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XCHT for Irinotecan-Induced Gut Toxicities (Run-in Study)

Primary Purpose

Malignant Tumor, Diarrhea

Status
Recruiting
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
Xiao Chai Hu Tang (XCHT)
Raloxifene
FOLFIRI regimen
Sponsored by
Guangzhou University of Traditional Chinese Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Malignant Tumor focused on measuring Malignant tumor, Irinotecan, chemotherapy-induced diarrhea, Classical Chinese Formula, safety

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Cohort A: Naïve (no irinotecan treatment before) postmenopausal female cancer patients.

Inclusion criteria:

  1. Malignant tumor confirmed by histology or cytology;
  2. Postmenopausal women, after bilateral oophorectomy; age > 60 years old, or age < 60 years old with menopause for more than 1 year;
  3. Age ≥ 18 years old, ≤ 75 years old;
  4. ECOG score of the patient ≤ 2 points;
  5. Never been treated with irinotecan;
  6. Plan to receive at least 3 rounds of FOLFIRI chemotherapy determined by physicians;
  7. Normal organ functions can meet the requirements for systemic chemotherapy:

    • Reserve functions of normal bone marrow: absolute neutrophil count (ANC) ≥ 1.5×109/L, PLT ≥ 100×109/L, hemoglobin ≥ 90 g/L;
    • Normal renal functions: serum creatinine ≤ 1.5 mg/dl (133 μmol/L) and/or creatinine clearance ≥ 60 ml/min;
    • Normal hepatic functions: total serum bilirubin level ≤ 1.5 times of the upper limit of normal value (ULN), serum aspartate aminotransferase (AST) & alanine aminotransferase (ALT) ≤ 2.5 × ULN; If abnormal hepatic functions are caused by a potentially malignant tumor, and AST & ALT ≤ 5 × ULN;
  8. Patient is willing to participate and cooperate to complete the questions in the case report form;
  9. Patient can understand and sign the informed consent form, is well compliant, and can be followed up.

Cohort B: cancer patients who experienced irinotecan -induced diarrhea (grade >2)

Inclusion criteria:

  1. Malignant tumor confirmed by histology or cytology;
  2. Age ≥ 18 years old, ≤ 75 years old;
  3. ECOG score of the patient ≤ 2 points;
  4. Patients who have diarrhea worse than grade 2 due to irinotecan chemotherapy (the last dose of irinotecan is administered within 1 month);
  5. Patients who plan to receive 3 rounds of FOLFIRI chemotherapy;
  6. Normal organ functions can meet the requirements for systemic chemotherapy:

    • Reserve functions of normal bone marrow: absolute neutrophil count (ANC) ≥ 1.5×109/L, PLT ≥ 100×109/L, hemoglobin ≥ 90g/L;
    • Normal renal functions: serum creatinine ≤ 1.5mg/dl (133μmol/L) and/or creatinine clearance ≥ 60ml/min;
    • Normal hepatic functions: total serum bilirubin level ≤ 1.5 times of the upper limit of normal value (ULN), serum aspartate aminotransferase (AST) & alanine aminotransferase (ALT) ≤ 2.5 × ULN; If abnormal hepatic functions are caused by a potentially malignant tumor, and AST & ALT ≤ 5 × ULN;
  7. Patient is willing to participate and cooperate to complete the questions in the case report form;
  8. Patients can understand and sign the informed consent form, is well compliant, and can be followed up.

Exclusion Criteria:

  1. Patients with diagnosed depression, obsession or/and schizophrenia;
  2. Patients with diagnosed inflammatory bowel diseases (including Crohn's disease, ulcerative colitis)
  3. Patient with active tuberculosis and other uncontrolled infections;
  4. Patient has previously received radiotherapy on the abdominal cavity and pelvic cavity;
  5. Pregnant or lactating women;
  6. Patient previously had or is now having thromboembolic (blood clotting) events.

Sites / Locations

  • Guangdong Provincial Hospital of Chinese MedicineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Irinotecan naive cohort

Irinotecan used cohort

Arm Description

This cohort will enroll 6 postmenopausal female patients who have never received irinotecan treatment before. Patients in irinotecan naive cohort will receive 3 cycles of FOLFIRI chemotherapy, during which 4 rounds of pharmacokinetic studies will be conducted. Round 0 (before chemotherapy): pharmacokinetic testing (raloxifene 60mg as probe) before XCHT administration, then XCHT for 4 days with pharmacokinetic testing (raloxifene 60mg as probe) on the 4th day of XCHT administration. Round 1(1st cycle of chemotherapy): XCHT for 5 days and FOLFIRI on day 4, with pharmacokinetic testing (without raloxifene) on day 4. Round 2 (2nd cycle of chemotherapy): XCHT for 5 days and FOLFIRI on day 4, with pharmacokinetic testing (raloxifene 60mg as probe) on day 3. Round 3 (3rd cycle of chemotherapy): XCHT for 5 days and FOLFIRI on day 4, with pharmacokinetic testing (raloxifene 60mg as probe) on day 3.

