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Ethacrynic Acid Elimination in Non-Muscle Invasive Bladder Cancer Patients Undergoing Transurethral Resection

Primary Purpose

Bladder Cancer

Status
Completed
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ethacrynic Acid
Sponsored by
Eugene Lee, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Bladder Cancer focused on measuring Non-Muscle, Invasive, Bladder, Cancer, Muscle, Surgery, Transurethral, Resection, Tumor, Ethacrynic, Acid, Mitomycin, Urine, NMIBC

Eligibility Criteria

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

INCLUSION CRITERIA:

NOTE: Both patients who will and will not receive standard of care concomitant mitomycin C are eligible to enroll in this study.

  • Ability to understand and the willingness to sign a written informed consent
  • Diagnosis of presumed non-muscle invasive bladder cancer based on office based cystoscopy (primary or recurrent), and planned transurethral resection of bladder tumor (TURBT)
  • Participants must have tumors with anticipated transurethral resection time ≤ 1 hour
  • Previous history of intravesical therapy allowed
  • Age ≥ 18 years
  • Performance Status 0-1
  • Adequate organ and marrow function as defined below:

    • leukocytes ≥ 3,000/mcL
    • absolute neutrophil count ≥ 1,500/mcL
    • platelets ≥ 100,000/mcl
    • total bilirubin within normal institutional limits
    • Aspartate Aminotransferase (AST) ≤ 2.5 X institutional upper limit of normal
    • Alanine Aminotransferase (ALT) ≤ 2.5 X institutional upper limit of normal
    • creatinine ≤ 2.5 X institutional upper limit of normal
  • Women of child-bearing potential (WOCP) and men with partners of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately *A woman of child-bearing potential is any female (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:

    • Has not undergone a hysterectomy or bilateral oophorectomy; or
    • Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months)

EXCLUSION CRITERIA:

Participants meeting any of the exclusion criteria at baseline will be excluded from study participation.

  • Current or anticipated use of other investigational agents.
  • Patient has known nodal or distant metastatic disease. Patients with nodal or metastatic disease require systemic chemotherapy. Furthermore, they should be excluded from this clinical trial because of their poor overall prognosis.
  • Patients with locally advanced bladder cancer based on cross-sectional imaging (suspicion of extravesical disease or hydronephrosis)
  • Patients with tumors with anticipated transurethral resection time greater than 1 hour
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to Ethacrynic acid or other agents used in study.
  • Systolic blood pressure < 90 mmHg and/or diastolic blood pressure < 50 mmHg
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Pregnant or nursing. There is a potential for congenital abnormalities and for this regimen to harm nursing infants.

Sites / Locations

  • The University of Kansas Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Enrolled Participants

Arm Description

Administration of a single, 50 mg oral dose of ethacrynic acid prior to bladder tumor removal surgery (Transurethral Resection of Bladder Tumor [TURBT])

Outcomes

Primary Outcome Measures

Urine Concentration - Ethacrynic Acid and its conjugates
Concentration of Ethacrynic acid and its conjugates in urine for baseline at 30 minutes before surgery. A: Ethacrynic acid concentration (ng/mL) B: Glutathione (ng/mL) C: Cysteine (ng/mL) D: Mercapturic acid (ng/mL) will be measured.
Urine Concentration - Ethacrynic Acid and its conjugates
Concentration of Ethacrynic acid and its conjugates in urine during surgery. A: Ethacrynic acid concentration (ng/mL) B: Glutathione (ng/mL) C: Cysteine (ng/mL) D: Mercapturic acid (ng/mL) will be measured.
Urine Concentration - Ethacrynic Acid and its conjugates
Concentration of Ethacrynic acid and its conjugates in urine at 2 hours after surgery. A: Ethacrynic acid concentration (ng/mL) B: Glutathione (ng/mL) C: Cysteine (ng/mL) D: Mercapturic acid (ng/mL) will be measured.
Urine Concentration - Ethacrynic Acid and its conjugates
Concentration of Ethacrynic acid and its conjugates in urine at 4 hours after surgery. A: Ethacrynic acid concentration (ng/mL) B: Glutathione (ng/mL) C: Cysteine (ng/mL) D: Mercapturic acid (ng/mL) will be measured.
Excretion Rates - Ethacrynic Acid and its conjugates
Urinary excretion rates of ethacrynic acid and its conjugates for baseline at 30 minutes before surgery. A: Ethacrynic acid concentration (ng) B: Glutathione (ng) C: Cysteine (ng) D: Mercapturic acid (ng) will be measured.
Excretion Rates - Ethacrynic Acid and its conjugates
Urinary excretion rates of ethacrynic acid and its conjugates during surgery. A: Ethacrynic acid concentration (ng) B: Glutathione (ng) C: Cysteine (ng) D: Mercapturic acid (ng) will be measured.
Excretion Rates - Ethacrynic Acid and its conjugates
Urinary excretion rates of ethacrynic acid and its conjugates 2 hours after surgery. A: Ethacrynic acid concentration (ng) B: Glutathione (ng) C: Cysteine (ng) D: Mercapturic acid (ng) will be measured.
Excretion Rates - Ethacrynic Acid and its conjugates
Urinary excretion rates of ethacrynic acid and its conjugates 4 hours after surgery. A: Ethacrynic acid concentration (ng) B: Glutathione (ng) C: Cysteine (ng) D: Mercapturic acid (ng) will be measured.

