Wild Type p53 Adenovirus for Oral Premalignancies

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Brief Title

Wild Type p53 Adenovirus for Oral Premalignancies

Official Title

Clinical Protocol for Wild Type p53 Gene Induction in Premalignancies of Squamous Epithelium of the Oral Cavity and Oral Pharynx Via an Adenoviral Vector [NCI Supplied Agent Ad-p53, (INGN 201) (Advexin®) NSC 683550, IND# 7135]

Brief Summary

      Primary Objectives:

        1. To determine the maximum tolerated dose and transduction efficiency of adenoviral
           mediated wild type p53 gene transfer in premalignancies of the upper aerodigestive
           tract.

        2. To determine the efficacy of single agent adenoviral mediated wild type p53 gene
           transfer in reversing oral premalignancies.
    

Detailed Description

      Some cancers that occur in the mouth may in some way be due to a defect in a gene called the
      p53 gene. In this study, an adenovirus is used as a tool (a "vector") to deliver the normal
      p53 gene into cells. The parts of the adenovirus that allow it to reproduce and promote
      infection are removed, and the experimental gene (p53) is added.

      Prior to beginning this study, all participants will have a complete medical history and
      physical exam, including measurement of vital signs and weight. Participants will have an
      electrocardiogram (ECG), a urine test, and blood tests, including an HIV test. At mid-cycle,
      another white blood cell count will have to be drawn. Women able to have children must have a
      negative blood pregnancy test. Participants will be asked what medications have been taken in
      the past 30 days. Additionally, a chest x-ray will be performed.

      All participants will undergo a complete head and neck examination. This includes both visual
      [direct as well as mirror (and fiberoptic if required)] of all mucosal sites from the nasal
      and lip areas to the back of the throat. The physician will manually examine areas of the
      skin, salivary glands, the neck, and thyroid bed. Also, the doctor will make sure the cranial
      nerves are working properly. Location and size of lesion(s) will be recorded and measured in
      two dimensions. All lesions present will be photographed prior to the start of the
      intervention.

      Physical examination including a fiberoptic exam, is the established standard of evaluating
      pre-cancerous lesion(s). Only if a concern for cancer is present , or symptoms are beyond
      those findings of the physical examination will a CT or MRI be prescribed. These tests (CT
      and MRI) should not have to be done since they have no established role in the evaluation,
      management, or follow-up of these lesion(s). If utilized, a CT (computerized tomography) scan
      is a special test using x-ray along with a computer to give detailed pictures of parts of the
      body. An MRI (magnetic resonance imaging) is a special test using a strong magnetic field and
      radio frequency signals to give detailed pictures of parts of the body. An x-ray shows a
      2-dimensional picture while a CT scan or an MRI shows 3 dimensions.

      Each study course includes one week of treatment followed by three weeks of observation. The
      length of the study is 6 months (6 courses) for most participants. Participants will return
      to the clinic twice a day for Days 2 - 5 for each month of participation, and should expect
      to spend a total of about 6 hours a day at the clinic.

      Participants in this study will receive INGN 201 in two ways. The first way will be by
      injection in the area of the lesion. The second way will be by mouth rinse. Vital signs will
      be checked each time before participants receive INGN 201. The injection will be given on the
      first day of each week of the course, after a numbing (anesthetic) medication is applied to
      prevent discomfort.

      The mouth rinse will be given one time on the first day and two times on Days 2 - 5 of each
      course of INGN 201. The injection and rinse (first day of each cycle), or the two rinses
      (Days 2 - 5 of each cycle), will be separated by at least two hours. There will be a 30
      second rinse with 5% acetic acid, a raspberry flavored, vinegar-like liquid, followed by a
      tap water rinse just before participants receive INGN 201. Participants will be asked to hold
      the INGN 201 in their mouth for 30 minutes. Eating and drinking should be avoided for one
      hour after receiving the mouth rinse. The injection and rinse series will be repeated on a
      monthly basis for a period of six months.

      Participants will be requested to have two biopsies (small tissue samples) of the
      premalignant lesion taken on Day 5 of the 1st and 6th courses. These biopsies will contribute
      to the understanding of how the experimental agent works on pre-cancerous cells. In
      particular, the biopsies will help to determine if the experimental agent is effective in
      killing pre-cancerous cells (this process is called apoptosis). These studies will also
      determine if the gene therapy injections have been effective in delivering the gene (p53) to
      the precancerous cells.

      Participants will be observed for three more weeks after the sixth course of treatment. At
      the end of the study, 28 days after the last dose of INGN 201, participants will have a
      physical exam, including measurement of weight and vital signs. Participants will have a
      medical history and blood and urine tests. These tests are done to monitor the effects of the
      study treatment.

      Participants who develop severe side effects will be taken off study, though they may
      continue to receive follow-up evaluations to monitor their health. Participants will be
      counseled by their physician should the lesion(s) progress to cancer during the study or
      follow up period. After counseling, participant may choose to have surgery to remove the
      precancerous lesion(s), laser surgery, or observation. The participant will then be monitored
      closely.

