Ignite Creation Date:
2024-05-05 @ 11:32 AM
Last Modification Date:
2024-10-26 @ 9:09 AM
Study NCT ID:
NCT00075023
Status:
TERMINATED
Last Update Posted:
2015-11-04
First Post:
2003-12-30
Brief Title:
Effectiveness of Topical Thalidomide to Treat Chronic Graft-Versus-Host-Disease Related Stomatitis
Sponsor:
National Institute of Nursing Research NINR
Organization:
National Institutes of Health Clinical Center CC
Study Overview
Official Title:
Evaluation of Efficacy and Mechanisms of Topical Thalidomide for Chronic Graft-Versus-Host-Disease Related Stomatitis
Status:
TERMINATED
Status Verified Date:
2015-10
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
unable to enroll adequate subjects
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
This study was designed to be conducted in 2 parts The first part is a pilot study to test the effects of topical thalidomide gel 20mg applied to up to 3 oral ulcers in patients who have developed oral chronic graft-versus-host-disease cGVHD-related ulcerative stomatitis following allogeneic bone marrowperipheral blood stem cell transplant HSCT Chronic GVHD may be related to increased levels of a cytokine called TNF-alpha TNFa following HSCT Thalidomides anti-inflammatory effects may lower TNFa levels lead to healing of these oral ulcers and decrease oral pain
If the pilot study is successful the second part of the study will be done This will test the effects of a 01 20mg thalidomide mouthwash in treating oral cGVHD-related stomatitis in patients following allogeneic HSCT Applying thalidomide directly to the GVHD-related mouth ulcer in gel form or to the entire oral cavity in mouthwash form rather than taking it in pill form may reduce the amount of drug that enters the blood stream and cause less side effects
In the pilot study participants will be randomly assigned to receive thalidomide gel 20mg or placebo identical gel with no thalidomide to use 4 times a day for 4 weeks In the mouthwash study participants will be randomly assigned to receive 01 20mg thalidomide mouthwash or placebo identical mouth rinse with no thalidomide to use 4 times a day for 4 weeks Participants will undergo the following procedures before beginning experimental treatment then once a week for 4 weeks and then approximately 8 weeks after the first visit
Interview about current medications and use of alcohol and cigarettes
Self-report of mouth and throat pain
Oral examination for stomatitis rating and oral ulcers measurement
Quality of life questionnaire repeated only at week 8 of the study
Mouth photography to measure and record the oral ulcer response to treatment
Saliva sampling to look for proinflammatory cytokines small proteins including TNFa
Oral ulcer exudate collected by filter paper to obtain fluid for measuring TNFa levels
Gentle swabbing of oral ulcers to culture for virus fungus and bacteria that may be present
Small punch biopsy of the area near the ulcer or affected area to check for presence of TNFa repeated only at week 4 of the study
Blood sampling to monitor TNFa levels
A urine pregnancy test for women who are able to have children repeated at weeks 2 4 and 8
If the pilot study is successful the second part of the study will be done This will test the effects of a 01 20mg thalidomide mouthwash in treating oral cGVHD-related stomatitis in patients following allogeneic HSCT Applying thalidomide directly to the GVHD-related mouth ulcer in gel form or to the entire oral cavity in mouthwash form rather than taking it in pill form may reduce the amount of drug that enters the blood stream and cause less side effects
In the pilot study participants will be randomly assigned to receive thalidomide gel 20mg or placebo identical gel with no thalidomide to use 4 times a day for 4 weeks In the mouthwash study participants will be randomly assigned to receive 01 20mg thalidomide mouthwash or placebo identical mouth rinse with no thalidomide to use 4 times a day for 4 weeks Participants will undergo the following procedures before beginning experimental treatment then once a week for 4 weeks and then approximately 8 weeks after the first visit
Interview about current medications and use of alcohol and cigarettes
Self-report of mouth and throat pain
Oral examination for stomatitis rating and oral ulcers measurement
Quality of life questionnaire repeated only at week 8 of the study
Mouth photography to measure and record the oral ulcer response to treatment
Saliva sampling to look for proinflammatory cytokines small proteins including TNFa
Oral ulcer exudate collected by filter paper to obtain fluid for measuring TNFa levels
Gentle swabbing of oral ulcers to culture for virus fungus and bacteria that may be present
Small punch biopsy of the area near the ulcer or affected area to check for presence of TNFa repeated only at week 4 of the study
Blood sampling to monitor TNFa levels
