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The Kinetics of Endocannabinoids in Patients With Chemotherapy Induced Peripheral Neuropathy by Using Medical Cannabis.

Primary Purpose

Chemotherapy-induced Peripheral Neuropathy

Status
Not yet recruiting
Phase
Not Applicable
Locations
Israel
Study Type
Interventional
Intervention
medical cannabis
Sponsored by
HaEmek Medical Center, Israel
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Chemotherapy-induced Peripheral Neuropathy

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 1. Age above 18 years and below 80 years old. 2. Pathology of Breast or GI malignancies. 3. Treatment with Taxans (Taxol/ Taxotere) or Oxaliplatin for adjuvant treatment or metastatic disease.

    4. Estimated life expectancy ≥ 6 months. 5. Performance status ≤1 (ECOG classification). 6. Sign of written informed consent. 7. CIPN is examined during the chemotherapy treatment DN4 score must be above 4 (and by physician decision) for more than one week.

    8. Patient with adequate liver/renal function at screening as described:

    • Creatinine clearance >30 ml/min as calculated by Cockcroft-Gault Equation.
    • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5 x ULN. 9. Patients who suffer from pain although using a stable analgesic treatment' at least 14 days before entering the trial (no limitation for the use of the analgesic).

      10. Patient possessed a valid license from the Israeli Ministry of Health to receive medicinal cannabis.

      11. Patient is able and willing to comply with study requirements. 12. Patient agrees to use only medical cannabis provided by study team until the end of study period.

      13. Patient has not undergone major surgery in the month prior to the study start.

      14. Patient agrees not to participate in other interventional clinical trial during the study participation.

Exclusion Criteria:

  • 1. Use of cannabis or synthetic cannabinoids in the last two weeks (urine test for cannabinoids are positive).

    2. Patient with known or past substance abuse. 3. Patients with major psychiatric disorders (e.g. schizophrenia, dementia, and intellectual disabilities).

    4. Patients with first degree siblings under the age of 30 years old with psychiatric disorders.

    5. Patients with uncontrolled diabetes mellitus, cardiovascular, or convulsive disorders according to investigator.

    6. Patients with sensitivity to cannabis or cannabinoids. 7. Patients with known neuropathic pain due to diabetes or other diseases. 8. Patients with severe respiratory disease. 9. Patients with brain metastases or brain tumors may participate if completed radiotherapy treatment at least 14 days prior to signing the informed consent and last imaging did not show any worsening.

    10. Female subjects who are pregnant, lactating, or want to get pregnant during the study period and one month following the study. Male subjects who want their partner to get pregnant during the study period and one month following the study.

    11. Females of childbearing potential or males whose partners with childbearing potential and did not use adequate contraceptives 28 days prior to study start or during the study.

    12. Other life-threatening medical conditions that disqualify the patient from participating in the study, according to the Primary Investigator's judgment.

    13. Anticipated alcohol or barbiturate use during the study period. 14. Participation in other clinical trials during the last month. 15. Subjects who are using one of the following medications: opiates (Primidone, Phenobarbitol, Arbamazepine, Rifampicin, Rifabutin, Troglitazone and Hypericum perforatum).

    16. Patient who has undergone a major surgery a month prior to study start.

Sites / Locations

  • Haemek MC

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

medical cannabis

Arm Description

All patients will start with 250mcg cannabis flos BID and will follow the titration plan of dose modification according to CIPN relief and adverse events. Maximum dose of 2,000mcg per day is prescribed at the end of titration period, which is continuous for 15 days (about 2 weeks).On 10 weeks visit all patients will be discontinued from the treatment. In case of worsening of neuropathy at any point during the 4 weeks of FU, patients might be able to restart with inhaled MC treatment for no more than 4 weeks. Total treatment in this study will be for no more than 14 weeks.

Outcomes

Primary Outcome Measures

Changes in the level of 150 different endocannabinoids.
Circulating endocannabinoids concentrations .

