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Effect of Perioperative Bronchodilator in COPD Patients Undergoing Lung Cancer Surgery

Primary Purpose

Chronic Obstructive Pulmonary Disease, Non Small Cell Lung Cancer

Status
Recruiting
Phase
Phase 3
Locations
Korea, Republic of
Study Type
Interventional
Intervention
Vilanterol and Umeclidinium Bromide
Placebo
Sponsored by
Samsung Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Chronic Obstructive Pulmonary Disease focused on measuring Chronic obstructive pulmonary disease, Non-small cell lung cancer, Lobectomy, Dual bronchodilator therapy, Pulmonary function

Eligibility Criteria

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

Inclusion Criteria:

  • Subjects of men or female over 40 years of age who are scheduled for curative pulmonary lobectomy due to confirmation (or high suspicion) of non-small cell lung cancer (NSCLC)
  • Subjects waiting at least 14 days for scheduled pulmonary lobectomy
  • Subjects who are newly diagnosed with COPD* or who have not used any bronchodilators within the past 3 months, even if they have previously been diagnosed with COPD

    • COPD : Post-bronchodilator (Post-BD) FEV1/FVC <0.7 and Post-BD FEV1 ≥70 %predicted (%pred)
  • Subjects with dyspnea of 0 or 1 grade measured by modified Medical Research Council (mMRC)

Exclusion Criteria:

  • Pregnancy: subjects of women who are pregnant, lactating, planning on becoming pregnant during the clinical trial, or of child bearing potential not using contraception methods
  • COPD treatment/acute exacerbation: subjects who have been treated with COPD within the past 3 months or have experienced acute exacerbation of COPD within the past 1 month (Acute exacerbation of COPD is defined as the cases requiring antibiotics, oral corticosteroids, emergency treatment, or hospitalization due to at least one symptom from increased breathlessness, sputum volume, or sputum purulence)
  • Other pulmonary diseases: subjects who are physician-diagnosed with asthma or Idiopathic Pulmonary Fibrosis (IPF)
  • Lung cancer treatment: subjects who have been received neo-adjuvant treatment for lung cancer (chemotherapy, radiotherapy, or concurrent chemo-radiotherapy)
  • Other diseases/abnormalities: subjects diagnosed with historical or current evidence of clinically significant cardiovascular, neurological, psychiatric, renal, hepatic, immunological, gastrointestinal, urogenital, nervous system, musculoskeletal, skin, sensory, endocrine (including uncontrolled diabetes or thyroid disease) or hematological abnormalities including medical condition corresponding to 'warnings and precautions' (such as coronary artery disease, acute myocardial infarction, cardiac arrhythmia, hypertension, convulsive disorders, thyrotoxicosis, hypokalemia, diabetes, narrow-angle glaucoma, urinary retention, prostatic hyperplasia, bladder-neck obstruction etc.) that are uncontrolled and/or with cancer within 5 years (Significant is defined as any disease that, in the opinion of the Investigator, would put the safety of the subject at risk through participation, or which would affect the efficacy or safety analysis if the disease/condition exacerbated during the study.)
  • Abnormal and clinically significant 12-Lead Eletrocardiogram (ECG): subjects with abnormal and clinically significant ECG findings (Significant is defined as any disease that, in the opinion of the Investigator, would put the safety of the subject at risk through participation, or which would affect the efficacy or safety analysis if the disease/condition exacerbated during the study.)
  • Contraindications: subjects with a history of allergy or hypersensitivity to any Long-Acting Muscarinic Antagonist (LAMA), Long-Acting Beta-Agonist (LABA), lactose/milk protein, stearic magnesium, with generic problems including galactose intolerance, Lapp lactose deficiency, or glucose-galactose malabsorption, or with contraindication of inhaled anticholinergic-containing drugs
  • Mobility: subjects who are not able to walk independently without mobility assistance or other people

Sites / Locations

  • Samsung Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

VI/UME

Control

Arm Description

Anoro (Vilanterol 25mcg/Umeclinidium 62.5mcg) in Ellipta device Inhaled through mouth once daily

Placebo (including lactose monohydrate) in Ellipta device Inhaled through mouth once daily

Outcomes

Primary Outcome Measures

Post-bronchodilator FEV1 at 16 weeks
Post-bronchodilator FEV1 (ml) measured at 16 weeks postoperatively

