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Eflornithine and/or Diclofenac in Treating Patients With Sun-Damaged Skin

Primary Purpose

Other Benign Neoplasm of Skin, Unspecified

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Diclofenac Na gel
Eflornithine HCL ointment
Sponsored by
University of Arizona
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Other Benign Neoplasm of Skin, Unspecified focused on measuring skin cancer

Eligibility Criteria

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

Inclusion Criteria:

  • Visible sun-induced damage to the skin as assessed by the study dermatologists
  • No inflammation of the skin on the lateral forearms
  • No more than 10 actinic keratoses on the left forearm, and no actinic keratoses in the treatment area
  • Resident of Pima or an adjoining Southern Arizona county
  • History of treated basal cell carcinoma and/or squamous cell carcinoma of the skin at any site other than the left forearm allowed if excision or topical treatment was completed more than 30 days ago (60 days for radiotherapy)
  • History of treated basal cell carcinoma and/or squamous cell carcinoma of the skin on the left forearm allowed 6 months after treatment is completed
  • Must agree to avoid sun exposure to the left forearm as much as possible
  • Not pregnant or nursing
  • Not moderately to highly immunosuppressed by virtue of medication or disease, except for mildly suppressive disorders (e.g., diabetes mellitus or on mildly immunosuppressive therapy such as inhaled steroids for asthma)
  • No serious concurrent illness that could interfere with study participation
  • No active peptic ulcer disease, bleeding disorder, renal failure (creatinine > 2.0 mg/dL), or porphyria
  • No known hypersensitivity to diclofenac sodium, eflornithine, acetylsalicylic acid, or NSAIDS
  • No evidence of serious underlying medical conditions as demonstrated by abnormal values on baseline laboratory assessment
  • More than 6 months since prior chemotherapy and in complete remission
  • More than 60 days since prior and no concurrent oral diclofenac sodium (Cataflam®, Voltaren®, Voltaren-XR®) or combination of diclofenac and misoprostol (Arthrotec®)
  • More than 60 days since prior and no concurrent IV eflornithine hydrochloride
  • More than 30 days since prior and no concurrent topical retinoids, steroids, imiquimod (Aldara®), aminolevulinic acid HCl (Levulan®), eflornithine (Vaniqa®), diclofenac sodium gel (Solaraze®), or fluorouracil at any site
  • More than 30 days since prior and no concurrent topical medication, other than emollients or sunscreens, on the left forearm
  • Not undergoing concurrent bone marrow or solid organ transplant
  • No concurrent immunosuppressive therapy (e.g., systemic chemotherapy or rheumatologic agents such as infliximab [Remicade®])
  • No concurrent sunscreen use to the left forearm
  • No concurrent active therapy for any invasive cancer
  • No concurrent NSAIDs for more than 14 days per month for arthritic and other pain conditions
  • Concurrent prednisone or other steroids with doses up to 20 mg/day (or the equivalent dose) allowed
  • At least 30 days since prior and no concurrent enrollment on other investigational drug or device trial

Exclusion Criteria:

  • Individuals receiving concurrent topical therapy with retinoids, steroids, 5-fluorouracil, Levulan, Vaniqa (eflornithine), Solaraze, or Imiquimod (Aldara®) within 30 days prior to study enrollment will be excluded. Subjects may be reconsidered for eligibility 30 days after the last topical treatment.
  • Individuals who have had treatment for basal cell carcinoma or squamous cell carcinoma of the skin of the left forearm within six months prior to evaluation for the study will not be eligible. If interested, these subjects will be encouraged to return for re-evaluation once the six-month period is over.
  • Individuals who are moderately to highly immunosuppressed by virtue of medication or disease will not be allowed to participate. This category includes individuals undergoing bone marrow or solid organ transplant, or receiving immunosuppressive therapy such as systemic chemotherapy or rheumatologic agents such as infliximab (Remicade®). However, individuals with mildly suppressive disorders such as diabetes mellitus or on mildly immunosuppressive therapy such as inhaled steroids for asthma will be eligible for participation. Doses up to 20 mg of prednisone per day or the equivalent dose of other steroids will be allowed.

