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To Check Safety of Ayurvedic Oral Cannabis in Breast and Head and Neck Cancer

Primary Purpose

Breast Cancer, Oral Cancer

Status
Active
Phase
Phase 1
Locations
India
Study Type
Interventional
Intervention
Cannabis capsules
Sponsored by
Tata Memorial Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Breast Cancer

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Histopathologically proven patients of breast or oral cavity SCC Age > 18 and < 65 Operable cancers planned to undergo upfront curative surgery Patient fit for surgery (ASA Grade I / II) Patient Voluntarily willing to give consent for study Exclusion Criteria: Planned for any other pre or peri-operative intervention such as neoadjuvant chemotherapy or targeted therapy or radiation Presence of medical disease such as pulmonary, renal, liver, gastro-intestinal disease which may interfere with any study specific procedure (deranged renal parameters > 1.5 times normal range or deranged liver function tests such as > 2.5 times raised liver enzymes) History of substance abuse (including cannabis-related products) or alcohol abuse Personal history of psychiatric disease or Significant family history of psychiatric disease Pregnancy and/or lactation Patients currently (within last 14 days before consenting) on other CNS depressants such as alcohol, barbiturates, benozodiazapines (like diazepam, alprazolam etc) Patients on other medications which will likely have a drug interaction with cannabis- such as clozapine, duloxetine, naproxen, cyclobenzaprine, olanzapine, haloperidol, and chlorpromazine, macrolides, calcium channel blockers, benzodiazepines, cyclosporine, sildenafil (and other PDE5 inhibitors), antihistamines, haloperidol, antiretrovirals Any other illness or abnormal laboratory investigations which the investigator considers as making the patients ineligible for the study Any patient with positive HIV, HBsAg, HCV status

Sites / Locations

  • Tata Memorial Center
  • Tata Memorial Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Cannabis

Arm Description

Cannabis capsules containing 5 mg of THC and CBD each or 2.5 mg of THC and CBD each.

Outcomes

Primary Outcome Measures

To establish safe dose of oral cannabis preparation
Number of participants with treatment-related adverse events with respect to cardiovascular, central nervous system and psychotropic of cannabis as assessed by CTCAE v4.0

Secondary Outcome Measures

Pharmacokinetic profiling
Blood samples collected during the administration of the IP for 5 days and up to 72 hours after surgery.
Biomarker analysis- Transcitpomics
Tumor and normal tissue samples.

Full Information

First Posted
May 31, 2022
Last Updated
July 22, 2023
Sponsor
Tata Memorial Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT05969314
Brief Title
To Check Safety of Ayurvedic Oral Cannabis in Breast and Head and Neck Cancer
Official Title
Phase I Study of Safety and Feasibility of Ayurvedic Oral Cannabis Preparation in the Peri-operative Period in Breast and Oral Cavity Squamous Cell Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
June 8, 2022 (Actual)
Primary Completion Date
December 31, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Tata Memorial Hospital

