Intraabdominal Cancers (Various Types)
Conditions
Keywords
intraabdominal cancer (carcinomas), agarose macrobeads, mouse kidney cancer cells, cancer cell growth inhibition
Brief summary
This is a phase 1 trial to evaluate the safety and toxicity of mouse kidney cancer cell-containing agarose-agarose macrobeads that are implanted in the abdominal cavity as a proposed biological treatment of patients with end-stage, treatment-resistant cancer. The macrobeads have been extensively tested in tumor models in mice and rats, as well as in forty-five veterinary patients (cats and dogs) with naturally occurring tumors of various types including breast cancer, prostate cancer, liver cancer, and lymphoma with clear tumor responses and no significant detectable toxicity.
Detailed description
Cancer in its various forms continues to be a major U.S. health problem, accounting for 550,000 deaths a year, as well as much disability and suffering. Treatment for cancer has traditionally consisted of three modalities: surgery, radiation therapy, and chemotherapy. Advances with all three modalities over the years have produced long-term remissions and/or cures in certain types of cancer such as the leukemias, and prolonged survival for many other patients. Much remains to be accomplished, however, especially with respect to the treatment of solid tumors, including some of the most common cancers such as those of the lung, colon, breast, ovary, prostate and kidney. New types of less toxic and debilitating therapy are needed. Among the therapeutic possibilities currently being explored, those that involve biological control mechanisms seem both promising and attractive. Although it has long been thought that cancer cells are not subject to the same regulatory growth control mechanisms that function in normal cells, there is a substantial body of evidence that they can respond to feedback signals telling them to slow or stop their growth. In addition, it has been determined that a relatively small population of cells within a tumor (cancer stem or progenitor cells) are responsible for continued tumor growth and that it is these cells that must be controlled if biological anti-tumor therapy is to be effective. The proposed cancer treatment being tested in this Phase 1 clinical trial is based on the concept that tumor growth can be controlled by tumor mass or signals that indicate that such mass is present. In this case, however, the induction of the growth-slowing signals is brought about not by tumor mass, but by placing mouse kidney cancer cells in an agarose matrix, which both selects for cancer progenitor cells and also causes them to produce and release signals that inhibit the growth of freely growing cancer cells of the same or different type in a laboratory dish or in a tumor-bearing animal or human (i.e. is also not species-specific). This approach has proven both safe and effective in animal models and veterinary patients, and it is now in the first stage of human testing. With Phase 1 completed, we are now implementing Phase 2 efficacy trials that for the present are focused on colorectal cancer, pancreatic cancer, and prostate cancer. The Phase 1 trial remains open to a range of epithelial-derived cancer.
Interventions
8 macrobeads per kg
Sponsors
Study design
Eligibility
Inclusion criteria
* End-stage, treatment resistant epithelial-derived cancer (carcinoma) arising originally within the abdominal cavity with expected minimum six-month survival
Exclusion criteria
* Multiple intraabdominal metastases or carcinomatosis or other medical conditions indicating that the procedure would be of too high a risk for the individual
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum Tolerated Dose (MTD) of RENCA Macrobeads | 6 months | Dose limiting toxicity (DLT) was defined as: * any Grade 2 allergic reaction of generalized urticaria or any other Grade ≥ 3 allergic reaction; * any Grade ≥ 3 infection and * any Grade ≥ 3 local (intraperitoneal) reaction and any Grade ≥ 3 hematologic or non- hematologic reaction. This definition of DLT is in accord with the NCI CTCAE v3.0. Maximum tolerated dose (MTD) was to be identified if, within a cohort, \> 1 subject out of the first 3, or 2 subjects out of 5 experienced DLT. In such a case, the MTD will have been exceeded, and the administration of the study agent was to cease. MTD would not be considered to have been reached if no DLTs were observed. |
| Number of Participants Who Experienced Dose-Limiting Toxicities (DLTs) | 6 months | Dose limiting toxicity (DLT) was defined as: * any Grade 2 allergic reaction of generalized urticaria or any other Grade ≥ 3 allergic reaction; * any Grade ≥ 3 infection and * any Grade ≥ 3 local (intraperitoneal) reaction and any Grade ≥ 3 hematologic or non- hematologic reaction. This definition of DLT is in accord with the NCI CTCAE v3.0. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Overall Survival | From date of RENCA macrobeads implantation until date of death from any cause | Overall Survival (OS) was measured as date of first implantation to date of death of any cause, and was analyzed using the Kaplan-Meier method. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Tumor Marker Response | Prior to Implantation and Day 7, Day 14, Day 21 and Day 28 after each implantation | Tumor marker response after the first implantation with RENCA macrobeads. Responders showed at least a 20% decrease from baseline in Cancer Antigen 19-9 (CA19-9) or Carcinoembryonic Antigen (CEA); Non-responders do not show at least a 20% decrease from baseline in CA19-9 or CEA. |
Countries
United States
Participant flow
Recruitment details
Fifty-six subjects provided informed consent to participate in this study; of these 31 subjects underwent the implantation of macrobeads that contain mouse renal adenocarcinoma cells (RENCA macrobeads). The first subject was implanted on 6 April 2005 and the last subject was implanted on 1 November 2011.
