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Use of Nanoparticle Paclitaxel (ABI-007) for the Prevention of In-Stent Restenosis (SNAPIST-III)

Primary Purpose

Coronary Restenosis

Status
Completed
Phase
Phase 1
Locations
Study Type
Interventional
Intervention
Nanoparticle Paclitaxel
Sponsored by
Celgene Corporation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Coronary Restenosis focused on measuring Prevention of Instent Restenosis

Eligibility Criteria

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

Inclusion Criteria: Male or non-pregnant and non-lactating female, and ≥ 18 years of age. Diagnosis of angina pectoris or unstable angina pectoris or patients with documented silent ischemia. Left ventricular ejection fraction ≥30% Patient has undergone successful and uncomplicated stenting of up to 2 de novo lesions in native coronary arteries OR patient has undergone successful and uncomplicated balloon angioplasty of up to 2 in-stent restenosis (ISR) lesions in native coronary arteries, but not both. Thrombolysis In Myocardial Infarction (TIMI) 3 coronary flow post-stenting for de novo lesions or post balloon angioplasty for ISR lesions. No angiographic evidence of thrombus post-procedure. Target vessel ≥2.5 mm diameter (by angiography). Each de novo lesion is such that it is stented with ≤ 25 mm of single continuous stent. Each in-stent restenosis (ISR) lesion is ≤ 25 mm in length. There is at least 5 mm of non-diseased vessel on either side of target lesion(s). By intravascular ultrasound (IVUS), stent is fully opposed and has a minimum diameter of 2.5 mm or an in-stent luminal area ≥ 5.0 mm^2 Patient or guardian has provided a signed written informed consent to participate in the study and in all follow-up assessments using a form that is approved by the local Institutional Review Board (IRB)/Ethics Committee of the investigative site. Exclusion Criteria: Target de novo lesion was treated with a drug-eluting stent Target ISR lesion requires any treatment other than balloon angioplasty Patient has both a de novo lesion and an ISR lesion. If more than 2 lesions are treated with percutaneous coronary intervention (PCI), or it is anticipated that additional lesions will require treatment within 2 months. Previous PCI within preceding two months. Intended surgical intervention within 6 months of enrollment in the study. Unprotected left main disease with >50% stenosis Malapposition, dissection, or unmasking of a significant narrowing in the inflow or outflow area of the implanted stent. Women who are pregnant and women of child bearing potential who do not use adequate contraception Previous participation in another study with any investigational drug or device within the past 30 days or current enrollment in any other clinical protocol or investigational drug or device trial. Patient has a life expectancy of less than 12 months or there are factors making clinical and/or angiographic follow-up difficult Any significant medical condition which, in the investigator's opinion, may interfere with the patient's optimal participation in the study Heart transplant candidate or recipient Patient is immunosuppressed or is HIV positive. Patient has experienced a Q wave or a non Q wave myocardial infarction (MI) with documented total creatine kinase (CK) ≥2 times normal within the preceding 24 hours and the CK and creatine kinase-MB fraction (CK-MB) enzymes remain above normal at the time of the procedure. Cardiogenic shock: sustained systolic blood pressure (SBP) less than 80 mmHg, with no response to fluids or SBP less than 100 mmHg with vasopressors (in absence of bradycardia) Any individual who may refuse a blood transfusion Documented major gastro-intestinal bleeding within 3 months The following lab values at baseline are exclusionary: Serum creatinine > 2.5 mg/dl; Platelet count < 150,000 cells/mm^3; Absolute neutrophil count (ANC) < 2000 cells/mm^3; Hemoglobin (HGB) <9 g/dl; Total bilirubin >1.5 mg/dl; Alanine Aminotransferase (SGPT) > 2.5 x upper limit of normal range (ULN); Aspartate Aminotransferase (SGOT) > 2.5 x ULN; Alkaline phosphatase > 2.5 x ULN. Known allergy/hypersensitivity/contraindication to the study drug; to any taxanes; or to any required study treatment: aspirin, clopidogrel bisulfate, stent materials Pre-existing peripheral neuropathy of National Cancer Institute (NCI) Toxicity Grade > 1.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm 4

