Efficacy of NOX-H94 on Anemia of Chronic Disease in Patients With Cancer
Primary Purpose
Anemia of Chronic Disease
Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
NOX-H94
Placebo solution
Sponsored by
About this trial
This is an interventional treatment trial for Anemia of Chronic Disease focused on measuring Hepcidin, Iron, Anemia of Chronic Disease, Anemia, Cancer, Interleukin-6, Iron restriction, Lymphoma, CLL, Multiple Myeloma, Hodgkin, anti-hepcidin
Eligibility Criteria
Inclusion Criteria:
- Written informed consent
- Female or male aged >18 years
- Clinically significant anemia of chronic disease (ACD) attributed to histologically or cytologically proven malignancy, either hematological or solid tumor, of any grade or stage: Hemoglobin (Hb) 7.0 g/dL to 10 g/dL, Transferrin saturation (TSAT) <50%, Serum iron <50 µg/dL (SI: <9.0 µmol/L), AND Ferritin >30 ng/mL (SI: >30 µg/L)
- Previous treatment with systemic anti-cancer therapy / regimen
- Eastern Cooperative Oncology Group (ECOG) performance status of ≤2
- Estimated life expectancy ≥12 weeks
- Men must agree to follow effective contraception methods during treatment and for 3 months after completion of treatment. Women of childbearing potential must agree to use two forms of effective contraception during treatment and for 3 months after completion of treatment.
Exclusion Criteria:
- Inability to personally provide written informed consent or to understand and collaborate throughout the study
- History of pure red cell aplasia, thalassemia major or sickle cell disease History of anemia unrelated to cancer <10 g/dL within 6 months prior to screening
- Uncorrected iron deficiency
- Regular need for blood transfusions at intervals <6 weeks
- Acute or myeloid leukemia
- Known or suspected chronic bleeding
- Tumor with gastro-intestinal involvement without negative test for fecal occult blood
- Suspected or known history of hemochromatosis
- Known infection with human immunodeficiency virus, hepatitis B, or hepatitis C
- Impaired liver function with bilirubin ≥2.0 mg/dL (26 μmol/L), AST or ALT ≥2 times upper limit
- History or risk of significant hepatic disease, e.g. chronic alcohol abuse, hepatic steatosis, hepatic cirrhosis, or organ transplantation
- Severe renal impairment: estimated glomerular filtration rate (eGFR) <30 mL/min (Cockcroft-Gault)
- Known central nervous system malignancy or metastasis
- Significant cardiac disease (e.g. uncontrolled hypertension: systolic blood pressure [BP] >150 mmHg or diastolic BP >100 mmHg; myocardial infarction or unstable angina pectoris) within 6 months prior to screening
- Positive pregnancy test (serum ß-hCG at screening, urine pregnancy test prior to first treatment) or lactation
- Previous participation in this study or treatment with an investigational agent <21 days prior to treatment start
- Hemolysis or bleeding >500 mL (measured or estimated) within 6 weeks prior to treatment start
- Treatment with erythropoiesis-stimulating agents (ESAs) or red blood cell (RBC) transfusions <21 days prior to treatment start
- Cytotoxic anti-tumor treatment <21 days prior to treatment start or planned during the anticipated study period (within 3 months from treatment start or randomization). Maintenance therapy is permitted throughout the study (e.g. lenalidomide, interferon)
Sites / Locations
- University Hospital
- AKH Vienna
- Wilhelminenspital
- University Hospital
- Tokuda Hospital
- University Hospital
- Spitalul Judetean
- Institutul Oncologic
- Spitalul Municipal
- Spitalul Judetean
- Oncomed
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Open-label pilot group
Arm Description
Twice weekly administration of NOX-H94
Outcomes
Primary Outcome Measures
Response rate of anemia
• Hb increase ≥1 g/dL OR reticulocyte index normalization (≥1%) at any time point until 1 week after the end of treatment
AND absence of all of the following treatment failure criteria until 1 week after the end of treatment:
Erythrocyte transfusion, ESA or IV iron,
Hb drop by ≥1 g/dL
Treatment interruption due to adverse events (AEs)
Secondary Outcome Measures
Response
Proportion of treatment responders at study visits V4, V6, V8, and V10 to V14, as defined for the primary efficacy endpoint
Failure
Proportion of treatment failures at study visits V4, V6, V8, and V10, as defined for the primary efficacy endpoint
Safety and tolerability
Adverse events, Safety signals derived from laboratory diagnostics, vital signs.
