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Trial of BMX-001 or Placebo in Head and Neck Cancer Patients

Primary Purpose

Head and Neck Cancer

Status
Withdrawn
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
BMX-001
Radiation Therapy
Cisplatin
Placebo
Sponsored by
BioMimetix JV, LLC
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Head and Neck Cancer focused on measuring head and neck squamous cell carcinoma

Eligibility Criteria

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

Inclusion Criteria:

  1. Pathologically confirmed (histologically or cytologically) diagnosis of squamous cell carcinoma of the oropharynx, larynx, hypopharynx, nasopharyngeal, or oral cavity with clinical or pathologic high-risk features who will be receiving radiation and concurrent cisplatin chemotherapy.
  2. Treatment plan to receive a continuous course of IMRT delivered as single daily fractions of 2.0 to 2.1 Gy with a cumulative radiation dose between 60 Gy and 70 Gy depending on whether patients are receiving post-operative or definitive intent therapy respectively.
  3. For patients undergoing curative intent resection, Patients must have undergone gross total surgical resection within 56 days prior to registration and beginning of therapy under the clinical trial.
  4. General history and physical examination by a qualified head and neck cancer specialist and physician within 8 weeks prior to enrollment (including fiberoptic endoscopy).
  5. Axial imaging of the neck and chest- CT, MRI and/or PET/CT is acceptable, within 8 weeks prior to date of consent.
  6. Age ≥ 18 years.
  7. Zubrod Performance Status 0-2 within 4 weeks prior to enrollment.
  8. CBC/differential obtained within 2 weeks prior to starting the study drug with adequate bone marrow function
  9. Adequate hepatic function
  10. Adequate renal function defined as follows:
  11. Patient must be willing and able to follow study procedures and instructions.
  12. Patient must provide study-specific informed consent within 28 days prior to starting the study drug.
  13. Negative pregnancy test for women of child-bearing potential within 48 hours prior to first dose of BMX-001.
  14. Women of childbearing potential and male participants must agree to use a medically effective means of birth control throughout their participation in the treatment phase of the study and until 12 months following the last study treatment.

Exclusion Criteria:

  1. Distant metastasis
  2. Hypertension
  3. Grade ≥2 hypotension at screening
  4. Concurrent treatment with nitrates or other drugs that may, in the judgment of the treating investigator, create a risk for a precipitous decrease in blood pressure
  5. History of syncope within the last 6 months
  6. Patients receiving, or unable to stop use of prohibited medications
  7. Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception
  8. Women who are breast feeding are not eligible
  9. Known hypersensitivity to compounds of similar chemical composition to BMX-001
  10. Grade 3-4 electrolyte abnormalities (CTCAE v 5.0)
  11. Prior unrelated malignancy requiring current active treatment with exceptions
  12. Prior history of HNSCC receiving radiation or chemo-radiation.
  13. Prior systemic chemotherapy for the study cancer (including neoadjuvant chemotherapy); note that prior chemotherapy for a different cancer is allowable.
  14. Prior radiotherapy that would result in overlap of radiation treatment fields with planned treatment for study cancer.
  15. A marked baseline prolongation of QT/QTc interval (e.g., repeated demonstration of a QTc interval >480 milliseconds (ms) using the specific/usual choice by clinical center for correction factor.
  16. A history of additional risk factors for TdP
  17. Severe, active co-morbidity as defined in the protocol

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Placebo Comparator

    Arm Label

    A BMX-001

    B Placebo

    Arm Description

    Patients will receive standard of care radiation therapy plus Cisplatin. BMX-001 will be given by subcutaneous injection with a loading dose of 28 mg/subject given within 4 days prior to initiation of radiation therapy and followed by biweekly maintenance doses at half the loading dose for a total of 8 weeks.

    Patients will receive standard of care radiation therapy plus Cisplatin. Placebo will be given by subcutaneous injection with a loading dose of 28 mg/subject given within 4 days prior to initiation of radiation therapy and followed by biweekly maintenance doses at half the loading dose for a total of 8 weeks.

