Pilot Study of Mesenchymal Stromal Cells in Patients With Xerostomia After Radiation Therapy for Head and Neck Cancer
概览
- 阶段
- 1 期
- 干预措施
- Autologous bone-marrow derived, interferon gamma stimulated mesenchymal stromal cells
- 疾病 / 适应症
- Xerostomia Following Radiotherapy
- 发起方
- University of Wisconsin, Madison
- 入组人数
- 6
- 试验地点
- 1
- 主要终点
- Percentage of Subjects Experiencing Dose Limiting Toxicity (DLT)
- 状态
- 进行中（未招募）
- 最后更新
- 24天前
概览
简要总结
This is a single center pilot study designed to determine the safety and tolerability of autologous bone marrow-derived Mesenchymal Stromal Cells (MSCs) in patients with xerostomia (dry mouth) after undergoing radiation therapy (XRT) for head and neck cancer (HNC). Up to 12 participants will be enrolled and can expect to be on study for up to 2 years.
详细描述
Following the completion of screening/baseline procedures, and written consent, eligible participants will undergo bone marrow aspirate in order to obtain MSCs. The MSC Investigational Medicinal Product (IMP) (dose level 0, n=6, staggered) will be injected into one submandibular gland under local anesthesia, in the gland that received the lowest radiation dose. Patients with only one submandibular gland will be ineligible. All participants will be called by a study coordinator 3 days (+/- 2 days) after injection to assess pain and will have a phone visit with a physician 1 week (+/- 2 days) after injection during which the investigator will assess pain and ask about the area of injection regarding redness and/or swelling. All participants will complete a pain diary with daily entries over the first month to record the occurrence and severity of pain using a 0-10 visual analog scale and occurrence and severity of other adverse events (e.g., redness, swelling, warmth, tenderness, rash, pruritis, nausea, vomiting, fatigue). Participants will also keep a log of all pain medications taken including both narcotic and non-narcotic medications (e.g. ibuprofen, acetaminophen, etc.) for the first month. Participants will complete 5 follow-up visits over the course of 24 months - at 1, 3, 6, 12, and 24 months following the intervention. Salivary collection for analysis as well as QoL surveys will be obtained at these visits. Dose Reduction: * If dose limiting toxicity (DLT) in less than or equal to 1 participant (n=6 participants, staggered at least 14 days), Dose Level 0 will be recommended as starting dose for subsequent trial. * If DLT in greater than 1 participant, dose level -1 will be administered, staggered at least 14 days in n=6 participants. * If DLT in this cohort is in less than or equal to 1 participant, Dose Level -1 will be recommended as starting dose for subsequent trial. If DLT in greater than or equal to 2 participants, study will be stopped. Primary Objective * To evaluate the safety and tolerability of MSCs for subjects with xerostomia after radiation therapy for HNC. Secondary Objectives * To evaluate the efficacy of MSCs for treatment of xerostomia and salivary hypofunction via quality-of-life (QoL) questionnaires, salivary amount, and salivary compositional analysis. * To assess the imaging characteristics in HNC patients after MSC injection using ultrasound. * To assess the feasibility of a future Phase 1 dose-escalation study. Per Amendment Approved 4/14/23: Sub-study added, all enrolled participants will be offered injection of MSCs into the contralateral submandibular gland upon completion of the trial's primary objective (1 month of follow-up after injection of MSCs without any DLTs). The MSC IMP will be injected into the contralateral submandibular gland under local anesthesia. Participants will complete 5 follow-up visits over the course of 24 months - at 1, 3, 6, 12, and 24 months following the contralateral injection. Salivary collection for analysis as well as QoL surveys will be obtained at all visits, except the 24 month follow-up visit.