Secondary Outcome Measures

Difference of predicted postoperative FEV1 and actual postoperative FEV1 at 16 weeks
Difference of predicted postoperative FEV1 (% predicted; calculated from baseline post-bronchodilator FEV1 [T0] and surgical extent) and actual post-bronchodilator FEV1 (% predicted) at 4 months postoperatively (PPO T3 - actual T3)
Difference of post-bronchodilator FEV1 between baseline and surgery
Difference of post-bronchodilator FEV1 (ml) at baseline and post-bronchodilator FEV1 (ml) before surgery (T0 - T1)
Difference of post-bronchodilator FEV1 before surgery and at 3 weeks
Difference of post-bronchodilator FEV1 (ml) before surgery and post-bronchodilator FEV1 (ml) at 3 weeks postoperatively (T1 - T2)
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
mMRC
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
CAT
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
BFI
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
SGRQ-C
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
EORTC-QLC C-30
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
LC-30
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
BDI/TDI
Exercise tolerance at postoperative 3 and 16 weeks
6-minute walk test distance (meter)
Postoperative pulmonary and cardiac complication
Postoperative pulmonary complications (PPC) occurring within the first 30 postoperative days is defined as any of the following conditions: 1) atelectasis requiring bronchoscopic toileting; 2) pneumonia (at least three among leukocytosis, pulmonary infiltrate or consolidation, fever [>38℃], culture-positive, or use of antibiotics); 3) acute lung injury or acute respiratory distress syndrome (rate of arterial oxygen partial pressure to fractional inspired oxygen [PaO2/FiO2] <300 and bilateral infiltrate seen on chest radiograph without evidence of congestive heart failure or volume overload), or 4) acute exacerbation of chronic obstructive pulmonary disease. Postoperative cardiac complications (PCC) was defined as acute myocardial infarction, ventricular tachycardia/fibrillation, primary cardiac arrest, complete heart block, any cardiac-related death, or atrial arrhythmia associated with the use of anti-arrhythmic drugs or anti-coagulants.
Length of hospital stay
Length of hospital stay from the admission for lung cancer surgery to discharge or death
COPD Acute exacerbation
Moderate acute exacerbation is defined as a clinic visit and severe acute exacerbations is defined as a hospitalization or an emergency room visit owing to one or more of the following worsening of dyspnea, increased sputum volume and purulent sputum requiring antibiotics and/ or oral corticosteroids.
Compliance
The compliance is defined by the percentage of use during the clinical trial: complete adherence (>80%), partial adherence (50-80%), low adherence (<50%).

Full Information

First Posted
August 24, 2020
Last Updated
April 1, 2021
Sponsor
Samsung Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT04536675
Brief Title
Effect of Perioperative Bronchodilator in COPD Patients Undergoing Lung Cancer Surgery
Official Title
Effect of Perioperative Fixed-dose Dual Bronchodilator Therapy on Post-operative Pulmonary Function Among Mild- to -Moderate COPD Patients Undergoing Lung Cancer Surgery
Study Type
Interventional

2. Study Status

Record Verification Date
April 2021
Overall Recruitment Status
Recruiting
Study Start Date
April 1, 2021 (Actual)
Primary Completion Date
November 2023 (Anticipated)
Study Completion Date
April 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Samsung Medical Center

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a double-blind randomized controlled trial evaluating the effect of perioperative dual bronchodilator therapy on post-operative pulmonary function and health-related quality of life (QoL) in mild-to-moderate less symptomatic COPD patients undergoing lung cancer surgery. Investigators hypothesized that dual bronchodilator, as compared with placebo, would prevent reduction of pulmonary function after surgical resection and improve postoperative health related QoL.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chronic Obstructive Pulmonary Disease, Non Small Cell Lung Cancer
Keywords
Chronic obstructive pulmonary disease, Non-small cell lung cancer, Lobectomy, Dual bronchodilator therapy, Pulmonary function