4. Oversight

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

5. Study Description

Brief Summary
Phase 1 study to assess the pharmacokinetic availability and safety and tolerability profile of one such ayurvedic preparation which contains 5 mg THC:CBD 1:1 preparation. Other than the PK profile, we will also be studying its effect on gene expression profiling of the breast and head neck oral cavity squamous cell carcinoma tissue.
Detailed Description
The ancient Ayurvedic medicine obtained from Cannabis sativa plant has recently been re-explored for its anti-inflammatory and anti-cancer potential. Various laboratory and preclinical studies have proven its anti-cancer activity and its effect on all the hallmarks of cancer. Anecdotal clinical evidence has shown regression of tumours with ingestion of such medicinal cannabis. A randomized controlled trial in Glioblastoma Multiforme, a kind of brain tumour, shows improvement in disease free survival when temozolamide was combined with Cannabis spray called Sativex. However, because of lack of systematic, large volume studies, the evidence is slow to emerge. We have previously seen changes related to NF-kb (inflammation) and AP1 (acute hypoxia/stress) pathway genes within the tumour tissue as assessed by transcriptomic analysis (Yet unpublished data). There is laboratory evidence to suggest that the changes induced in the AP1 pathway during surgery can be ameliorated by cannabis treatment. We intend to explore this anticancer potential of C sativa herbal preparation in the pre-operative setting in breast and head and neck cancer patients. Hence, we are proposing a phase 1 study to assess the pharmacokinetic availability and safety and tolerability profile of one such ayurvedic preparation which contains 5 mg THC:CBD 1:1 preparation. Other than the PK profile, we will also be studying its effect on gene expression profiling of the breast and head neck oral cavity squamous cell carcinoma tissue.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Breast Cancer, Oral Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Model Description
To determine the maximum tolerated dose (MTD). First 3 patients will receive the study preparation once a day at 9 am (+/- 60 min) (i.e 5 mg of CBD and 5 mg of THC in a 400 mg capsule). Subsequent cohorts will be administered doses of 10 (10 mg of THC and CBD each), 20 (20+20) and 30 (30+30) mg in a classical 3+3 dose escalation study. Briefly, 3 patients will be enrolled at dose level. Dose escalation to the next dose level will continue as long no DLT is observed in 3 patients (the incidence of DLT is ≤ 1/6) In any cohort, if 1/3 patients develop DLT, then 3 more patients will be added at that dose. The dose level at which more than 1/6 patients develop DLT will be considered the MTD and no further escalation will be done beyond the MTD. One dose level below the MTD will be considered for future trials. If MTD is not achieved, the highest dose (30+30) will be considered for future trials. If toxicity is seen at 30 mg, then de-escalation to 25 mg may be considered.
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cannabis
Arm Type
Experimental
Arm Description
Cannabis capsules containing 5 mg of THC and CBD each or 2.5 mg of THC and CBD each.
Intervention Type
Drug
Intervention Name(s)
Cannabis capsules
Intervention Description
Cannabis capsules containing 5 mg of THC and CBD each or 2.5 mg of THC and CBD each.
Primary Outcome Measure Information:
Title
To establish safe dose of oral cannabis preparation
Description
Number of participants with treatment-related adverse events with respect to cardiovascular, central nervous system and psychotropic of cannabis as assessed by CTCAE v4.0
Time Frame
From day 1 of IP dosing till 28 days .
Secondary Outcome Measure Information:
Title
Pharmacokinetic profiling
Description
Blood samples collected during the administration of the IP for 5 days and up to 72 hours after surgery.
Time Frame
1.Pre operative day 1 to 5 - one each day before cannabinoid dosing, after dosing 30 minutes, 1 hour, 2 hour and 8 hour. 2. On day of surgery - Before and after the surgery 3. Post operative day 1 , day 2, day 3 and day 14
Title
Biomarker analysis- Transcitpomics
Description
Tumor and normal tissue samples.
Time Frame
A baseline pre-cannabis tumor tissue sample will be collected before starting IP(day 0). Further blood and tumor as well as adjacent normal tissue samples will be collected during surgery (day6).

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histopathologically proven patients of breast or oral cavity SCC Age > 18 and < 65 Operable cancers planned to undergo upfront curative surgery Patient fit for surgery (ASA Grade I / II) Patient Voluntarily willing to give consent for study Exclusion Criteria: Planned for any other pre or peri-operative intervention such as neoadjuvant chemotherapy or targeted therapy or radiation Presence of medical disease such as pulmonary, renal, liver, gastro-intestinal disease which may interfere with any study specific procedure (deranged renal parameters > 1.5 times normal range or deranged liver function tests such as > 2.5 times raised liver enzymes) History of substance abuse (including cannabis-related products) or alcohol abuse Personal history of psychiatric disease or Significant family history of psychiatric disease Pregnancy and/or lactation Patients currently (within last 14 days before consenting) on other CNS depressants such as alcohol, barbiturates, benozodiazapines (like diazepam, alprazolam etc) Patients on other medications which will likely have a drug interaction with cannabis- such as clozapine, duloxetine, naproxen, cyclobenzaprine, olanzapine, haloperidol, and chlorpromazine, macrolides, calcium channel blockers, benzodiazepines, cyclosporine, sildenafil (and other PDE5 inhibitors), antihistamines, haloperidol, antiretrovirals Any other illness or abnormal laboratory investigations which the investigator considers as making the patients ineligible for the study Any patient with positive HIV, HBsAg, HCV status
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rajendra A Badwe, MS
Organizational Affiliation
Director, Tata Memorial Centre
Official's Role
Principal Investigator
Facility Information:
Facility Name
Tata Memorial Center
City
Mumbai
State/Province
Maharashtra
ZIP/Postal Code
400012
Country
India
Facility Name
Tata Memorial Hospital
City
Mumbai
State/Province
Maharastra
ZIP/Postal Code
400012
Country
India