    Arm Type

    Experimental

    Experimental

    Experimental

    Experimental

    Arm Label

    10 mg/m^2 nanoparticle paclitaxel

    22 mg/m^2 nanoparticle paclitaxel

    35 mg/m^2 nanoparticle paclitaxel

    45 mg/m^2 nanoparticle paclitaxel

    Arm Description

    Participants received a single dose of 10 mg/m^2 nanoparticle paclitaxel administered via intracoronary catheter immediately following percutaneous transluminal coronary angioplasty/stenting (de novo lesion) or balloon angioplasty (in-stent restenosis lesions).

    Participants received a single dose of 22 mg/m^2 nanoparticle paclitaxel administered via intracoronary catheter immediately following percutaneous transluminal coronary angioplasty/stenting (de novo lesions) or balloon angioplasty (in-stent restenosis lesions).

    Participants received a single dose of 35 mg/m^2 nanoparticle paclitaxel administered via intracoronary catheter immediately following percutaneous transluminal coronary angioplasty/stenting (de novo lesions) or balloon angioplasty (in-stent restenosis lesions).

    Participants received a single dose of 45 mg/m^2 nanoparticle paclitaxel administered via intracoronary catheter immediately following percutaneous transluminal coronary angioplasty/stenting (de novo lesions) or balloon angioplasty (in-stent restenosis lesions).

    Outcomes

    Primary Outcome Measures

    Phase I: Number of Participants With Dose-limiting Toxicities
    Toxicities were evaluated based on the U.S. National Cancer Institute (NCI) Common Terminology Criteria (CTC) for Adverse Events version 3.0. Any drug-related toxicities considered CTC Grade 3 or 4 were considered dose limiting. The maximum tolerated dose was defined as the lesser of 45 mg/m^2 or the dose at which any drug related toxicities were observed.
    Number of Participants With Procedural Complications
    Procedural complications include the following: Haemodynamic monitoring: changes in heart rate, arterial blood pressure or electrocardiogram changes; Arrhythmia: premature ventricular complexes, brady or tachyarrhythmia; Allergic reactions: rash, flushing, pyrexia, urticaria, angio-oedema; Angiographic complications: coronary artery spasm, dissection, thrombosis, TIMI (Thrombolysis In Myocardial Infarction) flow, no reflow; Clinical changes: chest pain.
    Number of Participants With Treatment Emergent Adverse Events (AEs)
    An AE is any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product, whether or not related to the medicinal product. An SAE is any event that: is fatal or life threatening results in persistent or significant disability or or incapacity; requires or prolongs existing hospitalization; is a congenital anomaly/birth defect in the offspring of a patient who received medication; conditions not included above that may jeopardize the patient or require intervention to prevent one of the outcomes listed above.
    Number of Participants With Major Adverse Cardiac Events (MACE) at 1 Month
    Major Adverse Cardiac Events (MACE) includes cardiac death, Coronary Artery Bypass Surgery, Myocardial Infarction, Target Vessel Revascularization (TVR) or Target Lesion Revascularization (TLR) and stent/vessel thrombotic occlusion.
    Number of Participants With Major Adverse Cardiac Events (MACE) at 6 Months
    Major Adverse Cardiac Events (MACE) includes cardiac death, Coronary Artery Bypass Surgery, Myocardial Infarction, Target Vessel Revascularization (TVR) or Target Lesion Revascularization (TLR) and stent/vessel thrombotic occlusion.

