Naltrexone RCT for Treatment-Emergent Fatigue in Patients Receiving Radiation Therapy for Breast Cancer
Study Details
Study Description
Brief Summary
Naltrexone is a drug which blocks some effects of chemicals called beta-endorphins that are made in the body. Beta-endorphins can be made in response to stress, injury, and also pleasurable activities. In previous studies, it has been shown that levels of beta-endorphins in the blood go up during radiation therapy, and that this increase is linked to fatigue. This suggests that naltrexone may help to reduce fatigue in people who are getting radiation therapy In this research study, the investigators are looking to see whether naltrexone works better than a placebo in reducing fatigue during radiation therapy.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2 |
Detailed Description
This trial has two phases (a monitoring and an intervention phase).
Monitoring Phase: Prior to starting radiotherapy for non-metastatic breast cancer, participants will be approached and consented for the monitoring phase of the study, which involves longitudinal monitoring of fatigue in order to establish whether a patient develops fatigue after starting radiation. The level of pre-radiotherapy fatigue will be obtained during the final two weeks before radiotherapy is started. All participants will undergo weekly monitoring of fatigue via a brief self-report questionnaire. The monitoring period will continue up until one month after the conclusion of radiotherapy. Those whose fatigue symptoms increase above the pre-specified threshold at any point during the monitoring period will be approached about enrollment into the intervention phase of the study.
Intervention Phase: This is a randomized, double-blind, parallel-arm 5-week clinical trial which will be used to determine the effect of naltrexone on fatigue emerging during radiation therapy for non-metastatic breast cancer.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Naltrexone The treatment schedule includes a daily dose of naltrexone for 5 weeks. Treatment will be initiated at 25 mg/day during the first week to improve tolerability. The dose will be escalated to 50 mg/day after one week barring significant early improvement in fatigue or adverse events precluding dose escalation, and participants will continue to take 50 mg/day (or 25 mg/day if dose is not escalated) for 4 weeks to complete a 5-week treatment period. |
Drug: Naltrexone
Other Names:
|
| Placebo Comparator: Sugar Pill The treatment schedule includes a daily dose of equivalent placebo for 5 weeks. Treatment will be initiated at 25 mg/day during the first week to improve tolerability. The dose will be escalated to 50 mg/day after one week barring significant early improvement in fatigue or adverse events precluding dose escalation, and participants will continue to take 50 mg/day (or 25 mg/day if dose is not escalated) for 4 weeks to complete a 5-week treatment period. |
Drug: Sugar Pill
|
Outcome Measures
Primary Outcome Measures
- Change in FACIT-fatigue Subscale Score From Randomization to End of Study [Evaluated at baseline, weekly monitoring visits from start of radiation therapy and meets fatigue eligibility threshold]
Functional Assessment of Chronic Illness Therapy-Fatigue Subscale (FACIT-fatigue subscale): This 13-item self-report scale measuring fatigue and functional impairment as a result of fatigue has been validated in cancer patients (Cella et al. Cancer 2002;94:528-38) The scale is reverse-scored and the range is 0 (maximum fatigue) - 52 (minimum fatigue). According to ICD10 criteria, a score <= 34 indicates significant cancer related fatigue. A change of 10 points has been shown to constitute a clinically meaningful difference on this subscale.
Eligibility Criteria
Criteria
Inclusion Criteria
Eligibility Criteria for Monitoring Phase
-
Age ≥ 18
-
Diagnosis of: invasive breast cancer (stage I-III), ductal carcinoma in situ, lobular carcinoma in situ, lobular carcinoma
-
Plan to receive radiation therapy
Eligibility Criteria for Randomization Phase
-
Participants may have had prior breast surgery and/or chemotherapy.
-
Age ≥18 years.
--Because no dosing or adverse event data are currently available on the use of naltrexone in cancer patients <18 years of age, children are excluded from this study, but will be eligible for future pediatric trials.
-
Participants must have acceptable pre-treatment laboratory values as defined below:
-
total bilirubin within normal institutional limits
-
AST(SGOT)/ALT(SGPT) ≤2.5 × institutional upper limit of normal
-
creatinine within normal institutional limits OR
-
creatinine clearance ≥60 mL/min/1.73 m2 for patients with creatinine levels above institutional normal.
