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Cancer Associated Thrombosis and Isoquercetin (CATIQ) (CATIQ)

Primary Purpose

Thromboembolism of Vein VTE in Colorectal Cancer, Thromboembolism of Vein in Pancreatic Cancer, Thromboembolism of Vein in Non-small Cell Lung Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Isoquercetin
Sponsored by
Jeffrey Zwicker, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Thromboembolism of Vein VTE in Colorectal Cancer focused on measuring Venous Thromboembolic Events in Cancer Patients, Thromboembolism of Vein in Colorectal Cancer, Thromboembolism of Vein in Pancreatic Cancer, Thromboembolism of Vein in Non-small Cell Lung Cancer

Eligibility Criteria

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

Inclusion Criteria:

  • Participants must meet the following criteria on screening examination to be eligible to participate in phase 2 and 3 of the study:
  • Participants must have histologically confirmed malignancy that is metastatic or currently unresectable.
  • Eligible malignancies include:

    • Adenocarcinoma of the pancreas (currently unresectable or metastatic)
    • Colorectal (stage IV)
    • Non-small cell lung cancer (currently unresectable stage III or stage IV)
  • Receiving or scheduled to receive first or second line chemotherapy (within 30 days of registration)
  • Minimum age 18 years. Because limited dosing or adverse event data are currently available on the use of isoquercetin in participants <18 years of age, children are excluded from this study but will be eligible for future pediatric isoquercetin trials.
  • Life expectancy of greater than 4 months.
  • ECOG performance status ≤2 (see Appendix B ).
  • Patient must be able to swallow capsules (phase III only)
  • Participants must have preserved organ and marrow function as defined below:

    • Absolute neutrophil count ≥1,000/mcL
    • Platelets ≥ 90,000/mcL
    • PT and PTT ≤ 1.5 x upper limit of normal
    • Total bilirubin < 2.0 mg/dl
    • AST (SGOT)/ALT (SGPT) ≤ 2.5 X institutional upper limit of normal Creatinine < 2.0 mg/dl
  • The effects of isoquercetin on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
  • Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  • Participants may not be receiving any other study agents.
  • Participants with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
  • Prior history of documented venous thromboembolic event within the last 2 years (excluding central line associated events whereby patients completed anticoagulation).
  • Active bleeding or high risk for bleeding (e.g. known acute gastrointestinal ulcer)
  • History of significant hemorrhage (requiring hospitalization or transfusion) outside of a surgical setting within the last 24 months
  • Familial bleeding diathesis
  • Known diagnosis of disseminated intravascular coagulation (DIC)
  • Currently receiving anticoagulant therapy
  • Current daily use of aspirin (>81mg daily), Clopidogrel (Plavix), cilostazol (Pletal), aspirin-dipyridamole (Aggrenox) (within 10 days) or considered to use regular use of higher doses of non-steroidal anti-inflammatory agents as determined by the treating physician (e.g ibuprofen > 800 mg daily or equivalent).
  • Uncontrolled intercurrent 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.
  • Known intolerance of niacin or ascorbic acid (including known G6PD deficiency)
  • Pregnant women are excluded from this study because isoquercetin is a PDI inhibitor with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk of adverse events in nursing infants secondary to treatment of the mother with isoquercetin, breastfeeding should be discontinued if the mother is treated with isoquercetin. These potential risks may also apply to other agents used in this study.

Sites / Locations

  • USC/Norris Comprehensive Cancer Center
  • VA Northern California Health Care System
  • VA Connecticut Healthcare System
  • Veterans Affair Medical Center
  • York Hospital-Oncology Treatment Center
  • Boston VA Healthcare System
  • Beth Israel Deaconess Medical Center
  • Mount Auburn Hospital
  • Washington University in St. Louis
  • Providence VA Medical Center
  • White River Junction VA Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Cohort A - Isoquercetin

Cohort B - Isoquercetin

Arm Description

-- Cohort A: 500 mg, Once daily, 28 days - For both cohorts A and B, lower extremity ultrasound will be performed at 56 days. Baseline D-dimer and correlative labs will be drawn at Day 1 and at 56 days. Patients will be followed for survival after completion of 56 days.

--Cohort B: 1000 mg, Once daily, 28 days - For both cohorts A and B, lower extremity ultrasound will be performed at 56 days. Baseline D-dimer and correlative labs will be drawn at Day 1 and at 56 days. Patients will be followed for survival after completion of 56 days.

