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L-Arginine Supplementation With or Without Enzyme Inhibitors Treating Erectile Function of Prostate Cancer Survivors

Primary Purpose

Male Erectile Disorder, Prostate Cancer, Radiation Toxicity

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Placebo
Oral L-Arginine
Oral L-Arginine
Sponsored by
Wake Forest University Health Sciences
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Male Erectile Disorder focused on measuring radiation toxicity, male erectile disorder, prostate cancer

Eligibility Criteria

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

INCLUSION CRITERIA:

  • Male prostate cancer survivor previously treated with radiotherapy and who identifies himself as concerned with sexual quality of life, including erectile dysfunction. (seed implants are eligible)
  • Had successful sexual activity prior to the commencement of radiotherapy.
  • Erectile dysfunction, defined as inability to achieve or maintain an erection sufficient for satisfactory sexual performance
  • Interested in sexual activity and agrees to make at least one sexual intercourse attempt with a partner every week during the study.
  • The usage of PDE-5 inhibitors will be voluntary and will serve as a stratification factor. Patients taking PDE-5 inhibitors must agree to assume the responsibility for the cost of PDE-5 inhibitor treatment during the protocol period (8 week period) as this is not covered in the cost of the trial.
  • Patients currently taking PDE-5 inhibitors sildenafil (Viagra®, Pfizer Pharmaceuticals), tadalafil(Cialis®, Lilly ICOS, LLC), and vardenafil (Levitra®, Bayer Healthcare / Schering Plough Corp.)must agree to take the medication only as prescribed by their treating physician.
  • Patients taking PDE-5 inhibitors as part of this study must be on a stable dose of drug for at least one month prior to study entry.
  • Must be able to take oral medications.
  • > 6 months following completion of all cancer therapy
  • No evidence of prostate cancer
  • Prior malignancies allowed if no evidence of recurrent disease.
  • If previously taken LHRH agonist androgen suppression (e.g, Lupron, Zoladex), anti-androgen (e.g., Casodex, Eulexin, Nilandron), or estrogenic (e.g., diethylstilbestrol) agents, serum testosterone must have returned to the laboratory normal range
  • No planned surgery while on protocol or for 4 weeks following completion of protocol
  • Prior cystoscopy is permitted.
  • Age > 18
  • ECOG performance status 0/1.
  • Patients must agree not to start taking an herbal product for erectile dysfunction during the eight weeks of study intervention.

EXCLUSION CRITERIA:

  • No other concurrent erectile dysfunction therapies permitted (i.e. vacuum pump,cavernosal injections, and other drug therapies). Past use of these and other therapies permitted if the patient can meet the inclusion criteria above.
  • No testosterone supplementation permitted.
  • Use of LHRH agonist androgen suppression (e.g, Lupron, Zoladex), anti- androgen (e.g., Casodex,Eulexin, Nilandron), or estrogenic (e.g., diethylstilbestrol) agents within the last 6 months.
  • Prior prostate or lower genitourinary surgery (bladder, penis, urethra, testicles)including transurethral resection of prostate (TURP). (Prior vasectomy is allowed)
  • Serious cardiovascular disease (unstable angina, supraventricular arrhythmia, myocardial infarction, symptomatic congestive heart failure, cardiac arrhythmia, coronary artery bypass surgery within 6 months prior to registration).
  • Hypotension (<90/50mm Hg), or uncontrolled hypertension (>170/100 mm Hg)
  • Stroke or spinal cord injury within 6 months before registration.
  • Patients on Persantine, heparin, Lovenox, warfarin, ginkgo biloba, Plavix, Disalcid, other blood-thinning medication or with a history of bleeding disorders will be excluded.(Aspirin < 325mg allowed)
  • Current use of cimetidine, ketoconazole, itraconazole, erythromycin, or ritonavir. Major medical or psychiatric illness which, in the opinion of the investigator, would prevent completion of treatment or would interfere with follow-up.
  • Current or prior use of any organic nitrate within the last 6 months (e.g., use of nitroglycerin)
  • May not receive other investigational agents or devices during 30 days prior to start of study drug.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to ArginMax (l-arginine, ginseng, or ginkgo biloba)

Sites / Locations

  • W F Baptist Health

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Placebo Comparator

Experimental

Experimental

Arm Label

Arm I - Placebo

Arm II - low dose

Arm III - high dose

Arm Description

Patients receive oral placebo twice daily (total of 6 capsules per day).