    Outcomes

    Primary Outcome Measures

    Mucositis Incidence
    The primary outcome measure used for each study subject is a dichotomous measure of whether they experienced severe oral mucositis (OM, defined as grade 3 or 4 according to WHO criteria) at any time between the first IMRT fraction until 30 days after the completion of RT. The primary analysis will thus test the difference in the proportion of subjects from each treatment group who experience severe OM.

    Secondary Outcome Measures

    Mucositis Duration
    The interval (measured in days) from the date of first determination of severe OM to the date of the first determination of not having severe OM, without a subsequent instance of severe OM.
    Mucositis Severity
    Days it takes for patients in each arm to develop severe oral mucositis.
    Xerostomia Incidence
    The dichotomous measure of whether the study subject had grade 2 (or greater) Xerostomia (as defined by CTCAE v 5.0). This will be assessed at 1, 6, 12, and 24 months after completion of RT.
    Saliva Production Measurements
    The continuous measure of saliva production (g/min), measured at baseline and 1, 6, 12, and 24 months after completion of RT. Both stimulated and unstimulated saliva production will be measured.
    Radiation Dermatitis Duration
    The continuous endpoint of duration of radiation dermatitis, where duration is defined as the interval (measured in days) from the date of first determination of radiation dermatitis to the date of the first determination of not having radiation dermatitis, without a subsequent instance of radiation dermatitis. For any subject whose radiation dermatitis persists, the final date will be 30 days after the completion of RT.
    Overall Survival
    Overall survival (OS), defined as the interval (measured in days) from the date of randomization until the date of death from any cause.
    Disease Free Survival
    Disease-free survival (DFS), defined as the interval (measured in days) from the date of randomization until the date of CT scan showing tumor progression.

    Full Information

    First Posted
    October 23, 2020
    Last Updated
    October 4, 2021
    Sponsor
    BioMimetix JV, LLC
    Collaborators
    Duke University, University of California, San Francisco
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04607642
    Brief Title
    Trial of BMX-001 or Placebo in Head and Neck Cancer Patients
    Official Title
    A Randomized, Blinded, Placebo Controlled Phase 2 Trial of Concurrent Radiation Therapy and Cisplatin With and Without BMX-001 in Patients With Locally Advanced Head and Neck Cancer
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2021
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    Will be conducted as a different study with different sponsorship
    Study Start Date
    July 2021 (Anticipated)
    Primary Completion Date
    July 2023 (Anticipated)
    Study Completion Date
    July 2025 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    BioMimetix JV, LLC
    Collaborators
    Duke University, University of California, San Francisco

    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
    There are an estimated 65,000 newly diagnosed cases of head and neck cancer each year in the United States. The most common treatment for head and neck cancers is radiotherapy in combination with cisplatin chemotherapy. This treatment regimen is effective in killing the tumor; however, the normal tissues that line the mouth and throat can sustain severe injury from the radiation. Side-effects incurred during irradiation include: mucositis, xerostomia, swelling, trouble swallowing, pain, infections, cavities, hair loss and reddening of the skin. Some of these side effects can be so severe that patients require feeding tubes and management of severe pain can lead to the premature halt of radiotherapy. There are currently no effective radio-protectors used to ameliorate these severe side-effects. BioMimetix has developed small molecular weight superoxide dismutase (SOD) mimetic, BMX-001, that is a very potent radio-protector of head and neck tissues. In our first clinical trial in a head and neck cancer patient cohort using this drug, we have early evidence that BMX-001 may protect against radiation-induced mucositis and xerostomia. This will be a randomized, placebo-controlled Phase 2 clinical trial to study the effects of BMX-001 (14 mg/subject biw) + radiation therapy + cisplatin against placebo + radiation therapy + cisplatin in prevention of acute and chronic mucositis and xerostomia.
    Detailed Description
    This study will seek to confirm protection of normal tissues by assessing the incidence, severity and duration of mucositis in a randomized, placebo controlled, Phase 2 clinical trial of BMX-001 in combination with standard RT and chemotherapy in newly diagnosed head and neck cancer patients (162 subjects, 1:1 randomization study drug: placebo). The study will also confirm protection of normal tissues by assessing the acute and chronic extent of xerostomia in the same trial.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Head and Neck Cancer
    Keywords
    head and neck squamous cell carcinoma