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
204 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
VI/UME
Arm Type
Experimental
Arm Description
Anoro (Vilanterol 25mcg/Umeclinidium 62.5mcg) in Ellipta device Inhaled through mouth once daily
Arm Title
Control
Arm Type
Placebo Comparator
Arm Description
Placebo (including lactose monohydrate) in Ellipta device Inhaled through mouth once daily
Intervention Type
Drug
Intervention Name(s)
Vilanterol and Umeclidinium Bromide
Intervention Description
Perioperative inhaler therapy with VI/UME (Vilanterol 25mcg/Umeclidinium 62.5mcg) once daily using Ellipta device from at least for 2 weeks preoperatively to at least 16 weeks post operatively.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Perioperative inhaler therapy with placebo once daily using Ellipta device from at least for 2 weeks preoperatively to at least 16 weeks post operatively.
Primary Outcome Measure Information:
Title
Post-bronchodilator FEV1 at 16 weeks
Description
Post-bronchodilator FEV1 (ml) measured at 16 weeks postoperatively
Time Frame
Postoperative 16 to 18 weeks (T3)
Secondary Outcome Measure Information:
Title
Difference of predicted postoperative FEV1 and actual postoperative FEV1 at 16 weeks
Description
Difference of predicted postoperative FEV1 (% predicted; calculated from baseline post-bronchodilator FEV1 [T0] and surgical extent) and actual post-bronchodilator FEV1 (% predicted) at 4 months postoperatively (PPO T3 - actual T3)
Time Frame
Postoperative 16 to 18 weeks (T3) and baseline (T0)
Title
Difference of post-bronchodilator FEV1 between baseline and surgery
Description
Difference of post-bronchodilator FEV1 (ml) at baseline and post-bronchodilator FEV1 (ml) before surgery (T0 - T1)
Time Frame
Baseline (T0) and before surgery (T1)
Title
Difference of post-bronchodilator FEV1 before surgery and at 3 weeks
Description
Difference of post-bronchodilator FEV1 (ml) before surgery and post-bronchodilator FEV1 (ml) at 3 weeks postoperatively (T1 - T2)
Time Frame
Before surgery (T1) and postoperative 2 to 4 weeks (T2)
Title
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
Description
mMRC
Time Frame
Postoperative 2 to 4 weeks (T2) and postoperative 16 to 18 weeks (T3)
Title
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
Description
CAT
Time Frame
Postoperative 2 to 4 weeks (T2) and postoperative 16 to 18 weeks (T3)
Title
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
Description
BFI
Time Frame
Postoperative 2 to 4 weeks (T2) and postoperative 16 to 18 weeks (T3)
Title
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
Description
SGRQ-C
Time Frame
Postoperative 2 to 4 weeks (T2) and postoperative 16 to 18 weeks (T3)
Title
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
Description
EORTC-QLC C-30
Time Frame
Postoperative 2 to 4 weeks (T2) and postoperative 16 to 18 weeks (T3)
Title
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
Description
LC-30
Time Frame
Postoperative 2 to 4 weeks (T2) and postoperative 16 to 18 weeks (T3)
Title
Dyspnea and health-related quality of life at postoperative 3 and 16 weeks
Description
BDI/TDI
Time Frame
Postoperative 2 to 4 weeks (T2) and postoperative 16 to 18 weeks (T3)
Title
Exercise tolerance at postoperative 3 and 16 weeks
Description
6-minute walk test distance (meter)
Time Frame
Postoperative 2 to 4 weeks (T2) and 16 to 18 weeks (T3)
Title
Postoperative pulmonary and cardiac complication
Description
Postoperative pulmonary complications (PPC) occurring within the first 30 postoperative days is defined as any of the following conditions: 1) atelectasis requiring bronchoscopic toileting; 2) pneumonia (at least three among leukocytosis, pulmonary infiltrate or consolidation, fever [>38℃], culture-positive, or use of antibiotics); 3) acute lung injury or acute respiratory distress syndrome (rate of arterial oxygen partial pressure to fractional inspired oxygen [PaO2/FiO2] <300 and bilateral infiltrate seen on chest radiograph without evidence of congestive heart failure or volume overload), or 4) acute exacerbation of chronic obstructive pulmonary disease. Postoperative cardiac complications (PCC) was defined as acute myocardial infarction, ventricular tachycardia/fibrillation, primary cardiac arrest, complete heart block, any cardiac-related death, or atrial arrhythmia associated with the use of anti-arrhythmic drugs or anti-coagulants.
Time Frame
Within 30 days and 90 days
Title
Length of hospital stay
Description
Length of hospital stay from the admission for lung cancer surgery to discharge or death
Time Frame
From the admission for lung cancer surgery to discharge or death, whichever comes first
Title
COPD Acute exacerbation
Description
Moderate acute exacerbation is defined as a clinic visit and severe acute exacerbations is defined as a hospitalization or an emergency room visit owing to one or more of the following worsening of dyspnea, increased sputum volume and purulent sputum requiring antibiotics and/ or oral corticosteroids.
Time Frame
Between randomization (T0) and postoperative 16 to 18 weeks (T3)
Title
Compliance
Description
The compliance is defined by the percentage of use during the clinical trial: complete adherence (>80%), partial adherence (50-80%), low adherence (<50%).
Time Frame
Between randomization (T0) and postoperative 16 to 18 weeks (T3)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Subjects of men or female over 40 years of age who are scheduled for curative pulmonary lobectomy due to confirmation (or high suspicion) of non-small cell lung cancer (NSCLC) Subjects waiting at least 14 days for scheduled pulmonary lobectomy Subjects who are newly diagnosed with COPD* or who have not used any bronchodilators within the past 3 months, even if they have previously been diagnosed with COPD COPD : Post-bronchodilator (Post-BD) FEV1/FVC <0.7 and Post-BD FEV1 ≥70 %predicted (%pred) Subjects with dyspnea of 0 or 1 grade measured by modified Medical Research Council (mMRC) Exclusion Criteria: Pregnancy: subjects of women who are pregnant, lactating, planning on becoming pregnant during the clinical trial, or of child bearing potential not using contraception methods COPD treatment/acute exacerbation: subjects who have been treated with COPD within the past 3 months or have experienced acute exacerbation of COPD within the past 1 month (Acute exacerbation of COPD is defined as the cases requiring antibiotics, oral corticosteroids, emergency treatment, or hospitalization due to at least one symptom from increased breathlessness, sputum volume, or sputum purulence) Other pulmonary diseases: subjects who are physician-diagnosed with asthma or Idiopathic Pulmonary Fibrosis (IPF) Lung cancer treatment: subjects who have been received neo-adjuvant treatment for lung cancer (chemotherapy, radiotherapy, or concurrent chemo-radiotherapy) Other diseases/abnormalities: subjects diagnosed with historical or current evidence of clinically significant cardiovascular, neurological, psychiatric, renal, hepatic, immunological, gastrointestinal, urogenital, nervous system, musculoskeletal, skin, sensory, endocrine (including uncontrolled diabetes or thyroid disease) or hematological abnormalities including medical condition corresponding to 'warnings and precautions' (such as coronary artery disease, acute myocardial infarction, cardiac arrhythmia, hypertension, convulsive disorders, thyrotoxicosis, hypokalemia, diabetes, narrow-angle glaucoma, urinary retention, prostatic hyperplasia, bladder-neck obstruction etc.) that are uncontrolled and/or with cancer within 5 years (Significant is defined as any disease that, in the opinion of the Investigator, would put the safety of the subject at risk through participation, or which would affect the efficacy or safety analysis if the disease/condition exacerbated during the study.) Abnormal and clinically significant 12-Lead Eletrocardiogram (ECG): subjects with abnormal and clinically significant ECG findings (Significant is defined as any disease that, in the opinion of the Investigator, would put the safety of the subject at risk through participation, or which would affect the efficacy or safety analysis if the disease/condition exacerbated during the study.) Contraindications: subjects with a history of allergy or hypersensitivity to any Long-Acting Muscarinic Antagonist (LAMA), Long-Acting Beta-Agonist (LABA), lactose/milk protein, stearic magnesium, with generic problems including galactose intolerance, Lapp lactose deficiency, or glucose-galactose malabsorption, or with contraindication of inhaled anticholinergic-containing drugs Mobility: subjects who are not able to walk independently without mobility assistance or other people
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Hye Yun Park, MD PhD
Phone
+82-2-3410-3429
Email
hyeyunpark@skku.edu
Facility Information:
Facility Name
Samsung Medical Center
City
Seoul
Country
Korea, Republic of
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hye Yun Park, MD, PhD
Email
hyeyunpark@skku.edu