Patients receive oral L-arginine and oral placebo twice daily (total of 3 capsules of each per day).

Oral L-arginine twice daily = 6 capsules per day.

Outcomes

Primary Outcome Measures

International Index of Erectile Function (IIEF)
The International Index of Erectile Function (IIEF) questionnaire consists of 15 questions, each of which is scored on a 0 to 5 or 1 to 5 scale. It is comprised of five domains, each scored as the sum of 2 to 5 questions. Erectile function is the sum of six questions with a range from 1 to 30. Higher scores indicate better functioning.

Secondary Outcome Measures

Retention
Retention is the percentage of participants who complete the 8 week visit.
Adherence
Adherence is the percentage of prescribed pills taken by the participants
Assessment of Quality of Life
Quality of life is quantified by the Functional Assessment of Cancer Therapy - Prostate (FACT_P) questionnaire. The FACT questionnaire is comprised of four subscales - social, emotional, functional, and physical. Each subscale is obtained by summing over 6-7 items, each of which is coded on a 0 to 4 scale. Negatively worded questions are reverse scored and higher scores for each subscale indicate better HRQOL. The social, functional, and physical subscales range from 0 to 28 while the emotional subscale ranges from 0 to 24. The overall score (FACT-G) is the sum over the four subscales and ranges from 0 to 108. Patients also completed 12 questions related to prostate cancer, and the prostate subscale score is the sum of those responses (with some items reverse scored). Scores range from 0 to 48, and as with the other FACT subscales higher scores indicate better HRQOL. FACT-P is the sum of FACT-G and the prostate subscale. This questionnaire was added half-way through the study.

Full Information

First Posted
April 14, 2010
Last Updated
September 7, 2021
Sponsor
Wake Forest University Health Sciences
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT01105130
Brief Title
L-Arginine Supplementation With or Without Enzyme Inhibitors Treating Erectile Function of Prostate Cancer Survivors
Official Title
A Randomized Phase II Dose Finding Study of ArginMax for Its Effect on Erectile Function and Quality of Life in Survivors of Prostate Cancer Previously Treated With Radiotherapy
Study Type
Interventional