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
16810401
Citation
Zuardi AW. History of cannabis as a medicine: a review. Braz J Psychiatry. 2006 Jun;28(2):153-7. doi: 10.1590/s1516-44462006000200015. Epub 2006 Jun 26.
Results Reference
background
PubMed Identifier
28120229
Citation
ElSohly MA, Radwan MM, Gul W, Chandra S, Galal A. Phytochemistry of Cannabis sativa L. Prog Chem Org Nat Prod. 2017;103:1-36. doi: 10.1007/978-3-319-45541-9_1.
Results Reference
background
PubMed Identifier
16540272
Citation
Ben Amar M. Cannabinoids in medicine: A review of their therapeutic potential. J Ethnopharmacol. 2006 Apr 21;105(1-2):1-25. doi: 10.1016/j.jep.2006.02.001. Epub 2006 Mar 15.
Results Reference
background
PubMed Identifier
26103030
Citation
Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, Keurentjes JC, Lang S, Misso K, Ryder S, Schmidlkofer S, Westwood M, Kleijnen J. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 2015 Jun 23-30;313(24):2456-73. doi: 10.1001/jama.2015.6358. Erratum In: JAMA. 2015 Aug 4;314(5):520. JAMA. 2015 Aug 25;314(8):837. JAMA. 2015 Dec 1;314(21):2308. JAMA. 2016 Apr 12;315(14):1522.
Results Reference
background
PubMed Identifier
23956774
Citation
Bar-Sela G, Vorobeichik M, Drawsheh S, Omer A, Goldberg V, Muller E. The medical necessity for medicinal cannabis: prospective, observational study evaluating the treatment in cancer patients on supportive or palliative care. Evid Based Complement Alternat Med. 2013;2013:510392. doi: 10.1155/2013/510392. Epub 2013 Jul 16.
Results Reference
background
PubMed Identifier
24937161
Citation
Waissengrin B, Urban D, Leshem Y, Garty M, Wolf I. Patterns of use of medical cannabis among Israeli cancer patients: a single institution experience. J Pain Symptom Manage. 2015 Feb;49(2):223-30. doi: 10.1016/j.jpainsymman.2014.05.018. Epub 2014 Jun 14.
Results Reference
background
PubMed Identifier
21475304
Citation
Vara D, Salazar M, Olea-Herrero N, Guzman M, Velasco G, Diaz-Laviada I. Anti-tumoral action of cannabinoids on hepatocellular carcinoma: role of AMPK-dependent activation of autophagy. Cell Death Differ. 2011 Jul;18(7):1099-111. doi: 10.1038/cdd.2011.32. Epub 2011 Apr 8. Erratum In: Cell Death Differ. 2011 Jul;18(7):1237.
Results Reference
background
PubMed Identifier
16818634
Citation
Caffarel MM, Sarrio D, Palacios J, Guzman M, Sanchez C. Delta9-tetrahydrocannabinol inhibits cell cycle progression in human breast cancer cells through Cdc2 regulation. Cancer Res. 2006 Jul 1;66(13):6615-21. doi: 10.1158/0008-5472.CAN-05-4566.
Results Reference
background
PubMed Identifier
18454173
Citation
Caffarel MM, Moreno-Bueno G, Cerutti C, Palacios J, Guzman M, Mechta-Grigoriou F, Sanchez C. JunD is involved in the antiproliferative effect of Delta9-tetrahydrocannabinol on human breast cancer cells. Oncogene. 2008 Aug 28;27(37):5033-44. doi: 10.1038/onc.2008.145. Epub 2008 May 5.
Results Reference
background
PubMed Identifier
19425170
Citation
