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Colorectal Cancer MetastaticPhase 2PaSToNCT03167268

Panitumumab Skin Toxicity Prevention Trial

A Phase 2 study testing Lycopene in people with Colorectal Cancer Metastatic and Skin Toxicity, run by Ospedale San Carlo Borromeo at 1 site in Italy.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Background and rationale: EGFR represents the main and more studied signal activation pathway in the development of colorectal carcinoma. KRAS, NRAS, BRAF and PI3KA mutations and ERBB2 and MET amplification are responsible for most of the cases of primary resistance to anti-EGFR antibody treatments. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Colorectal Cancer Metastatic, Skin Toxicity
What is being tested?
Lycopene
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
28 participants
Where
1 siteItaly
Study dates
3 Aug 2016to 30 Nov 2021
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 18 years;
  • Patients suffering from colorectal adenocarcinoma at stage-IV, for which a treatment with panitumumab is required;
  • No previous treatment with anti-EGFR drugs;
  • Presence of at least one neoplastic lesion one-dimensionally measurable;
  • No systemic anti-neoplastic therapy, nor experimental therapy or radiotherapy during the three weeks before randomization;
  • Proper contraceptive treatment by patient and his/her partner;
  • Written informed consent for participating to the study;
  • Performance Status (under ECOG scale) 0, 1. 2.

Who cannot join

  • PS > 2
  • Poor patient compliance;
  • Dermatological ongoing pathologies which contraindicate the treatment or made skin toxicity assessment difficult;
  • Presence of clinical conditions which could alter lycopene absorption (altered intestinal transit, malabsorption);
  • Pregnancy;
  • Absence of measurable lesions;
  • Previous treatment with anti-EGFR drugs;
  • Intolerance/allergy to tomato or milk.

Trial locations and contacts

1 site in 1 country.

Italy1 site
  • Marco Pirovano

    Milan, 20153

Other trials in Italy

About this study

Official title: Double-blind, Phase II Study to Assess the Effectiveness of Lycopene vs Placebo to Reduce Skin Toxicity in Patients With Colorectal Carcinoma Treated With Panitumumab

Background and rationale: EGFR represents the main and more studied signal activation pathway in the development of colorectal carcinoma. KRAS, NRAS, BRAF and PI3KA mutations and ERBB2 and MET amplification are responsible for most of the cases of primary resistance to anti-EGFR antibody treatments. Despite the identification of these resistance mechanisms, a primary resistance to the therapy was detected in a certain percentage of cases, in which tumour bio-molecular characteristics would suggest a possible response to anti-EGFR antibody treatment. In these cases, pathway activation mechanisms should exist, which act in an alternative, complementary or parallel way than the EGFR one, allowing tumour progression despite of EGFR pharmacological deactivation. Skin toxicity is a characteristic of drugs having EGFR as a target and it shows itself mainly as a sterile acneiform folliculitis together with neutrophils perifollicular infiltrates but also as skin xerosis and paronychia starting from the earliest cycles of treatment. This skin toxicity seems to be closely related to EGFR activation of pro-inflammatory cytokines able to activate specific inflammatory activators, which induce neutrophils granulocytes chemotaxis. Lycopene is a compound belonging to carotenoid group, largely contained in tomatoes and their derivatives, which has an extreme antioxidant activity. In Dermatology, prolonged use of β-carotenoids in general and of lycopene in particular in the diet showed to be effective in skin protection from ageing, sunlight and radiotherapy damages because these compounds may accumulate in skin and thus contribute to reduce free radicals and inflammation effects. Moreover, lycopene ability to induce apoptosis and to inhibit cell cycle progression in some types of tumour cells, both in vitro and in vivo, has already been described. Lycopene seems to be able to suppress significantly PCNA (Proliferating cell nuclear antigen, cofactor of DNA polymerase-β) and β-catenin nuclear expression in neoplastic cells, essential substrate of WNT/β-catenin pathway, which is itself closely connected to activating pathways often involved in carcinogenesis of some kinds of tumours, in particular of colorectal carcinoma, like Akt/GSK3β/β-catenin and Hippo pathways. For its proved skin anti-inflammatory activity as powerful free radicals scavenger, lycopene, which accumulates itself specifically in skin, could be effective in reducing anti-EGFR drugs toxicity. Contemporary use of lycopene could have a positive effect on anti-EGFR drugs treatment effectiveness in patients with metastatic colorectal carcinoma due to its ability to interfere with pathways involved in neoplastic cells proliferation.

