Efficacy and Safety of Dronabinol in the Improvement of Chemotherapy-induced and Tumor-related Symptoms in Advanced Pancreatic Cancer
Primary Purpose
Pancreatic Cancer Non-resectable, Chemotherapy-induced Nausea and Vomiting, Pancreatic Cancer Metastatic
Status
Recruiting
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
Dronabinol in Oral Dosage Form
Placebo in Oral Dosage Form
Sponsored by
About this trial
This is an interventional treatment trial for Pancreatic Cancer Non-resectable focused on measuring Dronabinol, THC, Placebo, Pancreatic Cancer, Chemotherapy-induced Nausea and Vomiting, Tumor related symptoms, Quality of life, EORTC QLQ-C30, FOLFIRINOX, Abraxane, Gemcitabine
Eligibility Criteria
Inclusion Criteria:
- Male and female subjects aged ≥18
- Patients with diagnosis of locally advanced, inoperable or metastatic pancreatic cancer, eligible for first-line chemotherapy with FOLFIRINOX or gemcitabine+Abraxane®
- According to investigator life expectancy of > 4 months at screening
- Female patients must either be post-menopausal or surgically sterilized or use a highly effective method of birth control (hormonal contraceptives, intra-uterine devices, or diaphragms with spermicide) for the duration of the study and/or must have a negative pregnancy test (female patients with childbearing potential only)
- Willing and able to provide written informed consent.
- Written informed consent given prior to any trial-related procedure not part of the normal medical practice.
Exclusion Criteria:
- Patients who are members of the staff of the trial center, staff of the sponsor or CRO, the investigator him/herself or close relatives of the investigator.
- Simultaneous participation in another interventional clinical trial, participation in another trial with less than 30 days or five half-lives of the IMP (whatever is longer) to screening, or previous participation in this trial.
- Ineligible for chemotherapy treatment with FOLFIRINOX or gemcitabine+Abraxane®
- Use of dronabinol or cannabis-based medicine with THC as constituent within 6 months before screening. A urine drug test will be performed during screening phase.
- Use of marihuana within the last 4 weeks and unwillingness to abstain for the duration of the study. A urine drug test will be performed during screening phase.
- Currently receiving chemotherapy or anticipated use of chemotherapy due to any condition not related to locally advanced or metastatic pancreatic cancer
- History of or existing cardiac diseases or pathological findings (e.g. chronic insufficiency NYHA III/IV, severe arrhythmia, unstable angina pectoris, myocardial infarction within the past 6 months, significant QT-prolongation etc.), which in the opinion of the investigator might interfere with the safety or tolerability of the study treatment. An ECG has to be done to exclude pathological findings and must not be older than 3 months before screening or if none is available, has to be performed during the screening phase and assessed prior to randomization
- Clinically relevant, severe pulmonary diseases, uncontrolled hypertension, or poorly controlled diabetes
- History of or existing relevant CNS and/or psychiatric disorders (e.g. schizophrenia, psychosis, manic and/or depressive disorders, suicidal ideations, etc) which might interfere with the safety or tolerability of the study treatment. Patients with reactive depression are not excluded from participation.
- Known current or past (within the last year prior to screening) alcohol, narcotics or drug abuse
- Pregnancy or breast feeding
- Known allergy to cannabinoids and other constituents of the investigational medicinal product
- Intake of prohibited concomitant medication
- Any other substantial medical condition that in the opinion of the investigator could create undue risk to the subject or could affect adherence with the trial protocol
- Legal incapacity, limited legal capacity or any other condition which makes the subject unable to understand the subject information and informed consent form (ICF)
- Patients unable or unwilling to waive driving motor vehicles or using machines especially during titration period
- Unable or unwilling to comply with the protocol regulations
Sites / Locations
- Klinikum Wels-Grieskirchen GmbH, Abteilung für Innere Medizin IVRecruiting
- KABEG-Klinikum Klagenfurt am Woerthersee, Abteilung f. Anaesthesie u. IntensivmedizinRecruiting
- LKH Hochsteiermark - Standort Leoben Abteilung für Innere Medizin und Hämatologie und internistische OnkologieRecruiting
- IIIrd Medical Department, Private Medical University Hospital SalzburgRecruiting
- Krankenhaus d. Barmherzigen Brüder, Abt. f. Innere MedizinRecruiting
- Pyhrn-Eisenwurzen Klinikum Steyr, Interne Medizin IIRecruiting
- Medizinische Univ. Wien, Univ.Klinik f. Innere Medizin I, Onkologie
- Hanusch Krankenhaus der Wiener GebietskrankenkasseRecruiting
- KH Zams, Innere Medizin, Internistische Onkologie u. HaematologieRecruiting
- Universitätsmedizin Göttingen Abt. f. Gastroenterologie, gastrointestinale Onkologie u. Endokrinologie
- München Klinik NeuperlachRecruiting
- Marienhospital Onkologie, Hämatologie, PalliativmedizinRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Placebo Comparator
Arm Label
Dronabinol
Placebo
Arm Description
BX-1 contains 25 mg dronabinol/ml (2.5% delta-9-trans-tetrahydrocannabinol = THC), oral solution; three applications per day from 2.5 mg (3 x 1 droplet) up to 30 mg (3 x 12 droplets)
Placebo: oral solution with cannabis flavor without active substance and otherwise identical to active comparator, three applications per day from 3 x 1 droplet up to 3 x 12 droplets
Outcomes
Primary Outcome Measures
Standardized area under the curve of the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 symptom summary score over the on-treatment period.