Pharmacokinetics
NOX-H94 plasma concentrations
Reticulocytes
Absolute values and change from baseline
Red blood cells
Absolute values and change from baseline
Transferrin
Absolute concentrations and change from baseline
Serum iron
Absolute concentrations and change from baseline
Ferritin
Absolute concentrations and change from baseline
Transferrin saturation
Absolute concentrations and change from baseline
Hemoglobin
Absolute concentrations and change from baseline
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT01691040
Brief Title
Efficacy of NOX-H94 on Anemia of Chronic Disease in Patients With Cancer
Official Title
Phase IIa Study to Characterize the Effects of the Spiegelmer® NOX H94 on Anemia of Chronic Disease in Patients With Cancer
Study Type
Interventional
2. Study Status
Record Verification Date
June 2014
Overall Recruitment Status
Completed
Study Start Date
September 2012 (undefined)
Primary Completion Date
November 2013 (Actual)
Study Completion Date
December 2013 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
TME Pharma AG
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
This study is conducted to determine the safety, tolerability, and efficacy of NOX-H94 in patients with anemia of chronic disease (ACD). Furthermore, this study is intended to provide data needed to correlate plasma concentrations of NOX-H94 with its efficacy and to choose the appropriate dose and dose schedule of subsequent efficacy studies.
Some chronic diseases, e.g. tumors, inflammation, renal disease, are associated with high hepcidin concentrations in the blood. These hepcidin concentrations cause a reduction in iron concentrations in the blood and subsequently impair formation of red blood cells. Treatment with NOX-H94 is expected to inhibit this patho-mechanism by binding and inactivating hepcidin.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Anemia of Chronic Disease
Keywords
Hepcidin, Iron, Anemia of Chronic Disease, Anemia, Cancer, Interleukin-6, Iron restriction, Lymphoma, CLL, Multiple Myeloma, Hodgkin, anti-hepcidin
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Open-label pilot group
Arm Type
Experimental
Arm Description
Twice weekly administration of NOX-H94
Intervention Type
Drug
Intervention Name(s)
NOX-H94
Other Intervention Name(s)
lexaptepid pegol
Intervention Description
intravenous injection
Intervention Type
Drug
Intervention Name(s)
Placebo solution
Other Intervention Name(s)
Glucose 5%
Intervention Description
intravenous injection
Primary Outcome Measure Information:
Title
Response rate of anemia
Description
• Hb increase ≥1 g/dL OR reticulocyte index normalization (≥1%) at any time point until 1 week after the end of treatment
AND absence of all of the following treatment failure criteria until 1 week after the end of treatment:
Erythrocyte transfusion, ESA or IV iron,
Hb drop by ≥1 g/dL
Treatment interruption due to adverse events (AEs)
Time Frame
treatment start to 1 week after treatment end
Secondary Outcome Measure Information:
Title
Response
Description
Proportion of treatment responders at study visits V4, V6, V8, and V10 to V14, as defined for the primary efficacy endpoint
Time Frame
Treatment start to 8 weeks after end of treatment
Title
Failure
Description
Proportion of treatment failures at study visits V4, V6, V8, and V10, as defined for the primary efficacy endpoint
Time Frame
Treatment start to 1 week after end of treatment
Title
Safety and tolerability
Description
Adverse events, Safety signals derived from laboratory diagnostics, vital signs.
Time Frame
Treatment start to 8 weeks after end of treatment
Title
Pharmacokinetics
Description
NOX-H94 plasma concentrations
Time Frame
Treatment start to 8 weeks after end of treatment
Title
Reticulocytes
Description
Absolute values and change from baseline
Time Frame
Treatment start until 8 weeks after end of treatment
Title
Red blood cells
Description
Absolute values and change from baseline
Time Frame
Treatment start until 8 weeks after end of treatment
Title
Transferrin
Description
Absolute concentrations and change from baseline
Time Frame
Treatment start to 8 weeks after end of treatment
Title
Serum iron
Description
Absolute concentrations and change from baseline
Time Frame
Treatment start to 8 weeks after end of treatment
Title
Ferritin
Description
Absolute concentrations and change from baseline
Time Frame
Treatment start to 8 weeks after end of treatment
Title
Transferrin saturation
Description
Absolute concentrations and change from baseline
Time Frame
Treatment start to 8 weeks after end of treatment
Title
Hemoglobin
Description
Absolute concentrations and change from baseline
Time Frame
Treatment start to 8 weeks after end of treatment
Other Pre-specified Outcome Measures:
Title
Exploratory analyses
Description
Soluble transferrin receptor
Time Frame
Treatment start to 1 week after end of treatment
Title
Exploratory analyses
Description
Reticulocyte hemoglobin content
Time Frame
Treatment start to 1 week after end of treatment
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Written informed consent
Female or male aged >18 years
Clinically significant anemia of chronic disease (ACD) attributed to histologically or cytologically proven malignancy, either hematological or solid tumor, of any grade or stage: Hemoglobin (Hb) 7.0 g/dL to 10 g/dL, Transferrin saturation (TSAT) <50%, Serum iron <50 µg/dL (SI: <9.0 µmol/L), AND Ferritin >30 ng/mL (SI: >30 µg/L)
Previous treatment with systemic anti-cancer therapy / regimen
Eastern Cooperative Oncology Group (ECOG) performance status of ≤2
Estimated life expectancy ≥12 weeks
Men must agree to follow effective contraception methods during treatment and for 3 months after completion of treatment. Women of childbearing potential must agree to use two forms of effective contraception during treatment and for 3 months after completion of treatment.