Sites / Locations

  • Virginia G. Piper Cancer Center at Scottsdale Healthcare - Shea
  • Veterans Affairs Medical Center - Tucson
  • Arizona Cancer Center at University of Arizona Health Sciences Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Active Comparator

Experimental

Arm Label

Eflornithine HCL

Diclofenac Na

Eflornithine HCL and Diclofenac Na

Arm Description

Patients apply Eflornithine HCL ointment to their left forearm twice daily on days 1-90.

Patients apply topical Diclofenac Na gel to their left forearm once daily on days 1-90.

Eflornithine HCl ointment and Diclofenac Na gel applied twice and once daily, respectively on days 1-90.

Outcomes

Primary Outcome Measures

Changes in Putrescine Over 3 Months
Putrescine is measured in nmole/g skin per biopsy. Baseline and End of Study biopsies were measured and the change was produced by subtracting baseline levels from End of Study levels. There was one baseline biopsy and one End of Study biopsy per participant.
Safety of Combination Therapy With Topical Eflornithine Hydrochloride Ointment and Topical Diclofenac Sodium Gel Over 3-months
Adverse events were compared across three treatment groups by severity determined by the clinician. All adverse events were resolved by the end of follow up.

Secondary Outcome Measures

Change in Histologic Score Diagnosis and Treatment Group
Change scores were computed by subtracting baseline histologic score from End of Study histologic score. Slides were formalin fixed. Histologic Score has been developed by this research group over the course of Grant (reference below). A standardized form captures data on the following criteria: basal or suprabasilar pleomorphism (atypia); inflammation; hyperkeratosis; parakeratosis. The atypia and inflammation were rated as: none (0), mild to moderate(1), and severe (2). The remaining criteria were rated as present (1) or absent (0). Histologic Scores were computed by adding together the codes for the histologic criteria. Higher scores reflected higher level of epidermal /dermal damage.

Full Information

First Posted
January 22, 2008
Last Updated
February 2, 2017
Sponsor
University of Arizona
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00601640
Brief Title
Eflornithine and/or Diclofenac in Treating Patients With Sun-Damaged Skin
Official Title
Phase IIB Study to Evaluate the Safety and Efficacy of Topical Difluoromethylornithine and Topical Diclofenac in the Treatment of Sun-Damaged Skin on the Forearm
Study Type
Interventional

2. Study Status

Record Verification Date
February 2017
Overall Recruitment Status
Completed
Study Start Date
January 2007 (undefined)
Primary Completion Date
February 2010 (Actual)
Study Completion Date
December 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Arizona
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: Chemoprevention is the use of certain drugs to keep cancer from forming. The use of eflornithine and diclofenac may stop cancer from growing in patients with sun-damaged skin. PURPOSE: This randomized phase II trial is studying the side effects and how well eflornithine works compared with diclofenac, given alone or together, in treating patients with sun-damaged skin.
Detailed Description
OBJECTIVES: Primary To determine if combination therapy with topical eflornithine hydrochloride ointment and topical diclofenac sodium gel over 3-months increases the efficacy versus either agent used alone in the treatment of moderately sun-damaged skin. Secondary To evaluate the safety of sequential administration of topical eflornithine hydrochloride ointment and topical diclofenac sodium gel. To determine the correlation of karyometric changes with histopathologic, immunohistochemical, clinical, and genetic polymorphism data. To obtain materials for microarray analysis. OUTLINE: Patients are randomized to 1 of 3 treatment arms. Eflornithine hydrochloride : Patients apply topical eflornithine hydrochloride ointment to their left forearm twice daily on days 1-90. Diclofenac sodium : Patients apply topical diclofenac sodium gel to their left forearm once daily on days 1-90. Eflornithine hydrochloride/Diclofenac sodium : Patients apply topical eflornithine hydrochloride ointment as in arm I twice daily and topical diclofenac sodium gel as in arm II once daily on days 1-90. Prior to treatment, three 4-mm punch biopsies are taken from the skin of the left lateral forearm for assessment of histopathology, the cyclooxygenase-2 enzyme and p53 expression, apoptosis, and nuclear chromatin karyometry. Tissue is also obtained for future use in microarray analysis. Blood is drawn for assessment of ornithine decarboxylase polymorphisms and for banking for subsequent studies. Biopsies are repeated 2-3 weeks after completion of treatment. Digital photographs are taken at baseline and 1-2 weeks after completion of study therapy to document improvement of sun damage, appearance of new skin lesions, and toxicity.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Other Benign Neoplasm of Skin, Unspecified
Keywords
skin cancer

