Calcium Electroporation for Head and Neck Cancer
|ClinicalTrials.gov Identifier: NCT03051269|
Recruitment Status : Unknown
Verified February 2017 by Irene Wessel, Rigshospitalet, Denmark.
Recruitment status was: Recruiting
First Posted : February 13, 2017
Last Update Posted : February 13, 2017
|Condition or disease||Intervention/treatment||Phase|
|Head Neck Cancer||Drug: Calcium chloride Device: Electroporation||Phase 1|
Calcium electroporation. Electroporation is a technique that facilitates the transport of molecules across the cell membrane by using electric pulses. The electric field applied to the cell membrane creates a temporary destabilization. As the electric capacity of the membrane is exceeded, cracks are formed in the membrane and the molecules are free to diffuse into the cytosol of the cell. The process is reversible and the cell membrane is stabilized in a matter of minutes. While the cell membrane is permeable there is an increased influx of Ca2+ into the cell. Calcium influx may be further improved by combining calcium together with electroporation; this is called calcium electroporation.
In vivo studies have shown that when enhancing the extracellular calcium concentration before applying electroporation, a larger Ca2+ influx occurs. The large Ca2+ influx can lead to a reduction in ATP (adenosine triphosphate) levels and cell death. A fall in ATP levels is seen for two reasons: First, an increase in intracellular Ca2+ leads to a higher activity of the Ca2+-ATPase and Na+/K+-ATPase. Secondly, the high concentration of Ca2+ leads to loss of the electrochemical gradient in the mitochondrial membrane, which causes mitochondrial collapse. Upon collapse of the mitochondria, the cell can no longer produce ATP. Overall, the increased consumption and decreased production of ATP leads to lover ATP levels. Combined with other cellular processes such as activation of lipases and proteases, the cell will eventually die.
- Primary outcome. Evaluating the safety measures of using calcium electroporation on mucosal head and neck cancer. This is done by continuously evaluating pain by VAS-score (visual analogue scale) and side effects by Common Terminology Criteria for Adverse Events (CTCAE) registration into Adverse Events (AE) and Serious Adverse Events (SAE). The safety of using calcium intratumourally is also evaluated by measurement of Ca2+ in blood samples after treatment.
- Secondary outcome. Evaluation of response by imaging: PET-MRI, Clinical photography, Biopsies from tumour site The subjects subjective evaluation of the treatment and post treatment period is evaluated through Quality of life questionnaires, EORTC QLQ-C30 and H&N35: two different questionnaires both validated for head and neck cancer patients.
- Tertiary outcome. The response to treatment will be compared to the results from our current trial, where we use electrochemotherapy on mucosal head and neck tumours. The comparison will be between imaging response, VAS score and results from questionnaires (EORTC QLQ-C30 and H&N35).
Trial design. This is a phase I, interventional, clinical trial for the safety of calcium electroporation on mucosal head and neck tumours. Subjects will have relapsed or primary head and neck cancer. Treatment is intended as palliative and not curative. All subjects will be offered standard treatment with surgery and radiotherapy before enrolment to the trial, if possible. There is no scheduled control group, meaning that all eligible patients will be offered treatment.
Electroporation and anaesthesia. The treatment is performed under general anaesthesia because the localization of head and neck tumours complicates treatment under local anaesthetic. After the patient is anaesthetized, the tumour area will be injected with calcium. After administration of calcium electrodes are inserted into the tumour and electrical pulses are generated and documented using a Cliniporator (IGEA, Capri, Italy). Overall operating time/anaesthesia time will be 1-2 hours and expected hospital stay of 3 days. Treatment is intended as a once-only treatment but measurable response on evaluation scans combined with continued cancer activity in the treated area can result in another treatment session.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||6 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Calcium Electroporation for Head and Neck Cancer|
|Study Start Date :||May 2016|
|Estimated Primary Completion Date :||December 2018|
|Estimated Study Completion Date :||February 2019|
Experimental: calcium chloride
Only one arm. All 6 enrolled patients are treated with calcium electroporation.
Drug: Calcium chloride
Tumour site is injected with a solution of 9 mg/ml calcium chloride and afterwards the tumour site is given electroporation to facilitate calcium to enter the cell cytosol.
Other Name: Calcium
Performed by single use electrodes attaches to a device called "Cliniporator" provided from IGEA, ITALY.
- Change in Treatment-Emergent Adverse Events [Safety and Tolerability] [ Time Frame: CTCAE are evaluated at several timepoints: 1) Baseline (before treatment). 2) 30 minutes and 6 hours after treatment. 3) Once at day 1, 2 and 3 after treatment. 4) 1 week after treatment. 5) 2 weeks after treatment. 6) 1 and 2 months after treatment. ]Evaluated by change in CTCAE (common terminology criteria for adverse events) at different timepoints.
- Change in Treatment-Emergent Adverse Events [Safety and Tolerability] [ Time Frame: Blood samples evaluating calcium levels are taken at 1) Baseline. 2) 30 min after treatment. 3) 6 hours after treatment. 4) At day 1, 2, and 3 after treatment. ]Evaluated by change in calcium levels in blood samples at different time points.
- Tumour response [ Time Frame: PET/MRI are performed at baseline and evaluated again at 1 and 2 months after treatment. ]By PET/MRI imaging
- Tumour response [ Time Frame: Clinical evaluation is performed daily in the first 3 days post-treatment, again at week 1 and 2, and 1 and 2 months post-treatment. ]By clinical evaluation.
- Tumour response [ Time Frame: Biopsies are performed at baseline and again at 1 and 2 months after treatment. ]By biopsies.
- Comparing calcium electroporation to electrochemotherapy [ Time Frame: 1 year ]The tumor response on MRI from calcium electroporation is compared to the tumor response on MRI from a previous study on a similar patient group treated with electrochemotherapy.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03051269
|Contact: Irene Wessel, MD||+45 35 45 83 email@example.com|
|Contact: Christina C Plaschke, MD||+45 29 25 92 firstname.lastname@example.org|
|Department of Otorhinolaryngology, Rigshospitalet, Copenhagen University Hospital||Recruiting|
|Copenhagen, Denmark, 2100|
|Contact: Christina C. Plaschke, MD +45 29 25 92 45 email@example.com|
|Contact: Irene Wessel, MD +45 35 45 83 22 firstname.lastname@example.org|
|Principal Investigator:||Irene Wessel||Rigshospitalet, Dept. of Head and Neck Surgery, Copenhagen, Denmark|