The EORTC-QLQ-C30 is an integrated system for assessing the health-related quality of life (QoL) of cancer patients participating in international clinical trials.
The validated QLQ-C30 summary score is calculated as mean score of the 13 of the 15 EORTC QLQ-C30 scales (v3.0), based on 27 of 30 items (the Financial Impact scale and Quality of Life score are not included). A high score for a symptom scale / item (fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea) represents a high level of symptomatology / problems. A high score for a functional scale (physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning) represents a high / healthy level of functioning. Scores for individual items: "Not at All" = 1 point, "A Little" = 2 points, "Quite a Bit" = 3 points, "Very Much" = 4 points.
A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Secondary Outcome Measures
Standardized area under the curve of the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 symptom summary score over the maintenance period
The European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) is an integrated system for assessing the health-related quality of life (QoL) of cancer patients participating in international clinical trials.
The validated QLQ-C30 summary score is calculated as mean score of items. A high score for a symptom scale / item (fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea) represents a high level of symptomatology / problems.
Scores for individual items: "Not at All" = 1 point, "A Little" = 2 points, "Quite a Bit" = 3 points, "Very Much" = 4 points. A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Change of European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 symptom summary score from baseline to summary score over the maintenance period
The European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) is an integrated system for assessing the health-related quality of life (QoL) of cancer patients participating in international clinical trials.
The validated QLQ-C30 summary score is calculated as mean score of items. A high score for a symptom scale / item (fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea) represents a high level of symptomatology / problems.
Scores for individual items: "Not at All" = 1 point, "A Little" = 2 points, "Quite a Bit" = 3 points, "Very Much" = 4 points. A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Symptom scales of European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30
A high score for a symptom scale / item (fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea) represents a high level of symptomatology / problems.
Scores for individual items: "Not at All" = 1 point, "A Little" = 2 points, "Quite a Bit" = 3 points, "Very Much" = 4 points. A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Global quality of life of the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30
The European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) is an integrated system for assessing the health-related quality of life (QoL) of cancer patients participating in international clinical trials.
The validated QLQ-C30 summary score is calculated as mean score of items. A high score for the global health status (overall health during the past week) and global QoL (overall quality of life during the past week) represents a high QoL.
Scores: 1 - 7, 1 = very poor and 7 = excellent. A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Functional scales of the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30
The European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) is an integrated system for assessing the health-related quality of life (QoL) of cancer patients participating in international clinical trials. A high score for a functional scale (physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning) represents a high / healthy level of functioning.
Scores for individual items: "Not at All" = 1 point, "A Little" = 2 points, "Quite a Bit" = 3 points, "Very Much" = 4 points.
A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Mean change from baseline of the Glasgow Prognostic Score
Change of serum levels of the score-defining biomarkers C-reactive protein (CRP) and albumin. Prognostic scores; 0 (CRP ≥ 10 mg/l), 1 (CRP > 10 mg/l and albumin ≥ 35 g/l), 2 CRP > 10 mg/l and albumin < 35g/l). Score 0 indicates good prognosis, score 1 intermediate prognosis and score 2 poor prognosis.