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
184 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Eflornithine HCL
Arm Type
Experimental
Arm Description
Patients apply Eflornithine HCL ointment to their left forearm twice daily on days 1-90.
Arm Title
Diclofenac Na
Arm Type
Active Comparator
Arm Description
Patients apply topical Diclofenac Na gel to their left forearm once daily on days 1-90.
Arm Title
Eflornithine HCL and Diclofenac Na
Arm Type
Experimental
Arm Description
Eflornithine HCl ointment and Diclofenac Na gel applied twice and once daily, respectively on days 1-90.
Intervention Type
Drug
Intervention Name(s)
Diclofenac Na gel
Other Intervention Name(s)
Solaraze
Intervention Description
Given topically twice daily on days 1-90
Intervention Type
Drug
Intervention Name(s)
Eflornithine HCL ointment
Other Intervention Name(s)
Vaniqa
Intervention Description
Given topically twice daily on days 1-90
Primary Outcome Measure Information:
Title
Changes in Putrescine Over 3 Months
Description
Putrescine is measured in nmole/g skin per biopsy. Baseline and End of Study biopsies were measured and the change was produced by subtracting baseline levels from End of Study levels. There was one baseline biopsy and one End of Study biopsy per participant.
Time Frame
3 months
Title
Safety of Combination Therapy With Topical Eflornithine Hydrochloride Ointment and Topical Diclofenac Sodium Gel Over 3-months
Description
Adverse events were compared across three treatment groups by severity determined by the clinician. All adverse events were resolved by the end of follow up.
Time Frame
3 months
Secondary Outcome Measure Information:
Title
Change in Histologic Score Diagnosis and Treatment Group
Description
Change scores were computed by subtracting baseline histologic score from End of Study histologic score. Slides were formalin fixed. Histologic Score has been developed by this research group over the course of Grant (reference below). A standardized form captures data on the following criteria: basal or suprabasilar pleomorphism (atypia); inflammation; hyperkeratosis; parakeratosis. The atypia and inflammation were rated as: none (0), mild to moderate(1), and severe (2). The remaining criteria were rated as present (1) or absent (0). Histologic Scores were computed by adding together the codes for the histologic criteria. Higher scores reflected higher level of epidermal /dermal damage.
Time Frame
3 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Visible sun-induced damage to the skin as assessed by the study dermatologists No inflammation of the skin on the lateral forearms No more than 10 actinic keratoses on the left forearm, and no actinic keratoses in the treatment area Resident of Pima or an adjoining Southern Arizona county History of treated basal cell carcinoma and/or squamous cell carcinoma of the skin at any site other than the left forearm allowed if excision or topical treatment was completed more than 30 days ago (60 days for radiotherapy) History of treated basal cell carcinoma and/or squamous cell carcinoma of the skin on the left forearm allowed 6 months after treatment is completed Must agree to avoid sun exposure to the left forearm as much as possible Not pregnant or nursing Not moderately to highly immunosuppressed by virtue of medication or disease, except for mildly suppressive disorders (e.g., diabetes mellitus or on mildly immunosuppressive therapy such as inhaled steroids for asthma) No serious concurrent illness that could interfere with study participation No active peptic ulcer disease, bleeding disorder, renal failure (creatinine > 2.0 mg/dL), or porphyria No known hypersensitivity to diclofenac sodium, eflornithine, acetylsalicylic acid, or NSAIDS No evidence of serious underlying medical conditions as demonstrated by abnormal values on baseline laboratory assessment More than 6 months since prior chemotherapy and in complete remission More than 60 days since prior and no concurrent