This cohort will recruit 18 patients who were treated with irinotecan previously and have at least one diarrhea episode with a severity of more than grade 2. Patients in irinotecan used cohort will receive 3 cycles of FOLFIRI chemotherapy, during which 3 rounds of pharmacokinetic studies will be conducted. Round 1(1st cycle of chemotherapy): FOLFIRI, with pharmacokinetic testing (raloxifene 60mg as probe) on the first day of chemotherapy. Round 2 (2nd cycle of chemotherapy): XCHT for 5 days and FOLFIRI on day 4, with pharmacokinetic testing (raloxifene 60mg as probe) on day 4. Round 3 (3rd cycle of chemotherapy): XCHT for 5 days and FOLFIRI on day 4, with pharmacokinetic testing (raloxifene 60mg as probe) on day 3.

Outcomes

Primary Outcome Measures

Average trajectory of irinotecan, raloxifene, XCHT and their metabolites (14 compounds)
Plasma concentration for each compounds will be tested at 8 points for each Round.

Secondary Outcome Measures

incidences of grade ≥3 diarrhea
The diarrhea severity will be evaluated following standard criteria in NCI-CTC AE 5.0
occult blood test for stool
occult blood test for stool, reported as negative, weak positive, and positive.
incidence of other chemo-related adverse effects
Other adverse reactions will be evaluated following standard criteria in NCI-CTC AE 5.0
incidence of diarrhea (grade ≥2)
The diarrhea severity will be evaluated following standard criteria in NCI-CTC AE 5.0 Grade 2 is defined as Stool is increased by 4-6 times each day relative to baseline; discharge from stoma moderately increased.

Full Information

First Posted
May 30, 2021
Last Updated
September 8, 2023
Sponsor
Guangzhou University of Traditional Chinese Medicine
Collaborators
University of Houston
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1. Study Identification

Unique Protocol Identification Number
NCT04926545
Brief Title
XCHT for Irinotecan-Induced Gut Toxicities (Run-in Study)
Official Title
Mechanistic and Pharmacokinetic Studies of Classical Chinese Formula Xiao Chai Hu Tang Against Irinotecan-Induced Gut Toxicities(Clinical Study Part:Run-in Safety Study)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 16, 2021 (Actual)
Primary Completion Date
August 1, 2024 (Anticipated)
Study Completion Date
October 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Guangzhou University of Traditional Chinese Medicine
Collaborators
University of Houston

4. Oversight

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

5. Study Description

Brief Summary
Run-in safety study, to determine the safety of co-administration of irinotecan, raloxifene, and Xiao Chai Hu Tang (XCHT), and to optimize the blood collection time points for pharmacokinetic (PK) study for another randomized control trial.
Detailed Description
There will be two cohorts with a total of 24 patients in this study. Cohort A will enroll 6 naïve postmenopausal female patients who have never received irinotecan treatment before. Patients in this group will have 4 rounds of studies following different protocol to determine (1) the impact of XCHT on raloxifene PK (Round 0, co-administration of XCHT and raloxifene); (2) the impact of XCHT on irinotecan PK (Round 1, co-administration of XCHT and standard FOLFIRI); (3) the safety of co- administration of XCHT, raloxifene, and FOLFIRI and evaluation of raloxifene as a probe for XCHT treatment to prevent irinotecan-induced severe delayed-onset diarrhea (Round 2 and 3, co-administration of XCHT, raloxifene, and standard FOLFIRI). The reason to recruit postmenopausal women is that these patients usually take raloxifene to prevent osteoporosis and the risk of raloxifene is expected to be limited. Cohort B will recruit 18 patients who were treated with irinotecan previously and have at least one diarrhea episode with a severity of ≥grade 2. The reason we propose to recruit patients who had diarrhea induced by irinotecan is that these patients are supposed to be sensitive to irinotecan so that we can determine the PK changes and safety. Patients in this group will have 3 rounds of FOLFIRI chemotherapy to determine (1) the impact of FOLFIRI on raloxifene PK (Round 1, co-administration of FOLFIRI with raloxifene); (2) the complete PK profile of SN-38, SN-38G, raloxifene, raloxifene-glucuronide, and XCHT components (Round 2, co- administration of FOLFIRI with XCHT and raloxifene); and (3) the safety of co-administration of XCHT, raloxifene, and FOLFIRI in sensitive patients and evaluation of raloxifene as a probe for XCHT treatment to prevent irinotecan-induced diarrhea (Round 3, co-administration of XCHT, raloxifene and standard FOLFIRI).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Malignant Tumor, Diarrhea
Keywords
Malignant tumor, Irinotecan, chemotherapy-induced diarrhea, Classical Chinese Formula, safety

