Colorectal Carcinoma
Conditions
Brief summary
This phase I trial studies how well dolcanatide works in preventing colorectal cancer in healthy participants. Dolcanatide is similar to a natural hormone released into the intestine. It is thought that people who have low levels of the hormone are more likely to get colon cancer. It may be possible to prevent colon cancer by giving a drug that is similar to the hormone, such as dolcanatide.
Detailed description
PRIMARY OBJECTIVES: I. To identify the ability of dolcanatide (SP333), when administered as a single daily dose of 27 mg x 7 days, to induce a direct pharmacological effect on cGMP levels, based on biopsy samples from the rectum obtained pre- and post-intervention, as compared to placebo. SECONDARY OBJECTIVES: I. To assess the pharmacodynamic (PD) response rate between arms (dolcanatide versus placebo). II. To confirm the safety and tolerability of dolcanatide, as compared to placebo. OUTLINE: Participants are randomized to 1 of 2 arms. ARM A: Participants receive dolcanatide orally (PO) once daily (QD) for 7 days. ARM B: Participants receive placebo PO QD for 7 days. After completion of study, participants are followed up at 21 and 51 days.
Interventions
DRUGDolcanatide
Given PO
OTHERLaboratory Biomarker Analysis
Correlative studies
OTHERPlacebo Administration
Given PO
OTHERQuestionnaire Administration
Ancillary studies
Sponsors
National Cancer Institute (NCI)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* PRE-REGISTRATION INCLUSION * Able to understand and willingness to sign a written informed consent document and follow study procedures * Willing to abstain from grapefruit juice during study * Willing to employ adequate contraception for men and women of childbearing potential; Note: acceptable methods include double barrier methods, intrauterine device (IUD), postmenopausal status documented by serum follicle stimulating hormone (FSH), and/or documentation of surgical sterilization * Willing to provide blood and tissue specimens for research purposes * REGISTRATION INCLUSION * Normal organ function and have normal laboratory findings without clinically significant findings * Leukocytes \>= 3 x 10\^3/microliter (B/L) * Absolute neutrophil count \>= 1.5 x 10\^3/microliter (B/L) * Platelets \>= 100 x 10\^3/microliter (B/L) * Total bilirubin within normal institutional limits * Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase \[SGOT\])/ alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase \[SGPT\]) =\< 1.5 x institutional upper limit of normal (ULN) * Creatinine =\< institutional upper limit of normal * Body mass index \< 35 kg/m\^2 * No findings in the rectum of advanced adenoma, chronic inflammation, or cancer
Exclusion criteria
* PRE-REGISTRATION EXCLUSION * Documented history of advanced adenomas (\>= 1 cm in maximal diameter, \>= 3 in total number, villous morphology, or high-grade dysplasia) or colorectal cancer * Family history of polyposis syndrome (e.g., familial adenomatous polyposis \[FAP\], hereditary nonpolyposis colorectal cancer \[HNPCC\]) or colorectal cancer (first degree relatives younger than 60 years old) * History of gastroparesis * History of surgery involving the luminal gastrointestinal (GI) tract, including bariatric surgery; exception: prior appendectomy \>= 60 days prior to pre-registration is not an exclusion criterion * History of celiac disease * Inflammatory bowel disease (Crohn's disease, ulcerative colitis) * Previous diagnosis of irritable bowel syndrome, chronic constipation, functional bowel disorders, colonic motility disorder, or opioid-induced constipation * Any malignancy within 3 years of baseline; exception: participants with a history of basal cell or squamous cell skin cancer may be enrolled at the discretion of the investigator * Currently receiving any other investigational agents * History of allergic reactions attributed to compounds of similar chemical or biologic composition to dolcanatide or to any of the excipients * History of difficulty with sigmoidoscopy or abnormal colorectal anatomy * Uncontrolled current 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 or lactating women * Current use of laxatives more than 3 times per week * Current use of \>= 5 cigarettes/day * Current use of \>= 3 alcoholic drinks/day * Use of anti-coagulants or anti-platelet agents within 5 days prior to anticipated sigmoidoscopy; exception: individuals taking aspirin will not be excluded and will not be subject to a wash-out period * History of bleeding/coagulation problems * Any medical condition reported by the participant or documented in the medical record that is judged by the investigator to constitute a risk to safe participation * Known or suspected mechanical gastrointestinal obstruction * REGISTRATION EXCLUSION * Sigmoidoscopy finding requiring clinical intervention * Use of any illicit or illegal substances detected by urinary drug screen
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pharmacological Effect on Cyclic Guanosine Monophosphate (cGMP) Levels for Dolcanatide Arm Versus (vs.) Placebo, as Measured by the Differences in Mean cGMP Levels After 7 Days of Intervention | Baseline to 7 days | Pharmacological effect on cyclic guanosine monophosphate (cGMP) levels for dolcanatide arm versus (vs.) placebo, where this effect is defined as the arithmetic difference in mean cGMP levels before and after 7 days of dolcanatide from subject biopsies. This represents the increase in cGMP stimulated by 7 days of dolcanatide in an individual subject. The mean cGMP value will be calculated based on 6 biopsies collected from the rectum during a flexible sigmoidoscopy procedure. Each biopsy was analyzed in triplicate using a commercially available EIA kit. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pharmacodynamic (PD) Response Rate | Baseline to 7 days | Each participant will be assessed for PD response. The calculation is based on the standardized difference in means for the pharmacological effect on cGMP levels at the participant level, where a subject with a z \>= 1.645 will be considered a PD responder. A participant with a z \< 1.645 will be considered a non-responder. The PD response rate (percentage) of patients are summarized below by arm. |
| Percentage of Participants With Grade 3 or Higher Diarrhea Per National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0 | Up to 21 days | The overall adverse event rates (percentages) for grade 3 or higher adverse events regardless of attribution to treatment are reported below. The percentages below are summarized for Diarrhea. |
Countries
United States
Participant flow
Pre-assignment details
37 patients were pre-registered, where 10 were screen failures, leaving 27 patients who proceeded to randomization.