Amount of concomitant medication taken
Special focus on antiemetic, psychotropic and pain medication
Mean time to critical weight-loss (5%)
Assessed with a standard scale
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Lean body mass (LBM)
Mean change of Lean body mass (LBM = Fat free mass FFM) kg
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Total body water (TBW)
Mean change of Total body water (TBW) kg
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Fat mass (FM)
Mean change of Fat mass (FM) kg
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Body cell mass (BCM)
Mean change of Body cell mass (BCM) kg
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Extracellular mass (EM)
Mean change of Extracellular mass (ECM) kg
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Phase angle (PA)
Mean change of Phase angle (PA); Phase Angle has long been linked to nutritional status. This marker is fast becoming recognised as a global health marker in total body health assessment. A higher Phase Angle could mean an increase in muscle mass (body cell mass) or a decrease in fluid, either from recovery from infection or injury (a good thing!) or a decrease in fluid from dehydration (a bad thing!). A loss of fat could also increase Phase Angle.
A lower Phase Angle could mean a loss of muscle mass (a bad thing), or an increase of fluid (rehydrating which is a good thing, or sign of inflammation or infection - a bad thing), or gaining fat (which could be a good or bad thing depending on your state of health).
Phase Angle is a direct measurement, (not a calculation using equations) of the cell membrane.
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Resistance (Rz)
Mean change of Resistance (Rz), unit ohm; the resistance reflects the water or fluid in the body
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Reactance(Xc)
Mean change of Reactance (Xc), unit ohm; reactance reflects the body cell mass.
Mean change from baseline of muscle strength
To assess physical strength of patient's handgrip strength will be measured prior and after study treatment using a hydraulic hand dynamometer; mean value of three consecutive measurements will be documented
Proportion of patients not adhering to individual baseline chemotherapy regimen
Percentage of patients who do not receive full dose of planned chemotherapy regimen and/or within scheduled time frame (interruption or delay)
Chemotherapeutic dose intensity over the treatment period of 18 weeks
The total amount of applied chemotherapy over the study treatment phase is documented
Frequency and severity of (serious) adverse events (S)AE
Assessed with Common Terminology Criteria for Adverse Events (NCI-CTCAE V5.0)
Incidence of adverse drug reactions (ARs)
Frequency and severity of ARs
Progression-free survival (PFS)
PFS in months; ; patients will be asked to agree on collection of data regarding PFS also after end of trial
Overall survival (OS)
OS in months; ; patients will be asked to agree on collection of data regarding PFS also after end of trial
Full Information
NCT ID
NCT03984214
First Posted
May 28, 2019
Last Updated
September 4, 2023
Sponsor
Arbeitsgemeinschaft medikamentoese Tumortherapie
Collaborators
Medical University of Graz, Unidata Geodesign, Bionorica SE
1. Study Identification
Unique Protocol Identification Number
NCT03984214
Brief Title
Efficacy and Safety of Dronabinol in the Improvement of Chemotherapy-induced and Tumor-related Symptoms in Advanced Pancreatic Cancer
Official Title
Multicenter, Randomized, Double-blind, Placebo-controlled, Phase III Clinical Trial to Investigate the Efficacy and Safety of Dronabinol in the Improvement of ChemOthErapy-induced and Tumor-Related Symptoms in Patients With Locally Advanced or Metastatic Pancreatic Cancer During First-line Chemotherapy (DIsCOvER)
Study Type
Interventional
2. Study Status
Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 16, 2019 (Actual)
Primary Completion Date
March 31, 2024 (Anticipated)
Study Completion Date
March 31, 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Arbeitsgemeinschaft medikamentoese Tumortherapie
Collaborators
Medical University of Graz, Unidata Geodesign, Bionorica SE
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
Aim of this phase III trial is to investigate the efficacy and safety of dronabinol (orally administered tetrahydrocannabinol (THC)) as adjuvant therapy to first-line standard chemotherapy in patients with metastatic pancreatic cancer for improvement of chemotherapy- and tumor-related symptoms applicated by individual titration up to the maximum tolerated dose.
Detailed Description
Patients with pancreatic cancer suffer from multiple symptoms related to the tumor itself or induced by the chemotherapy. The available supportive therapy is still not able to relief all symptoms that are caused by the malignancy itself as well as by the antineoplastic therapy.
Additionally, anorexia and weight loss, that often result in increased morbidity and mortality in this patient population as well as in psycho-social burden and suffering in patients and their relatives, are unmet needs in pancreatic cancer patients.
Therapeutic approaches focus on treating the malignancy itself, additional nutritional support and physical examination might prevent patients from further side effects such as sarcopenia.
During the last decades a number of appetite-modulating drugs have been under clinical investigation. A number of studies focused on the endocannabinoid system, which is involved amongst others in appetite-modulating, antiemetic, analgesic and anti-inflammatory processes.