2. Study Status

Record Verification Date
September 2021
Overall Recruitment Status
Completed
Study Start Date
October 1, 2010 (Actual)
Primary Completion Date
February 4, 2014 (Actual)
Study Completion Date
February 4, 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Wake Forest University Health Sciences
Collaborators
National Cancer Institute (NCI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
RATIONALE: L-arginine supplements may improve the quality of life and erectile function in men who are prostate cancer survivors. PURPOSE: This randomized phase II trial is studying how well L-arginine supplementation works with or without enzyme inhibitors in treating erectile function and quality of life of prostate cancer survivors previously treated with radiation therapy.
Detailed Description
OBJECTIVES: Primary To determine the "best dose" (defined as the dose that shows the greatest improvement in the erectile function domain of the International Index of Erectile Function [IIEF] after 8 weeks of therapy) of an L-arginine/Korean ginseng/gingko biloba/damiana-based supplement (L-arginine) to be used in a subsequent phase III trial in prostate cancer survivors previously treated with radiotherapy. Secondary Evaluate the toxicity of treatment with L-arginine with or without phosphodiesterase-5 inhibitors. Estimate trial accrual, retention, adherence, and variability. Assess changes in quality of life (QOL) and sexual function as defined by changes in the QOL of these patients using the Expanded Prostate Cancer Index Composite, changes in the other domains of the IIEF (i.e., orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), changes in the Sexual Encounter Profile, and changes in the percentage of "yes" (positive) responses to either of the two global efficacy questions. OUTLINE: Patients are stratified according to age (< 65 years vs ≥ 65 years) and current use of phosphodiesterase-5 (PDE-5) inhibitors (yes vs no). Patients are randomized to 1 of 3 treatment arms. Arm I: Patients receive oral placebo twice daily (total of 6 capsules per day). Arm II: Patients receive oral L-arginine and oral placebo twice daily (total of 3 capsules of each per day). Arm III: Patients receive oral L-arginine twice daily (total of 6 capsules per day). In all arms, treatment continues for 8 weeks in the absence of unacceptable toxicity. Patients may also receive oral sildenafil, tadalafil, or vardenafil (PDE-5 inhibitors). Patients complete the International Index of Erectile Function and the Expanded Prostate Cancer Index Composite-26 at baseline and at weeks 4 and 8. Patients also complete the Sexual Encounter Profile Questionnaire, FACT-P, and the Global Efficacy Questionnaire at weeks 4 and 8.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Male Erectile Disorder, Prostate Cancer, Radiation Toxicity
Keywords
radiation toxicity, male erectile disorder, prostate cancer

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
140 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm I - Placebo
Arm Type
Placebo Comparator
Arm Description
Patients receive oral placebo twice daily (total of 6 capsules per day).
Arm Title
Arm II - low dose
Arm Type
Experimental
Arm Description
Patients receive oral L-arginine and oral placebo twice daily (total of 3 capsules of each per day).
Arm Title
Arm III - high dose
Arm Type
Experimental
Arm Description
Oral L-arginine twice daily = 6 capsules per day.
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Given orally
Intervention Type
Drug
Intervention Name(s)
Oral L-Arginine
Other Intervention Name(s)
ArginMax, Placebo
Intervention Description
Given orally 3 capsules ArginMax and 3 Placebo capsules
Intervention Type
Drug
Intervention Name(s)
Oral L-Arginine
Other Intervention Name(s)
ArginMax
Intervention Description
Patients will take 6 capsules of ArginMax twice daily
Primary Outcome Measure Information:
Title
International Index of Erectile Function (IIEF)
Description
The International Index of Erectile Function (IIEF) questionnaire consists of 15 questions, each of which is scored on a 0 to 5 or 1 to 5 scale. It is comprised of five domains, each scored as the sum of 2 to 5 questions. Erectile function is the sum of six questions with a range from 1 to 30. Higher scores indicate better functioning.
Time Frame
8 weeks
Secondary Outcome Measure Information:
Title
Retention
Description
Retention is the percentage of participants who complete the 8 week visit.
Time Frame
8 weeks
Title
Adherence
Description
Adherence is the percentage of prescribed pills taken by the participants
Time Frame
8 weeks
Title
Assessment of Quality of Life
Description
Quality of life is quantified by the Functional Assessment of Cancer Therapy - Prostate (FACT_P) questionnaire. The FACT questionnaire is comprised of four subscales - social, emotional, functional, and physical. Each subscale is obtained by summing over 6-7 items, each of which is coded on a 0 to 4 scale. Negatively worded questions are reverse scored and higher scores for each subscale indicate better HRQOL. The social, functional, and physical subscales range from 0 to 28 while the emotional subscale ranges from 0 to 24. The overall score (FACT-G) is the sum over the four subscales and ranges from 0 to 108. Patients also completed 12 questions related to prostate cancer, and the prostate subscale score is the sum of those responses (with some items reverse scored). Scores range from 0 to 48, and as with the other FACT subscales higher scores indicate better HRQOL. FACT-P is the sum of FACT-G and the prostate subscale. This questionnaire was added half-way through the study.
Time Frame
8 weeks

