Phase IIA Trial of Encapsulated Rapamycin (eRapa) to Prevent Progression in Familial Adenomatous Polyposis Patients Under Active Surveillance
试验速览
- 阶段
- 2 期
- 状态
- 进行中（未招募）
- 发起方
- 入组人数
- 30
- 试验地点
- 4
- 主要终点
- Frequency and severity of adverse events associated with low dose eRapa in FAP patients
研究概览
简要总结
Patients with Familial Adenomatous Polyposis (FAP) who are undergoing endoscopic surveillance will be given Encapsulated Rapamycin (eRapa) at one of three escalating doses/schedules for 12 months with the aim of reducing polyp burden.
详细描述
Patients with FAP who are undergoing endoscopic surveillance will be given eRapa at one of three escalating doses/ schedules (0.5mg every other day, 0.5mg daily every other week, or 0.5mg daily) for 12 months with the aim of reducing polyp burden. Patients will serve as their own controls. Patients will be assessed with surveillance endoscopy at baseline, 6 months, and 12 months for change in polyp burden. Correlation between immune markers and clinical outcomes will be explored.
This is a Phase IIa trial which will enroll at approximately 6-8 sites within the United States that have specialty expertise in FAP treatment and surveillance. The trial is anticipated to last approximately 24 months for treatment and follow up.
The trial will enroll 30 patients with the genetic or clinical diagnosis of FAP. The clinical diagnosis includes individuals with 100 or more cumulative tubular adenomas throughout the colorectum. Patients must be undergoing surveillance for known FAP and can include those with intact colons as well as those who have undergone surgical therapy. For those patients who have undergone partial or total colectomy, they must have documented residual polyps in their rectum for which they are receiving active surveillance.
Once the recommended phase 2 dose (RP2D) is identified, subjects will undergo evaluation under fed and fasted states to determine the food effect on eRapa absorption.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Sequential
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Sign and date an informed consent form.
- •Stated willingness to comply with all study procedures and availability for the duration of the study.
- •Male or female, age at least 18 years at the time of consent.
- •Phenotypic familial adenomatous polyposis (FAP) with disease involvement of the colorectum by either genetic or clinical diagnosis: Adenomatous polyposis coli (APC) germline mutation with or without family history, or with greater than a cumulative lifetime history of (>) 100 adenomas in large intestine and a family history of FAP, or FAP phenotype post colectomy for polyposis with a family history of FAP. Minimum number of polyps required for enrollment is
- •Abilitiy to safely undergo endoscopy.
- •Ability to take oral medication and be willing to adhere to the eRapa regimen.
- •For females of reproductive potential: use of highly effective contraception for at least 1 month prior to screening and agreement to use such a method during study participation and for an additional 12 weeks after the end of eRapa administration.
- •A woman must agree not to breast feed or donate eggs (ova, oocytes) during the study and for a period of 12 weeks after the last administration of study drug.
排除标准
- •Risk-reduction surgery (colectomy or partial colectomy) within the 12 months prior to screening.
- •Use of non-steroidal anti-inflammatory drugs other than aspirin during the study. The use of 81 milligrams (mg) of aspirin a day or 650 mg of aspirin per week is allowed.
- •Treatment with other FAP-directed drug therapy (including NSAID [Non-steroidal anti-inflammatory drug] drugs), unless completes a 4 week washout period prior to enrollment.
- •Duodenum or colon/ rectum with high grade dysplasia or cancer on biopsy at screening.
- •Duodenal or colorectal polyp > 1 centimeter (cm) not excised at the screening evaluation.
- •Pregnancy or breast feeding.
- •Unable to provide consent or anticipated inability to attend appropriate follow-up visits.
- •Serum creatinine or measured/ calculated creatinine clearance (or glomerular filtration rate [GFR]) > 1.5 x ULN OR < 30mL/min for participants with creatine levels > 1.5 x institutional ULN. Bilirubin ≥ 1.5 x ULN unless conjugated bilirubin ≤ ULN; alkaline phosphatase > 5 x ULN; ALT/AST > 2 x ULN.
- •INR or PT or aPTT > 1.5 x institutional ULN unless the patient is receiving anticoagulant therapy as long as the PT or aPTT is within therapeutic range of intended use of anticoagulants.
- •Proteinuria > 1+ on urinalysis or > 1g/24h on 24h urine.
- •History of interstitial lung disease or non-infectious pneumonitis.
- •Immunosuppressed state (e.g., HIV, use of chronic steroids), active, uncontrolled infection.
- •On agents known to alter rapamycin metabolism significantly.
- •Concurrent involvement in other clinical trials specifically evaluating chemoprevention in FAP.
- •Patients with a colonic polyp burden too numerous to count.
研究组 & 干预措施
Cohort 1
Cohort 1 will receive 0.5mg of eRapa every other day.
干预措施: Encapsulated Rapamycin (eRapa) (Drug)
Cohort 2
Cohort 2 will receive 0.5mg of eRapa daily with 7 days on therapy, followed by 7 days off therapy.
干预措施: Encapsulated Rapamycin (eRapa) (Drug)
Cohort 3
Cohort 3 will receive 0.5 mg of eRapa daily.
干预措施: Encapsulated Rapamycin (eRapa) (Drug)
Food Effect
Upon identification of the RP2D, after a 2 week washout (14 days), subjects will be randomized into a fed and fasted (2 weeks - 14 days) two period cross over, with an intervening 2 week washout (14 days) for a total of 2 months (8 weeks).
干预措施: Encapsulated Rapamycin (eRapa) (Drug)
结局指标
主要结局
Frequency and severity of adverse events associated with low dose eRapa in FAP patients
时间窗: All adverse events with start dates occurring any time after informed consent is obtained until 7 days (for non-serious adverse events) or 30 days (for serious adverse events) after the last day of study participation will be recorded.
Safety and tolerability of eRapa as determined by graded toxicity assessed throughout the trial per CTCAE v5.0.
Determine the Recommended Phase 2 Dose (RP2D)
时间窗: After informed consent is obtained up to 30 days after the last day of study participation.
The Recommended Phase 2 Dose (RP2D) will be determined by examining and analyzing safety/ adverse events as reflected by Outcome 1, dose delays, dose reductions, withdrawal of treatment secondary to low-grade toxicities, and serum pharmacokinetic monitoring.
Efficacy of eRapa in delaying polyp progression in patients with FAP as measured by change in polyp burden over time.
时间窗: Time for each patient is baseline to 6 months.
Percentage change from baseline in colorectal polyp burden as measure by endoscopy at 6 months.
次要结局
- Clinical effect of eRapa on polyp burden.(Following patients out to 12 months.)
- Clinical effect of eRapa on International Society for Gastrointestinal Hereditary Tumors Stage.(Following patients out to 6 and 12 months.)
- Determine the effect of food on eRapa absorption(2 months)
- Clinical effect of eRapa on duodenal polyp number and burden.(Following patients out to 6 and 12 months.)
- Clinical effect of eRapa on Spigelman Stage Score.(Following patients out to 6 and 12 months.)