Participants by arm
| Arm | Count |
|---|---|
| All Participants All participants who had at least one implantation of RENCA macrobeads, either at 8 RENCA macrobeads/kg body weight or 16 RENCA macrobeads/kg body weight. | 31 |
| Total | 31 |
Baseline characteristics
| Characteristic | All Participants |
|---|---|
| Age, Continuous | 59.1 years STANDARD_DEVIATION 8.53 |
| Race/Ethnicity, Customized Asian | 1 participants |
| Race/Ethnicity, Customized Hispanic | 2 participants |
| Race/Ethnicity, Customized Not Available | 16 participants |
| Race/Ethnicity, Customized White | 12 participants |
| Sex: Female, Male Female | 16 Participants |
| Sex: Female, Male Male | 15 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 27 / 31 |
| serious Total, serious adverse events | 20 / 31 |
Outcome results
Maximum Tolerated Dose (MTD) of RENCA Macrobeads
Dose limiting toxicity (DLT) was defined as: * any Grade 2 allergic reaction of generalized urticaria or any other Grade ≥ 3 allergic reaction; * any Grade ≥ 3 infection and * any Grade ≥ 3 local (intraperitoneal) reaction and any Grade ≥ 3 hematologic or non- hematologic reaction. This definition of DLT is in accord with the NCI CTCAE v3.0. Maximum tolerated dose (MTD) was to be identified if, within a cohort, \> 1 subject out of the first 3, or 2 subjects out of 5 experienced DLT. In such a case, the MTD will have been exceeded, and the administration of the study agent was to cease. MTD would not be considered to have been reached if no DLTs were observed.
Time frame: 6 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Participants | Maximum Tolerated Dose (MTD) of RENCA Macrobeads | NA RENCA Macrobeads/kg |
Number of Participants Who Experienced Dose-Limiting Toxicities (DLTs)
Dose limiting toxicity (DLT) was defined as: * any Grade 2 allergic reaction of generalized urticaria or any other Grade ≥ 3 allergic reaction; * any Grade ≥ 3 infection and * any Grade ≥ 3 local (intraperitoneal) reaction and any Grade ≥ 3 hematologic or non- hematologic reaction. This definition of DLT is in accord with the NCI CTCAE v3.0.
Time frame: 6 months
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| All Participants | Number of Participants Who Experienced Dose-Limiting Toxicities (DLTs) | 0 Participants who observed DLT |
| Day 14 | Number of Participants Who Experienced Dose-Limiting Toxicities (DLTs) | 0 Participants who observed DLT |
Overall Survival
Overall Survival (OS) was measured as date of first implantation to date of death of any cause, and was analyzed using the Kaplan-Meier method.
Time frame: From date of RENCA macrobeads implantation until date of death from any cause
| Arm | Measure | Group | Value (MEDIAN) |
|---|---|---|---|
| All Participants | Overall Survival | All Cancer Type | 5.4 months |
| All Participants | Overall Survival | Colorectal Cancer | 7.0 months |
| All Participants | Overall Survival | Pancreatic Cancer | 1.1 months |
| All Participants | Overall Survival | Other Cancer | 5.7 months |
Tumor Marker Response
Tumor marker response after the first implantation with RENCA macrobeads. Responders showed at least a 20% decrease from baseline in Cancer Antigen 19-9 (CA19-9) or Carcinoembryonic Antigen (CEA); Non-responders do not show at least a 20% decrease from baseline in CA19-9 or CEA.
Time frame: Prior to Implantation and Day 7, Day 14, Day 21 and Day 28 after each implantation
Population: All participants who had at least one implantation of RENCA macrobeads, either at 8 macrobeads/kg body weight or 16 macrobeads/kg body weight.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| All Participants | Tumor Marker Response | Responder | 5 participants |
| All Participants | Tumor Marker Response | Non-Responder | 15 participants |
| Day 14 | Tumor Marker Response | Non-Responder | 8 participants |
| Day 14 | Tumor Marker Response | Responder | 13 participants |
| Day 21 | Tumor Marker Response | Responder | 9 participants |
| Day 21 | Tumor Marker Response | Non-Responder | 4 participants |
| Day 28 | Tumor Marker Response | Responder | 10 participants |
| Day 28 | Tumor Marker Response | Non-Responder | 7 participants |