid (SAHA), Panobinostat (LBH589), etc.) within 6 months prior to starting study treatment or while on study therapy;
  • Current treatment with warfarin;
  • Use of dietary supplements or herbal remedies which may affect the study outcome - unless the participant is willing to discontinue taking them for 1 month prior to starting study;
  • Usual consumption of > 5 servings per week of brassica vegetables;
  • Gastrointestinal ailments which would interfere with the ability to adequately absorb SFN;
  • Allergy/known intolerance to cruciferous vegetables;
  • Used antibiotics (more than 3 doses) within 10 days prior to study (day -14 prior to study randomization);
  • Current smoker.

Sites / Locations

  • H. Lee Moffitt Cancer Center and Research Institute
  • James A. Haley Veteran's Administration Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Sulforaphane Plus Surgery

Placebo Plus Surgery

Arm Description

Sulforaphane Administration prior to bladder cancer surgery.

Placebo Administration prior to bladder cancer surgery.

Outcomes

Primary Outcome Measures

Magnitude of Change
Magnitude of change in Intermediate Endpoint Biomarkers (IEBs) of proliferation (Ki-67 expressing cells- an independent marker of poor prognosis in bladder cancer (BC)) from baseline to end of treatment with 20 mgs Prostaphane® [Nutinov Labs, France] containing 200 μmol of Sulforaphane (SFN) a day at 3-4 weeks (maximum 30 days) in BC cells and benign/adjacent cells.

Secondary Outcome Measures

Effectiveness of Sulforaphane vs. Placebo
Effectiveness of SFN at this dose (vs. placebo) as indicated by modulation of other IEBs of proliferation, apoptosis and phase II enzymes, as well as the potential molecular mechanism of SFN, we will measure changes in: (i) BC histology grade; (ii) labeling index of a sensitive biomarker that is a member of DNA replication origin licensing complex, Mcm2; (iii) apoptosis (Caspase-3); (iv) Phase II enzymes (glutathione transferases, epoxide hydrolase, Nicotinamide adenine dinucleotide phosphate (NAD(P)H): quinone reductase, and glucuronosyltransferases); (v) Nrf2 and Transcription factor (NF-kB) signaling, from baseline to end of treatment in BC cells and benign/adjacent cells.
Occurrence of Adverse Events per Study Arm
Safety of SFN at this dose (vs. Placebo) as indicated by incidence of adverse events and toxicities, monitored using Common Toxicity Criteria version 5.0, complete blood count (CBC), and complete metabolic panel (CMP) from baseline at mid-point and at end of trial.
Mid-study Bioavailability of Sulforaphane
Bioavailability, of SFN at this dose vs. Placebo. Investigators will measure change in SFN in plasma and bladder tissue from baseline, at mid-point and at end of study.
End of Study Bioavailability of Sulforaphane
Bioavailability, of SFN at this dose vs. Placebo. Investigators will measure change in SFN in plasma and bladder tissue from baseline, at mid-point and at end of study.
Adherence of Sulforaphane vs. Placebo
Adherence based on pill counts and diet and pill logs from baseline.
Acceptability of Sulforaphane vs. Placebo
Acceptability based on pill counts and diet and pill logs from baseline.

Full Information

First Posted
April 26, 2018
Last Updated
May 26, 2020
Sponsor
H. Lee Moffitt Cancer Center and Research Institute
Collaborators
National Institutes of Health (NIH), Johns Hopkins University
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1. Study Identification

Unique Protocol Identification Number
NCT03517995
Brief Title
Randomized, Phase II Clinical Trial of Sulforaphane in Bladder Cancer Chemoprevention
Official Title
Randomized, Phase II Clinical Trial of Sulforaphane in Bladder Cancer Chemoprevention
Study Type
Interventional