oral diclofenac sodium (Cataflam®, Voltaren®, Voltaren-XR®) or combination of diclofenac and misoprostol (Arthrotec®) More than 60 days since prior and no concurrent IV eflornithine hydrochloride More than 30 days since prior and no concurrent topical retinoids, steroids, imiquimod (Aldara®), aminolevulinic acid HCl (Levulan®), eflornithine (Vaniqa®), diclofenac sodium gel (Solaraze®), or fluorouracil at any site More than 30 days since prior and no concurrent topical medication, other than emollients or sunscreens, on the left forearm Not undergoing concurrent bone marrow or solid organ transplant No concurrent immunosuppressive therapy (e.g., systemic chemotherapy or rheumatologic agents such as infliximab [Remicade®]) No concurrent sunscreen use to the left forearm No concurrent active therapy for any invasive cancer No concurrent NSAIDs for more than 14 days per month for arthritic and other pain conditions Concurrent prednisone or other steroids with doses up to 20 mg/day (or the equivalent dose) allowed At least 30 days since prior and no concurrent enrollment on other investigational drug or device trial Exclusion Criteria: Individuals receiving concurrent topical therapy with retinoids, steroids, 5-fluorouracil, Levulan, Vaniqa (eflornithine), Solaraze, or Imiquimod (Aldara®) within 30 days prior to study enrollment will be excluded. Subjects may be reconsidered for eligibility 30 days after the last topical treatment. Individuals who have had treatment for basal cell carcinoma or squamous cell carcinoma of the skin of the left forearm within six months prior to evaluation for the study will not be eligible. If interested, these subjects will be encouraged to return for re-evaluation once the six-month period is over. Individuals who are moderately to highly immunosuppressed by virtue of medication or disease will not be allowed to participate. This category includes individuals undergoing bone marrow or solid organ transplant, or receiving immunosuppressive therapy such as systemic chemotherapy or rheumatologic agents such as infliximab (Remicade®). However, individuals with mildly suppressive disorders such as diabetes mellitus or on mildly immunosuppressive therapy such as inhaled steroids for asthma will be eligible for participation. Doses up to 20 mg of prednisone per day or the equivalent dose of other steroids will be allowed.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joanne M. Jeter, MD
Organizational Affiliation
University of Arizona
Official's Role
Principal Investigator
Facility Information:
Facility Name
Virginia G. Piper Cancer Center at Scottsdale Healthcare - Shea
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85258
Country
United States
Facility Name
Veterans Affairs Medical Center - Tucson
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85723
Country
United States
Facility Name
Arizona Cancer Center at University of Arizona Health Sciences Center
City
Tucson
State/Province
Arizona
ZIP/Postal Code
85724-5024
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
14603727
Citation
Bozzo P, Saboda K, Einspahr JG, Ranger-Moore J, Farmer ER, Cockerell CJ, Elder DE, Bangert JL, Hart N, Kramer CB, Alberts DS. Reliability and validity of a histologic score as a marker for skin cancer chemoprevention studies. Anal Quant Cytol Histol. 2003 Oct;25(5):285-92.
Results Reference
background
PubMed Identifier
26712942
Citation
Jeter JM, Curiel-Lewandrowski C, Stratton SP, Myrdal PB, Warneke JA, Einspahr JG, Bartels HG, Yozwiak M, Bermudez Y, Hu C, Bartels P, Alberts DS. Phase IIB Randomized Study of Topical Difluoromethylornithine and Topical Diclofenac on Sun-Damaged Skin of the Forearm. Cancer Prev Res (Phila). 2016 Feb;9(2):128-34. doi: 10.1158/1940-6207.CAPR-15-0232. Epub 2015 Dec 28.
Results Reference
derived

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Eflornithine and/or Diclofenac in Treating Patients With Sun-Damaged Skin

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