Secondary Outcome Measures

Number of Participants with treatment-related adverse events as assessed by CTCAE 4.03
Adverse events / toxicity related to Ethacrynic Acid as reported by participants will be recorded. Toxicity will be measured via analysis of patient adverse events (physiological parameter). Adverse events will be scored using NCI Common Toxicity Criteria for Adverse Events v 4.0.3 (June 14,2010).
Number of Participants with Tumor Recurrence / Non-Recurrence using RECIST version 1.1
Tumor Recurrence / Non-Recurrence will be measured using RECIST version 1.1 to assess efficacy of ethacrynic acid

Full Information

First Posted
June 28, 2016
Last Updated
August 17, 2017
Sponsor
Eugene Lee, MD
Collaborators
University of Kansas Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT02852564
Brief Title
Ethacrynic Acid Elimination in Non-Muscle Invasive Bladder Cancer Patients Undergoing Transurethral Resection
Official Title
Ethacrynic Acid Elimination in Non-Muscle Invasive Bladder Cancer Patients Undergoing Transurethral Resection
Study Type
Interventional

2. Study Status

Record Verification Date
August 2017
Overall Recruitment Status
Completed
Study Start Date
August 2016 (Actual)
Primary Completion Date
July 2017 (Actual)
Study Completion Date
July 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Eugene Lee, MD
Collaborators
University of Kansas Medical Center

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Phase 1 study to provide quantitative characterization of the renal elimination of ethacrynic acid and metabolites in patients with non-muscle invasive bladder cancer (NMIBC) at the time of transurethral resection of bladder tumor
Detailed Description
Bladder cancer continues to be a significant healthcare and financial liability in the United States. Patients with Non-Muscle Invasive Bladder Cancer (NMIBC) are in desperate need for both effective and easily tolerated treatment options. Current standard of care includes immediate post-operative Mitomycin C (MMC), which decreases the rate of recurrence but does not alter progression. Furthermore, in patients with high-grade NMIBC, standard of care dictates that patients undergo intravesical Bacillus Calmette-Guerin (BCG) therapy. This treatment has a high degree of morbidity with both local and systemic side effects along with significant discomfort from treatment (intra-urethral catheterization and bladder instillation). Our goal is to develop a bladder cancer treatment strategy designed to decrease recurrence/progression rates in addition to decreasing the morbidity of treatment. Twelve evaluable NMIBC patients will participate in this Phase 1 trial. Treatment - patients will receive a single, 50 mg oral dose of ethacrynic acid administered as two 25 mg strength EDECRIN® tablets immediately prior to transurethral resection of bladder tumor. Concentrations and excretion rates of ethacrynic acid in the urine, as well as of cysteine, glutathione, and mercapturate metabolites, will be measured for each of 4 urine specimens collected on the day of surgery (before, during, and at 2 timepoints after surgery). Adverse events, serious adverse events, laboratory values, and vital sign measurements will be collected. Efficacy of ethacrynic acid treatment will be estimated by recording recurrence/non-recurrence of disease at 3 months post-treatment

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Bladder Cancer
Keywords
Non-Muscle, Invasive, Bladder, Cancer, Muscle, Surgery, Transurethral, Resection, Tumor, Ethacrynic, Acid, Mitomycin, Urine, NMIBC

