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出境医 / 临床实验 / Evaluation of Ascorbate-Meglumine Therapeutic for SRS

Evaluation of Ascorbate-Meglumine Therapeutic for SRS

Study Description
Brief Summary:
Phase 1, Single-Center, Dose-Escalating, Open-Label, Safety Clinical Trial of Parenteral Ascorbate-Meglumine as a Novel Magnetic Resonance Imaging-guided Adjunctive Therapeutic for Stereotactic Radiosurgery (SRS).

Condition or disease Intervention/treatment Phase
Safety Drug: Ascorbate-Meglumine Phase 1

Detailed Description:

Phase 1, single-center, open-label study in subjects receiving SRS for brain metastases.

The study will consist of 4 principal cohorts (n=3 in each cohort). Each cohort will receive an escalating dose of ascorbate-meglumine as an MRI-detectable adjunctive therapeutic to SRS.

Subjects will complete a planning MRI for SRS with gadolinium- diethylenetriamine penta-acetic acid (GD-DPTA) per standard of care for SRS. Forty-eight hours after the planning MRI, the subjects will complete the study MRI with ascorbate-meglumine contrast agent. Each cohort will receive an escalating dose of ascorbate-meglumine by intravenous administration over 1 hour during the MRI. The total dose of ascorbate-meglumine-will escalate from the first cohort to the next cohort in a sequential manner. During ascorbate-meglumine infusion, MRI scans will be performed to evaluate the contrast effect and PK blood draws will occur at defined time points.

Patients will return for the SRS procedure within 1 week following the planning MRI per standard of care. During SRS, subjects will receive a second dose of ascorbate-meglumine as an adjunctive therapeutic.

Patients will enter into a follow up phase within 2 weeks after the SRS procedure per standard of care.

The primary endpoint is to evaluate the safety of parenteral ascorbate-meglumine as a MRI-detectable adjunctive therapeutic to SRS.

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Intervention Model Description: dose escalation
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase 1, Single-Center, Dose-Escalating, Open-Label, Safety Clinical Trial of Parenteral Ascorbate-Meglumine as a Novel Magnetic Resonance Imaging-guided Adjunctive Therapeutic for Stereotactic Radiosurgery
Estimated Study Start Date : December 1, 2021
Estimated Primary Completion Date : August 1, 2024
Estimated Study Completion Date : August 1, 2024
Arms and Interventions
Arm Intervention/treatment
Experimental: Cohort 1
Patients receiving SRS treatment for cancer metastatic to the brain from an extracranial primary site with a contrast-enhanced MRI scan showing 1-3 brain metastases, including post-operative patients with 1-3 residual metastases The first cohort of patients will receive ascorbate-meglumine at a dose administration rate of 0.16 g/min for 60 minutes.
Drug: Ascorbate-Meglumine
Ascorbate, meglumine and sodium salt made by combining 375 mM sodium ascorbate, 125 mM ascorbic acid and 125 mM meglumine in sterile water for injection.
Other Name: Vitamin C

Experimental: Cohort 2
Patients receiving SRS treatment for cancer metastatic to the brain from an extracranial primary site with a contrast-enhanced MRI scan showing 1-3 brain metastases, including post-operative patients with 1-3 residual metastases The first cohort of patients will receive ascorbate-meglumine at a dose administration rate of 0.31 g/min for 60 minutes.
Drug: Ascorbate-Meglumine
Ascorbate, meglumine and sodium salt made by combining 375 mM sodium ascorbate, 125 mM ascorbic acid and 125 mM meglumine in sterile water for injection.
Other Name: Vitamin C

Experimental: Cohort 3
Patients receiving SRS treatment for cancer metastatic to the brain from an extracranial primary site with a contrast-enhanced MRI scan showing 1-3 brain metastases, including post-operative patients with 1-3 residual metastases The second cohort of patients will receive ascorbate-meglumine at a dose administration rate of 0.63 g/min for 60 minutes.
Drug: Ascorbate-Meglumine
Ascorbate, meglumine and sodium salt made by combining 375 mM sodium ascorbate, 125 mM ascorbic acid and 125 mM meglumine in sterile water for injection.
Other Name: Vitamin C

Experimental: Cohort 4
Patients receiving SRS treatment for cancer metastatic to the brain from an extracranial primary site with a contrast-enhanced MRI scan showing 1-3 brain metastases, including post-operative patients with 1-3 residual metastases The third cohort of patients will receive ascorbate-meglumine at a dose administration rate of 1.25 g/min for 60 minutes.
Drug: Ascorbate-Meglumine
Ascorbate, meglumine and sodium salt made by combining 375 mM sodium ascorbate, 125 mM ascorbic acid and 125 mM meglumine in sterile water for injection.
Other Name: Vitamin C

Outcome Measures
Primary Outcome Measures :
  1. Safety, as measured by adverse events [ Time Frame: 1 week after receiving study drug with SRS ]
    Adverse events will be monitored in patients receiving ascorbate formulated with meglumine during the SRS procedure