As dronabinol is already used as magistral formulation, its beneficial effect has often been observed in these patients in the clinical routine, especially in patients with therapy-refractory nausea and emesis. Due to its broad efficacy it might be of benefit for patients suffering from malignancy. Thus, investigators want to evaluate the efficacy of dronabinol in the improvement of chemotherapy-induced and tumor-related symptoms in advanced pancreatic patients during systemic first-line chemotherapy. However, data on optimal dosage are conflicting yet.
In detail, investigators want to study whether dronabinol has a positive influence on quality of life and whether symptoms caused by the tumor or by the chemotherapy itself might be palliated by dronabinol. Beneficial and potential harmful side effects and the personal perception of advanced pancreatic cancer patients will be documented.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pancreatic Cancer Non-resectable, Chemotherapy-induced Nausea and Vomiting, Pancreatic Cancer Metastatic
Keywords
Dronabinol, THC, Placebo, Pancreatic Cancer, Chemotherapy-induced Nausea and Vomiting, Tumor related symptoms, Quality of life, EORTC QLQ-C30, FOLFIRINOX, Abraxane, Gemcitabine
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
104 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Dronabinol
Arm Type
Active Comparator
Arm Description
BX-1 contains 25 mg dronabinol/ml (2.5% delta-9-trans-tetrahydrocannabinol = THC), oral solution; three applications per day from 2.5 mg (3 x 1 droplet) up to 30 mg (3 x 12 droplets)
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo: oral solution with cannabis flavor without active substance and otherwise identical to active comparator, three applications per day from 3 x 1 droplet up to 3 x 12 droplets
Intervention Type
Drug
Intervention Name(s)
Dronabinol in Oral Dosage Form
Other Intervention Name(s)
BX-1
Intervention Description
Titration period for 4 weeks: titration according to tolerability from 2.5 mg (3 x 1 droplet) up to 30 mg (3 x 12 droplets) per day; dose increased by 2.5 mg (3 x 1 droplet) every other day Maintenance period for 12 weeks: individually tolerated maximum dose (up to 30 mg ≙ 3 x 12 droplets) at end of titration period will be continued for maintenance treatment Tapering period for 2 weeks: dose is decreased every other day by 5 mg (3 x 2 droplets) Safety follow-up: 4 weeks after end of treatment
Intervention Type
Drug
Intervention Name(s)
Placebo in Oral Dosage Form
Intervention Description
Titration period for 4 weeks: titration according to tolerability from 3 x 1 droplet up to 3 x 12 droplets per day; dose increased by 3 x 1 droplet every other day Maintenance period for 12 weeks: individually tolerated maximum dose (up to 3 x 12 droplets) at end of titration period will be continued for maintenance treatment Tapering period for 2 weeks: dose is decreased every other day by 3 x 2 droplets Safety follow-up: 4 weeks after end of treatment
Primary Outcome Measure Information:
Title
Standardized area under the curve of the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 symptom summary score over the on-treatment period.
Description
The EORTC-QLQ-C30 is an integrated system for assessing the health-related quality of life (QoL) of cancer patients participating in international clinical trials.
The validated QLQ-C30 summary score is calculated as mean score of the 13 of the 15 EORTC QLQ-C30 scales (v3.0), based on 27 of 30 items (the Financial Impact scale and Quality of Life score are not included). A high score for a symptom scale / item (fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea) represents a high level of symptomatology / problems. A high score for a functional scale (physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning) represents a high / healthy level of functioning. Scores for individual items: "Not at All" = 1 point, "A Little" = 2 points, "Quite a Bit" = 3 points, "Very Much" = 4 points.
A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Time Frame
Prior to treatment start until end of 16 weeks maintenance treatment
Secondary Outcome Measure Information:
Title
Standardized area under the curve of the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 symptom summary score over the maintenance period
Description
The European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) is an integrated system for assessing the health-related quality of life (QoL) of cancer patients participating in international clinical trials.
The validated QLQ-C30 summary score is calculated as mean score of items. A high score for a symptom scale / item (fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea) represents a high level of symptomatology / problems.
Scores for individual items: "Not at All" = 1 point, "A Little" = 2 points, "Quite a Bit" = 3 points, "Very Much" = 4 points. A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Time Frame
After 4 weeks of treatment until week 16
Title
Change of European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 symptom summary score from baseline to summary score over the maintenance period
Description
The European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) is an integrated system for assessing the health-related quality of life (QoL) of cancer patients participating in international clinical trials.