Salazar M, Carracedo A, Salanueva IJ, Hernandez-Tiedra S, Lorente M, Egia A, Vazquez P, Blazquez C, Torres S, Garcia S, Nowak J, Fimia GM, Piacentini M, Cecconi F, Pandolfi PP, Gonzalez-Feria L, Iovanna JL, Guzman M, Boya P, Velasco G. Cannabinoid action induces autophagy-mediated cell death through stimulation of ER stress in human glioma cells. J Clin Invest. 2009 May;119(5):1359-72. doi: 10.1172/jci37948.
Results Reference
background
PubMed Identifier
22727410
Citation
Lopes CF, de Angelis BB, Prudente HM, de Souza BV, Cardoso SV, de Azambuja Ribeiro RI. Concomitant consumption of marijuana, alcohol and tobacco in oral squamous cell carcinoma development and progression: recent advances and challenges. Arch Oral Biol. 2012 Aug;57(8):1026-33. doi: 10.1016/j.archoralbio.2012.05.006. Epub 2012 Jun 22.
Results Reference
background
PubMed Identifier
19189054
Citation
Cozzolino R, Cali G, Bifulco M, Laccetti P. A metabolically stable analogue of anandamide, Met-F-AEA, inhibits human thyroid carcinoma cell lines by activation of apoptosis. Invest New Drugs. 2010 Apr;28(2):115-23. doi: 10.1007/s10637-009-9221-0. Epub 2009 Feb 3.
Results Reference
background
PubMed Identifier
21670457
Citation
Badwe R, Hawaldar R, Parmar V, Nadkarni M, Shet T, Desai S, Gupta S, Jalali R, Vanmali V, Dikshit R, Mittra I. Single-injection depot progesterone before surgery and survival in women with operable breast cancer: a randomized controlled trial. J Clin Oncol. 2011 Jul 20;29(21):2845-51. doi: 10.1200/JCO.2010.33.0738. Epub 2011 Jun 13.
Results Reference
background
PubMed Identifier
25115386
Citation
Chakravarti B, Ravi J, Ganju RK. Cannabinoids as therapeutic agents in cancer: current status and future implications. Oncotarget. 2014 Aug 15;5(15):5852-72. doi: 10.18632/oncotarget.2233.
Results Reference
background
PubMed Identifier
20191092
Citation
Nagarkatti P, Pandey R, Rieder SA, Hegde VL, Nagarkatti M. Cannabinoids as novel anti-inflammatory drugs. Future Med Chem. 2009 Oct;1(7):1333-49. doi: 10.4155/fmc.09.93.
Results Reference
background
PubMed Identifier
6250760
Citation
Ohlsson A, Lindgren JE, Wahlen A, Agurell S, Hollister LE, Gillespie HK. Plasma delta-9 tetrahydrocannabinol concentrations and clinical effects after oral and intravenous administration and smoking. Clin Pharmacol Ther. 1980 Sep;28(3):409-16. doi: 10.1038/clpt.1980.181.
Results Reference
background
PubMed Identifier
21078841
Citation
Karschner EL, Darwin WD, Goodwin RS, Wright S, Huestis MA. Plasma cannabinoid pharmacokinetics following controlled oral delta9-tetrahydrocannabinol and oromucosal cannabis extract administration. Clin Chem. 2011 Jan;57(1):66-75. doi: 10.1373/clinchem.2010.152439. Epub 2010 Nov 15.
Results Reference
background
PubMed Identifier
29125702
Citation
Atsmon J, Heffetz D, Deutsch L, Deutsch F, Sacks H. Single-Dose Pharmacokinetics of Oral Cannabidiol Following Administration of PTL101: A New Formulation Based on Gelatin Matrix Pellets Technology. Clin Pharmacol Drug Dev. 2018 Sep;7(7):751-758. doi: 10.1002/cpdd.408. Epub 2017 Nov 10.
Results Reference
background
PubMed Identifier
28736128
Citation
Cherniakov I, Izgelov D, Domb AJ, Hoffman A. The effect of Pro NanoLipospheres (PNL) formulation containing natural absorption enhancers on the oral bioavailability of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in a rat model. Eur J Pharm Sci. 2017 Nov 15;109:21-30. doi: 10.1016/j.ejps.2017.07.003. Epub 2017 Jul 20.