-
If child-bearing potential, willingness to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately.
-
Ability to understand and the willingness to sign a written informed consent document
-
Receiving radiation therapy of any type at DFCI, BWH, or MGH (including but not limited to partial breast irradiation, two-field, three-field, and four-field plans)
-
FACIT-F subscale score >=10 pre-radiation therapy and decrease in FACIT-F of 10 points or more as compared to pre-radiotherapy baseline
Exclusion Criteria:
Exclusion Criteria for Monitoring Phase
-
Suicidal ideation, as determined via PHQ-9
-
Non-English speaking
Exclusion Criteria for Randomization Phase
-
Participants with major depressive disorder and/or suicidal ideation as determined by PHQ-9.
-
Participants who are receiving any other investigational agents that might interact with study medication or influence the measurement of study outcomes.
-
Participants with known metastatic disease should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
-
History of allergic reactions attributed to compounds of similar chemical or biologic composition to naltrexone.
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Participants who have used opioid-containing medications (including cough/cold medications containing codeine and/or antidiarrheals containing loperamide) in the past 2 weeks, or who are expected to require opioid-containing medications within the duration of the treatment period.
-
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
-
Pregnant women are excluded from this study because naltrexone is category C agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with naltrexone, breastfeeding should be discontinued if the mother is treated with naltrexone.
-
Participants using other contraindicated medications (thioridazine, yohimbine)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Massachusetts General Hosptial | Boston | Massachusetts | United States | 02114 |
| 2 | Dana-Farber Cancer Institute | Boston | Massachusetts | United States | 02215 |
Sponsors and Collaborators
- Dana-Farber Cancer Institute
- National Cancer Institute (NCI)
Investigators
- Principal Investigator: Fremonta Meyer, MD, Dana-Farber Cancer Institute
Study Documents (Full-Text)
More Information
Publications
None provided.- 14-056
- R01CA150226
Study Results
Participant Flow
| Recruitment Details | |
|---|---|
| Pre-assignment Detail | In the monitoring phase, eligibility for randomization was defined as FACIT-F subscale score >=10 pre-radiation therapy and decrease in FACIT-F of 10 points. |
| Arm/Group Title | Naltrexone | Sugar Pill |
|---|---|---|
| Arm/Group Description | The dose will be escalated to 50 mg/day (or equivalent placebo) after one week barring significant early improvement in fatigue or adverse events precluding dose escalation, and participants will continue to take 50 mg/day (or 25 mg/day if dose is not escalated) for 4 weeks to complete a 5-week treatment period. | daily dose placebo for 5 week treatment period |
| Period Title: Overall Study | ||
| STARTED | 2 | 1 |
| COMPLETED | 0 | 0 |
| NOT COMPLETED | 2 | 1 |
Baseline Characteristics
| Arm/Group Title | Naltrexone | Placebo: Sugar Pill | Total |
|---|---|---|---|
| Arm/Group Description | The dose will be escalated to 50 mg/day (or equivalent placebo) after one week barring significant early improvement in fatigue or adverse events precluding dose escalation, and participants will continue to take 50 mg/day (or 25 mg/day if dose is not escalated) for 4 weeks to complete a 5-week treatment period. | daily dose placebo for 5 week treatment period | Total of all reporting groups |
| Overall Participants | 2 | 1 | 3 |
| Age (Years) [Mean (Full Range) ] | |||
| Mean (Full Range) [Years] |
49
|
59
|
52.3
|
| Sex: Female, Male (Count of Participants) | |||
| Female |
2
100%
|
1
100%
|
3
100%
|
| Male |
0
0%
|
0
0%
|
0
0%
|
| Race/Ethnicity, Customized (Count of Participants) | |||
| White |
2
100%
|
1
100%
|
3
100%
|
| Region of Enrollment (participants) [Number] | |||
| United States |
2
100%
|
1
100%
|
3
100%
|
Outcome Measures
| Title | Change in FACIT-fatigue Subscale Score From Randomization to End of Study |
|---|---|