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
INCLUSION CRITERIA: Male prostate cancer survivor previously treated with radiotherapy and who identifies himself as concerned with sexual quality of life, including erectile dysfunction. (seed implants are eligible) Had successful sexual activity prior to the commencement of radiotherapy. Erectile dysfunction, defined as inability to achieve or maintain an erection sufficient for satisfactory sexual performance Interested in sexual activity and agrees to make at least one sexual intercourse attempt with a partner every week during the study. The usage of PDE-5 inhibitors will be voluntary and will serve as a stratification factor. Patients taking PDE-5 inhibitors must agree to assume the responsibility for the cost of PDE-5 inhibitor treatment during the protocol period (8 week period) as this is not covered in the cost of the trial. Patients currently taking PDE-5 inhibitors sildenafil (Viagra®, Pfizer Pharmaceuticals), tadalafil(Cialis®, Lilly ICOS, LLC), and vardenafil (Levitra®, Bayer Healthcare / Schering Plough Corp.)must agree to take the medication only as prescribed by their treating physician. Patients taking PDE-5 inhibitors as part of this study must be on a stable dose of drug for at least one month prior to study entry. Must be able to take oral medications. > 6 months following completion of all cancer therapy No evidence of prostate cancer Prior malignancies allowed if no evidence of recurrent disease. If previously taken LHRH agonist androgen suppression (e.g, Lupron, Zoladex), anti-androgen (e.g., Casodex, Eulexin, Nilandron), or estrogenic (e.g., diethylstilbestrol) agents, serum testosterone must have returned to the laboratory normal range No planned surgery while on protocol or for 4 weeks following completion of protocol Prior cystoscopy is permitted. Age > 18 ECOG performance status 0/1. Patients must agree not to start taking an herbal product for erectile dysfunction during the eight weeks of study intervention. EXCLUSION CRITERIA: No other concurrent erectile dysfunction therapies permitted (i.e. vacuum pump,cavernosal injections, and other drug therapies). Past use of these and other therapies permitted if the patient can meet the inclusion criteria above. No testosterone supplementation permitted. Use of LHRH agonist androgen suppression (e.g, Lupron, Zoladex), anti- androgen (e.g., Casodex,Eulexin, Nilandron), or estrogenic (e.g., diethylstilbestrol) agents within the last 6 months. Prior prostate or lower genitourinary surgery (bladder, penis, urethra, testicles)including transurethral resection of prostate (TURP). (Prior vasectomy is allowed) Serious cardiovascular disease (unstable angina, supraventricular arrhythmia, myocardial infarction, symptomatic congestive heart failure, cardiac arrhythmia, coronary artery bypass surgery within 6 months prior to registration). Hypotension (<90/50mm Hg), or uncontrolled hypertension (>170/100 mm Hg) Stroke or spinal cord injury within 6 months before registration. Patients on Persantine, heparin, Lovenox, warfarin, ginkgo biloba, Plavix, Disalcid, other blood-thinning medication or with a history of bleeding disorders will be excluded.(Aspirin < 325mg allowed) Current use of cimetidine, ketoconazole, itraconazole, erythromycin, or ritonavir. Major medical or psychiatric illness which, in the opinion of the investigator, would prevent completion of treatment or would interfere with follow-up. Current or prior use of any organic nitrate within the last 6 months (e.g., use of nitroglycerin) May not receive other investigational agents or devices during 30 days prior to start of study drug. History of allergic reactions attributed to compounds of similar chemical or biologic composition to ArginMax (l-arginine, ginseng, or ginkgo biloba)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
James J. Urbanic, MD
Organizational Affiliation
Wake Forest University Health Sciences
Official's Role
Study Chair
Facility Information:
Facility Name
W F Baptist Health
City
Winston-Salem
State/Province
North Carolina
ZIP/Postal Code
27157
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

L-Arginine Supplementation With or Without Enzyme Inhibitors Treating Erectile Function of Prostate Cancer Survivors

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