OnTARGET: Prophylaxis of Diarrhea in Adult Cancer Patients Receiving Targeted Cancer Therapy

Sponsor

Napo Pharmaceuticals, Inc. (Industry)

Overall Status

Recruiting

CT.gov ID

NCT04538625

Collaborator

(none)

256

Enrollment

Locations

Arms

33.8

Anticipated Duration (Months)

18.3

Patients Per Site

0.5

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

A 24-week, (two 12-week stages), randomized, placebo-controlled, double-blind study to evaluate the safety and efficacy of crofelemer in providing prophylaxis of diarrhea in adult patients with solid tumors treated with targeted cancer therapy-containing treatment regimens. Diarrhea grading will be done according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 5.0.

Patients will be randomized 1:1 to placebo or crofelemer and will be stratified by the type of targeted cancer therapy and the tumor type. Placebo and/or crofelemer will be dispensed at Visit 1/Day 1 with the concurrent start of the targeted cancer therapy regimen. The initial Stage I double-blind placebo-controlled primary treatment phase will occur over a 12-week period to accommodate approximately 3 cycle chemotherapy cancer treatment dosing-cycles. The Primary and Secondary Endpoints will be analyzed after the last patient last visit (LPLV) of Stage I.

After completing the Stage I double-blind, placebo-controlled primary treatment phase, the subjects will have the option to remain on their assigned treatment arm and reconsented to enter into the Stage II extension phase. Reconsent will be required to enter into Stage II. For subjects who do not reconsent, visit 5 will be the last study visit.

Condition or Disease	Intervention/Treatment	Phase
Cancer Therapy-Related Diarrhea Chemotherapy-related Diarrhea Adult Solid Tumor Prophylaxis of Diarrhea Symptomatic Relief of Diarrhea Targeted Therapy-related Diarrhea	Drug: Crofelemer 125 MG [Mytesi] Drug: Placebo	Phase 3

Detailed Description

Randomization will be at a 1:1 ratio with subjects randomized either to crofelemer 125 mg delayed-release tablets or matching placebo tablets administered orally twice daily with or without food. Randomization will be stratified by the type of targeted cancer therapy and by tumor type. Placebo and crofelemer treatment will be initiated concomitantly with the administration of targeted cancer therapy-containing regimens.

The Stage I double-blind placebo-controlled primary treatment phase will be the first 12-week period to accommodate targeted cancer therapy with approximately three (3) cycle chemotherapy regimens (if needed) over the inclusive 12-week period after initiation of crofelemer or placebo treatment in Stage I.

After completing the Stage I treatment phase (12 weeks), and after the LPLV of the primary Stage I treatment phase, the primary and secondary endpoints will be analyzed. The subjects will have the option to remain on their assigned treatment arm and reconsented to enter into the Stage II extension phase. Reconsent will be required to enter into Stage II. For subjects who do not reconsent, Visit 5 will be the last study visit. Subjects who enter into the Stage II extension phase will continue on their originally assigned study treatment commenced at the beginning of Stage I.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

256 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Intervention Model Description:

A randomized, placebo controlled, double blind study to evaluate the safety and efficacy of crofelemer in providing prophylaxis of diarrhea in adult patients with solid tumors receiving targeted cancer therapy containing regimens. Diarrhea grading will be done according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE Ver. 5.0).A randomized, placebo controlled, double blind study to evaluate the safety and efficacy of crofelemer in providing prophylaxis of diarrhea in adult patients with solid tumors receiving targeted cancer therapy containing regimens. Diarrhea grading will be done according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE Ver. 5.0).

Masking:

Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Masking Description:

Double-blind, placebo controlled

Primary Purpose:

Prevention

Official Title:

A Phase 3 Multicenter, Randomized, Double-blind Placebo-controlled Trial Evaluating Crofelemer for the Prophylaxis of Diarrhea in Adult Patients With Solid Tumors Receiving Targeted-cancer Therapies With or Without Standard Chemotherapy

Actual Study Start Date :

Oct 7, 2020

Anticipated Primary Completion Date :

Mar 1, 2023

Anticipated Study Completion Date :

Aug 1, 2023

Arms and Interventions

Arm	Intervention/Treatment
Placebo Comparator: Placebo Subjects randomized to the placebo arm, will receive oral doses of matching placebo tablets twice daily with or without food.	Drug: Placebo Matching placebo tablets
Experimental: Crofelemer Subjects randomized to the crofelemer arm, will receive oral doses of crofelemer 125mg delayed-release tablets twice daily with or without food.	Drug: Crofelemer 125 MG [Mytesi] Randomized, Double-blind, Placebo-controlled, two arm trial

Arm

Intervention/Treatment

Placebo Comparator: Placebo

Subjects randomized to the placebo arm, will receive oral doses of matching placebo tablets twice daily with or without food.

Drug: Placebo

Matching placebo tablets

Experimental: Crofelemer

Subjects randomized to the crofelemer arm, will receive oral doses of crofelemer 125mg delayed-release tablets twice daily with or without food.

Drug: Crofelemer 125 MG [Mytesi]

Randomized, Double-blind, Placebo-controlled, two arm trial

Outcome Measures

Primary Outcome Measures

Frequency of Number of Loose/watery Stools [For the entire 12-week double-blind placebo-controlled treatment period (The Stage 1 Primary Treatment Phase).]
The frequency of diarrhea as measured by the average number of loose/watery stools per week will be evaluated as a continuous endpoint.