A urine pregnancy test for women who are able to have children repeated at weeks 2 4 and 8
Detailed Description:
Oncology patients undergoing allogeneic bone marrowperipheral blood stem cell transplant HSCT frequently experience an allo-immune condition termed graft-versus-host-disease GVHD The pathogenesis of GVHD derives from an immune attack mediated by donor T-cells recognizing antigens expressed on normal tissues of the patient This condition occurs in HSCT rather than autologous BMT because of disparities in minor histocompatibility antigens between donor and recipient inherited independently of HLA genes Lazarus Vogelsang and Rowe 1997 GVHD may be conceptualized as a cytokine storm stemming from an outpouring of endogenous cytokines resulting in many tissue effects Lazrarus et al 1997 Oral chronic GVHD cGVHD presents with tissue atrophy and erythema lichenoid changes hyperkeratotic striae patches plaques and papules and pseudomembranous ulcerations typically occurring on the buccal and labial mucosa and the lateral tongue mucoceles due to inflammation of minor salivary glands and xerostomia Lloid 1995 The ulcerative phase often leads to a cascade of negative sequelae including oropharyngeal pain critical treatment alterations or cessation diminished capacity for food intake and decreased quality of life
Optimal treatment strategies for cGVHD-related ulcerative stomatitis and related oropharyngeal pain have not been established Therefore there is a critical need to examine the pathogenesis of and to evaluate interventions for cGVHD-related ulcerative stomatitis and related acute oropharyngeal pain in the randomized controlled clinical trial setting to both advance the science of cancer treatment-related oral complications and to improve patient care We hypothesize that the mechanisms of tissue injury occurring at the mucosal level leading to cGVHD-related stomatitis are similar to other types of stomatitis such as cancer chemotherapy-related stomatitis and aphthous stomatitis and are therefore amenable to treatment with anti-inflammatory strategies Therefore the purpose of this study is to elucidate the role of inflammation in GVHD-related ulcerative stomatitis by testing the efficacy of a topical thalidomide gel on the resolution of cGVHD-related stomatitis and related oropharyngeal pain The actions of thalidomide which include inhibition of the release of tumor necrosis factor-alpha TNFa and resultant alteration of the inflammatory cascade may provide insight into the role of local mucosal inflammation in cGVHD-related stomatitis
This study will be conducted in two parts The first part is a pilot study testing the effects of a thalidomide gel 20mg in patients who have developed oral cGVHD-related ulcerative stomatitis following allogeneic bone marrowperipheral blood stem cell transplant HSCT Stomatitis is an inflammation of the lining of the throat and mouth that may lead to ulcers and pain in the mouth and throat GVHD - a condition in which the donor cells see patients cells as foreign and mount an immune response to them - may be related to increased levels of a substance called TNF-alpha TNFa following HSCT Thalidomides anti-inflammatory effects may lower TNFa levels and decrease cGVHD-related stomatitis and oral pain in these patients
If this pilot study is successful then the second part of the study will be conducted The second part of this study will test the effects of a 01 20mg thalidomide mouthwash in treating oral cGVHD-related stomatitis in patients following allogeneic HSCT Applying thalidomide directly to the GVHD-related mouth ulcer in gel form or to the entire oral cavity in mouthwash form rather than taking the thalidomide in pill form may reduce the amount of drug that enters the blood stream and cause fewer side effects
Patients between 18 and 80 years of age who have received a HSCT and developed oral cGVHD-related stomatitis as confirmed by surgical biopsy may be eligible for this study The only eligible female participants for the pilot study will be women who are unable to have children In the pilot study participants will be randomly assigned to receive thalidomide gel 20mg or placebo a gel with no thalidomide to use four times a day for 4 weeks In the mouthwash study participants will be randomly assigned to receive 01 20mg thalidomide mouthwash or placebo a mouth rinse with no thalidomide to use four times a day for 4 weeks
Participants will have the following data collected and undergo the following procedures before beginning experimental treatment then once a week for 4 weeks and then approximately 8 weeks after the first visit
Interview about current medications and use of alcohol and cigarettes
Self-report of mouth and throat pain ratings
Oral examination for stomatitis rating
Quality of life questionnaire The questionnaire is repeated only at week 8 of the study