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
19476597
Citation
Kobayashi S, Suzuki S, Niikawa H, Sugawara T, Yanai M. Preoperative use of inhaled tiotropium in lung cancer patients with untreated COPD. Respirology. 2009 Jul;14(5):675-9. doi: 10.1111/j.1440-1843.2009.01543.x. Epub 2009 May 19.
Results Reference
background
PubMed Identifier
20872194
Citation
Suzuki H, Sekine Y, Yoshida S, Suzuki M, Shibuya K, Takiguchi Y, Tatsumi K, Yoshino I. Efficacy of perioperative administration of long-acting bronchodilator on postoperative pulmonary function and quality of life in lung cancer patients with chronic obstructive pulmonary disease. Preliminary results of a randomized control study. Surg Today. 2010 Oct;40(10):923-30. doi: 10.1007/s00595-009-4196-1. Epub 2010 Sep 25.
Results Reference
background
PubMed Identifier
20970351
Citation
Bolukbas S, Eberlein M, Eckhoff J, Schirren J. Short-term effects of inhalative tiotropium/formoterol/budenoside versus tiotropium/formoterol in patients with newly diagnosed chronic obstructive pulmonary disease requiring surgery for lung cancer: a prospective randomized trial. Eur J Cardiothorac Surg. 2011 Jun;39(6):995-1000. doi: 10.1016/j.ejcts.2010.09.025. Epub 2010 Oct 22.
Results Reference
background

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Effect of Perioperative Bronchodilator in COPD Patients Undergoing Lung Cancer Surgery

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