2. Study Status

Record Verification Date
February 2020
Overall Recruitment Status
Withdrawn
Why Stopped
Grant not approved
Study Start Date
April 2020 (Anticipated)
Primary Completion Date
December 2021 (Anticipated)
Study Completion Date
December 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
H. Lee Moffitt Cancer Center and Research Institute
Collaborators
National Institutes of Health (NIH), Johns Hopkins University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
The main purpose of this study is to see if Prostaphane is effective and can help reduce the progression of bladder cancer. Researchers also want to find out if Prostaphane is safe and tolerable, and to evaluate how Prostaphane works to reduce the progression of bladder cancer. This study will compare Prostaphane with a placebo to see if taking Prostaphane is better than taking a placebo. A placebo is a pill that looks like Prostaphane but has no drug or other active ingredients in it. The study will be presented to eligible patients by the patient's surgeon at the time when an appointment is made for cystoscopy for suspicion of bladder cancer (BC) or to confirm BC diagnosis.
Detailed Description
The study will be presented to eligible patients by the patient's surgeon at the time when an appointment is made for cystoscopy for suspicion of bladder cancer (BC) or to confirm BC diagnosis. Participants will be asked to spend 21 to 30 days in this study. The study will be conducted during the time from when the participant is diagnosed with bladder cancer to when they undergo a surgical procedure for the treatment or removal of their bladder cancer. The surgical procedure is done as a part of their regular medical care. Participants will be asked to come for 1 additional visit as part of this research study at the midpoint between their biopsy and surgery.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bladder Cancer, Bladder Tumor, Urothelial Carcinoma
Keywords
primary bladder tumor, non-muscle invasive bladder tumor, muscle invasive bladder tumor, sulforaphane, chemoprevention