| Description | Functional Assessment of Chronic Illness Therapy-Fatigue Subscale (FACIT-fatigue subscale): This 13-item self-report scale measuring fatigue and functional impairment as a result of fatigue has been validated in cancer patients (Cella et al. Cancer 2002;94:528-38) The scale is reverse-scored and the range is 0 (maximum fatigue) - 52 (minimum fatigue). According to ICD10 criteria, a score <= 34 indicates significant cancer related fatigue. A change of 10 points has been shown to constitute a clinically meaningful difference on this subscale. |
| Time Frame | Evaluated at baseline, weekly monitoring visits from start of radiation therapy and meets fatigue eligibility threshold |
Outcome Measure Data
| Analysis Population Description |
|---|
| trial terminated early |
| Arm/Group Title | Naltrexone | Sugar Pill |
|---|---|---|
| Arm/Group Description | The treatment schedule includes a daily dose of naltrexone for 5 weeks. Treatment will be initiated at 25 mg/day during the first week to improve tolerability. The dose will be escalated to 50 mg/day after one week barring significant early improvement in fatigue or adverse events precluding dose escalation, and participants will continue to take 50 mg/day (or 25 mg/day if dose is not escalated) for 4 weeks to complete a 5-week treatment period. Naltrexone | The treatment schedule includes a daily dose of equivalent placebo for 5 weeks. Treatment will be initiated at 25 mg/day during the first week to improve tolerability. The dose will be escalated to 50 mg/day after one week barring significant early improvement in fatigue or adverse events precluding dose escalation, and participants will continue to take 50 mg/day (or 25 mg/day if dose is not escalated) for 4 weeks to complete a 5-week treatment period. Sugar Pill |
| Measure Participants | 0 | 0 |
Adverse Events
| Time Frame | Participants in the monitoring phase of the study will be followed for a maximum of 10 weeks, ending 4 weeks after cessation of radiotherapy or until they consent (if eligible) to participate in the intervention phase of the study, followed until the end of the study and beyond, until resolution or stabilization of the adverse event has occurred. | |||
|---|---|---|---|---|
| Adverse Event Reporting Description | Serious AEs (SAE) were defined as events with treatment-attribution of possibly, probably or definitely and grade 3 or higher. All remaining AEs are classified as Other AEs (OAE) including grade 3 or higher events with treatment-attribution of unlikely and unrelated plus all grade 1 and 2 events. Maximum grade toxicity by type was then calculated within SAE and OAE datasets. No further data is available to specify classification of other beyond the general term. | |||
| Arm/Group Title | Naltrexone | Sugar Pill | ||
| Arm/Group Description | The dose will be escalated to 50 mg/day (or equivalent placebo) after one week barring significant early improvement in fatigue or adverse events precluding dose escalation, and participants will continue to take 50 mg/day (or 25 mg/day if dose is not escalated) for 4 weeks to complete a 5-week treatment period. | daily dose placebo for 5 week treatment period | ||
All Cause Mortality |
||||
| Naltrexone | Sugar Pill | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/2 (0%) | 0/1 (0%) | ||
Serious Adverse Events |
||||
| Naltrexone | Sugar Pill | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/2 (0%) | 0/1 (0%) | ||
Other (Not Including Serious) Adverse Events |
||||
| Naltrexone | Sugar Pill | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 2/2 (100%) | 1/1 (100%) | ||
| Gastrointestinal disorders | ||||
| nausea | 1/2 (50%) | 0/1 (0%) | ||
| dizziness | 1/2 (50%) | 1/1 (100%) | ||
| General disorders | ||||
| fatigue | 2/2 (100%) | 1/1 (100%) | ||
| irritability | 1/2 (50%) | 1/1 (100%) | ||
| Injury, poisoning and procedural complications | ||||
| Dermatitis radiation | 2/2 (100%) | 1/1 (100%) | ||
| Nervous system disorders | ||||
| headache | 1/2 (50%) | 0/1 (0%) | ||
| mental fogginess | 1/2 (50%) | 1/1 (100%) | ||
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
| Name/Title | Fremonta Meyer, MD |
|---|---|
| Organization | Dana-Farber Cancer Institute/Brigham and Women's Hospital |
| Phone | |
| flmeyer@partners.org |
- 14-056
- R01CA150226