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
12 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Enrolled Participants
Arm Type
Experimental
Arm Description
Administration of a single, 50 mg oral dose of ethacrynic acid prior to bladder tumor removal surgery (Transurethral Resection of Bladder Tumor [TURBT])
Intervention Type
Drug
Intervention Name(s)
Ethacrynic Acid
Other Intervention Name(s)
Edecrin
Intervention Description
One oral dose at 50 mg prior to bladder tumor removal surgery
Primary Outcome Measure Information:
Title
Urine Concentration - Ethacrynic Acid and its conjugates
Description
Concentration of Ethacrynic acid and its conjugates in urine for baseline at 30 minutes before surgery. A: Ethacrynic acid concentration (ng/mL) B: Glutathione (ng/mL) C: Cysteine (ng/mL) D: Mercapturic acid (ng/mL) will be measured.
Time Frame
Baseline at 30 minutes before surgery
Title
Urine Concentration - Ethacrynic Acid and its conjugates
Description
Concentration of Ethacrynic acid and its conjugates in urine during surgery. A: Ethacrynic acid concentration (ng/mL) B: Glutathione (ng/mL) C: Cysteine (ng/mL) D: Mercapturic acid (ng/mL) will be measured.
Time Frame
During surgery
Title
Urine Concentration - Ethacrynic Acid and its conjugates
Description
Concentration of Ethacrynic acid and its conjugates in urine at 2 hours after surgery. A: Ethacrynic acid concentration (ng/mL) B: Glutathione (ng/mL) C: Cysteine (ng/mL) D: Mercapturic acid (ng/mL) will be measured.
Time Frame
2 hours after surgery
Title
Urine Concentration - Ethacrynic Acid and its conjugates
Description
Concentration of Ethacrynic acid and its conjugates in urine at 4 hours after surgery. A: Ethacrynic acid concentration (ng/mL) B: Glutathione (ng/mL) C: Cysteine (ng/mL) D: Mercapturic acid (ng/mL) will be measured.
Time Frame
4 hours after surgery
Title
Excretion Rates - Ethacrynic Acid and its conjugates
Description
Urinary excretion rates of ethacrynic acid and its conjugates for baseline at 30 minutes before surgery. A: Ethacrynic acid concentration (ng) B: Glutathione (ng) C: Cysteine (ng) D: Mercapturic acid (ng) will be measured.
Time Frame
30 minutes before surgery
Title
Excretion Rates - Ethacrynic Acid and its conjugates
Description
Urinary excretion rates of ethacrynic acid and its conjugates during surgery. A: Ethacrynic acid concentration (ng) B: Glutathione (ng) C: Cysteine (ng) D: Mercapturic acid (ng) will be measured.
Time Frame
during surgery
Title
Excretion Rates - Ethacrynic Acid and its conjugates
Description
Urinary excretion rates of ethacrynic acid and its conjugates 2 hours after surgery. A: Ethacrynic acid concentration (ng) B: Glutathione (ng) C: Cysteine (ng) D: Mercapturic acid (ng) will be measured.
Time Frame
2 hours after surgery
Title
Excretion Rates - Ethacrynic Acid and its conjugates
Description
Urinary excretion rates of ethacrynic acid and its conjugates 4 hours after surgery. A: Ethacrynic acid concentration (ng) B: Glutathione (ng) C: Cysteine (ng) D: Mercapturic acid (ng) will be measured.
Time Frame
4 hours after surgery
Secondary Outcome Measure Information:
Title
Number of Participants with treatment-related adverse events as assessed by CTCAE 4.03
Description
Adverse events / toxicity related to Ethacrynic Acid as reported by participants will be recorded. Toxicity will be measured via analysis of patient adverse events (physiological parameter). Adverse events will be scored using NCI Common Toxicity Criteria for Adverse Events v 4.0.3 (June 14,2010).
Time Frame
During and after surgery, up to 3 months following surgery
Title
Number of Participants with Tumor Recurrence / Non-Recurrence using RECIST version 1.1
Description
Tumor Recurrence / Non-Recurrence will be measured using RECIST version 1.1 to assess efficacy of ethacrynic acid
Time Frame
90 days after surgery

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: NOTE: Both patients who will and will not receive standard of care concomitant mitomycin C are eligible to enroll in this study. Ability to understand and the willingness to sign a written informed consent Diagnosis of presumed non-muscle invasive bladder cancer based on office based cystoscopy (primary or recurrent), and planned transurethral resection of bladder tumor (TURBT) Participants must have tumors with anticipated transurethral resection time ≤ 1 hour Previous history of intravesical therapy allowed Age ≥ 18 years Performance Status 0-1 Adequate organ and marrow function as defined below: leukocytes ≥ 3,000/mcL absolute neutrophil count ≥ 1,500/mcL platelets ≥ 100,000/mcl total bilirubin within normal institutional limits Aspartate Aminotransferase (AST) ≤ 2.5 X institutional upper limit of normal Alanine Aminotransferase (ALT) ≤ 2.5 X institutional upper limit of normal creatinine ≤ 2.5 X institutional upper limit of normal Women of child-bearing potential (WOCP) and men with partners of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately *A woman of child-bearing potential is any female (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria: Has not undergone a hysterectomy or bilateral oophorectomy; or Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months) EXCLUSION CRITERIA: Participants meeting any of the exclusion criteria at baseline will be excluded from study participation. Current or anticipated use of other investigational agents. Patient has known nodal or distant metastatic disease. Patients with nodal or metastatic disease require systemic chemotherapy. Furthermore, they should be excluded from this clinical trial because of their poor overall prognosis. Patients with locally advanced bladder cancer based on cross-sectional imaging (suspicion of extravesical disease or hydronephrosis) Patients with tumors with anticipated transurethral resection time greater than 1 hour History of allergic reactions attributed to compounds of similar chemical or biologic composition to Ethacrynic acid or other agents used in study. Systolic blood pressure < 90 mmHg and/or diastolic blood pressure < 50 mmHg Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Pregnant or nursing. There is a potential for congenital abnormalities and for this regimen to harm nursing infants.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Eugene K Lee, MD
Organizational Affiliation
The University of Kansas - Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
The University of Kansas Medical Center
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Ethacrynic Acid Elimination in Non-Muscle Invasive Bladder Cancer Patients Undergoing Transurethral Resection

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