Erlotinib Hydrochloride in Reducing Duodenal Polyp Burden in Patients With Familial Adenomatous Polyposis at Risk of Developing Colon Cancer

NCT ID: NCT02961374

Last Updated: 2022-07-26

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 46 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2017-10-27
• Study Completion Date: 2021-09-27

Brief Summary

This phase II trial studies the side effects of erlotinib hydrochloride and how well it works in reducing duodenal polyp burden in patients with familial adenomatous polyposis at risk of developing colon cancer. Erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

Detailed Description

PRIMARY OBJECTIVES:

I. To assess the mean percent change in duodenal polyp burden (sum of diameters from all polyps) from baseline to 6 months post-intervention for familial adenomatous polyposis (FAP) subjects receiving weekly erlotinib hydrochloride (erlotinib).

II. To assess the grade 2/3 adverse event rate in this population and compare it to historical data.

SECONDARY OBJECTIVES:

I. To evaluate all adverse events at least possibly attributed to weekly erlotinib.

II. To assess the absolute and percent change in duodenal polyp number from baseline to 6 months.

III. To assess the absolute and percent changes in lower gastrointestinal polyp burden and number for the subset of participants with ileal pouch anal anastomosis (IPAA) or ileo-rectal anastomosis with rectal stump.

IV. To assess the absolute and percent change in desmoid tumor size in participants who have baseline and follow up computed tomography (CT)s performed as part of their standard of care.

CORRELATIVE OBJECTIVES:

I. Gene expression profiles in duodenal adenomas and uninvolved tissue will be compared between baseline and endpoint samples using negative binomial statistics (DESeq2).

II. Identify differentially expressed genes between duodenal polyps and uninvolved tissue at endpoint compared to baseline.

III. Evaluate the effect of weekly erlotinib on EGFR and Wnt target gene expression in duodenal adenomas.

IV. Evaluate the effect of weekly erlotinib on immune response signaling in duodenal adenomas and uninvolved tissue.

OUTLINE:

Patients receive erlotinib hydrochloride orally (PO) once weekly. Treatment continues for up to 6 months in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up at 30 days.

Conditions

Attenuated Familial Adenomatous Polyposis; Familial Adenomatous Polyposis

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

Treatment (erlotinib hydrochloride)

Patients receive erlotinib hydrochloride PO once weekly. Treatment continues for up to 6 months in the absence of disease progression or unacceptable toxicity.

Group Type: EXPERIMENTAL

Erlotinib

Intervention Type: DRUG

Given PO

Erlotinib Hydrochloride

Intervention Type: DRUG

Given PO

Interventions

Erlotinib

Given PO

Intervention Type: DRUG

Erlotinib Hydrochloride

Given PO

Intervention Type: DRUG

Other Intervention Names

Cp-358,774; OSI-774; Tarceva

Eligibility Criteria

Inclusion Criteria

• PRE-REGISTRATION INCLUSION
• Diagnosis of familial adenomatous polyposis (FAP) or attenuated familial adenomatous polyposis (AFAP), defined as at least one of the following:

• Genetic diagnosis with confirmed APC mutation (Clinical Laboratory Improvement Act [CLIA] certified lab or research testing)
• Obligate carrier
• Clinical diagnosis of classic FAP with >= 100 colorectal adenomas status post colectomy and a family history of FAP
• Clinical diagnosis of FAP, based on personal and family history; Note: This criterion requires documented review and agreement from either the study chair or the Cancer Prevention Network (CPN) lead investigator
• Ability to understand and the willingness to sign a written informed consent document
• Willing to discontinue taking nonsteroidal anti-inflammatory drugs (NSAIDS) for 30 days prior to initiation of and during intervention; exception: use of =< 81 mg daily or =< 650 mg weekly aspirin is allowed
• Willing to discontinue smoking for the duration of study intervention
• Willing to provide mandatory biospecimens as specified in the protocol
• REGISTRATION INCLUSION
• Eastern Cooperative Oncology Group (ECOG) performance status =< 1
• Leukocytes (white blood cells [WBC]) >= 3,000/uL (>= 2,500/uL for African-American participants)
• Platelet count >= 100 x 10^9/L
• Hemoglobin >= 11.5 g/dL
• Total bilirubin =< 1.5 x institutional upper limit of normal (ULN)
• Alkaline phosphatase =< 1.5 x institutional upper limit of normal (ULN)
• Aspartate aminotransferase (AST)/serum glutamic-oxaloacetic transaminase (SGOT) =< 2 x institutional upper limit of normal (ULN)
• Alanine aminotransferase (ALT)/serum glutamate pyruvate transaminase (SGPT) =< 2 x institutional upper limit of normal (ULN)
• Creatinine =< institutional upper limits of normal (ULN)
• Urinary testing results within institutional limits of normal or deemed clinically insignificant
• Spigelman 2-3
• Not pregnant or breast feeding; Note: the effects of erlotinib (Tarceva ) on the developing human fetus at the recommended therapeutic dose are unknown; for this reason, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her study physician immediately; breastfeeding should be discontinued if the mother is treated with erlotinib
• Willing to use adequate contraception to avoid pregnancy or impregnation until 2 weeks after discontinuing study agent

