A phase I study of lipoteichoic acid-T (LTA-T, Oncomycin™) in malignant pleural effusion
ISRCTN | ISRCTN44367564 |
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DOI | https://doi.org/10.1186/ISRCTN44367564 |
Secondary identifying numbers | 2.1 |
- Submission date
- 17/06/2008
- Registration date
- 23/06/2008
- Last edited
- 07/09/2012
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Cancer
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Plain English summary of protocol
Not provided at time of registration
Contact information
Dr Najib Rahman
Scientific
Scientific
Oxford Respiratory Trials Unit
University of Oxford
Oxford
OX3 0DF
United Kingdom
Phone | +44 (0)1865 225256 |
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najib.rahman@ndm.ox.ac.uk |
Study information
Study design | Single centre, open label phase I toxicity trial |
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Primary study design | Interventional |
Secondary study design | Randomised controlled trial |
Study setting(s) | Hospital |
Study type | Treatment |
Participant information sheet | Not available in web format, please use the contact details below to request a patient information sheet |
Scientific title | |
Study objectives | The hypothesis that forms the basis for this study is that the intrapleural administration of lipoteichoic acid-T (LTAT-T) could reduce the recurrence of malignant pleural effusion and thereby alleviate a significant cause of morbidity in metastatic solid malignancies. The mechanism by which this might occur is not fully elucidated. Pleural infection is characterised by fibrotic obliteration of the pleural cavity (pleurodesis) during an indolent illness, and therapeutic replication of this response could produce a clinically effective pleurodesis. Gram positive pathogens are immunologically recognised by the binding of their cell wall motifs to toll-like receptors (TLRs) on the cell surface. One such motif is LTA-T, which mediates its effects through TLRs. We hypothesised that LTA-T may be capable of inducing a therapeutically effective pleurodesis for the control of malignant pleural effusion. We have performed a dose escalation study to assess the toxicity/tolerability of LTA-T administered into the pleural space, and to produce preliminary data assessing potential pleurodesis efficacy. The purpose of this study is to confirm the favourable safety profile of LTA-T when administered intrapleurally and to define a maximum tolerated dose. |
Ethics approval(s) | Ethics approval received from the Central Oxford Research Ethics Committee in July 2004 (ref: 04/Q1606/53). |
Health condition(s) or problem(s) studied | Malignant pleural effusion |
Intervention | An indwelling pleural catheter (PleurX, Denver, Colorado) was placed in the pleural effusion and the pleural space fully drained. After initial complete fluid drainage, 30 ml intra-pleural saline (saline control) was administered (day 1). The daily pleural fluid drainage was then recorded for seven days to quantify the rate of production of pleural fluid. On day seven, subjects received a single intra-pleural injection of LTA-T, according to an escalating dosing schedule. Over the next 7 days (days 7 - 14), daily pleural fluid volume drainage and pleural fluid cytology for malignant cells was performed unless pleural fluid flow ceased. On day 14, the intra-pleural catheter was flushed and closed (but left in situ) and not used again for the duration of the study unless recurrent pleural fluid caused dyspnoea. The starting dose of LTA-T was 250 µg, with three patients planned at each dose and an increase in dose determined by side effects seen in these patients. |
Intervention type | Drug |
Pharmaceutical study type(s) | |
Phase | Phase I |
Drug / device / biological / vaccine name(s) | Lipoteichoic acid-T (LTA-T, Oncomycin™) |
Primary outcome measure | Adverse events (phase I toxicity trial), measured over the entire course of the study (i.e 12 weeks). |
Secondary outcome measures | 1. To compare the daily production of pleural fluid over days 5 to 10 after administration of intra-pleural LTA-T with that of the previous five days after the administration of intra-pleural saline, compared from week 1 (saline control) to week 2 (LTA-T) 2. To define the time to symptomatic pleural effusion recurrence - 'pleurodesis failure' following LTA-T administration and to estimate by comparison with the published time to recurrence after simple drainage, whether LTA-T reduces the requirement for later pleural effusion drainage, assessed at 1 month 3. To assess whether intra-pleural LTA-T alters the presence of cancer cells in drained pleural fluid and whether it induces a cellular inflammatory pleural fluid response, assessed at 2 weeks and whenever fluid available subsequently 4. To assess whether intra-pleural LTA-T influences the levels of pleural fluid cytokines known to be associated with pleural fluid production, assessed post LTAT administration (3 days) |
Overall study start date | 09/11/2004 |
Completion date | 24/11/2005 |
Eligibility
Participant type(s) | Patient |
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Age group | Adult |
Lower age limit | 18 Years |
Sex | Both |
Target number of participants | Unknown initially as dose finding study - 14 patients recruited in total |
Key inclusion criteria | 1. Aged greater than or equal to 18 years, either sex 2. Histocytologically proven malignant pleural effusion 3. A Karnofsky Performance Status of greater than or equal to 60% 4. Life expectancy of more than three months 5. Written informed consent 6. Participants were required to be willing and able to comply with the protocol 7. Participants who were at least 4 weeks from their last chemotherapy cycle |
Key exclusion criteria | 1. Serious uncontrolled intercurrent infection 2. Proven infection in this episode of pleural effusion 3. Any bleeding diathesis such that chest tube insertion would be hazardous 4. Previous surgical pleurodesis for this pleural effusion 5. Any of the following abnormal laboratory results: 5.1. Haemoglobin less than 8 g/dl (correction by transfusion allowed) 5.2. Neutrophils less than 2.0 x10^9/l 5.3. Platelet count less than 100 x 10^9/l 5.4. Serum creatinine greater than 3 x upper normal limit 5.5. Serum bilirubin greater than 5 x upper normal limit 5.6. Alanine transaminase or aspartate aminotransferase greater than 5 x upper normal limit 6. A known sensitivity to lipoteichoic acid (LTA-T) 7. If female patients were pregnant or lactating; to include all women of childbearing potential unless using a reliable and appropriate contraceptive method was used and a negative pregnancy test was confirmed 8. Any patient with organ allografts, significant cardiac disease, uncontrolled seizures, central nervous system disorders or psychiatric disability 9. Participation in any other investigational drug study within 4 weeks 10. Living too far from the study centre to attend for study follow up |
Date of first enrolment | 09/11/2004 |
Date of final enrolment | 24/11/2005 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centre
Oxford Respiratory Trials Unit
Oxford
OX3 0DF
United Kingdom
OX3 0DF
United Kingdom
Sponsor information
Oxford University (UK)
University/education
University/education
Clinical Trials Research and Governance
Manor House
John Radcliffe Hospital
Headington
Oxford
OX3 9DU
England
United Kingdom
Heather.House@admin.ox.ac.uk | |
Website | http://www.ox.ac.uk/ |
https://ror.org/052gg0110 |
Funders
Funder type
Other
Lunamed AG (Switzerland) - unrestricted grant
No information available
National Institute for Health Research (NIHR) (UK) - Biomedical Research Centre Programme (salary for Chief Investigator)
No information available
The funders had no role or influence on the study design, analysis or execution.
No information available
Results and Publications
Intention to publish date | |
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Individual participant data (IPD) Intention to share | No |
IPD sharing plan summary | Not provided at time of registration |
Publication and dissemination plan | Not provided at time of registration |
IPD sharing plan |
Study outputs
Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
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Results article | results | 01/10/2008 | Yes | No |