The validated QLQ-C30 summary score is calculated as mean score of items. A high score for a symptom scale / item (fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea) represents a high level of symptomatology / problems.
Scores for individual items: "Not at All" = 1 point, "A Little" = 2 points, "Quite a Bit" = 3 points, "Very Much" = 4 points. A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Time Frame
From treatment start until week 16
Title
Symptom scales of European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30
Description
A high score for a symptom scale / item (fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea) represents a high level of symptomatology / problems.
Scores for individual items: "Not at All" = 1 point, "A Little" = 2 points, "Quite a Bit" = 3 points, "Very Much" = 4 points. A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Time Frame
At baseline and 2-weekly until end of treatment at week 18
Title
Global quality of life of the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30
Description
The European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) is an integrated system for assessing the health-related quality of life (QoL) of cancer patients participating in international clinical trials.
The validated QLQ-C30 summary score is calculated as mean score of items. A high score for the global health status (overall health during the past week) and global QoL (overall quality of life during the past week) represents a high QoL.
Scores: 1 - 7, 1 = very poor and 7 = excellent. A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Time Frame
At baseline and 2-weekly until end of treatment at week 18
Title
Functional scales of the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30
Description
The European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ) is an integrated system for assessing the health-related quality of life (QoL) of cancer patients participating in international clinical trials. A high score for a functional scale (physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning) represents a high / healthy level of functioning.
Scores for individual items: "Not at All" = 1 point, "A Little" = 2 points, "Quite a Bit" = 3 points, "Very Much" = 4 points.
A linear transformation is used to standardize the raw score, so that overall scores range from 0 to 100.
Time Frame
At baseline and 2-weekly until end of treatment at week 18
Title
Mean change from baseline of the Glasgow Prognostic Score
Description
Change of serum levels of the score-defining biomarkers C-reactive protein (CRP) and albumin. Prognostic scores; 0 (CRP ≥ 10 mg/l), 1 (CRP > 10 mg/l and albumin ≥ 35 g/l), 2 CRP > 10 mg/l and albumin < 35g/l). Score 0 indicates good prognosis, score 1 intermediate prognosis and score 2 poor prognosis.
Time Frame
At baseline and at end of treatment at week 16
Title
Amount of concomitant medication taken
Description
Special focus on antiemetic, psychotropic and pain medication
Time Frame
From baseline until end of treatment at week 18
Title
Mean time to critical weight-loss (5%)
Description
Assessed with a standard scale
Time Frame
From baseline until end of treatment at week 16
Title
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Lean body mass (LBM)
Description
Mean change of Lean body mass (LBM = Fat free mass FFM) kg
Time Frame
At baseline and at end of treatment at week 16
Title
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Total body water (TBW)
Description
Mean change of Total body water (TBW) kg
Time Frame
At baseline and at end of treatment at week 16
Title
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Fat mass (FM)
Description
Mean change of Fat mass (FM) kg
Time Frame
At baseline and at end of treatment at week 16
Title
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Body cell mass (BCM)
Description
Mean change of Body cell mass (BCM) kg
Time Frame
At baseline and at end of treatment at week 16
Title
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Extracellular mass (EM)
Description
Mean change of Extracellular mass (ECM) kg
Time Frame
At baseline and at end of treatment at week 16
Title
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Phase angle (PA)
Description
Mean change of Phase angle (PA); Phase Angle has long been linked to nutritional status. This marker is fast becoming recognised as a global health marker in total body health assessment. A higher Phase Angle could mean an increase in muscle mass (body cell mass) or a decrease in fluid, either from recovery from infection or injury (a good thing!) or a decrease in fluid from dehydration (a bad thing!). A loss of fat could also increase Phase Angle.
A lower Phase Angle could mean a loss of muscle mass (a bad thing), or an increase of fluid (rehydrating which is a good thing, or sign of inflammation or infection - a bad thing), or gaining fat (which could be a good or bad thing depending on your state of health).
Phase Angle is a direct measurement, (not a calculation using equations) of the cell membrane.
Time Frame
At baseline and at end of treatment at week 16
Title
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Resistance (Rz)
Description
Mean change of Resistance (Rz), unit ohm; the resistance reflects the water or fluid in the body
Time Frame
At baseline and at end of treatment at week 16
Title
Mean changes from baseline for Bioelectrical Impedance Analysis (BIA) parameter Reactance(Xc)
Description
Mean change of Reactance (Xc), unit ohm; reactance reflects the body cell mass.