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
24 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Irinotecan naive cohort
Arm Type
Experimental
Arm Description
This cohort will enroll 6 postmenopausal female patients who have never received irinotecan treatment before. Patients in irinotecan naive cohort will receive 3 cycles of FOLFIRI chemotherapy, during which 4 rounds of pharmacokinetic studies will be conducted. Round 0 (before chemotherapy): pharmacokinetic testing (raloxifene 60mg as probe) before XCHT administration, then XCHT for 4 days with pharmacokinetic testing (raloxifene 60mg as probe) on the 4th day of XCHT administration. Round 1(1st cycle of chemotherapy): XCHT for 5 days and FOLFIRI on day 4, with pharmacokinetic testing (without raloxifene) on day 4. Round 2 (2nd cycle of chemotherapy): XCHT for 5 days and FOLFIRI on day 4, with pharmacokinetic testing (raloxifene 60mg as probe) on day 3. Round 3 (3rd cycle of chemotherapy): XCHT for 5 days and FOLFIRI on day 4, with pharmacokinetic testing (raloxifene 60mg as probe) on day 3.
Arm Title
Irinotecan used cohort
Arm Type
Experimental
Arm Description
This cohort will recruit 18 patients who were treated with irinotecan previously and have at least one diarrhea episode with a severity of more than grade 2. Patients in irinotecan used cohort will receive 3 cycles of FOLFIRI chemotherapy, during which 3 rounds of pharmacokinetic studies will be conducted. Round 1(1st cycle of chemotherapy): FOLFIRI, with pharmacokinetic testing (raloxifene 60mg as probe) on the first day of chemotherapy. Round 2 (2nd cycle of chemotherapy): XCHT for 5 days and FOLFIRI on day 4, with pharmacokinetic testing (raloxifene 60mg as probe) on day 4. Round 3 (3rd cycle of chemotherapy): XCHT for 5 days and FOLFIRI on day 4, with pharmacokinetic testing (raloxifene 60mg as probe) on day 3.
Intervention Type
Drug
Intervention Name(s)
Xiao Chai Hu Tang (XCHT)
Other Intervention Name(s)
Xiao Chai Hu Tang granules from Nin Jiom Medicine Manufactory (Hong Kong) Ltd.
Intervention Description
XCHT 9g, po qd, 3 days before each cycle of chemotherapy for 5 days, except the 1st cycle of chemotherapy for irinotecan used cohort patients. Additional XCHT, 9g qd will be orally administrated for 4 days during the Round 0 study for irinotecan naive cohort patients.
Intervention Type
Other
Intervention Name(s)
Raloxifene
Other Intervention Name(s)
Evista from Eli Lilly
Intervention Description
Raloxifene 60mg po, used as probe for pharmacokinetic testing. For irinotecan naive cohort patients, raloxifene 60mg will be orally administrated on Day 1 and Day 5 (4th day of XCHT administration) during round 0 study, Day 3 (the day before chemotherapy) during round 2 and round 3 study. For irinotecan used cohort patients, raloxifene 60mg will be orally administrated on Day 1 (irinotecan using day) during round 1 study, Day 4 (irinotecan using day) during round 2 study, and Day 3 (the day before chemotherapy) during round 3 study.
Intervention Type
Drug
Intervention Name(s)
FOLFIRI regimen
Other Intervention Name(s)
Irinotecan Hydrochloride from Pfizer+Folinic acid+5-fluorouracil (5-FU)
Intervention Description
Patients will receive 3 cycles of FOLFIRI regimen for chemotherapy. Irinotecan intravenous (IV) infusion (180 mg/m2) through a drip into the bloodstream over 90 minutes. Folinic acid (400 mg/m2) IV infusion through a drip into the bloodstream over 2 hours. 5-fluorouracil (5-FU) IV bolus (400 mg/m2) into the bloodstream over 5 minutes, followed by 5-FU (2400 mg/m2) continuous IV infusion through a drip or pump into the bloodstream for 46-48 hours.
Primary Outcome Measure Information:
Title
Average trajectory of irinotecan, raloxifene, XCHT and their metabolites (14 compounds)
Description
Plasma concentration for each compounds will be tested at 8 points for each Round.
Time Frame
The blood samples (2.0 ml) will be collected at 8 points for each Round (hour 0, hour 0.5, hour 1, hour 2, hour 4, hour 6, hour 8, and hour 24 after raloxifene administration)
Secondary Outcome Measure Information:
Title
incidences of grade ≥3 diarrhea
Description
The diarrhea severity will be evaluated following standard criteria in NCI-CTC AE 5.0
Time Frame
Through study completion, an average of 2 months
Title
occult blood test for stool
Description
occult blood test for stool, reported as negative, weak positive, and positive.
Time Frame
Through study completion, an average of 2 months