Secondary Outcome Measures

Changes from the baseline of neuropathic pain during medical cannabis treatment .
Neuropathic pain detected by DN4 questionnaire .
Changes in Quality of life by FACT-GOG-Ntx
Changes of Quality of life will be evaluated by Functional Assessment of Cancer Therapy - Gynecologic Oncology Group-Neurotoxicity ( FACT-GOG-Ntx) questionnaire
Changes in Quality of life by BPI
Changes of Quality of life will be evaluated by BRIEF PAIN INVENTORY (BPI) tool.

Full Information

First Posted
October 31, 2019
Last Updated
March 15, 2022
Sponsor
HaEmek Medical Center, Israel
Collaborators
Technion, Israel Institute of Technology, Syqe Medical
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1. Study Identification

Unique Protocol Identification Number
NCT04376437
Brief Title
The Kinetics of Endocannabinoids in Patients With Chemotherapy Induced Peripheral Neuropathy by Using Medical Cannabis.
Official Title
The Kinetics of Endocannabinoids in Patients With Chemotherapy Induced Peripheral Neuropathy by Using a Portable Metered-Dose Cannabis Inhaler
Study Type
Interventional

2. Study Status

Record Verification Date
March 2022
Overall Recruitment Status
Not yet recruiting
Study Start Date
March 15, 2022 (Anticipated)
Primary Completion Date
December 1, 2022 (Anticipated)
Study Completion Date
December 1, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
HaEmek Medical Center, Israel
Collaborators
Technion, Israel Institute of Technology, Syqe Medical

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No

5. Study Description

Brief Summary
Chemotherapy-induced peripheral neuropathy (CIPN) is the most common neurological cancer treatment complication. Medical cannabis is indicated in Israel for the treatment of chronic pain, spasticity and for the control of pain and other symptoms in patients with cancer. The proposed study aims are to study about the changes in level of endocannabinoids following continuous exposure to phytocannabinoids and about the long-term effect of medical cannabis on CIPN.
Detailed Description
This will be a self-titrated, open-label design study. Subjects who begin taxanes or oxaliplatine therapy and were diagnosed with CIPN will be recruited to the study. After providing their written informed consent, the study physician obtained a medical history, demographic details and conducted a physical examination. During the current study, baseline period for CIPN evaluation will be 2 weeks, while patients will fill several questionnaires. Baseline CIPN will be evaluating by DN4 and BPI questionnaires. EQ-5D and PSQI will be filled for baseline Quality of life (QOL) and sleepiness status, accordingly.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Chemotherapy-induced Peripheral Neuropathy

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Syqe Medical Cannabis inhaler is approval medical device in Israel , this is only Basic science study with main purpose to learn more about the kinetics of endocannabinoids .
Masking
None (Open Label)
Allocation
N/A
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
medical cannabis
Arm Type
Experimental
Arm Description
All patients will start with 250mcg cannabis flos BID and will follow the titration plan of dose modification according to CIPN relief and adverse events. Maximum dose of 2,000mcg per day is prescribed at the end of titration period, which is continuous for 15 days (about 2 weeks).On 10 weeks visit all patients will be discontinued from the treatment. In case of worsening of neuropathy at any point during the 4 weeks of FU, patients might be able to restart with inhaled MC treatment for no more than 4 weeks. Total treatment in this study will be for no more than 14 weeks.
Intervention Type
Drug
Intervention Name(s)
medical cannabis
Other Intervention Name(s)
medical marijuana
Intervention Description
inhalation by using a Portable Metered-Dose Cannabis Inhaler
Primary Outcome Measure Information:
Title
Changes in the level of 150 different endocannabinoids.
Description
Circulating endocannabinoids concentrations .
Time Frame
Determined on blood samples collected during the 4 months of participation in the study
Secondary Outcome Measure Information:
Title
Changes from the baseline of neuropathic pain during medical cannabis treatment .
Description
Neuropathic pain detected by DN4 questionnaire .
Time Frame
during 4 months of participation in the study
Title
Changes in Quality of life by FACT-GOG-Ntx
Description
Changes of Quality of life will be evaluated by Functional Assessment of Cancer Therapy - Gynecologic Oncology Group-Neurotoxicity ( FACT-GOG-Ntx) questionnaire
Time Frame
This exam will be performed every visit.during 4 months of participation in the study
Title
Changes in Quality of life by BPI
Description
Changes of Quality of life will be evaluated by BRIEF PAIN INVENTORY (BPI) tool.
Time Frame
This exam will be performed every visit.during 4 months of participation in the study