    Secondary Outcome Measures

    Percentage of Participants With Binary Restenosis
    Binary restenosis was assessed by quantitative coronary angiography and defined as >50% diameter stenosis within the stented region (In-stent) or the stented region plus 5 mm on either side of the stent (In-segment) at follow-up. Angiograms were centrally assessed by the Angiographic Core Laboratory.
    Late Lumen Loss
    Late lumen loss represents the extent of neointimal hyperplasia within the stented region (In-stent) or the stented region plus 5 mm on either side of the stent (In-segment) and was measured by quantitative coronary angiography. Late Loss = Minimum Lumen Diameter (MLD) Post Procedure minus the MLD at Follow-up.
    Percentage of In-Stent Volume Obstruction at 6 Months
    In-stent volume obstruction at 6 months was measured by intra-vascular ultrasound (IVUS) and centrally assessed by the IVUS Core Laboratory. Percent in-stent volume obstruction was calculated as neointimal volume / stent volume * 100.

    Full Information

    First Posted
    July 27, 2005
    Last Updated
    March 28, 2012
    Sponsor
    Celgene Corporation
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    1. Study Identification

    Unique Protocol Identification Number
    NCT00124943
    Brief Title
    Use of Nanoparticle Paclitaxel (ABI-007) for the Prevention of In-Stent Restenosis
    Acronym
    SNAPIST-III
    Official Title
    A Phase I/II Safety Trial of Intracoronary Administration of Systemic Nanoparticle Paclitaxel (ABI-007) for the Prevention of In-Stent Restenosis
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    March 2012
    Overall Recruitment Status
    Completed
    Study Start Date
    July 2005 (undefined)
    Primary Completion Date
    August 2009 (Actual)
    Study Completion Date
    August 2009 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Celgene Corporation

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The purpose of this study was to investigate the use of systemic intracoronary administration of albumin-bound paclitaxel, ABI-007, for the prevention and reduction of restenosis following de novo stenting or following angioplasty for in-stent restenosis.
    Detailed Description
    This study consisted of a Phase I non-randomized dose escalation phase to determine the maximum tolerated dose and a randomized Phase II component to assess preliminary efficacy. Nanoparticle paclitaxel was administered by intracoronary catheter following either successful and uncomplicated stenting of de novo lesions in native coronary arteries or following successful and uncomplicated balloon angioplasty of instent restenosis (ISR) lesions.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Coronary Restenosis
    Keywords
    Prevention of Instent Restenosis