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Capable of giving written informed consent to participate in the study before undergoing any screening procedures
  2. Age greater than (>) 18
  3. Life expectancy of at least 3 months
  4. GPA score 0.5 or greater
  5. A contrast-enhanced brain MRI scan performed within 2 weeks of study registration
  6. Imaging demonstrates the presence of 1 to 3 intact (not previously irradiated or resected) brain metastases
  7. Maximum tumor diameter ≤ 3 cm for the largest lesion

Exclusion Criteria:

  1. Primary lesion with radiosensitive histology (i.e., small cell carcinoma, germ-cell tumors, lymphoma, leukemia, and multiple myeloma)
  2. Metastases in the brain stem, pons or medulla or within 3 mm of optic apparatus (such that some portion of the optic nerve or chiasm would receive >10Gy)
  3. Previous whole-brain radiation (previous SRS to or surgical resection of other brain metastases is permitted if more than 3 months prior to the date of enrollment on this protocol.)
  4. Pregnancy
  5. History or manifestation of glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency
  6. History of oxalate kidney stones
  7. History of iron overload or hemochromatosis
  8. History of allergy to ascorbic acid
  9. Anuria, dehydration, severe pulmonary congestion or pulmonary edema or fixed low cardiac input since all are conditions for which osmotic diuresis are contraindicated and ascorbic acid has high osmolarity
  10. Subjects who are on the following drugs and cannot have a drug substitution: flecainide, methadone, amphetamines, quinidine, and chlorpropamide; note: high dose ascorbic acid may affect urine acidification and, as a result, may affect clearance rates of these drugs.
  11. Subjects who are on strong inducers, inhibitors or substrates of CYP within 3 days of planned administration of study ascorbate-meglumine.
  12. Patients for which MRI is contra-indicated
Contacts and Locations

Locations
Layout table for location information
United States, North Carolina
Duke Cancer Center
Durham, North Carolina, United States, 27710
Sponsors and Collaborators
Chris Lascola, MD
Duke University
Investigators
Layout table for investigator information
Principal Investigator: John Kirkpatrick, M.D. Ph.D. Duke Health
Tracking Information
First Submitted Date  ICMJE April 17, 2019
First Posted Date  ICMJE April 25, 2019
Last Update Posted Date January 19, 2021
Estimated Study Start Date  ICMJE December 1, 2021
Estimated Primary Completion Date August 1, 2024   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: July 29, 2020)
Safety, as measured by adverse events [ Time Frame: 1 week after receiving study drug with SRS ]
Adverse events will be monitored in patients receiving ascorbate formulated with meglumine during the SRS procedure
Original Primary Outcome Measures  ICMJE
 (submitted: April 24, 2019)
  • Adverse events [ Time Frame: 1 hour after intervention ]
    Adverse events will be monitored in patients receiving ascorbate formulated with meglumine
  • systolic and diastolic blood pressure [ Time Frame: 1 hour after intervention ]
    systolic and diastolic blood pressure will be measured in patients receiving ascorbate formulated with meglumine
  • Heart Rate [ Time Frame: 1 hour after intervention ]
    heart rate (HR) will be measured in patients receiving ascorbate formulated with meglumine
  • Respiratory Rate [ Time Frame: 1 hour after intervention ]
    respiratory rate will be measured in patients receiving ascorbate formulated with meglumine
  • Pulse oximetry saturation [ Time Frame: 1 hour after intervention ]
    pulse oximetry saturation will be measured in patients receiving ascorbate formulated with meglumine
  • temperature [ Time Frame: 1 hour after intervention ]
    Temperature will be measured in patients receiving ascorbate formulated with meglumine
  • Adverse events [ Time Frame: 1 week after intervention ]
    Adverse events will be monitored in patients receiving ascorbate formulated with meglumine
Change History
Current Secondary Outcome Measures  ICMJE Not Provided
Original Secondary Outcome Measures  ICMJE Not Provided
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Evaluation of Ascorbate-Meglumine Therapeutic for SRS
Official Title  ICMJE Phase 1, Single-Center, Dose-Escalating, Open-Label, Safety Clinical Trial of Parenteral Ascorbate-Meglumine as a Novel Magnetic Resonance Imaging-guided Adjunctive Therapeutic for Stereotactic Radiosurgery
Brief Summary Phase 1, Single-Center, Dose-Escalating, Open-Label, Safety Clinical Trial of Parenteral Ascorbate-Meglumine as a Novel Magnetic Resonance Imaging-guided Adjunctive Therapeutic for Stereotactic Radiosurgery (SRS).
Detailed Description

Phase 1, single-center, open-label study in subjects receiving SRS for brain metastases.

The study will consist of 4 principal cohorts (n=3 in each cohort). Each cohort will receive an escalating dose of ascorbate-meglumine as an MRI-detectable adjunctive therapeutic to SRS.

Subjects will complete a planning MRI for SRS with gadolinium- diethylenetriamine penta-acetic acid (GD-DPTA) per standard of care for SRS. Forty-eight hours after the planning MRI, the subjects will complete the study MRI with ascorbate-meglumine contrast agent. Each cohort will receive an escalating dose of ascorbate-meglumine by intravenous administration over 1 hour during the MRI. The total dose of ascorbate-meglumine-will escalate from the first cohort to the next cohort in a sequential manner. During ascorbate-meglumine infusion, MRI scans will be performed to evaluate the contrast effect and PK blood draws will occur at defined time points.