Outcomes

Primary Outcome Measures

Percent Change in D-dimer Value
D-dimer concentrations will be compared for each patient at day 0 and day 56 by a paired-t test analysis. Analysis will be performed on an intention to treat basis for patients who undergo randomization and completed the baseline and day 56 D-dimer assessments.

Secondary Outcome Measures

Number of Participants With Hemorrhage
Investigating the safety of isoquercetin in cancer patients
Cumulative Incidence of VTE at 56 Days
To investigate the cumulative incidence of VTE according to tissue factor bearing microparticle status (and isoquercetin randomization).

Full Information

First Posted
May 13, 2014
Last Updated
February 11, 2021
Sponsor
Jeffrey Zwicker, MD
Collaborators
Quercegen Pharmaceuticals, National Heart, Lung, and Blood Institute (NHLBI)
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1. Study Identification

Unique Protocol Identification Number
NCT02195232
Brief Title
Cancer Associated Thrombosis and Isoquercetin (CATIQ)
Acronym
CATIQ
Official Title
Randomized, Placebo-controlled, Double-blind Phase II/III Trial of Oral Isoquercetin to Prevent Venous Thromboembolic Events in Cancer Patients.
Study Type
Interventional

2. Study Status

Record Verification Date
February 2021
Overall Recruitment Status
Completed
Study Start Date
January 2015 (Actual)
Primary Completion Date
December 2018 (Actual)
Study Completion Date
October 22, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Jeffrey Zwicker, MD
Collaborators
Quercegen Pharmaceuticals, National Heart, Lung, and Blood Institute (NHLBI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This research study is evaluating a drug called isoquercetin to prevent venous thrombosis (blood clots), in participants who have pancreas, non small cell lung cancer or colorectal cancer.
Detailed Description
This research study is a Phase II/III clinical trial. --The goal of this trial is to evaluate if isoquercetin can prevent blood clots in patients with pancreas, non small cell lung cancer or colorectal cancer. In the Phase II part of this study, the investigators are looking for the dose of isoquercetin to reduce D-dimer and demonstrate safety. Phase III Endpoint and Treatment Plan Primary Endpoint for Phase III portion of protocol: Cumulative incidence of VTE. Following the completion of the phase II portion, enrolled patients will be randomized 1:1 to Arm C (isoquercetin) or Arm D (placebo). The dose for Arm C will be determined after evaluation of the Phase II portion of the trial. The protocol will be amended when the decision is made whether to proceed to Phase III and what dose to use for Arm C. The study will be double-blinded to treatment arm. Lower extremity ultrasound will be performed at 56 days. Baseline D-dimer and correlative labs will be drawn at Day 1 and at 56 days. Patients will be followed for survival after completion of 56 days. At BIDMC, optional blood draw will be performed at time 0 and 4 hours following the first dose of study drug.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Thromboembolism of Vein VTE in Colorectal Cancer, Thromboembolism of Vein in Pancreatic Cancer, Thromboembolism of Vein in Non-small Cell Lung Cancer
Keywords
Venous Thromboembolic Events in Cancer Patients, Thromboembolism of Vein in Colorectal Cancer, Thromboembolism of Vein in Pancreatic Cancer, Thromboembolism of Vein in Non-small Cell Lung Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
64 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cohort A - Isoquercetin
Arm Type
Experimental
Arm Description
-- Cohort A: 500 mg, Once daily, 28 days - For both cohorts A and B, lower extremity ultrasound will be performed at 56 days. Baseline D-dimer and correlative labs will be drawn at Day 1 and at 56 days. Patients will be followed for survival after completion of 56 days.
Arm Title
Cohort B - Isoquercetin
Arm Type
Experimental
Arm Description
--Cohort B: 1000 mg, Once daily, 28 days - For both cohorts A and B, lower extremity ultrasound will be performed at 56 days. Baseline D-dimer and correlative labs will be drawn at Day 1 and at 56 days. Patients will be followed for survival after completion of 56 days.
Intervention Type
Drug
Intervention Name(s)
Isoquercetin
Other Intervention Name(s)
quercetin-3-O-glucoside, 482-35-9
Primary Outcome Measure Information:
Title
Percent Change in D-dimer Value
Description
D-dimer concentrations will be compared for each patient at day 0 and day 56 by a paired-t test analysis. Analysis will be performed on an intention to treat basis for patients who undergo randomization and completed the baseline and day 56 D-dimer assessments.
Time Frame
Baseline, 56 Day
Secondary Outcome Measure Information:
Title
Number of Participants With Hemorrhage
Description
Investigating the safety of isoquercetin in cancer patients
Time Frame
study visits until day 56
Title
Cumulative Incidence of VTE at 56 Days
Description
To investigate the cumulative incidence of VTE according to tissue factor bearing microparticle status (and isoquercetin randomization).
Time Frame