Time Frame
At baseline and at end of treatment at week 16
Title
Mean change from baseline of muscle strength
Description
To assess physical strength of patient's handgrip strength will be measured prior and after study treatment using a hydraulic hand dynamometer; mean value of three consecutive measurements will be documented
Time Frame
At baseline and at end of treatment at week 16
Title
Proportion of patients not adhering to individual baseline chemotherapy regimen
Description
Percentage of patients who do not receive full dose of planned chemotherapy regimen and/or within scheduled time frame (interruption or delay)
Time Frame
From baseline until end of treatment at week 18
Title
Chemotherapeutic dose intensity over the treatment period of 18 weeks
Description
The total amount of applied chemotherapy over the study treatment phase is documented
Time Frame
From baseline until end of treatment at week 18
Title
Frequency and severity of (serious) adverse events (S)AE
Description
Assessed with Common Terminology Criteria for Adverse Events (NCI-CTCAE V5.0)
Time Frame
From baseline until safety visit at week 22
Title
Incidence of adverse drug reactions (ARs)
Description
Frequency and severity of ARs
Time Frame
From baseline until safety visit at week 22
Title
Progression-free survival (PFS)
Description
PFS in months; ; patients will be asked to agree on collection of data regarding PFS also after end of trial
Time Frame
From treatment start until the date of first documented progression or death from any cause assessed up to week 22
Title
Overall survival (OS)
Description
OS in months; ; patients will be asked to agree on collection of data regarding PFS also after end of trial
Time Frame
From treatment start until death from any cause assessed up to week 22
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Male and female subjects aged ≥18
Patients with diagnosis of locally advanced, inoperable or metastatic pancreatic cancer, eligible for first-line chemotherapy with FOLFIRINOX or gemcitabine+Abraxane®
According to investigator life expectancy of > 4 months at screening
Female patients must either be post-menopausal or surgically sterilized or use a highly effective method of birth control (hormonal contraceptives, intra-uterine devices, or diaphragms with spermicide) for the duration of the study and/or must have a negative pregnancy test (female patients with childbearing potential only)
Willing and able to provide written informed consent.
Written informed consent given prior to any trial-related procedure not part of the normal medical practice.
Exclusion Criteria:
Patients who are members of the staff of the trial center, staff of the sponsor or CRO, the investigator him/herself or close relatives of the investigator.
Simultaneous participation in another interventional clinical trial, participation in another trial with less than 30 days or five half-lives of the IMP (whatever is longer) to screening, or previous participation in this trial.
Ineligible for chemotherapy treatment with FOLFIRINOX or gemcitabine+Abraxane®
Use of dronabinol or cannabis-based medicine with THC as constituent within 6 months before screening. A urine drug test will be performed during screening phase.
Use of marihuana within the last 4 weeks and unwillingness to abstain for the duration of the study. A urine drug test will be performed during screening phase.
Currently receiving chemotherapy or anticipated use of chemotherapy due to any condition not related to locally advanced or metastatic pancreatic cancer
History of or existing cardiac diseases or pathological findings (e.g. chronic insufficiency NYHA III/IV, severe arrhythmia, unstable angina pectoris, myocardial infarction within the past 6 months, significant QT-prolongation etc.), which in the opinion of the investigator might interfere with the safety or tolerability of the study treatment. An ECG has to be done to exclude pathological findings and must not be older than 3 months before screening or if none is available, has to be performed during the screening phase and assessed prior to randomization
Clinically relevant, severe pulmonary diseases, uncontrolled hypertension, or poorly controlled diabetes
History of or existing relevant CNS and/or psychiatric disorders (e.g. schizophrenia, psychosis, manic and/or depressive disorders, suicidal ideations, etc) which might interfere with the safety or tolerability of the study treatment. Patients with reactive depression are not excluded from participation.