Title
incidence of other chemo-related adverse effects
Description
Other adverse reactions will be evaluated following standard criteria in NCI-CTC AE 5.0
Time Frame
Through study completion, an average of 2 months.
Title
incidence of diarrhea (grade ≥2)
Description
The diarrhea severity will be evaluated following standard criteria in NCI-CTC AE 5.0 Grade 2 is defined as Stool is increased by 4-6 times each day relative to baseline; discharge from stoma moderately increased.
Time Frame
Through study completion, an average of 2 months.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Cohort A: Naïve (no irinotecan treatment before) postmenopausal female cancer patients. Inclusion criteria: Malignant tumor confirmed by histology or cytology; Postmenopausal women, after bilateral oophorectomy; age > 60 years old, or age < 60 years old with menopause for more than 1 year; Age ≥ 18 years old, ≤ 75 years old; ECOG score of the patient ≤ 2 points; Never been treated with irinotecan; Plan to receive at least 3 rounds of FOLFIRI chemotherapy determined by physicians; Normal organ functions can meet the requirements for systemic chemotherapy: Reserve functions of normal bone marrow: absolute neutrophil count (ANC) ≥ 1.5×109/L, PLT ≥ 100×109/L, hemoglobin ≥ 90 g/L; Normal renal functions: serum creatinine ≤ 1.5 mg/dl (133 μmol/L) and/or creatinine clearance ≥ 60 ml/min; Normal hepatic functions: total serum bilirubin level ≤ 1.5 times of the upper limit of normal value (ULN), serum aspartate aminotransferase (AST) & alanine aminotransferase (ALT) ≤ 2.5 × ULN; If abnormal hepatic functions are caused by a potentially malignant tumor, and AST & ALT ≤ 5 × ULN; Patient is willing to participate and cooperate to complete the questions in the case report form; Patient can understand and sign the informed consent form, is well compliant, and can be followed up. Cohort B: cancer patients who experienced irinotecan -induced diarrhea (grade >2) Inclusion criteria: Malignant tumor confirmed by histology or cytology; Age ≥ 18 years old, ≤ 75 years old; ECOG score of the patient ≤ 2 points; Patients who have diarrhea worse than grade 2 due to irinotecan chemotherapy (the last dose of irinotecan is administered within 1 month); Patients who plan to receive 3 rounds of FOLFIRI chemotherapy; Normal organ functions can meet the requirements for systemic chemotherapy: Reserve functions of normal bone marrow: absolute neutrophil count (ANC) ≥ 1.5×109/L, PLT ≥ 100×109/L, hemoglobin ≥ 90g/L; Normal renal functions: serum creatinine ≤ 1.5mg/dl (133μmol/L) and/or creatinine clearance ≥ 60ml/min; Normal hepatic functions: total serum bilirubin level ≤ 1.5 times of the upper limit of normal value (ULN), serum aspartate aminotransferase (AST) & alanine aminotransferase (ALT) ≤ 2.5 × ULN; If abnormal hepatic functions are caused by a potentially malignant tumor, and AST & ALT ≤ 5 × ULN; Patient is willing to participate and cooperate to complete the questions in the case report form; Patients can understand and sign the informed consent form, is well compliant, and can be followed up. Exclusion Criteria: Patients with diagnosed depression, obsession or/and schizophrenia; Patients with diagnosed inflammatory bowel diseases (including Crohn's disease, ulcerative colitis) Patient with active tuberculosis and other uncontrolled infections; Patient has previously received radiotherapy on the abdominal cavity and pelvic cavity; Pregnant or lactating women; Patient previously had or is now having thromboembolic (blood clotting) events.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yanjuan Zhu, Dr
Phone
86-020-81887233
Ext
34830
Email
zyjsophy@gzucm.edu.cn
First Name & Middle Initial & Last Name or Official Title & Degree
Yadong Chen, Dr
Phone
86-020-81887233
Ext
34830
Email
794053913@qq.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Haibo Zhang, Prof
Organizational Affiliation
Guangdong Provincial Hospital of Traditional Chinese Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Guangdong Provincial Hospital of Chinese Medicine
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510120
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Yan-juan Zhu, Dr
Phone
(86)20 81887233-34830
Email
zyjsophy@gzucm.edu.cn

12. IPD Sharing Statement

Plan to Share IPD
No

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XCHT for Irinotecan-Induced Gut Toxicities (Run-in Study)

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