56 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants must meet the following criteria on screening examination to be eligible to participate in phase 2 and 3 of the study: Participants must have histologically confirmed malignancy that is metastatic or currently unresectable. Eligible malignancies include: Adenocarcinoma of the pancreas (currently unresectable or metastatic) Colorectal (stage IV) Non-small cell lung cancer (currently unresectable stage III or stage IV) Receiving or scheduled to receive first or second line chemotherapy (within 30 days of registration) Minimum age 18 years. Because limited dosing or adverse event data are currently available on the use of isoquercetin in participants <18 years of age, children are excluded from this study but will be eligible for future pediatric isoquercetin trials. Life expectancy of greater than 4 months. ECOG performance status ≤2 (see Appendix B ). Patient must be able to swallow capsules (phase III only) Participants must have preserved organ and marrow function as defined below: Absolute neutrophil count ≥1,000/mcL Platelets ≥ 90,000/mcL PT and PTT ≤ 1.5 x upper limit of normal Total bilirubin < 2.0 mg/dl AST (SGOT)/ALT (SGPT) ≤ 2.5 X institutional upper limit of normal Creatinine < 2.0 mg/dl The effects of isoquercetin on the developing human fetus are unknown. For this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately. Ability to understand and the willingness to sign a written informed consent document. Exclusion Criteria: Participants may not be receiving any other study agents. Participants with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events. Prior history of documented venous thromboembolic event within the last 2 years (excluding central line associated events whereby patients completed anticoagulation). Active bleeding or high risk for bleeding (e.g. known acute gastrointestinal ulcer) History of significant hemorrhage (requiring hospitalization or transfusion) outside of a surgical setting within the last 24 months Familial bleeding diathesis Known diagnosis of disseminated intravascular coagulation (DIC) Currently receiving anticoagulant therapy Current daily use of aspirin (>81mg daily), Clopidogrel (Plavix), cilostazol (Pletal), aspirin-dipyridamole (Aggrenox) (within 10 days) or considered to use regular use of higher doses of non-steroidal anti-inflammatory agents as determined by the treating physician (e.g ibuprofen > 800 mg daily or equivalent). Uncontrolled intercurrent 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. Known intolerance of niacin or ascorbic acid (including known G6PD deficiency) Pregnant women are excluded from this study because isoquercetin is a PDI inhibitor with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk of adverse events in nursing infants secondary to treatment of the mother with isoquercetin, breastfeeding should be discontinued if the mother is treated with isoquercetin. These potential risks may also apply to other agents used in this study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jeffrey Zwicker, MD
Organizational Affiliation
Beth Israel Deaconess Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
USC/Norris Comprehensive Cancer Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90033
Country
United States
Facility Name
VA Northern California Health Care System
City
Sacramento
State/Province
California
ZIP/Postal Code
95655
Country
United States
Facility Name
VA Connecticut Healthcare System
City
West Haven
State/Province
Connecticut
ZIP/Postal Code
06450
Country
United States
Facility Name
Veterans Affair Medical Center
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20422
Country
United States
Facility Name
York Hospital-Oncology Treatment Center
City
York
State/Province
Maine
ZIP/Postal Code
03909
Country
United States
Facility Name
Boston VA Healthcare System
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02130
Country
United States
Facility Name
Beth Israel Deaconess Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Facility Name
Mount Auburn Hospital
City
Waltham
State/Province
Massachusetts
ZIP/Postal Code
02138
Country
United States
Facility Name
Washington University in St. Louis
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Facility Name
Providence VA Medical Center
City
Providence
State/Province
Rhode Island
ZIP/Postal Code
02908
Country
United States
Facility Name
White River Junction VA Medical Center
City
White River Junction
State/Province
Vermont
ZIP/Postal Code
05009
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
30652973
Citation
Zwicker JI, Schlechter BL, Stopa JD, Liebman HA, Aggarwal A, Puligandla M, Caughey T, Bauer KA, Kuemmerle N, Wong E, Wun T, McLaughlin M, Hidalgo M, Neuberg D, Furie B, Flaumenhaft R; CATIQ Investigators11. Targeting protein disulfide isomerase with the flavonoid isoquercetin to improve hypercoagulability in advanced cancer. JCI Insight. 2019 Feb 21;4(4):e125851. doi: 10.1172/jci.insight.125851. eCollection 2019 Feb 21.
Results Reference
derived

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Cancer Associated Thrombosis and Isoquercetin (CATIQ)

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