Prevention of inflammation of the mouth and lips caused by the anti-cancer drug Everolimus

ISRCTN ISRCTN14568888
DOI https://doi.org/10.1186/ISRCTN14568888
Secondary identifying numbers GION 2013-01
Submission date
15/07/2019
Registration date
02/08/2019
Last edited
23/10/2020
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Digestive System
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Stomatitis (mouth sores) is a common problem for people getting cancer treatment.
To date, no standard preventive measures for stomatitis have been suggested for cancer patients undergoing Everolimus treatment.
Orasol Plus® is a nutritional supplement of the industry, available in liquid form, containing a number of natural components endowed by anti-inflammatory, analgesic and cytoprotective properties. Notably, as per the product data sheet, Orasol Plus® can be swallowed at the end of the rinsing, thus expanding its protective effect not only in the oral cavity, but also in the esophageal mucosa.
The STOmatitis Prevention trial (‘STOP’) is thus aimed at investigating the possibility of using Orasol Plus® in patients with advanced RCC treated with Everolimus, in order to prevent the development of stomatitis of any grade.

Who can participate?
Patients who received Everolimus for cancer treatment.

What does the study involve?
Patients will be asked to practice standard oral hygiene, according to the National Association of Italian Dentists (ANDI) guidelines with or without additional use of Orasol Plus® mouthwash.

What are the possible benefits and risks of participating?
Benefits: expected reduction, in terms of severity and/or duration, the oral stomatitis so frequently observed in cancer patients treated with the oral agent Everolimus
Risks: being a natural compound and not a true drug, we do not expect any significant risk for patients taking part in this study

Where is the study run from?
1. IRCCS San Matteo University Hospital Foundation, Italy
2. IRCCS National Cancer Institute, Italy
3. Santi Antonio e Biagio e C. Arrigo Hospital, Italy
4. Papa Giovanni XXIII Hospital, Italy
5. Spedali Civili, Italy

When is the study starting and how long is it expected to run for?
August 2013 to December 2014

Who is funding the study?
Investigator initiated and funded

Who is the main contact?
Prof. Camillo Porta

Contact information

Prof Camillo Porta
Scientific

Medical Oncology
IRCCS San Matteo University Hospital
Pavia
27100
Italy

ORCiD logoORCID ID 0000-0003-2412-1563
Phone +39-0382-592265
Email camillo.porta@icsmaugeri.it

Study information

Study designProspective multicentre randomized open-label study
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Home
Study typePrevention
Participant information sheet Not available in web format, please use contact details to request a participant information sheet
Scientific titleSTOP (everolimus-induced STOmatitis Prevention trial) - randomized phase III study to assess the effectiveness of Orasol Plus ™ mouthwashes associated with standard oral hygiene (vs standard oral hygiene) to prevent everolimus-induced stomatitis in patients with advanced renal carcinoma
Study acronymSTOP
Study objectivesUse of a commercial natural multicomponent mouthwash, in association with standard oral hygiene (vs oral hygiene alone), could prevent everolimus-induced stomatitis in advanced renal cell carcinoma patients
Ethics approval(s)Approved 06/05/2013, IRCCS San Matteo University Hospital Institutional Review Board (IRB) (Comitato Etico IRCCS Policlinico San Matteo, piazzale C. Golgi 19, 27100 Pavia, Italy; +39-0382-502508; c.fiocchi@smatteo.pv.it), ref: 3DG0764
Health condition(s) or problem(s) studiedOral stomatitis induced by everolimus treatment
Intervention‘STOP’ is a prospective, multicentre, randomized (1:1), open-label study, aimed at comparing the incidence and duration of cases of mucositis of any grade in two groups of metastatic renal cell carcinoma patients on everolimus anticancer therapy treated prophylactically with Orasol Plus® in addition to standard oral hygiene, or with standard oral hygiene alone.

Experimental prophylactic treatment consisted of oral mouth rinses with Orasol Plus® mouthwash plus standard oral hygiene, while standard treatment consisted of oral hygiene alone. Based on the Orasol Plus® data sheet, the patients performed three mouth rinses within 24 hours (at least three hours apart from each other), using for each rinsing a measure of undiluted mouthwash: the patient rinsed for at least 30 seconds and then swallowed the product. In order to standardize how the rinses were performed, during the screening visit the patient was carefully instructed in this regard and performed two test rinses (with water) in the presence of the Physician who proposed the protocol.
Standard oral hygiene, according to the National Association of Italian Dentists (ANDI) guidelines, all patients enrolled in the protocol were required to follow and that was adequately explained to them, included the following activities:
1. Brush teeth twice a day and use dental floss daily
2. Use fluoride-containing toothpaste.
In particular, a correct use of the toothbrush involves the following steps:
• Place the toothbrush at an angle of 45 ° against the gingival margin and brush or rotate away from the gingival margin
• Gently brush the outside, the inside and the surface of each tooth with fast forward and backward movements
• Gently brush the tongue to remove bacteria and refresh the breath
A correct use of dental floss involves the following steps:
• Use about 45 cm of thread, rolling it around the middle finger of both hands and leaving a few centimeters to work with
• Gently follow the curves of the teeth
• Be sure to clean under the gum line and avoid hitting them

