A Clinical Trial of COX and EGFR Inhibition in Familial Polyposis Patients

Phase 2

Completed

Conditions: Adenomatous Polyposis Coli

Interventions: Drug: Placebo A
Drug: Erlotinib
Drug: Placebo B
Drug: Sulindac

Registration Number: NCT01187901

Lead Sponsor: University of Utah

Brief Summary: The purpose of this study is to determine in a randomized, placebo-controlled, phase II trial if the combination of sulindac and erlotinib causes a significant regression of duodenal and colorectal adenomas in familial adenomatous polyposis (FAP) and attenuated FAP (AFAP) patients.

Detailed Description: This will be a single-center, phase-II, six-month-long, placebo-controlled, double blinded, randomized trial of the epidermal growth factor receptor (EGFR) inhibitor, erlotinib (Tarceva) and the cyclooxygenase (COX-2) inhibitor, sulindac in patients with familial adenomatous polyposis (FAP) or attenuated FAP. FAP is an autosomal dominant inherited colon cancer predisposition with a 100% risk of colon cancer in the absence of preventive care (endoscopy and surgery). Efficacious chemoprevention for duodenal adenomas is an unmet clinical need in FAP patients that would reduce the morbidity from duodenectomy and risk of duodenal adenocarcinoma. Currently the only Food and Drug Administration (FDA)-approved chemopreventive agent is celecoxib which results in a modest reduction of duodenal and colorectal polyps and is associated with cardiac toxicity at effective doses. If it can be shown that combinatorial inhibition of COX-2 and EGFR activity leads to successful regression in duodenal adenomatous polyps in FAP, it could be used as an effective chemopreventive regimen in FAP patients with duodenal adenomas or who have undergone surgical resection of duodenal adenomas or have many rectal adenomas. FAP and AFAP patients will be screened by endoscopy for presence of 5 or more duodenal polyps, then randomized to either A) erlotinib at 75 mg/day and sulindac at 150 mg/day or B) placebo for 6 months. The endpoint will be endoscopy at 6 months.

Primary Aim : To determine if the combination of sulindac and erlotinib causes a significant regression of duodenal polyp burden at 6 mohths in FAP and attenuated FAP patients.

Secondary Aim: To measure if combination of sulindac and erlotinib cause a reduction in total duodenal polyp count, and change in duodenal polyp burden or count stratified by genotype and initial polyp burden.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 92

Inclusion Criteria

Patients who are 18 years or older with a clinical or genetic diagnosis of FAP or attenuated FAP.
Presence of duodenal polyps with a sum of diameters ≥ 5mm.
Minimum of two weeks since any major surgery
WHO performance status ≤1
Adequate bone marrow function as show by: normal leukocyte count, platelet count ≥ 120 x 109/L, Hgb > 12 g/dL
Adequate liver function as shown by: normal serum bilirubin(≤ 1.5 Upper Limit Normal {ULN}) and serum transaminases (≤ 2.0 ULN)
Patient must discontinue taking any Nonsteroidal anti-inflammatory drugs (NSAIDS) within one month of treatment initiation.
Patients must be able to provide written informed consent.

Exclusion Criteria

Prior treatment with any investigational drug within the preceding 4 weeks.
Malignancies within the past 3 years except for adequately treated carcinoma of the cervix or basal or squamous cell carcinomas of the skins.
Patients who have any severe and/or uncontrolled medical conditions or other conditions that could affect their participation in the study as determined by the Principal Investigator such as:
1. Unstable angina pectoris, symptomatic congestive heart failure, myocardial infarction ≤ 6 months prior to first study treatment, serious uncontrolled cardiac arrhythmia
2. Severely impaired lung function
3. Any active (acute or chronic) or uncontrolled infection/ disorders.
4. Nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by the treatment with the study therapy
5. Liver disease such as cirrhosis, chronic active hepatitis or chronic persistent hepatitis
Screening clinical laboratory values that indicate any of the following:
1. anemia
2. thrombocytopenia
3. leucopenia
4. elevations of transaminases greater than 2X ULN
5. elevation of bilirubin > 1.5 X ULN
6. alkaline phosphatase elevation > 1.5 X ULN
7. increased creatinine, urinary protein, or urinary casts outside the clinically normal range.
Gastrointestinal bleeding (symptoms including dyspnea, fatigue, angina, weakness, malaise, melena, hematochezia, hematemesis, anemia or abdominal pain will require clinical assessment to rule out gastrointestinal bleeding).
Patient who is currently taking any anti-coagulation medication.
Women who are pregnant or breast feeding.
Patients with a known hypersensitivity to sulindac or erlotinib or to their excipients

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo A and Placebo B	Placebo B	Placebo capsules matching erlotinib active comparator (Placebo A) once daily and placebo capsules matching sulindac active comparator (Placebo B) twice daily for 6 months
Placebo A and Placebo B	Placebo A	Placebo capsules matching erlotinib active comparator (Placebo A) once daily and placebo capsules matching sulindac active comparator (Placebo B) twice daily for 6 months
Erlotinib and Sulindac	Sulindac	Erlotinib 75 mg per day in combination with sulindac 150 mg twice daily for 6 months.
Erlotinib and Sulindac	Erlotinib	Erlotinib 75 mg per day in combination with sulindac 150 mg twice daily for 6 months.

Primary Outcome Measures

Name	Time	Method
Change in Duodenal Polyp Burden From Baseline to 6 Months	Baseline and 6 months	A comparison between the Sulindac-erlotinib and Placebo arms of the change in polyp burden from a 10-centimeter segment of the duodenum, measured as the sum of the diameters of the polyps, in millimeters (mm), from the duodenal segment (6-month polyp burden minus baseline polyp burden).

Secondary Outcome Measures

Name	Time	Method
Change in Duodenal Polyp Burden From Baseline to 6 Months in Attenuated FAP Participants	Baseline and 6 months	A comparison between the Sulindac-erlotinib and Placebo arm Attenuated FAP subgroups of the change in polyp burden from a 10-centimeter segment of the duodenum, measured as the sum of the diameters of the polyps, in millimeters (mm), from the duodenal segment (6-month polyp burden minus baseline polyp burden).
Change in Number of Duodenal Polyps From Baseline to 6 Months	Baseline and 6 months	A comparison between the Sulindac-erlotinib and Placebo arms of the change in number of polyps in a 10-centimeter segment of the duodenum (6-month polyp count minus baseline polyp count).
Change in Number of Duodenal Polyps From Baseline to 6 Months in Classic FAP Participants	Baseline and 6 months	A comparison between the Sulindac-erlotinib and Placebo arm Classic FAP subgroups of the change in number of polyps in a 10-centimeter segment of the duodenum (6-month polyp count minus baseline polyp count)
Change in Number of Duodenal Polyps From Baseline to 6 Months in Attenuated FAP Participants	Baseline and 6 months	A comparison between the Sulindac-erlotinib and Placebo arm Attenuated FAP subgroups of the change in number of polyps in a 10-centimeter segment of the duodenum (6-month polyp count minus baseline polyp count)
Change in Duodenal Polyp Burden From Baseline to 6 Months in Classic Familial Adenomatous Polyposis (FAP) Participants	Baseline and 6 months	A comparison between the Sulindac-erlotinib and Placebo arm Classic FAP subgroups of the change in polyp burden from a 10-centimeter segment of the duodenum, measured as the sum of the diameters of the polyps, in millimeters (mm), from the duodenal segment (6-month polyp burden minus baseline polyp burden).