Description:
Lung cancer is the leading cause of cancer death in the country, surpassing deaths caused by
colorectal, prostate and breast cancers combined. Veterans are at higher risk of lung cancer
due to the higher rate of smoking and environmental toxin exposures. The lack of effective
therapy for lung cancer provides the impetus to search for alternative, safe, and effective
treatment agents to improve treatment strategy against lung cancer, enhance the probability
of a cure and reduce recurrence. Based on encouraging preclinical and clinical findings from
an early phase I lung cancer prevention study, using a special formulation of a standardized
grape seed extract with enhanced absorption called leucoselect phytosome (LP), the purpose of
this new CSR&D Merit Review project is to evaluate the potential usefulness of LP for
pre-surgical treatment of early stage lung cancer patients in a phase IIa clinical trial.
Findings from this study may set the stage for larger, confirmatory trials in the near
future.
Title
- Brief Title: Leucoselect Phytosome for Neoadjuvant Treatment of Early Stage Lung Cancer
- Official Title: Leucoselect Phytosome for Neoadjuvant Treatment of Early Stage Lung Cancer
Clinical Trial IDs
- ORG STUDY ID:
ONCB-006-19F
- SECONDARY ID:
I01CX002028
- NCT ID:
NCT04515004
Conditions
- Early Stage Lung Cancer (I and II)
Interventions
Drug | Synonyms | Arms |
---|
leucoselect phytosome | | Intervention |
Purpose
Lung cancer is the leading cause of cancer death in the country, surpassing deaths caused by
colorectal, prostate and breast cancers combined. Veterans are at higher risk of lung cancer
due to the higher rate of smoking and environmental toxin exposures. The lack of effective
therapy for lung cancer provides the impetus to search for alternative, safe, and effective
treatment agents to improve treatment strategy against lung cancer, enhance the probability
of a cure and reduce recurrence. Based on encouraging preclinical and clinical findings from
an early phase I lung cancer prevention study, using a special formulation of a standardized
grape seed extract with enhanced absorption called leucoselect phytosome (LP), the purpose of
this new CSR&D Merit Review project is to evaluate the potential usefulness of LP for
pre-surgical treatment of early stage lung cancer patients in a phase IIa clinical trial.
Findings from this study may set the stage for larger, confirmatory trials in the near
future.
Detailed Description
The investigators will conduct a phase IIa, single arm study using 2-3 weeks of oral LP
treatment for 30 early stage I and II lung cancer patients before surgical resection of their
tumors.
Screening: Patients who have suspected early stage lung cancer will be recruited from
Pulmonary and Thoracic Surgery clinics prior to diagnostic biopsy.
Following informed consent, which includes allowing the investigators to collect and store
some of the samples from the clinical diagnostic procedures as pretreatment samples, such as
bronchoscopy, needle aspirations, etc., subject will be screened with history and physical
examination (H & P), respiratory/general health questionnaires, food frequency
self-assessment questionnaires, review of medical records, including radiographic imaging
data, pulmonary function test (PFT), 12-lead EKG, clinical labs (complete blood chemistry
panel, blood cell counts, PT, PTT). Most of these diagnostic tests will have already been
obtained as a part of the clinical work up. However, new blood tests will be obtained if the
last results were over 3 months ago). Blood samples and urine samples will be collected for
research. Serum cotinine will be obtained to ascertain smoking status. A portion of the
biospecimens (blood, urine, diagnostic samples) collected will be kept for future research at
the NMVAHCS in an approved repository. A pregnancy test will be done for a woman who is able
to have children.
Intervention: (treatment with study medication). If stage I or II lung cancer is diagnosed
from standard clinical practice, the qualified subject will be enrolled into the intervention
study to receive 2-3 weeks of LP, taken by mouth once a day, until the lung cancer surgery.
At the time of surgery, serial clinical samples, including bronchoscopic and various
surgically resected tissues, blood and urine will be collected as post-treatment samples.