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 1, Phase 2
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    112 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    10 mg/m^2 nanoparticle paclitaxel
    Arm Type
    Experimental
    Arm Description
    Participants received a single dose of 10 mg/m^2 nanoparticle paclitaxel administered via intracoronary catheter immediately following percutaneous transluminal coronary angioplasty/stenting (de novo lesion) or balloon angioplasty (in-stent restenosis lesions).
    Arm Title
    22 mg/m^2 nanoparticle paclitaxel
    Arm Type
    Experimental
    Arm Description
    Participants received a single dose of 22 mg/m^2 nanoparticle paclitaxel administered via intracoronary catheter immediately following percutaneous transluminal coronary angioplasty/stenting (de novo lesions) or balloon angioplasty (in-stent restenosis lesions).
    Arm Title
    35 mg/m^2 nanoparticle paclitaxel
    Arm Type
    Experimental
    Arm Description
    Participants received a single dose of 35 mg/m^2 nanoparticle paclitaxel administered via intracoronary catheter immediately following percutaneous transluminal coronary angioplasty/stenting (de novo lesions) or balloon angioplasty (in-stent restenosis lesions).
    Arm Title
    45 mg/m^2 nanoparticle paclitaxel
    Arm Type
    Experimental
    Arm Description
    Participants received a single dose of 45 mg/m^2 nanoparticle paclitaxel administered via intracoronary catheter immediately following percutaneous transluminal coronary angioplasty/stenting (de novo lesions) or balloon angioplasty (in-stent restenosis lesions).
    Intervention Type
    Drug
    Intervention Name(s)
    Nanoparticle Paclitaxel
    Other Intervention Name(s)
    ABI-007, Abraxane®, Coroxane™
    Intervention Description
    Nanoparticle albumin-bound paclitaxel, administered via intracoronary catheter.
    Primary Outcome Measure Information:
    Title
    Phase I: Number of Participants With Dose-limiting Toxicities
    Description
    Toxicities were evaluated based on the U.S. National Cancer Institute (NCI) Common Terminology Criteria (CTC) for Adverse Events version 3.0. Any drug-related toxicities considered CTC Grade 3 or 4 were considered dose limiting. The maximum tolerated dose was defined as the lesser of 45 mg/m^2 or the dose at which any drug related toxicities were observed.
    Time Frame
    Up to 1 week following percutaneous coronary intervention.
    Title
    Number of Participants With Procedural Complications
    Description
    Procedural complications include the following: Haemodynamic monitoring: changes in heart rate, arterial blood pressure or electrocardiogram changes; Arrhythmia: premature ventricular complexes, brady or tachyarrhythmia; Allergic reactions: rash, flushing, pyrexia, urticaria, angio-oedema; Angiographic complications: coronary artery spasm, dissection, thrombosis, TIMI (Thrombolysis In Myocardial Infarction) flow, no reflow; Clinical changes: chest pain.
    Time Frame
    From Day 0 - Day 1 (from study drug administration until 24 hours post-procedure).
    Title
    Number of Participants With Treatment Emergent Adverse Events (AEs)
    Description
    An AE is any unfavorable and unintended sign, symptom, or disease temporally associated with the use of a medicinal product, whether or not related to the medicinal product. An SAE is any event that: is fatal or life threatening results in persistent or significant disability or or incapacity; requires or prolongs existing hospitalization; is a congenital anomaly/birth defect in the offspring of a patient who received medication; conditions not included above that may jeopardize the patient or require intervention to prevent one of the outcomes listed above.
    Time Frame
    Up to 6 months.
    Title
    Number of Participants With Major Adverse Cardiac Events (MACE) at 1 Month
    Description
    Major Adverse Cardiac Events (MACE) includes cardiac death, Coronary Artery Bypass Surgery, Myocardial Infarction, Target Vessel Revascularization (TVR) or Target Lesion Revascularization (TLR) and stent/vessel thrombotic occlusion.
    Time Frame
    From the day of Percutaneous Coronary Intervention to 1 Month.
    Title
    Number of Participants With Major Adverse Cardiac Events (MACE) at 6 Months
    Description
    Major Adverse Cardiac Events (MACE) includes cardiac death, Coronary Artery Bypass Surgery, Myocardial Infarction, Target Vessel Revascularization (TVR) or Target Lesion Revascularization (TLR) and stent/vessel thrombotic occlusion.
    Time Frame
    From the day of Percutaneous Coronary Intervention to Month 6.
    Secondary Outcome Measure Information:
    Title
    Percentage of Participants With Binary Restenosis
    Description
    Binary restenosis was assessed by quantitative coronary angiography and defined as >50% diameter stenosis within the stented region (In-stent) or the stented region plus 5 mm on either side of the stent (In-segment) at follow-up. Angiograms were centrally assessed by the Angiographic Core Laboratory.
    Time Frame
    6 months
    Title
    Late Lumen Loss
    Description
    Late lumen loss represents the extent of neointimal hyperplasia within the stented region (In-stent) or the stented region plus 5 mm on either side of the stent (In-segment) and was measured by quantitative coronary angiography. Late Loss = Minimum Lumen Diameter (MLD) Post Procedure minus the MLD at Follow-up.
    Time Frame
    Day 0 (post-procedure baseline) and 6 months.
    Title
    Percentage of In-Stent Volume Obstruction at 6 Months
    Description
    In-stent volume obstruction at 6 months was measured by intra-vascular ultrasound (IVUS) and centrally assessed by the IVUS Core Laboratory. Percent in-stent volume obstruction was calculated as neointimal volume / stent volume * 100.
    Time Frame
    6 months