Randomization:
A randomization list has been generated, which is managed by the Coordinating Center; as a result of the arrival of relative screening card, each individual patient is randomized and the relative outcome of the randomization is communicated directly to each participating Center via fax.

Data collection and follow-up:
Individual patient's data are collected using a paper CRF, a copy of which has to be sent to the Coordinating Center when the patient completes the study or withdraws from it, while the original remains at each single participating center. The study duration, in light of the expected average duration of Everolimus treatment, predictable based on the results of the RECORD-1 pivotal study, the STOP study will have a maximum duration of 150 days; patients who eventually stop treatment before day 150, whether due to toxicity or ineffectiveness of the treatment, will still be included in the analysis. After a maximum of 150 days patients will not be further followed-up for study purposes.
Intervention typeSupplement
Primary outcome measureEfficacy of Orasol Plus® in addition to standard oral hygiene in the prevention of Everolimus-induced mucositis evaluated through physical examination and patient's interview at T0 (screening), T1 (day +15 from treatment start), T2 (day +30), T3 (day +90) and T4 (day +150/study end).
Secondary outcome measuresAll evaluated through physical examination and patient's interview at T0 (screening), T1 (day +15 from treatment start), T2 (day +30), T3 (day +90) and T4 (day +150/study end):
1. Pain and the consequent need for analgesic (NSAIDs, major analgesics, steroids)
2. Incidence of infectious episodes in the oral cavity
3. Evaluation of nutritional status
Overall study start date07/05/2013
Completion date31/12/2014

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participants62
Total final enrolment62
Key inclusion criteria1. Patients affected by locally advanced and/or metastatic RCC (of any histological subtype), for which a second or third line treatment with Everolimus was provided (as indicated by the Italian Medicines Agency [AIFA])
2. Patients who received Everolimus as part of experimental protocols were included in the present study only if Everolimus was administered as monotherapy (not in combination) and any protocol in question did not explicitly prohibit the use of food supplements; age over 18
3. Written informed consent to join the study
4. ECOG Performance Status of 0, 1 or 2
Key exclusion criteriaPoor patient compliance, and ongoing systemic or oral infections
Date of first enrolment01/08/2013
Date of final enrolment31/12/2014

Locations

Countries of recruitment

  • Italy

Study participating centres

IRCCS San Matteo University Hospital Foundation
Piazzale Golgi 9
Pavia
27100
Italy
IRCCS National Cancer Institute
Via Venezian 1
Milan
20133
Italy
Santi Antonio e Biagio e C. Arrigo Hospital
Via Venezia 16
Alessandria
15121
Italy
Papa Giovanni XXIII Hospital
Centro Ospedaliero
Bergamo
24129
Italy
Spedali Civili
Piazza Spedali Civili 1
Brescia
25123
Italy

Sponsor information

Italian Nephro-Oncology Group (GION)
Charity

via Liutprando 9
Pavia
27100
Italy

Phone +39-335-6230539
Email camillo.porta@gmail.com

Funders

Funder type

Other

Investigator initiated and funded

No information available

Results and Publications

Intention to publish date15/08/2019
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planFinal study results to be published as a full paper on an international peer-reviewed journal
IPD sharing planThe datasets generated during and/or analysed during the current study will be stored in a non-publically available repository. The dataset of the present study is stored in the database of all the studies conducted by the STOP trial's Sponsor, i.e. the Italian Group of Onconephrology/Gruppo Italiano di Onco-Nefrologia (GION). Anonymised data will be available from the time of study results' publication for a period of two years for possible audit purposes from Regulatory authorities, provided a formal request for data access. Patients authorized this use of collected data signing study's informed consent.

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article results 03/05/2020 23/10/2020 Yes No

Editorial Notes

23/10/2020: The following changes were made to the trial record:
1. Publication reference added.
2. The total final enrolment was added.
29/08/2019: Internal review.
01/08/2019: Trial’s existence confirmed by IRCCS San Matteo University Hospital Institutional Review Board.