Estimated population:100 patients (50 for each of the two groups of treatment)

Read more

Study Framework: In this study, patients suffering from metastatic colorectal cancer and submitted to therapy with panitumumab would be enrolled. According to indications, panitumumab would be used:

in first line combined with Folfox or Folfiri;

in second line combined with Folfiri or treatments containing Irinotecan

in monotherapy in any therapeutic line in patients resistant to Fluoropyrimidines, Oxaliplatin and Irinotecan or intolerant to these drugs.

Standard schedules of these treatments would be used.

This is a phase-II, randomized, double-blind study between experimental prophylactic treatment with Lycopene vs placebo:

  • Treatment A - lycopene tablets 20 mg
  • Treatment B - placebo tablets

Patients should take orally Lycopene/placebo after dinner (to promote its absorption), starting the day before the beginning of treatment with panitumumab for the entire duration of the therapy, until progression of the disease or definitive drug suspension for toxicity.

Objectives of the study

Primary objective: to assess the effectiveness of lycopene versus placebo in reducing skin toxicity induced by panitumumab in patients treated for metastatic colorectal carcinoma.

Secondary objective: to assess lycopene pharmacokinetics

Exploratory objectives: to assess lycopene effectiveness versus placebo in increasing panitumumab effectiveness in terms of Disease Control (DC), Objective Response (OR) and Stabilisation of the Disease (SD). To assess lycopene effectiveness versus placebo in increasing panitumumab effectiveness in terms of Progression Free Survival (PFS).

As far as randomization is concerned, the two groups will be balanced according to sex, therapeutic line and institution in which patients will be treated.

Being tested
Lycopene, Placebo
Keywords
Lycopene, Anti EGFR therapy

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • LycopeneDrug

  • PlaceboOther

Study groups in NCT03167268
Study groupRoleWhat they receive
Lycopene 20mg cpr/dieExperimentalLycopene is a compound belonging to carotenoid group, largely contained in tomatoes and their derivatives, which has an extreme antioxidant activity. In Dermatology, prolonged use of β-carotenoids in general and of lycopene in particular in the diet showed to be effective in skin protection from ageing, sunlight and radiotherapy damages because these compounds may accumulate in skin and thus contribute to reduce free radicals and inflammation effects.
Receives: Drug: Lycopene
PlaceboPlacebo comparatorContaining same excipients than the experimental "Lycopene 20 mg" but not active principle (Lycopene)
Receives: Other: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Skin toxicity reduction

    Reduction of grade 2/4 skin toxicity of 30% in the experimental group.

    Toxicity will be evaluated as:

    1. worst toxicity for each patient during the treatment;
    2. grade 3 or grade 4 toxicity duration related to the treatment duration for each patient in the two arms;
    3. number and duration of tetracyclines and antibiotic treatment related to the treatment duration for each patient in the two arms;
    4. toxicity in difference time points (G15, G29, .....) for each clinical skin features (rash papular, pustular - xerosis skin - paronychia) in the two arms

    Measured: Skin toxicity will be verified every two weeks assessed up to 12 weeks, from date of randomization until the date of first documented progression

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 May 2017
  2. Study start3 Aug 2016
  3. Primary completion13 Jan 2020
  4. Study completion30 Nov 2021 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
28 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03167268
Sponsor's protocol ID
PaSTo
Acronym
PaSTo
Status last verified
Sep 2021
First submitted
27 Feb 2017
Last updated
9 Sep 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Hu JC, Sadeghi P, Pinter-Brown LC, Yashar S, Chiu MW. Cutaneous side effects of epidermal growth factor receptor inhibitors: clinical presentation, pathogenesis, and management. J Am Acad Dermatol. 2007 Feb;56(2):317-26. doi: 10.1016/j.jaad.2006.09.005. Epub 2006 Dec 1.

    PubMed 17141360
  • Galimont-Collen AF, Vos LE, Lavrijsen AP, Ouwerkerk J, Gelderblom H. Classification and management of skin, hair, nail and mucosal side-effects of epidermal growth factor receptor (EGFR) inhibitors. Eur J Cancer. 2007 Mar;43(5):845-51. doi: 10.1016/j.ejca.2006.11.016. Epub 2007 Feb 7.

