The Role of Ghrelin in Cancer Cachexia

This study is currently recruiting participants. (see Contacts and Locations)
Verified June 2014 by Department of Veterans Affairs
Sponsor:
Collaborator:
Helsinn Therapeutics (U.S.), Inc
Information provided by (Responsible Party):
Department of Veterans Affairs
ClinicalTrials.gov Identifier:
NCT01505764
First received: December 7, 2011
Last updated: June 11, 2014
Last verified: June 2014
  Purpose

Cancer is often coupled with a condition called cachexia. In this condition, individuals continue to lose weight and lean body mass, which means their muscles are getting smaller and weaker. Studies have shown that cancer patients who are losing weight often are responding poorly to chemotherapy, are at greater risk of infection and have a reduced life expectancy. Also, people may not want to eat. To date, there are no approved treatments available for this condition.

This study is going to study the benefits of the use of the study drug, Anamorelin HCl in treatment or prevention of cachexia associated with cancer. Studies done before with the study drug have shown that the drug can help the cachectic condition. The purpose of this research study is to evaluate the effectiveness of Anamorelin HCl compared to placebo on body composition (amount of cell mass, fat, muscle, etc.) including measurements of body potassium and nitrogen stores.

In addition to the above, the study will also assess the effect of the study drug on handgrip strength, body weight, lean muscle mass, quality of life, appetite & food intake, certain blood markers, energy expenditure (the amount of energy you are burning), functional performance, safety and tolerability of Anamorelin HCl.


Condition Intervention Phase
Cancer Cachexia
Drug: Anamorelin HCl
Drug: Placebo
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator)
Primary Purpose: Treatment
Official Title: The Role of Ghrelin in Cancer Cachexia

Resource links provided by NLM:


Further study details as provided by Department of Veterans Affairs:

Primary Outcome Measures:
  • Total body potassium. [ Time Frame: 2 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Body composition as measured by Densitometry. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  • Muscle strength as measured by grip strength. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  • Body weight. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  • Quality of life. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    Quality of life as assessed using the ASAS, EQ-5D and FACIT-F, Patient Reported Outcome assessments

  • Appetite. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    Appetite measured by a visual analogue scale and a food diary.

  • Resting energy expenditure. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  • Functional performance. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    Functional performance using stair-climbing power, 6-minute walk, tests of the major muscle groups and 24 hour physical activity levels

  • Body composition. [ Time Frame: 2 years ] [ Designated as safety issue: No ]
    Body composition as measured by Total body nitrogen and bioimpedance.

  • Safety and tolerability. [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
    The safety and tolerability of Anamorelin HCl assessed through the number of participants with Adverse Events.

  • Biomarkers TNF-alpha, IL-6, IGF-1 and IGFBP-3. [ Time Frame: 2 years ] [ Designated as safety issue: No ]

Estimated Enrollment: 90
Study Start Date: June 2012
Estimated Study Completion Date: March 2016
Estimated Primary Completion Date: January 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm 1
Anamorelin HCl
Drug: Anamorelin HCl
100 mg tablets; oral administration every day for 84 days, at least 1 hour before the first meal of the day.
Placebo Comparator: Arm 2
Placebo
Drug: Placebo
Placebo tablets identical in appearance to active tablets; oral administration QD for 84 days, at least 1 hour before the first meal of the day.

Detailed Description:

Subjects enrolled in the study will be randomly chosen to receive either Anamorelin HCL at a dose of 100 mg per day for 12 weeks or matching placebo. The chances of receiving anamorelin or placebo are 1 in 2. Which subject receives anamorelin or placebo will be decided at random. Neither the subject nor the study doctor will know which study drug the subject is receiving. The subject will be asked to visit the clinic at Day 1, Day 28, Day 56 and Day 84. There will also be a Day 112 follow-up visit and the medical records will be checked after that to see how the subjects are doing.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Must have incurable, histologically or cytologically documented Non-Small Cell Lung Cancer or Colo-rectal Cancer.
  • Females and males at least 18 years of age.
  • Documented histologic or cytologic diagnosis of AJCC unresectable Stage III or IV NSCLC and/or stage III or IV CRC (not amenable to curative resection)..
  • Involuntary weight loss of 5% body weight over a period of 6 months.
  • ECOG performance status 2 at screening.
  • Estimated life expectancy of greater than 4 months at the time of screening.
  • Presence and functional use of both hands.
  • Able to understand and comply with the procedures of the handgrip strength evaluation.
  • If the patient is a woman of childbearing potential or a fertile man, he/she must agree to use an effective form of contraception during the study and for 28 days following the last dose of study medication.
  • Willing and able to give signed informed consent and, in the opinion of the Investigator, to comply with the protocol tests and procedures.