      Study participants will be followed for five years, and must agree to stay in contact with
      their personal doctor or the doctor responsible for this study even if they move after the
      study ends. The participant's personal doctor may be asked to provide information about any
      anticancer treatments received after the study's completion, as well as information about the
      patient's overall health.

      This is an investigational study. This experimental use of human genes is an example of gene
      therapy. This is the first time that adenovirus gene therapy has been used for a
      pre-cancerous condition. This is the first study to use INGN 201 as a mouth rinse. A total of
      20 patients will be enrolled at M. D. Anderson. A maximum of 51 subjects will be entered in
      this multi-center study.
    

Study Phase

Phase 1

Study Type

Interventional


Primary Outcome

Maximum Tolerated Dose (MTD) of INGN 201


Condition

Mouth Cancer

Intervention

INGN 201

Study Arms / Comparison Groups

 INGN 201
Description:  INGN201 injection + oral rinse, day 1, courses 1-6. Twice-daily oral rinses, days 2-5, courses 1-6.

Publications

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information


Recruitment Status

Genetic

Estimated Enrollment

4

Start Date

June 2003

Completion Date

November 2010

Primary Completion Date

March 2008

Eligibility Criteria

        Inclusion Criteria:

          -  Males and females, aged 18 years and older.

          -  Patients must have histologically confirmed diagnosis of mild-moderate dysplasia or
             severe dysplasia/carcinoma in situ (CIS) of the oral cavity or oral pharynx.

          -  Patients must have clinical evidence of mild to moderate dysplasia or severe
             dysplasia/CIS of the oral cavity or oral pharynx that is diffuse.

          -  Patients must have diffuse* premalignant disease of the oral cavity or oral pharynx
             and must have: a) been previously treated with conventional treatment (e.g.: radiation
             or surgery) for a prior head & neck malignancy or b) failed biochemoprevention
             approaches for premalignant disease or c) failed other therapeutic approaches for
             premalignant disease. (*See protocol for definition of diffuse.)

          -  All patients must have a Karnofsky performance status of greater than or equal to 70%
             (Karnofsky scale, Appendix B).

          -  All patients must sign an informed consent indicating that they are aware of the
             investigational nature of this study in keeping with the policies of the institution.

          -  If female and of childbearing potential (non-childbearing defined as 1 year post
             menopause or surgically sterilized), patients must have a negative serum pregnancy
             test. Patients (male and female) must agree to use barrier contraception while on
             study and to avoid pregnancy for 1 year after treatment.

          -  Patients must have negative serology for the Human Immunodeficiency Virus (HIV) Type
             I. (Safety of the product has not been established or studied in immunosuppressed
             populations).

          -  Patients must have adequate bone marrow function (defined as peripheral absolute
             granulocyte count of greater than or equal to 2,000/ul and platelet count of greater
             than or equal to 100,000/ul), adequate liver function (bilirubin less than or equal to
             1.0 mg/dl), and adequate renal function (creatinine less than or equal to 1.5 mg/dl).

          -  Patients must not knowingly be in contact with former tissue or organ transplant
             recipients and persons known to them to be suffering from severe immunodeficiency
             disease (either acquired or congenital) during treatment or within 28 days following
             the last dosing with Ad5CMV p53 (INGN 201).

        Exclusion Criteria:

          -  Active squamous cell carcinoma of the head and neck.

          -  History of prior malignancies (excluding non-melanoma skin cancers and aerodigestive
             cancers) unless curatively treated and disease free for greater than or equal to 2
             years.

          -  Prior experimental therapy oral, systemic, topical, or directly injected into the
             lesion selected for treatment in this study, or radiation directly involving the
             lesion selected in the last three (3) months.

          -  Chemotherapy within 21 days prior to study (42 days for mitomycin C and nitrosoureas).

          -  Pregnant or lactating females. (Transplacental transfer and excretion in breast milk
             have not been studied with this agent).

          -  Active systemic viral, bacterial, or fungal infections requiring treatment.

          -  Patients with serious concurrent illness of psychological, familial, sociological,
             geographical or other concomitant conditions which do not allow for adequate follow up
             and compliance with the study protocol.

          -  Concurrent use of other investigational agents.

          -  Prior use of any other investigational agent requires a washout period of 8 weeks.

          -  Any immunosuppressive therapy (including corticosteroids > 10 mg/day) of prednisone or
             the equivalent.

          -  Aspirin use in an average dose of >175 mg/d.

          -  Patients evaluated by Internal Medicine with a baseline blood pressure of > or equal
             to 140/90 and deemed hypertensive.
      

Gender

All

Ages

18 Years - N/A

Accepts Healthy Volunteers

No

Contacts

Gary L. Clayman, MD, , 

Location Countries

United States

Location Countries

United States

Administrative Informations


NCT ID

NCT00410865

Organization ID

ID00-193


Responsible Party

Sponsor

Study Sponsor

M.D. Anderson Cancer Center

Collaborators

 National Cancer Institute (NCI)

Study Sponsor

Gary L. Clayman, MD, Principal Investigator, U.T. MD Anderson Cancer Center


Verification Date

December 2011