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantOutcomes Assessor
    Masking Description
    Patients will be blinded as well as use of blinded assessors.
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    A BMX-001
    Arm Type
    Experimental
    Arm Description
    Patients will receive standard of care radiation therapy plus Cisplatin. BMX-001 will be given by subcutaneous injection with a loading dose of 28 mg/subject given within 4 days prior to initiation of radiation therapy and followed by biweekly maintenance doses at half the loading dose for a total of 8 weeks.
    Arm Title
    B Placebo
    Arm Type
    Placebo Comparator
    Arm Description
    Patients will receive standard of care radiation therapy plus Cisplatin. Placebo will be given by subcutaneous injection with a loading dose of 28 mg/subject given within 4 days prior to initiation of radiation therapy and followed by biweekly maintenance doses at half the loading dose for a total of 8 weeks.
    Intervention Type
    Drug
    Intervention Name(s)
    BMX-001
    Other Intervention Name(s)
    manganese butoxyethyl pyridyl porphyrin, MnTnBuOE-2-PyP5+
    Intervention Description
    BMX-001 consists of a porphyrin ring with pyridyl groups attached at each of the four methane bridge carbons. The nitrogen in the pyridyl ring is at the 2 position and has a side chain consisting of six carbons with an ether linkage. A manganese atom is chelated into the porphyrin ring and is the active center of the molecule. This molecule is an enzymatic scavenger of free radical species operating at close to diffusion-limited rates.
    Intervention Type
    Radiation
    Intervention Name(s)
    Radiation Therapy
    Intervention Description
    Treatment plan should include a continuous course of treatment delivered as single daily fractions of 2.0 to 2.1 Gy with a cumulative radiation dose between 60 Gy and 70 Gy. Planned radiation treatment volumes must include at least two oral mucosal sub-sites (buccal mucosa, retromolar trigone, floor of mouth, tongue, soft palate, hard palate) with a portion of each site receiving at least 50 Gy.
    Intervention Type
    Drug
    Intervention Name(s)
    Cisplatin
    Intervention Description
    Cisplatin is an IV chemotherapeutic agent approved to treat head and neck cancers. Cisplatin will be administered per institution's standard of care practice. Common standard of care practice includes dosing cisplatin at 100mg/m2 IV q21 days starting on Day 1 of RT for 2-3 doses or dosing cisplatin at 40 mg/m2 IV each week of RT for 6-7 total doses. Cisplatin will be infused per institutional guidelines.
    Intervention Type
    Other
    Intervention Name(s)
    Placebo
    Intervention Description
    The placebo to be used in this study is 0.9% Sodium Chloride Injection, USP.
    Primary Outcome Measure Information:
    Title
    Mucositis Incidence
    Description
    The primary outcome measure used for each study subject is a dichotomous measure of whether they experienced severe oral mucositis (OM, defined as grade 3 or 4 according to WHO criteria) at any time between the first IMRT fraction until 30 days after the completion of RT. The primary analysis will thus test the difference in the proportion of subjects from each treatment group who experience severe OM.
    Time Frame
    12 weeks
    Secondary Outcome Measure Information:
    Title
    Mucositis Duration
    Description
    The interval (measured in days) from the date of first determination of severe OM to the date of the first determination of not having severe OM, without a subsequent instance of severe OM.
    Time Frame
    12 weeks
    Title
    Mucositis Severity
    Description
    Days it takes for patients in each arm to develop severe oral mucositis.
    Time Frame
    12 weeks
    Title
    Xerostomia Incidence
    Description
    The dichotomous measure of whether the study subject had grade 2 (or greater) Xerostomia (as defined by CTCAE v 5.0). This will be assessed at 1, 6, 12, and 24 months after completion of RT.
    Time Frame
    1, 6, 12, and 24 months
    Title
    Saliva Production Measurements
    Description
    The continuous measure of saliva production (g/min), measured at baseline and 1, 6, 12, and 24 months after completion of RT. Both stimulated and unstimulated saliva production will be measured.
    Time Frame
    1, 6, 12, and 24 months
    Title
    Radiation Dermatitis Duration
    Description
    The continuous endpoint of duration of radiation dermatitis, where duration is defined as the interval (measured in days) from the date of first determination of radiation dermatitis to the date of the first determination of not having radiation dermatitis, without a subsequent instance of radiation dermatitis. For any subject whose radiation dermatitis persists, the final date will be 30 days after the completion of RT.
    Time Frame
    12 weeks
    Title
    Overall Survival
    Description
    Overall survival (OS), defined as the interval (measured in days) from the date of randomization until the date of death from any cause.
    Time Frame
    2 years
    Title
    Disease Free Survival
    Description
    Disease-free survival (DFS), defined as the interval (measured in days) from the date of randomization until the date of CT scan showing tumor progression.
    Time Frame
    2 years