Exclusion Criteria:

  • Other forms of lung cancer.
  • Women who are pregnant or breast-feeding.
  • Obesity.
  • Recent active excessive alcohol or illicit drug use current use of marijuana or history of marijuana use over the previous 6 months.
  • Severe depression.
  • Other causes of cachexia such as:

    • Liver disease (AST or ALT > 3x normal levels)
    • Renal failure (creatinine > 2.5 mg/dL)
    • Untreated thyroid disease
    • Class III-IV CHF
    • AIDS
    • Other cancer diagnosed within the past five years other than non-melanoma skin cancer and prostate cancer
    • Severe COPD requiring use of home O2.
  • Inability to increase food intake.
  • Recent administration of highly emetogenic chemotherapy.
  • Known HIV, active hepatitis B or C (with increased LFTs), or active tuberculosis.
  • Patients who have received two prior regimens of cytotoxic chemotherapy and are undergoing, or planning to undergo, a third regimen of cytotoxic chemotherapy.
  • Currently taking prescription medications intended to increase appetite or treat weight loss; these include, but are not limited to:

    • Testosterone
    • Androgenic compounds
    • Megestrol acetate
    • Methylphenidate
    • Dronabinol
  • Current use of steroids or history of use over the previous 6 months except as pre- and post-medications for chemotherapy administration.
  • Patients unable to readily swallow oral tablets.
  • An active, uncontrolled infection.
  • Uncontrolled diabetes mellitus.
  • Known or suspected brain metastases.
  • Patients receiving strong CYP3A4 inhibitors.
  • Patients receiving tube feedings or parenteral nutrition.
  • Patients with any concomitant medical or psychiatric condition or social situation that would make it difficult to comply with protocol requirements, including the inability to comply with handgrip strength determinations in both hands; for example, pre-existing neurological impairment.
  • Previous exposure to Anamorelin HCl.
  • Patients actively receiving a concurrent investigational agent, or any patients that have received an investigational agent within four weeks prior to randomization.
  • Current use of diuretics or history of intermittent diuretic usage for any reason over the previous 3 months.
  • History of claustrophobia.
  • Cachexia deemed by the investigator to be solely due to chemo or radiation treatment
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01505764

Contacts
Contact: Jose M Garcia, MD PhD (713) 794-7989 jose.garcia@va.gov
Contact: Gina M Cardwell, LVN (713) 794-7989 Gina.Cardwell@va.gov

Locations
United States, Texas
Michael E. DeBakey VA Medical Center (152) Recruiting
Houston, Texas, United States, 77030
Contact: Jose M Garcia, MD PhD    713-794-7989    jose.garcia@va.gov   
Contact: Gina M Cardwell, LVN    (713) 794-7989    Gina.Cardwell@va.gov   
Principal Investigator: Jose M. Garcia, MD PhD         
Sponsors and Collaborators
Helsinn Therapeutics (U.S.), Inc
Investigators
Principal Investigator: Jose M. Garcia, MD PhD Michael E. DeBakey VA Medical Center (152)
  More Information

No publications provided

Responsible Party: Department of Veterans Affairs
ClinicalTrials.gov Identifier: NCT01505764     History of Changes
Other Study ID Numbers: CLIN-013-08F, HT-ANAM-208
Study First Received: December 7, 2011
Last Updated: June 11, 2014
Health Authority: United States: Federal Government
United States: Food and Drug Administration

Keywords provided by Department of Veterans Affairs:
Cachexia

Additional relevant MeSH terms:
Cachexia
Body Weight
Body Weight Changes
Emaciation
Signs and Symptoms
Weight Loss

ClinicalTrials.gov processed this record on October 23, 2014