    PubMed 17289377
  • Pastore S, Mascia F, Mariani V, Girolomoni G. The epidermal growth factor receptor system in skin repair and inflammation. J Invest Dermatol. 2008 Jun;128(6):1365-74. doi: 10.1038/sj.jid.5701184. Epub 2007 Nov 29.

    PubMed 18049451
  • Rodeck U. Skin toxicity caused by EGFR antagonists-an autoinflammatory condition triggered by deregulated IL-1 signaling? J Cell Physiol. 2009 Jan;218(1):32-4. doi: 10.1002/jcp.21585.

    PubMed 18781585
  • Requena C, Llombart B, Sanmartin O. Acneiform eruptions induced by epidermal growth factor receptor inhibitors: treatment with oral isotretinoin. Cutis. 2012 Aug;90(2):77-80.

    PubMed 22988651
  • Chen J, Song Y, Zhang L. Effect of lycopene supplementation on oxidative stress: an exploratory systematic review and meta-analysis of randomized controlled trials. J Med Food. 2013 May;16(5):361-74. doi: 10.1089/jmf.2012.2682. Epub 2013 Apr 30.

    PubMed 23631493
  • Misale S, Di Nicolantonio F, Sartore-Bianchi A, Siena S, Bardelli A. Resistance to anti-EGFR therapy in colorectal cancer: from heterogeneity to convergent evolution. Cancer Discov. 2014 Nov;4(11):1269-80. doi: 10.1158/2159-8290.CD-14-0462. Epub 2014 Oct 7.

    PubMed 25293556
  • Lemieux E, Cagnol S, Beaudry K, Carrier J, Rivard N. Oncogenic KRAS signalling promotes the Wnt/beta-catenin pathway through LRP6 in colorectal cancer. Oncogene. 2015 Sep 17;34(38):4914-27. doi: 10.1038/onc.2014.416. Epub 2014 Dec 15.

    PubMed 25500543
  • Kim M, Jho EH. Cross-talk between Wnt/beta-catenin and Hippo signaling pathways: a brief review. BMB Rep. 2014 Oct;47(10):540-5. doi: 10.5483/bmbrep.2014.47.10.177.

    PubMed 25154721
  • Kahn M. Can we safely target the WNT pathway? Nat Rev Drug Discov. 2014 Jul;13(7):513-32. doi: 10.1038/nrd4233.

    PubMed 24981364
  • Khuda-Bukhsh AR, Das S, Saha SK. Molecular approaches toward targeted cancer prevention with some food plants and their products: inflammatory and other signal pathways. Nutr Cancer. 2014;66(2):194-205. doi: 10.1080/01635581.2014.864420. Epub 2013 Dec 30.

    PubMed 24377653
  • Stahl W, Sies H. beta-Carotene and other carotenoids in protection from sunlight. Am J Clin Nutr. 2012 Nov;96(5):1179S-84S. doi: 10.3945/ajcn.112.034819. Epub 2012 Oct 10.

    PubMed 23053552
  • Di Franco R, Calvanese M, Murino P, Manzo R, Guida C, Di Gennaro D, Anania C, Ravo V. Skin toxicity from external beam radiation therapy in breast cancer patients: protective effects of Resveratrol, Lycopene, Vitamin C and anthocianin (Ixor(R)). Radiat Oncol. 2012 Jan 30;7:12. doi: 10.1186/1748-717X-7-12.

    PubMed 22289566
  • Kasdagly M, Radhakrishnan S, Reddivari L, Veeramachaneni DN, Vanamala J. Colon carcinogenesis: influence of Western diet-induced obesity and targeting stem cells using dietary bioactive compounds. Nutrition. 2014 Nov-Dec;30(11-12):1242-56. doi: 10.1016/j.nut.2014.02.016. Epub 2014 Mar 12.

    PubMed 25280404
  • Li Y, Wicha MS, Schwartz SJ, Sun D. Implications of cancer stem cell theory for cancer chemoprevention by natural dietary compounds. J Nutr Biochem. 2011 Sep;22(9):799-806. doi: 10.1016/j.jnutbio.2010.11.001. Epub 2011 Feb 4.

    PubMed 21295962

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Lycopene in people with Colorectal Cancer Metastatic and Skin Toxicity, run by Ospedale San Carlo Borromeo at 1 site in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 9 Sep 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Skin toxicity reduction (time frame: Skin toxicity will be verified every two weeks assessed up to 12 weeks, from date of randomization until the date of first documented progression). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03167268, which also lists 22 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Sep 2021.

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