Exclusion Criteria:
Inability to personally provide written informed consent or to understand and collaborate throughout the study
History of pure red cell aplasia, thalassemia major or sickle cell disease History of anemia unrelated to cancer <10 g/dL within 6 months prior to screening
Uncorrected iron deficiency
Regular need for blood transfusions at intervals <6 weeks
Acute or myeloid leukemia
Known or suspected chronic bleeding
Tumor with gastro-intestinal involvement without negative test for fecal occult blood
Suspected or known history of hemochromatosis
Known infection with human immunodeficiency virus, hepatitis B, or hepatitis C
Impaired liver function with bilirubin ≥2.0 mg/dL (26 μmol/L), AST or ALT ≥2 times upper limit
History or risk of significant hepatic disease, e.g. chronic alcohol abuse, hepatic steatosis, hepatic cirrhosis, or organ transplantation
Severe renal impairment: estimated glomerular filtration rate (eGFR) <30 mL/min (Cockcroft-Gault)
Known central nervous system malignancy or metastasis
Significant cardiac disease (e.g. uncontrolled hypertension: systolic blood pressure [BP] >150 mmHg or diastolic BP >100 mmHg; myocardial infarction or unstable angina pectoris) within 6 months prior to screening
Positive pregnancy test (serum ß-hCG at screening, urine pregnancy test prior to first treatment) or lactation
Previous participation in this study or treatment with an investigational agent <21 days prior to treatment start
Hemolysis or bleeding >500 mL (measured or estimated) within 6 weeks prior to treatment start
Treatment with erythropoiesis-stimulating agents (ESAs) or red blood cell (RBC) transfusions <21 days prior to treatment start
Cytotoxic anti-tumor treatment <21 days prior to treatment start or planned during the anticipated study period (within 3 months from treatment start or randomization). Maintenance therapy is permitted throughout the study (e.g. lenalidomide, interferon)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kai Riecke, MD
Organizational Affiliation
TME Pharma AG
Official's Role
Study Director
Facility Information:
Facility Name
University Hospital
City
Graz
ZIP/Postal Code
8036
Country
Austria
Facility Name
AKH Vienna
City
Vienna
ZIP/Postal Code
1090
Country
Austria
Facility Name
Wilhelminenspital
City
Vienna
ZIP/Postal Code
1160
Country
Austria
Facility Name
University Hospital
City
Plovdiv
ZIP/Postal Code
4000
Country
Bulgaria
Facility Name
Tokuda Hospital
City
Sofia
ZIP/Postal Code
1407
Country
Bulgaria
Facility Name
University Hospital
City
Varna
ZIP/Postal Code
9010
Country
Bulgaria
Facility Name
Spitalul Judetean
City
Brasov
ZIP/Postal Code
500326
Country
Romania
Facility Name
Institutul Oncologic
City
Cluj-Napoca
ZIP/Postal Code
400124
Country
Romania
Facility Name
Spitalul Municipal
City
Craiova
ZIP/Postal Code
208028
Country
Romania
Facility Name
Spitalul Judetean
City
Targu-Mures
ZIP/Postal Code
540136
Country
Romania
Facility Name
Oncomed
City
Timisoara
ZIP/Postal Code
300239
Country
Romania
12. IPD Sharing Statement
Citations:
PubMed Identifier
30957581
Citation
Park EJ, Choi J, Lee KC, Na DH. Emerging PEGylated non-biologic drugs. Expert Opin Emerg Drugs. 2019 Jun;24(2):107-119. doi: 10.1080/14728214.2019.1604684. Epub 2019 Apr 19.
Results Reference
derived
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Efficacy of NOX-H94 on Anemia of Chronic Disease in Patients With Cancer
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