Participants by arm
| Arm | Count |
|---|---|
| Arm A (Placebo) Participants receive placebo PO QD for 7 days. All participants will undergo sigmoidoscopies at baseline and after seven days of daily dosing with placebo. | 13 |
| Arm B (Dolcanatide) Participants receive dolcanatide PO QD for 7 days.All participants will undergo sigmoidoscopies at baseline and after seven days of daily dosing with dolcanatide. | 14 |
| Total | 27 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 0 | 1 |
| Overall Study | Inadequate bowel prep | 1 | 0 |
| Overall Study | Withdrawal by Subject | 1 | 0 |
Baseline characteristics
| Characteristic | Arm A (Placebo) | Arm B (Dolcanatide) | Total |
|---|---|---|---|
| Age, Continuous | 44.2 years STANDARD_DEVIATION 11.67 | 48.7 years STANDARD_DEVIATION 5.72 | 46.6 years STANDARD_DEVIATION 9.19 |
| ECOG Performance Status = 0 | 13 Participants | 14 Participants | 27 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 10 Participants | 8 Participants | 18 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 3 Participants | 6 Participants | 9 Participants |
| Sex: Female, Male Female | 4 Participants | 0 Participants | 4 Participants |
| Sex: Female, Male Male | 9 Participants | 14 Participants | 23 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 13 | 0 / 14 |
| other Total, other adverse events | 4 / 13 | 11 / 14 |
| serious Total, serious adverse events | 0 / 13 | 0 / 14 |
Outcome results
Primary
Pharmacological Effect on Cyclic Guanosine Monophosphate (cGMP) Levels for Dolcanatide Arm Versus (vs.) Placebo, as Measured by the Differences in Mean cGMP Levels After 7 Days of Intervention
Pharmacological effect on cyclic guanosine monophosphate (cGMP) levels for dolcanatide arm versus (vs.) placebo, where this effect is defined as the arithmetic difference in mean cGMP levels before and after 7 days of dolcanatide from subject biopsies. This represents the increase in cGMP stimulated by 7 days of dolcanatide in an individual subject. The mean cGMP value will be calculated based on 6 biopsies collected from the rectum during a flexible sigmoidoscopy procedure. Each biopsy was analyzed in triplicate using a commercially available EIA kit.
Time frame: Baseline to 7 days
Population: Only patients who completed the study in the Participant Flow are included in this analysis.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Arm B (Dolcanatide) | Pharmacological Effect on Cyclic Guanosine Monophosphate (cGMP) Levels for Dolcanatide Arm Versus (vs.) Placebo, as Measured by the Differences in Mean cGMP Levels After 7 Days of Intervention | -0.42 pmol/mg | Standard Deviation 0.43 |
| Arm A (Placebo) | Pharmacological Effect on Cyclic Guanosine Monophosphate (cGMP) Levels for Dolcanatide Arm Versus (vs.) Placebo, as Measured by the Differences in Mean cGMP Levels After 7 Days of Intervention | -0.22 pmol/mg | Standard Deviation 0.29 |
p-value: 0.15Wilcoxon (Mann-Whitney)
Secondary
Percentage of Participants With Grade 3 or Higher Diarrhea Per National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0
The overall adverse event rates (percentages) for grade 3 or higher adverse events regardless of attribution to treatment are reported below. The percentages below are summarized for Diarrhea.
Time frame: Up to 21 days
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm B (Dolcanatide) | Percentage of Participants With Grade 3 or Higher Diarrhea Per National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0 | 7.1 percentage of patients |
| Arm A (Placebo) | Percentage of Participants With Grade 3 or Higher Diarrhea Per National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0 | 0 percentage of patients |
Secondary
Pharmacodynamic (PD) Response Rate
Each participant will be assessed for PD response. The calculation is based on the standardized difference in means for the pharmacological effect on cGMP levels at the participant level, where a subject with a z \>= 1.645 will be considered a PD responder. A participant with a z \< 1.645 will be considered a non-responder. The PD response rate (percentage) of patients are summarized below by arm.
Time frame: Baseline to 7 days
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm B (Dolcanatide) | Pharmacodynamic (PD) Response Rate | 0 percentage of patients |
| Arm A (Placebo) | Pharmacodynamic (PD) Response Rate | 0 percentage of patients |