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Male or non-pregnant and non-lactating female, and ≥ 18 years of age. Diagnosis of angina pectoris or unstable angina pectoris or patients with documented silent ischemia. Left ventricular ejection fraction ≥30% Patient has undergone successful and uncomplicated stenting of up to 2 de novo lesions in native coronary arteries OR patient has undergone successful and uncomplicated balloon angioplasty of up to 2 in-stent restenosis (ISR) lesions in native coronary arteries, but not both. Thrombolysis In Myocardial Infarction (TIMI) 3 coronary flow post-stenting for de novo lesions or post balloon angioplasty for ISR lesions. No angiographic evidence of thrombus post-procedure. Target vessel ≥2.5 mm diameter (by angiography). Each de novo lesion is such that it is stented with ≤ 25 mm of single continuous stent. Each in-stent restenosis (ISR) lesion is ≤ 25 mm in length. There is at least 5 mm of non-diseased vessel on either side of target lesion(s). By intravascular ultrasound (IVUS), stent is fully opposed and has a minimum diameter of 2.5 mm or an in-stent luminal area ≥ 5.0 mm^2 Patient or guardian has provided a signed written informed consent to participate in the study and in all follow-up assessments using a form that is approved by the local Institutional Review Board (IRB)/Ethics Committee of the investigative site. Exclusion Criteria: Target de novo lesion was treated with a drug-eluting stent Target ISR lesion requires any treatment other than balloon angioplasty Patient has both a de novo lesion and an ISR lesion. If more than 2 lesions are treated with percutaneous coronary intervention (PCI), or it is anticipated that additional lesions will require treatment within 2 months. Previous PCI within preceding two months. Intended surgical intervention within 6 months of enrollment in the study. Unprotected left main disease with >50% stenosis Malapposition, dissection, or unmasking of a significant narrowing in the inflow or outflow area of the implanted stent. Women who are pregnant and women of child bearing potential who do not use adequate contraception Previous participation in another study with any investigational drug or device within the past 30 days or current enrollment in any other clinical protocol or investigational drug or device trial. Patient has a life expectancy of less than 12 months or there are factors making clinical and/or angiographic follow-up difficult Any significant medical condition which, in the investigator's opinion, may interfere with the patient's optimal participation in the study Heart transplant candidate or recipient Patient is immunosuppressed or is HIV positive. Patient has experienced a Q wave or a non Q wave myocardial infarction (MI) with documented total creatine kinase (CK) ≥2 times normal within the preceding 24 hours and the CK and creatine kinase-MB fraction (CK-MB) enzymes remain above normal at the time of the procedure. Cardiogenic shock: sustained systolic blood pressure (SBP) less than 80 mmHg, with no response to fluids or SBP less than 100 mmHg with vasopressors (in absence of bradycardia) Any individual who may refuse a blood transfusion Documented major gastro-intestinal bleeding within 3 months The following lab values at baseline are exclusionary: Serum creatinine > 2.5 mg/dl; Platelet count < 150,000 cells/mm^3; Absolute neutrophil count (ANC) < 2000 cells/mm^3; Hemoglobin (HGB) <9 g/dl; Total bilirubin >1.5 mg/dl; Alanine Aminotransferase (SGPT) > 2.5 x upper limit of normal range (ULN); Aspartate Aminotransferase (SGOT) > 2.5 x ULN; Alkaline phosphatase > 2.5 x ULN. Known allergy/hypersensitivity/contraindication to the study drug; to any taxanes; or to any required study treatment: aspirin, clopidogrel bisulfate, stent materials Pre-existing peripheral neuropathy of National Cancer Institute (NCI) Toxicity Grade > 1.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Jose' Iglesias, MD
    Organizational Affiliation
    Celgene Corporation
    Official's Role
    Study Director

    12. IPD Sharing Statement

    Learn more about this trial

    Use of Nanoparticle Paclitaxel (ABI-007) for the Prevention of In-Stent Restenosis

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