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Pathologically confirmed (histologically or cytologically) diagnosis of squamous cell carcinoma of the oropharynx, larynx, hypopharynx, nasopharyngeal, or oral cavity with clinical or pathologic high-risk features who will be receiving radiation and concurrent cisplatin chemotherapy. Treatment plan to receive a continuous course of IMRT delivered as single daily fractions of 2.0 to 2.1 Gy with a cumulative radiation dose between 60 Gy and 70 Gy depending on whether patients are receiving post-operative or definitive intent therapy respectively. For patients undergoing curative intent resection, Patients must have undergone gross total surgical resection within 56 days prior to registration and beginning of therapy under the clinical trial. General history and physical examination by a qualified head and neck cancer specialist and physician within 8 weeks prior to enrollment (including fiberoptic endoscopy). Axial imaging of the neck and chest- CT, MRI and/or PET/CT is acceptable, within 8 weeks prior to date of consent. Age ≥ 18 years. Zubrod Performance Status 0-2 within 4 weeks prior to enrollment. CBC/differential obtained within 2 weeks prior to starting the study drug with adequate bone marrow function Adequate hepatic function Adequate renal function defined as follows: Patient must be willing and able to follow study procedures and instructions. Patient must provide study-specific informed consent within 28 days prior to starting the study drug. Negative pregnancy test for women of child-bearing potential within 48 hours prior to first dose of BMX-001. Women of childbearing potential and male participants must agree to use a medically effective means of birth control throughout their participation in the treatment phase of the study and until 12 months following the last study treatment. Exclusion Criteria: Distant metastasis Hypertension Grade ≥2 hypotension at screening Concurrent treatment with nitrates or other drugs that may, in the judgment of the treating investigator, create a risk for a precipitous decrease in blood pressure History of syncope within the last 6 months Patients receiving, or unable to stop use of prohibited medications Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception Women who are breast feeding are not eligible Known hypersensitivity to compounds of similar chemical composition to BMX-001 Grade 3-4 electrolyte abnormalities (CTCAE v 5.0) Prior unrelated malignancy requiring current active treatment with exceptions Prior history of HNSCC receiving radiation or chemo-radiation. Prior systemic chemotherapy for the study cancer (including neoadjuvant chemotherapy); note that prior chemotherapy for a different cancer is allowable. Prior radiotherapy that would result in overlap of radiation treatment fields with planned treatment for study cancer. A marked baseline prolongation of QT/QTc interval (e.g., repeated demonstration of a QTc interval >480 milliseconds (ms) using the specific/usual choice by clinical center for correction factor. A history of additional risk factors for TdP Severe, active co-morbidity as defined in the protocol
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    James Crapo, MD
    Organizational Affiliation
    BioMimetix JV, LLC
    Official's Role
    Study Director

    12. IPD Sharing Statement

    Plan to Share IPD
    No

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    Trial of BMX-001 or Placebo in Head and Neck Cancer Patients

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