Known current or past (within the last year prior to screening) alcohol, narcotics or drug abuse
Pregnancy or breast feeding
Known allergy to cannabinoids and other constituents of the investigational medicinal product
Intake of prohibited concomitant medication
Any other substantial medical condition that in the opinion of the investigator could create undue risk to the subject or could affect adherence with the trial protocol
Legal incapacity, limited legal capacity or any other condition which makes the subject unable to understand the subject information and informed consent form (ICF)
Patients unable or unwilling to waive driving motor vehicles or using machines especially during titration period
Unable or unwilling to comply with the protocol regulations
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Richard Greil, Prof.MD
Phone
+43 57255
Ext
25801
Email
r.greil@agmt.at
First Name & Middle Initial & Last Name or Official Title & Degree
Daniela Wolkersdorfer, PhD
Phone
+43 662640
Ext
4412
Email
d.wolkersdorfer@agmt.at
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Felix Keil, Prof.MD
Organizational Affiliation
Med. Dept. III, Hematolog and Oncology
Official's Role
Principal Investigator
Facility Information:
Facility Name
Klinikum Wels-Grieskirchen GmbH, Abteilung für Innere Medizin IV
City
Wels
State/Province
Oberösterreich
ZIP/Postal Code
4600
Country
Austria
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Gudrun Piringer, MD
Phone
+43 7242 415
Ext
3452
Email
Gurdrun.Piringer@klinikum-wegr.at
First Name & Middle Initial & Last Name & Degree
Christa Reder, BScN
Phone
+43 7242 415
Ext
93464
Email
christa.reder@klinikum-wegr.at
First Name & Middle Initial & Last Name & Degree
Gudrun Piringer, MD
Facility Name
KABEG-Klinikum Klagenfurt am Woerthersee, Abteilung f. Anaesthesie u. Intensivmedizin
City
Klagenfurt
ZIP/Postal Code
9020
Country
Austria
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Rudolf Likar, Prof.MD.MSc
Phone
+43 463 538
Ext
26100
Email
rudolf.likar@kabeg.at
First Name & Middle Initial & Last Name & Degree
Brigitte Trummer
Phone
+43 463 538
Ext
35756
Email
brigitte.trummer@kabeg.at
First Name & Middle Initial & Last Name & Degree
Rudolf Likar, Prof.MD.MSc
Facility Name
LKH Hochsteiermark - Standort Leoben Abteilung für Innere Medizin und Hämatologie und internistische Onkologie
City
Leoben
ZIP/Postal Code
8700
Country
Austria
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Thamer Sliwa, MD, Lead
Phone
+43 3842 401
Ext
2821
Email
thamer.sliwa@kages.at
First Name & Middle Initial & Last Name & Degree
Manuela Maderdonner, BSc.,MSc.
Phone
+43 3842 401
Ext
3402
Email
manuela.maderdonner@kages.at
First Name & Middle Initial & Last Name & Degree
Thamer Sliwa, MD, Lead
Facility Name
IIIrd Medical Department, Private Medical University Hospital Salzburg
City
Salzburg
ZIP/Postal Code
5020
Country
Austria
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Richard Greil, Prof.MD
Phone
+43 57255
Ext
25801
Email
r.greil@salk.at
First Name & Middle Initial & Last Name & Degree
Michaela Schachner, Mag.
Phone
+43 57255
Ext
25823
Email
m.schachner@salk.at
Facility Name
Krankenhaus d. Barmherzigen Brüder, Abt. f. Innere Medizin
City
St. Veit an der Glan
ZIP/Postal Code
9300
Country
Austria
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Harald Weiß, Senior MD
Phone
+43 4212 499
Email
harald.weiss@bbstveit.at
First Name & Middle Initial & Last Name & Degree
Maria Piribauer, MD
Phone
+43 4212 499
Email
maria.piribauer@bbstveit.at
First Name & Middle Initial & Last Name & Degree
Harald Weiss, Senior MD
Facility Name
Pyhrn-Eisenwurzen Klinikum Steyr, Interne Medizin II
City
Steyr
ZIP/Postal Code
A-4400
Country
Austria
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Georg Schreil, MD
Phone
+43 50554 66
Ext
24208
Email
georg.schreil@ooeg.at
First Name & Middle Initial & Last Name & Degree
Regina Neuhauser
Phone
+43 50554 66
Ext
24202
Email
regina.neuhauser@ooeg.at
First Name & Middle Initial & Last Name & Degree
Georg Schreil, MD
Facility Name
Medizinische Univ. Wien, Univ.Klinik f. Innere Medizin I, Onkologie
City
Vienna
ZIP/Postal Code
1090
Country
Austria
Individual Site Status
Withdrawn
Facility Name