Patients will return for the SRS procedure within 1 week following the planning MRI per standard of care. During SRS, subjects will receive a second dose of ascorbate-meglumine as an adjunctive therapeutic.

Patients will enter into a follow up phase within 2 weeks after the SRS procedure per standard of care.

The primary endpoint is to evaluate the safety of parenteral ascorbate-meglumine as a MRI-detectable adjunctive therapeutic to SRS.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 1
Study Design  ICMJE Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Intervention Model Description:
dose escalation
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE Safety
Intervention  ICMJE Drug: Ascorbate-Meglumine
Ascorbate, meglumine and sodium salt made by combining 375 mM sodium ascorbate, 125 mM ascorbic acid and 125 mM meglumine in sterile water for injection.
Other Name: Vitamin C
Study Arms  ICMJE
  • Experimental: Cohort 1
    Patients receiving SRS treatment for cancer metastatic to the brain from an extracranial primary site with a contrast-enhanced MRI scan showing 1-3 brain metastases, including post-operative patients with 1-3 residual metastases The first cohort of patients will receive ascorbate-meglumine at a dose administration rate of 0.16 g/min for 60 minutes.
    Intervention: Drug: Ascorbate-Meglumine
  • Experimental: Cohort 2
    Patients receiving SRS treatment for cancer metastatic to the brain from an extracranial primary site with a contrast-enhanced MRI scan showing 1-3 brain metastases, including post-operative patients with 1-3 residual metastases The first cohort of patients will receive ascorbate-meglumine at a dose administration rate of 0.31 g/min for 60 minutes.
    Intervention: Drug: Ascorbate-Meglumine
  • Experimental: Cohort 3
    Patients receiving SRS treatment for cancer metastatic to the brain from an extracranial primary site with a contrast-enhanced MRI scan showing 1-3 brain metastases, including post-operative patients with 1-3 residual metastases The second cohort of patients will receive ascorbate-meglumine at a dose administration rate of 0.63 g/min for 60 minutes.
    Intervention: Drug: Ascorbate-Meglumine
  • Experimental: Cohort 4
    Patients receiving SRS treatment for cancer metastatic to the brain from an extracranial primary site with a contrast-enhanced MRI scan showing 1-3 brain metastases, including post-operative patients with 1-3 residual metastases The third cohort of patients will receive ascorbate-meglumine at a dose administration rate of 1.25 g/min for 60 minutes.
    Intervention: Drug: Ascorbate-Meglumine
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Withdrawn
Actual Enrollment  ICMJE
 (submitted: January 14, 2021)
0
Original Estimated Enrollment  ICMJE
 (submitted: April 24, 2019)
12
Estimated Study Completion Date  ICMJE August 1, 2024
Estimated Primary Completion Date August 1, 2024   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  1. Capable of giving written informed consent to participate in the study before undergoing any screening procedures
  2. Age greater than (>) 18
  3. Life expectancy of at least 3 months
  4. GPA score 0.5 or greater
  5. A contrast-enhanced brain MRI scan performed within 2 weeks of study registration
  6. Imaging demonstrates the presence of 1 to 3 intact (not previously irradiated or resected) brain metastases
  7. Maximum tumor diameter ≤ 3 cm for the largest lesion

Exclusion Criteria:

  1. Primary lesion with radiosensitive histology (i.e., small cell carcinoma, germ-cell tumors, lymphoma, leukemia, and multiple myeloma)
  2. Metastases in the brain stem, pons or medulla or within 3 mm of optic apparatus (such that some portion of the optic nerve or chiasm would receive >10Gy)
  3. Previous whole-brain radiation (previous SRS to or surgical resection of other brain metastases is permitted if more than 3 months prior to the date of enrollment on this protocol.)
  4. Pregnancy
  5. History or manifestation of glucose-6-phosphate dehydrogenase (G6PD) enzyme deficiency
  6. History of oxalate kidney stones
  7. History of iron overload or hemochromatosis
  8. History of allergy to ascorbic acid
  9. Anuria, dehydration, severe pulmonary congestion or pulmonary edema or fixed low cardiac input since all are conditions for which osmotic diuresis are contraindicated and ascorbic acid has high osmolarity
  10. Subjects who are on the following drugs and cannot have a drug substitution: flecainide, methadone, amphetamines, quinidine, and chlorpropamide; note: high dose ascorbic acid may affect urine acidification and, as a result, may affect clearance rates of these drugs.
  11. Subjects who are on strong inducers, inhibitors or substrates of CYP within 3 days of planned administration of study ascorbate-meglumine.
  12. Patients for which MRI is contra-indicated
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years and older   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03927625
Other Study ID Numbers  ICMJE Pro00103610
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party Chris Lascola, MD, Duke University
Study Sponsor  ICMJE Chris Lascola, MD
Collaborators  ICMJE Duke University
Investigators  ICMJE
Principal Investigator: John Kirkpatrick, M.D. Ph.D. Duke Health
PRS Account Duke University
Verification Date January 2021

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP

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