研究者
入排标准
入选标准
- •Willing to provide informed consent
- •Willing to comply with all study procedures and be available for the duration of the study
- •Histological diagnosis of Head and Neck Cancer (HNC) and ≥ 2 years from completion of treatment for HNC, either clinically or radiologically No Evidence of Disease (NED), as assessed by ENT or Radiation Oncologist within 28 days of study registration
- •Individuals at least 18 years of age and no older than 90 years of age
- •Xerostomia defined as less than or equal to 80 percent of baseline (pre-radiation) salivary function per patient estimate
- •Karnofsky performance status ≥ 70, patient eligible for bone marrow aspirate with wakeful anesthesia
- •Radiographically confirmed bilateral submandibular glands
- •Females of childbearing potential must agree to have a negative urine or serum pregnancy test within 7 days prior to bone marrow biopsy. A female of child-bearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:
- •has not undergone a hysterectomy or bilateral oophorectomy; or
- •has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months)
排除标准
- •History of sialolithiasis
- •Patients with one submandibular gland
- •History of autoimmune diseases affecting salivary glands, including Sjögren's syndrome, lupus, scleroderma, type I diabetes, sarcoidosis, and amyloidosis
- •Chronic graft vs host disease
- •Untreated oral candidiasis
- •Use of anti-cholinergic medications (e.g. atropine, ipratropium, oxybutynin, scopolamine, solifenacin, tiotropium, etc…) while enrolled on study
- •Malignancy within the past 2 years, except adequately treated stage I lung cancer, low risk prostate cancer that has been treated or is undergoing active surveillance, adequately treated non-melanoma skin cancer, adequately treated ductal carcinoma in situ (DCIS), or adequately treated stage I cervical cancer
- •Expected life expectancy ≤ 6 months
- •Lidocaine allergy
- •Use of investigational drugs, biologics, or devices within 30 days prior to enrollment
研究组 & 干预措施
Treatment with MSCs
A single dose of MSCs injected into the submandibular glands of patients with radiation-induced xerostomia (primary objective) Following primary outcomes, a second injection of 10 (8 - 12) x 106 MSCs will be offered for injection into each participant's contralateral submandibular gland.
干预措施: Autologous bone-marrow derived, interferon gamma stimulated mesenchymal stromal cells
结局指标
主要结局
Percentage of Subjects Experiencing Dose Limiting Toxicity (DLT)
时间窗: up to 1 month post injection (up to 3 months from consent)
Dose limiting toxicity is defined as: submandibular pain \> 5 on a pain scale of 0-10 at 1-month after MSC injection OR any serious AE OR any of the selected toxicities listed per protocol within one-month post-injection.
次要结局
- Saliva Composition Analysis: Change in Amylase Concentration in Saliva(baseline (up to 8 weeks before injection), 1, 3, 6, 12, and 24 months post-injection)
- Saliva Composition Analysis: Change in Mucin Concentration in Saliva(baseline (up to 8 weeks before injection), 1, 3, 6, 12, and 24 months post-injection)
- Change in Salivary Gland Stiffness Measured by Shear Wave Velocity(baseline (up to 8 weeks before injection), 3, 6, and 12 months post-injection)
- Participant Drop Out Rate(up to 24 months post-injection (up to 26 months from consent))
- Change in Saliva Production Rate(baseline (up to 8 weeks before injection), 1, 3, 6, 12, and 24 months post-injection)
- Saliva Composition Analysis: Change in Total Protein Concentration in Saliva(baseline (up to 8 weeks before injection), 1, 3, 6, 12, and 24 months post-injection)
- Change in Salivary Gland Size(baseline (up to 8 weeks before injection), 3, 6, and 12 months post-injection)
- Saliva Composition Analysis: Change in Salivary pH(baseline (up to 8 weeks before injection), 1, 3, 6, 12, and 24 months post-injection)
- Change in Visual Analogue Scale (VAS) Xerostomia Score(baseline (up to 8 weeks before injection), 1, 3, 6, 12, and 24 months post-injection)
- Change in The University of Michigan Xerostomia Related Quality of Life (XeQOL) Score(baseline (up to 8 weeks before injection), 1, 3, 6, 12, and 24 months post-injection)
- Change in The MD Anderson Dysphagia Index (MDADI) Score(baseline(up to 8 weeks before injection), 1, 3, 6, 12, and 24 months post-injection)