Hanusch Krankenhaus der Wiener Gebietskrankenkasse
City
Vienna
ZIP/Postal Code
1140
Country
Austria
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Adelheid Seebacher, MD, Senior physician
Phone
+43 1 910 21
Ext
57314
Email
adelheid.seebacher@oegk.at
First Name & Middle Initial & Last Name & Degree
Ewa Schogger, MSc
Phone
+43 1 910 21
Ext
57340
Email
ewa.schogger@oegk.at
First Name & Middle Initial & Last Name & Degree
Adelheid Seebacher, MD, Senior physician
Facility Name
KH Zams, Innere Medizin, Internistische Onkologie u. Haematologie
City
Zams
ZIP/Postal Code
6511
Country
Austria
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ewald Wöll, Prof. MD
Phone
+43 5442 600
Ext
7421
Email
ewald.woell@krankenhaus-zams.at
First Name & Middle Initial & Last Name & Degree
Carmen Ruepp
Phone
+43 664 600 85 5971
Email
carmen.ruepp@krankenhaus-zams.at
First Name & Middle Initial & Last Name & Degree
Ewald Wöll, Prof.MD
Facility Name
Universitätsmedizin Göttingen Abt. f. Gastroenterologie, gastrointestinale Onkologie u. Endokrinologie
City
Göttingen
ZIP/Postal Code
37075
Country
Germany
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ute König, MD, Senior physician
Phone
+49 551 39 63881
Email
ute.koenig@med.uni-goettingen.de
First Name & Middle Initial & Last Name & Degree
Annika Richter
Phone
+49 551 39 65447
Email
sz-umg.gastroenterologie@med.uni-goettingen.de
First Name & Middle Initial & Last Name & Degree
Ute König, MD, Senior Physician
Facility Name
München Klinik Neuperlach
City
München
ZIP/Postal Code
81737
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Meinolf Karthaus, Prof. MD
Phone
+49 896794
Ext
2651
Email
Meinolf.Karthaus@muenchen-klinik.de
First Name & Middle Initial & Last Name & Degree
Bärbel Höll, Dr.
Phone
+49 89 6794
Ext
2737
Email
baerbel.hoell-neugebauer@muenchen-klinik.de
First Name & Middle Initial & Last Name & Degree
Meinolf Karthaus, Prof. MD
Facility Name
Marienhospital Onkologie, Hämatologie, Palliativmedizin
City
Stuttgart
ZIP/Postal Code
07199
Country
Germany
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Claudio Denzlinger, Prof.MD
Phone
+49 711 6489
Ext
8100
Email
Claudio.Denzlinger@vinzenz.de
First Name & Middle Initial & Last Name & Degree
Jessika Strentzsch
Phone
+ 49 7116489
Ext
8107
Email
jessika.strentzsch@vinzenz.de
First Name & Middle Initial & Last Name & Degree
Claudio Denzlinger, Prof.MD
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
28189366
Citation
van Amerongen G, Kanhai K, Baakman AC, Heuberger J, Klaassen E, Beumer TL, Strijers RLM, Killestein J, van Gerven J, Cohen A, Groeneveld GJ. Effects on Spasticity and Neuropathic Pain of an Oral Formulation of Delta9-tetrahydrocannabinol in Patients WithProgressive Multiple Sclerosis. Clin Ther. 2018 Sep;40(9):1467-1482. doi: 10.1016/j.clinthera.2017.01.016. Epub 2017 Feb 9.
Results Reference
background
PubMed Identifier
27407130
Citation
Davis MP. Cannabinoids for Symptom Management and Cancer Therapy: The Evidence. J Natl Compr Canc Netw. 2016 Jul;14(7):915-22. doi: 10.6004/jnccn.2016.0094.
Results Reference
background
PubMed Identifier
16849753
Citation
Cannabis-In-Cachexia-Study-Group; Strasser F, Luftner D, Possinger K, Ernst G, Ruhstaller T, Meissner W, Ko YD, Schnelle M, Reif M, Cerny T. Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. J Clin Oncol. 2006 Jul 20;24(21):3394-400. doi: 10.1200/JCO.2005.05.1847.
Results Reference
background
PubMed Identifier
28457056
Citation
Turgeman I, Bar-Sela G. Cannabis Use in Palliative Oncology: A Review of the Evidence for Popular Indications. Isr Med Assoc J. 2017 Feb;19(2):85-88.
Results Reference
background
PubMed Identifier
11786587
Citation
Jatoi A, Windschitl HE, Loprinzi CL, Sloan JA, Dakhil SR, Mailliard JA, Pundaleeka S, Kardinal CG, Fitch TR, Krook JE, Novotny PJ, Christensen B. Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. J Clin Oncol. 2002 Jan 15;20(2):567-73. doi: 10.1200/JCO.2002.20.2.567.
Results Reference
background
Links:
URL
http://www.agmt.at
Description
Sponsor
Learn more about this trial
Efficacy and Safety of Dronabinol in the Improvement of Chemotherapy-induced and Tumor-related Symptoms in Advanced Pancreatic Cancer
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