Exclusion Criteria

• PRE-REGISTRATION EXCLUSION
• Any prior treatment with erlotinib or other agent whose primary mechanism of action is known to inhibit EGFR
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to erlotinib
• Use of potent CYP3A4 inhibitors, including but not limited to ketoconazole, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, troleandomycin, voriconazole, and grapefruit or grapefruit juice
• Use of potent CYP3A4 inducers, including but not limited to rifampicin, rifabutin, rifapentine, phenytoin, carbamazepine, phenobarbital, and St. John's wort
• Use of any other investigational agents =< 12 weeks prior to pre-registration
• Uncontrolled intercurrent illness or recent surgical procedure that in the opinion of the investigative team would limit compliance with study requirements, including, but not limited to:

• Ongoing or active infection
• Symptomatic congestive heart failure
• Myocardial infarction =< 6 months prior to intervention
• Severely impaired lung function
• Nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by the treatment with study intervention
• Diagnosed liver disease, such as cirrhosis, chronic active hepatitis, or chronic persistent hepatitis
• Unstable angina pectoris
• Cardiac arrhythmia
• Psychiatric illness/social situations
• History of invasive malignancy =< 3 years prior to pre-registration; exception: adequately treated carcinoma of the cervix, carcinoma in situ, or basal or squamous cell carcinomas of the skin
• Individuals on anticoagulation medications who cannot safely discontinue the medication for at least 48 hours prior to the study endoscopy, as determined by the study investigator and/or participant's primary healthcare provider
• History of any upper gastrointestinal (GI) surgery that does not permit access to or evaluation of a 10 cm segment of the duodenum that includes the duodenal bulb, i.e. Whipple procedure or similar
• REGISTRATION EXCLUSION
• Histologically-confirmed high grade dysplasia (HGD), cancer, or polyp burden that is not quantifiable
• Regular (>= 2 times per week) use of drugs that alter the pH of the gastrointestinal tract (GI) tract, such as proton pump inhibitors (PPI) and antacids; exceptions: individuals who use prescription PPIs and have approval from their primary health care provider to replace the PPI with an H2 receptor agonist, i.e. ranitidine, for the duration of the trial will be eligible
• Gastrointestinal bleeding; note that the presence of any symptoms (dyspnea, fatigue, angina, weakness, malaise, melena, hematochezia, hematemesis, anemia, abdominal pain) will require clinical assessment to rule out gastrointestinal bleeding

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 69 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Cancer Institute (NCI)

NIH

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Niloy J Samadder

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

Locations

Mayo Clinic in Arizona

Scottsdale, Arizona, United States

University of Michigan Comprehensive Cancer Center

Ann Arbor, Michigan, United States

Mayo Clinic in Rochester

Rochester, Minnesota, United States

Cleveland Clinic Foundation

Cleveland, Ohio, United States

University of Pittsburgh Cancer Institute (UPCI)

Pittsburgh, Pennsylvania, United States

M D Anderson Cancer Center

Houston, Texas, United States

Huntsman Cancer Institute/University of Utah

Salt Lake City, Utah, United States

University of Puerto Rico

San Juan, , Puerto Rico

Countries

United States; Puerto Rico

References

Stone JK, Mehta NA, Singh H, El-Matary W, Bernstein CN. Endoscopic and chemopreventive management of familial adenomatous polyposis syndrome. Fam Cancer. 2023 Oct;22(4):413-422. doi: 10.1007/s10689-023-00334-3. Epub 2023 Apr 29.

Reference Type: DERIVED

PMID: 37119510 (View on PubMed)

Samadder NJ, Foster N, McMurray RP, Burke CA, Stoffel E, Kanth P, Das R, Cruz-Correa M, Vilar E, Mankaney G, Buttar N, Thirumurthi S, Turgeon DK, Sossenheimer M, Westover M, Richmond E, Umar A, Della'Zanna G, Rodriguez LM, Szabo E, Zahrieh D, Limburg PJ. Phase II trial of weekly erlotinib dosing to reduce duodenal polyp burden associated with familial adenomatous polyposis. Gut. 2023 Feb;72(2):256-263. doi: 10.1136/gutjnl-2021-326532. Epub 2022 May 30.

Reference Type: DERIVED

PMID: 35636921 (View on PubMed)

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

NCI-2016-01674

Identifier Type: REGISTRY

Identifier Source: secondary_id

N01-CN-2012-00042

Identifier Type: -

Identifier Source: secondary_id

MAY2016-07-01

Identifier Type: OTHER

Identifier Source: secondary_id

MAY2016-07-01

Identifier Type: OTHER

Identifier Source: secondary_id

N01CN00042

Identifier Type: NIH

Identifier Source: secondary_id

View Link

P30CA015083

Identifier Type: NIH

Identifier Source: secondary_id

View Link

NCI-2016-01674

Identifier Type: -

Identifier Source: org_study_id