Pre- and post-treatment samples will be compared to assess how well oral LP has been
absorbed, and whether or not there are encouraging anti-cancer changes occurring in the cells
and molecules in response to the LP treatment. Once enrolled for intervention, all subjects
will be monitored with weekly phone follow up, the safety of LP will be monitored weekly
using standard reporting tools (including the NCI common terminology criteria for adverse
events Version 5.0 and adverse reaction questionnaires), as well as pre-surgery H&P and blood
tests.
Follow up: Post-surgery phone follow up will occur at 3-4 weeks, 6 months and annually for up
to 4 years.
Trial Arms
Name | Type | Description | Interventions |
---|
Intervention | Experimental | All qualified participants meeting entry criteria that are enrolled will receive 2-3 weeks of oral LP treatment. | |
Eligibility Criteria
Inclusion Criteria:
A. Initial screening:
- Lesions suspicious for lung cancer
- Competent to provide consent
- CBC within normal limits (WNL)
- liver function test WNL
- Normal Creatinine clearance as measured by the Cockcroft-Gault equation
- ECOG Performance status: 0-1
B. Enrollment for treatment with LP:
- Histologically proven and surgically resectable clinical I and II stage NSCLC
Exclusion Criteria:
- Inability to provide informed consent (e.g. cognitive impairment, severe psychiatric
disorders)
- Hypersensitivity to grapes or related products
- Advance respiratory disease (Post resection FEV1 < 0.8 liters, resting hypoxemia, to
ensure pts have adequate reserve to undergo diagnostic procedures and surgical
resection)
- Unstable angina
- Other concurrent malignancy, excluding non-melanoma type skin cancer
- Have had a solid organ or bone marrow transplant
- Pregnancy
- Breast feeding
- Systemic corticoid steroid therapy of > 10 mg prednisone equivalent daily
- Coagulopathy (PT-INR > 1.2, PTT > 40 seconds) or history of bleeding/clotting problems
- Concurrent use of Grapes or related products
- Unwilling to refrain from drinking more than 1 glass of wine a day
- Pts receiving medications known to be modulators of cytochrome P450 3A4 if alternative
medication cannot be provided
- Currently taking other investigational agents
- Pts with concurrent medical conditions that may interfere with completion of tests,
therapy, or the follow up schedule
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 21 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Delay in the planned surgery of >14 days that is possibly related to study medication (Safety and feasibility). |
Time Frame: | No greater than 14 days delay in planned surgery. |
Safety Issue: | |
Description: | Defined as no delay in the planned surgery of >14 days that is possibly related to study medication. |
Secondary Outcome Measures
Measure: | Tumor Ki-67 labeling index (LI), a marker of cell proliferation. |
Time Frame: | Interim analysis on matched, pre- and post-treatment comparisons will be performed after 10 subjects have completed the treatment portion of the study, anticipated to be in year 2 |
Safety Issue: | |
Description: | Modulations of tumor Ki-67 LI. |
Measure: | Histopathology: pathological response of resected tumor and Lymph nodes. |
Time Frame: | Interim analysis on matched, pre- and post-treatment comparisons will be performed after 10 subjects have completed the treatment portion of the study, anticipated to be in year 2 |
Safety Issue: | |
Description: | Tumors and lymph nodes with no more than 10% viable tumor cells will be considered to have had a major pathological response. |
Measure: | Tumor activated caspase 3. |
Time Frame: | Interim analysis on matched, pre- and post-treatment comparisons will be performed after 10 subjects have completed the treatment portion of the study, anticipated to be in year 2 |
Safety Issue: | |
Description: | Modulations of this marker of apoptosis in tumors. |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Not yet recruiting |
Lead Sponsor: | VA Office of Research and Development |
Trial Keywords
- Grape seed procyanidin extract
- Early stage lung cancer
- Neoadjuvant treatment
Last Updated
June 7, 2021