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 1. Age above 18 years and below 80 years old. 2. Pathology of Breast or GI malignancies. 3. Treatment with Taxans (Taxol/ Taxotere) or Oxaliplatin for adjuvant treatment or metastatic disease. 4. Estimated life expectancy ≥ 6 months. 5. Performance status ≤1 (ECOG classification). 6. Sign of written informed consent. 7. CIPN is examined during the chemotherapy treatment DN4 score must be above 4 (and by physician decision) for more than one week. 8. Patient with adequate liver/renal function at screening as described: Creatinine clearance >30 ml/min as calculated by Cockcroft-Gault Equation. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5 x ULN. 9. Patients who suffer from pain although using a stable analgesic treatment' at least 14 days before entering the trial (no limitation for the use of the analgesic). 10. Patient possessed a valid license from the Israeli Ministry of Health to receive medicinal cannabis. 11. Patient is able and willing to comply with study requirements. 12. Patient agrees to use only medical cannabis provided by study team until the end of study period. 13. Patient has not undergone major surgery in the month prior to the study start. 14. Patient agrees not to participate in other interventional clinical trial during the study participation. Exclusion Criteria: 1. Use of cannabis or synthetic cannabinoids in the last two weeks (urine test for cannabinoids are positive). 2. Patient with known or past substance abuse. 3. Patients with major psychiatric disorders (e.g. schizophrenia, dementia, and intellectual disabilities). 4. Patients with first degree siblings under the age of 30 years old with psychiatric disorders. 5. Patients with uncontrolled diabetes mellitus, cardiovascular, or convulsive disorders according to investigator. 6. Patients with sensitivity to cannabis or cannabinoids. 7. Patients with known neuropathic pain due to diabetes or other diseases. 8. Patients with severe respiratory disease. 9. Patients with brain metastases or brain tumors may participate if completed radiotherapy treatment at least 14 days prior to signing the informed consent and last imaging did not show any worsening. 10. Female subjects who are pregnant, lactating, or want to get pregnant during the study period and one month following the study. Male subjects who want their partner to get pregnant during the study period and one month following the study. 11. Females of childbearing potential or males whose partners with childbearing potential and did not use adequate contraceptives 28 days prior to study start or during the study. 12. Other life-threatening medical conditions that disqualify the patient from participating in the study, according to the Primary Investigator's judgment. 13. Anticipated alcohol or barbiturate use during the study period. 14. Participation in other clinical trials during the last month. 15. Subjects who are using one of the following medications: opiates (Primidone, Phenobarbitol, Arbamazepine, Rifampicin, Rifabutin, Troglitazone and Hypericum perforatum). 16. Patient who has undergone a major surgery a month prior to study start.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Gil Bar Sela, Prof
Phone
+97250-206-1207
Email
gil_ba@clalit.org.il
First Name & Middle Initial & Last Name or Official Title & Degree
Ela Lutwak, M.SC
Phone
+972546459510
Email
ella_lu@clalit.org.il
Facility Information:
Facility Name
Haemek MC
City
Afula
State/Province
North
Country
Israel

12. IPD Sharing Statement

Plan to Share IPD
No
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The Kinetics of Endocannabinoids in Patients With Chemotherapy Induced Peripheral Neuropathy by Using Medical Cannabis.

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