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Sulforaphane Plus Surgery
Arm Type
Active Comparator
Arm Description
Sulforaphane Administration prior to bladder cancer surgery.
Arm Title
Placebo Plus Surgery
Arm Type
Placebo Comparator
Arm Description
Placebo Administration prior to bladder cancer surgery.
Intervention Type
Drug
Intervention Name(s)
Sulforaphane Administration
Other Intervention Name(s)
Prostaphane
Intervention Description
1 capsule (10 mg Prostaphane) taken two times per day (2 capsules, 20 mg Prostaphane total).
Intervention Type
Other
Intervention Name(s)
Placebo Administration
Intervention Description
1 capsule (placebo) taken two times per day (2 capsules total).
Intervention Type
Procedure
Intervention Name(s)
Standard of Care Surgery
Other Intervention Name(s)
post study treatment surgery, bladder cancer surgery
Intervention Description
The study will be conducted during the time from when participants are diagnosed with bladder cancer to when they undergo a surgical procedure for the treatment or removal of their bladder cancer. The surgical procedure is done as a part of their regular medical care.
Primary Outcome Measure Information:
Title
Magnitude of Change
Description
Magnitude of change in Intermediate Endpoint Biomarkers (IEBs) of proliferation (Ki-67 expressing cells- an independent marker of poor prognosis in bladder cancer (BC)) from baseline to end of treatment with 20 mgs Prostaphane® [Nutinov Labs, France] containing 200 μmol of Sulforaphane (SFN) a day at 3-4 weeks (maximum 30 days) in BC cells and benign/adjacent cells.
Time Frame
Up to 30 days
Secondary Outcome Measure Information:
Title
Effectiveness of Sulforaphane vs. Placebo
Description
Effectiveness of SFN at this dose (vs. placebo) as indicated by modulation of other IEBs of proliferation, apoptosis and phase II enzymes, as well as the potential molecular mechanism of SFN, we will measure changes in: (i) BC histology grade; (ii) labeling index of a sensitive biomarker that is a member of DNA replication origin licensing complex, Mcm2; (iii) apoptosis (Caspase-3); (iv) Phase II enzymes (glutathione transferases, epoxide hydrolase, Nicotinamide adenine dinucleotide phosphate (NAD(P)H): quinone reductase, and glucuronosyltransferases); (v) Nrf2 and Transcription factor (NF-kB) signaling, from baseline to end of treatment in BC cells and benign/adjacent cells.
Time Frame
End of study, approximately 30 days
Title
Occurrence of Adverse Events per Study Arm
Description
Safety of SFN at this dose (vs. Placebo) as indicated by incidence of adverse events and toxicities, monitored using Common Toxicity Criteria version 5.0, complete blood count (CBC), and complete metabolic panel (CMP) from baseline at mid-point and at end of trial.
Time Frame
End of study, approximately 30 days
Title
Mid-study Bioavailability of Sulforaphane
Description
Bioavailability, of SFN at this dose vs. Placebo. Investigators will measure change in SFN in plasma and bladder tissue from baseline, at mid-point and at end of study.
Time Frame
Mid-study, approximately 15 days
Title
End of Study Bioavailability of Sulforaphane
Description
Bioavailability, of SFN at this dose vs. Placebo. Investigators will measure change in SFN in plasma and bladder tissue from baseline, at mid-point and at end of study.
Time Frame
End of study, approximately 30 days
Title
Adherence of Sulforaphane vs. Placebo
Description
Adherence based on pill counts and diet and pill logs from baseline.
Time Frame
End of study, approximately 30 days
Title
Acceptability of Sulforaphane vs. Placebo
Description
Acceptability based on pill counts and diet and pill logs from baseline.
Time Frame
End of study, approximately 30 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Men and women; age ≥18 years; evidence of non-muscle invasive or muscle invasive primary bladder tumor (urothelial carcinoma +/- variant histology) discovered on cystoscopy or radiologic imaging performed within 60 days of randomization; with no evidence of distant metastases; planned Transurethral Resection+B21 (TURBT), cystoscopy with biopsies or cystectomy (total or partial); Absent prior pelvic radiation; normal organ function; Absent neoadjuvant chemotherapy (refusal or ineligibility); (the participant may have prior intravesical treatment exposure (including Bacillus Calmette-Guerin (BCG), mitomycin, gemcitabine, valrubicin, docetaxel, etc.) for bladder cancer (BC) (excluding primary bladder radiation therapy) provided that treatment was completed greater than 30 days prior to the patient's randomization visit); Non-smokers (urinary cotinine tested); Agree to restrict dietary sources of Sulforaphane (SFN) to 3 or 5 servings/week and abstain from consuming SFN supplements beginning three days prior to start of study and throughout duration of the study; Eastern Cooperative Oncology Group (ECOG) performance status 0-2; Willing to discontinue current vitamin/mineral supplement use and substitute with a standard multivitamin supplement provided for the study; Willing to use an effective method of contraception, if the partner is of child-bearing age, while on study; Willing to comply with proposed visit and treatment schedule; Able to understand and willing to sign a written informed consent document; Participants must have normal organ and marrow function. Exclusion Criteria: Evidence of other cancers (excluding non-melanoma skin cancer) or metastatic disease; Prior pelvic radiation; concurrent systemic chemotherapy for any other cancer, excluding non-melanoma skin cancer; Any treatment for the bladder tumor other than intravesical therapy; Prior treatment with a known histone deacetylase inhibitor (including but not limited to valproic acid, suberoylanilide hydroxamic acid (SAHA), Panobinostat (LBH589), etc.) within 6 months prior to starting study treatment or while on study therapy; Current treatment with warfarin; Use of dietary supplements or herbal remedies which may affect the study outcome - unless the participant is willing to discontinue taking them for 1 month prior to starting study; Usual consumption of > 5 servings per week of brassica vegetables; Gastrointestinal ailments which would interfere with the ability to adequately absorb SFN; Allergy/known intolerance to cruciferous vegetables; Used antibiotics (more than 3 doses) within 10 days prior to study (day -14 prior to study randomization); Current smoker.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nagi Kumar, Ph.D
Organizational Affiliation
H. Lee Moffitt Cancer Center and Research Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
H. Lee Moffitt Cancer Center and Research Institute
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States
Facility Name
James A. Haley Veteran's Administration Hospital
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States

12. IPD Sharing Statement

Learn more about this trial

Randomized, Phase II Clinical Trial of Sulforaphane in Bladder Cancer Chemoprevention

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