Secondary Outcome Measures

Proportion of Durable, Clinical Responders [Initial 12-week (Stage 1) period of the study.]
Proportion of "durable responders" defined as the proportion of subjects with ≤7 loose and/or watery bowel movements per week for at least 50% of the time over the Stage 1 double-blind placebo-controlled primary treatment period (Stage 1).
Maximum Number of Weekly Loose/Watery Stools [Initial 12-week (Stage 1) period of the study.]
Maximum number of weekly unformed (loose and/or watery) bowel movements from Week 1 through end of Week 12.
Fecal Incontinence [Initial 12-week (Stage 1) period of the study.]
Mean number of fecal incontinence episodes from Week 1 through end of Week 12

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

1. Patients to receive targeted cancer therapy drugs that have a reported an all grade diarrhea incidence of 50% or higher (e.g., tyrosine kinase inhibitors, cdk inhibitors, anti-EGFR, etc., for treatment of solid tumors.

Patients able to provide written informed consent.
Men and women ≥ 18 years of age.
Pathologically and/or radiologically confirmed diagnosis of solid tumors scheduled to receive targeted cancer therapy.
Patients eligible to receive targeted cancer therapy per NCCN (National Comprehensive Cancer Network) guidelines and/or standard-of-care practice, with or without cycle chemotherapy.
Patient can receive concomitant cycle [standard] chemotherapy agents together with their targeted cancer therapy treatment regimens.
ECOG (Eastern Cooperative Oncology Group) performance status 0-2 and expected to survive a 12-week course of targeted therapy with or without chemotherapy
Negative urine pregnancy test at time of informed consent for women of childbearing potential.

Exclusion Criteria:

1. Patients receiving any type of immunotherapy including but not limited to immune checkpoint inhibitors that inhibit negative regulatory components of immune response such as cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) and the programmed cell death protein-1 and its ligand (PD1/ PDL1) and IL-2 cancer immunotherapy.

Any cancer therapy for which antidiarrheal (antimotility) medications in the prophylaxis setting is mandatory, including but not limited to patients receiving neratinib and irinotecan.
Ongoing irritable bowel syndrome (IBS) or colitis (including but not limited to ulcerative colitis, Crohn's disease, microscopic colitis, etc.).
Ongoing diarrhea and/or diarrheal episodes within the previous 7 days prior to randomization into the study.
Laxative use within 7 days prior to randomization or a history of constipation requiring the use of laxatives for more than ≥ 30 consecutive days.
Inadequate organ function, which may include, but is not limited to, the following laboratory results within 28 days prior to signing consent: Total bilirubin > upper limit of normal (ULN), AST (SGOT) and ALT (SPGT) > 2.5 ULN (unless the participant has documented Gilbert's syndrome, hepatocellular carcinoma or hepatic metastases), serum creatinine > 2.0 mg/dL or 177 μmol/L.
NOTE: Investigator discretion will determine continued eligibility after randomization occurs, in the event the liver function test results are greater than (>) the proposed upper limit of normal.
Use of other investigational drugs within 4 weeks of signed informed consent or foreseen use during the study.
Use of antibiotics within the past 7 days (up to 2 prophylactic doses of antibiotic for procedures, including but not limited to port placement, is permitted) prior to randomization.
Total colectomy and/or any type of gastrointestinal ostomy.
Major abdominal or pelvic surgery within the past 3 months.
Previous (within 1 month) or planned abdominal and/or pelvic radiation.
Fecal incontinence from ongoing radiation-induced diarrhea or constipation
Active systemic infection requiring ongoing intervention, including but not limited to oral and intravenous antibiotics, anti-fungals, anti-parasitics, and anti-viral drugs.
Inability to comply with study requirements as judged by the Investigator.
Pregnant and/or breastfeeding.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	The Oncology Institute of Hope and Innovation	Corona	California	United States	92882
2	The Oncology Institute of Hope and Innovation	Glendale	California	United States	91204
3	SCL Health Research Institute	Lafayette	Colorado	United States	80218
4	BRCR Global	Plantation	Florida	United States	33322
5	Advanced Research Institute	Saint Petersburg	Florida	United States	33710
6	American Oncology Partners of Maryland	Bethesda	Maryland	United States	20817
7	Nebraska Methodist Hospital	Omaha	Nebraska	United States	68114
8	North Shore Hematology Oncology Associates dba New York Cancer and Blood Specialists	Port Jefferson Station	New York	United States	11776
9	Gabrail Cancer Research	Canton	Ohio	United States	44718
10	Oregon Health & Science University (OHSU) Knight Cancer Institute	Portland	Oregon	United States	97239
11	The West Clinic Research	Germantown	Tennessee	United States	38138
12	MD Anderson Cancer Center	Houston	Texas	United States	77030
13	Inova Schar Cancer Institute	Fairfax	Virginia	United States	22031
14	MultiCare Institute for Research and Innovation	Tacoma	Washington	United States	98405

Sponsors and Collaborators

Napo Pharmaceuticals, Inc.

Investigators

Principal Investigator: Pablo Okhuysen, MD, M.D. Anderson Cancer Center
Study Chair: Pravin Chaturvedi, PhD, Napo Pharmaceuticals

Study Documents (Full-Text)

None provided.

More Information

Publications

Responsible Party:

Napo Pharmaceuticals, Inc.

ClinicalTrials.gov Identifier:

NCT04538625

Other Study ID Numbers:

NP 303-102

First Posted:

Sep 4, 2020

Last Update Posted:

May 4, 2022

Last Verified:

May 1, 2022

Individual Participant Data (IPD) Sharing Statement:

Plan to Share IPD:

Studies a U.S. FDA-regulated Drug Product:

Yes

Studies a U.S. FDA-regulated Device Product:

Additional relevant MeSH terms:

Diarrhea

Study Results

No Results Posted as of May 4, 2022