Mouth photography to measure and record the oral ulcer response to treatment
Saliva sampling to look for proinflammatory cytokines small proteins including TNFa
Oral ulcer exudate collected by filter paper to obtain fluid for measuring TNFa levels
Gentle swabbing of oral ulcers to culture for virus fungus and bacteria that may be present
Small punch biopsy of the area near the ulcer or affected area to check for presence of TNFa The punch biopsy is repeated only at week 4 of the study
Blood sampling to monitor TNFa levels
A urine pregnancy test for women who are able to have children The pregnancy test is repeated at weeks 2 4 and 8
Optimal treatment strategies for cGVHD-related ulcerative stomatitis and related oropharyngeal pain have not been established Therefore there is a critical need to examine the pathogenesis of and to evaluate interventions for cGVHD-related ulcerative stomatitis and related acute oropharyngeal pain in the randomized controlled clinical trial setting to both advance the science of cancer treatment-related oral complications and to improve patient care We hypothesize that the mechanisms of tissue injury occurring at the mucosal level leading to cGVHD-related stomatitis are similar to other types of stomatitis such as cancer chemotherapy-related stomatitis and aphthous stomatitis and are therefore amenable to treatment with anti-inflammatory strategies Therefore the purpose of this study is to elucidate the role of inflammation in GVHD-related ulcerative stomatitis by testing the efficacy of a topical thalidomide gel on the resolution of cGVHD-related stomatitis and related oropharyngeal pain The actions of thalidomide which include inhibition of the release of tumor necrosis factor-alpha TNFa and resultant alteration of the inflammatory cascade may provide insight into the role of local mucosal inflammation in cGVHD-related stomatitis
This study will be conducted in two parts The first part is a pilot study testing the effects of a thalidomide gel 20mg in patients who have developed oral cGVHD-related ulcerative stomatitis following allogeneic bone marrowperipheral blood stem cell transplant HSCT Stomatitis is an inflammation of the lining of the throat and mouth that may lead to ulcers and pain in the mouth and throat GVHD - a condition in which the donor cells see patients cells as foreign and mount an immune response to them - may be related to increased levels of a substance called TNF-alpha TNFa following HSCT Thalidomides anti-inflammatory effects may lower TNFa levels and decrease cGVHD-related stomatitis and oral pain in these patients
If this pilot study is successful then the second part of the study will be conducted The second part of this study will test the effects of a 01 20mg thalidomide mouthwash in treating oral cGVHD-related stomatitis in patients following allogeneic HSCT Applying thalidomide directly to the GVHD-related mouth ulcer in gel form or to the entire oral cavity in mouthwash form rather than taking the thalidomide in pill form may reduce the amount of drug that enters the blood stream and cause fewer side effects
Patients between 18 and 80 years of age who have received a HSCT and developed oral cGVHD-related stomatitis as confirmed by surgical biopsy may be eligible for this study The only eligible female participants for the pilot study will be women who are unable to have children In the pilot study participants will be randomly assigned to receive thalidomide gel 20mg or placebo a gel with no thalidomide to use four times a day for 4 weeks In the mouthwash study participants will be randomly assigned to receive 01 20mg thalidomide mouthwash or placebo a mouth rinse with no thalidomide to use four times a day for 4 weeks
Participants will have the following data collected and undergo the following procedures before beginning experimental treatment then once a week for 4 weeks and then approximately 8 weeks after the first visit
Interview about current medications and use of alcohol and cigarettes
Self-report of mouth and throat pain ratings
Oral examination for stomatitis rating
Quality of life questionnaire The questionnaire is repeated only at week 8 of the study
Mouth photography to measure and record the oral ulcer response to treatment
Saliva sampling to look for proinflammatory cytokines small proteins including TNFa
Oral ulcer exudate collected by filter paper to obtain fluid for measuring TNFa levels
Gentle swabbing of oral ulcers to culture for virus fungus and bacteria that may be present
Small punch biopsy of the area near the ulcer or affected area to check for presence of TNFa The punch biopsy is repeated only at week 4 of the study
Blood sampling to monitor TNFa levels
A urine pregnancy test for women who are able to have children The pregnancy test is repeated at weeks 2 4 and 8
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| 04-NR-0069 | None | None | None |