Results Reference
background
PubMed Identifier
25748562
Citation
Manini AF, Yiannoulos G, Bergamaschi MM, Hernandez S, Olmedo R, Barnes AJ, Winkel G, Sinha R, Jutras-Aswad D, Huestis MA, Hurd YL. Safety and pharmacokinetics of oral cannabidiol when administered concomitantly with intravenous fentanyl in humans. J Addict Med. 2015 May-Jun;9(3):204-10. doi: 10.1097/ADM.0000000000000118.
Results Reference
background
PubMed Identifier
28158482
Citation
Vandrey R, Herrmann ES, Mitchell JM, Bigelow GE, Flegel R, LoDico C, Cone EJ. Pharmacokinetic Profile of Oral Cannabis in Humans: Blood and Oral Fluid Disposition and Relation to Pharmacodynamic Outcomes. J Anal Toxicol. 2017 Mar 1;41(2):83-99. doi: 10.1093/jat/bkx012.
Results Reference
background
PubMed Identifier
22129319
Citation
Bergamaschi MM, Queiroz RH, Zuardi AW, Crippa JA. Safety and side effects of cannabidiol, a Cannabis sativa constituent. Curr Drug Saf. 2011 Sep 1;6(4):237-49. doi: 10.2174/157488611798280924.
Results Reference
background
PubMed Identifier
6285406
Citation
Zuardi AW, Shirakawa I, Finkelfarb E, Karniol IG. Action of cannabidiol on the anxiety and other effects produced by delta 9-THC in normal subjects. Psychopharmacology (Berl). 1982;76(3):245-50. doi: 10.1007/BF00432554.
Results Reference
background
PubMed Identifier
14583744
Citation
Crippa JA, Zuardi AW, Garrido GE, Wichert-Ana L, Guarnieri R, Ferrari L, Azevedo-Marques PM, Hallak JE, McGuire PK, Filho Busatto G. Effects of cannabidiol (CBD) on regional cerebral blood flow. Neuropsychopharmacology. 2004 Feb;29(2):417-26. doi: 10.1038/sj.npp.1300340.
Results Reference
background
PubMed Identifier
19124693
Citation
Fusar-Poli P, Crippa JA, Bhattacharyya S, Borgwardt SJ, Allen P, Martin-Santos R, Seal M, Surguladze SA, O'Carrol C, Atakan Z, Zuardi AW, McGuire PK. Distinct effects of delta9-tetrahydrocannabinol and cannabidiol on neural activation during emotional processing. Arch Gen Psychiatry. 2009 Jan;66(1):95-105. doi: 10.1001/archgenpsychiatry.2008.519.
Results Reference
background
PubMed Identifier
19924114
Citation
Bhattacharyya S, Morrison PD, Fusar-Poli P, Martin-Santos R, Borgwardt S, Winton-Brown T, Nosarti C, O' Carroll CM, Seal M, Allen P, Mehta MA, Stone JM, Tunstall N, Giampietro V, Kapur S, Murray RM, Zuardi AW, Crippa JA, Atakan Z, McGuire PK. Opposite effects of delta-9-tetrahydrocannabinol and cannabidiol on human brain function and psychopathology. Neuropsychopharmacology. 2010 Feb;35(3):764-74. doi: 10.1038/npp.2009.184. Epub 2009 Nov 18.
Results Reference
background
PubMed Identifier
21592732
Citation
Schubart CD, Sommer IE, van Gastel WA, Goetgebuer RL, Kahn RS, Boks MP. Cannabis with high cannabidiol content is associated with fewer psychotic experiences. Schizophr Res. 2011 Aug;130(1-3):216-21. doi: 10.1016/j.schres.2011.04.017. Epub 2011 May 17.
Results Reference
background

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To Check Safety of Ayurvedic Oral Cannabis in Breast and Head and Neck Cancer

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