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Oral Mucositis (Ulcerative)Phase 3NCT04896164

Randomized Trial of Curcumin to Reduce Mucositis in Autologous Transplant Setting

A Phase 3 study testing Curcumin Lozenges in people with Oral Mucositis (Ulcerative), run by Tata Memorial Centre at 1 site in India.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Mucositis is a very common complication in bone marrow transplant setting. It is a result of injury to the gut caused by high dose chemotherapy. Currently there are no universal protocols that have been accepted as a standard to prevent and treat mucositis in the transplant setting. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Oral Mucositis (Ulcerative)
What is being tested?
Curcumin Lozenges
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
190 participants
Where
1 siteIndia
Study dates
16 Dec 2018to 16 May 2025
Phase
Phase 3
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

  • Male or female patients 18 years and above.
  • Patients who give written informed consent
  • Patients with performance status - 0,1 or 2 (ECOG scale)
  • Patients receiving any of the following high dose chemotherapy regimens for autologous transplant in any indicated malignant disease.
  • Melphalan- 200 mg/m2 or more (MEL-200 mg/m2)
  • Busulfan and Melphalan (BuMEL)
Show all 9Show fewer
  • Carmustine (BCNU), Etoposide, Cytosine Arabinoside and Melphalan ( BEAM)
  • Patients who have creatinine clearance > 50 ml/min
  • Patients with serum bilirubin levels < 2mg/dl. and serum liver enzymes (ALT or AST or both) lesser than 5 times the upper limit of normal value.

Who cannot join

  • Patients who are on NSAIDs, aspirin, antioxidants or systemic steroids for more than 3 months and the last dose taken within the last one week.
  • Patients being treated for active infection at the time of starting high dose chemotherapy.

Trial locations and contacts

1 site in 1 country.

Navin Khattry, MD, DM contact

022-27405000 ext. 5034

nkhattry@gmail.com

India1 site, 1 recruiting
  • Tata Memorial Centre

    Navi Mumbai, Maharashtra, 410210

    Navin Khattry, MD, DM, 022-24705000 ext. 5034, nkhattry@gmail.com

    Recruiting

Other trials in India

About this study

Official title: Phase III Randomized, Double Blind, Placebo Controlled Study of Curcumin to Reduce Mucositis in Autologous Transplant Setting

Mucositis is a very common complication in bone marrow transplant setting. It is a result of injury to the gut caused by high dose chemotherapy. Currently there are no universal protocols that have been accepted as a standard to prevent and treat mucositis in the transplant setting. Post transplant upto 80% of patients suffer from a severe mucositis. Proinflammatory cytokines play a major role in the development of mucositis. Interventions that decrease the levels of these cytokines may be beneficial in preventing mucositis. This study is aimed at evaluating the role of curcumin in reducing cytokine levels and the incidence and duration of mucositis in patients undergoing autologous stem cell transplantation.

Read the detailed description

Mucositis is an inevitable side-effect of intensive conditioning therapy used for hematopoietic stem cell transplantation and affects the quality of life of patients undergoing transplant. The incidence of oral mucositis (WHO grades 3/4 ) with certain myeloablative conditioning regimens has been reported in up to 90% with range of severe mucositis (WHO grade 3/4) from 10 to 78%. Pro-inflammatory cytokines such as IL-1, IL-6, IL-8, IL-17, TNF-α, TGF-B, IFN-γ and certain prostaglandins play a central role in its pathogenesis. Transcription factors such as NF-kappa B, modify the genetic expression of these cytokines and enzymes which are critical in producing tissue damage.

A number of agents and methods have been investigated to prevent or reduce mucositis in transplant setting. Some of them are amifostine, caphasol, palifermin, cryotherapy, chlorhexidine, glutamine, GM-CSF, histamine, misoprostol, laser therapy and traumeel, but only palifermin and cryotherapy have shown significant benefit.

Curcumin, polyphenol derivative with low toxicity profile, is commonly used in India for its anti-inflammatory actions. Curcumin inhibits various inflammatory cytokines through inhibition of Nuclear Factor Kappa- β. It is derived from the plant Curcuma longa. In vitro studies have shown potent anti-inflammatory activity at concentrations of 1 umol/L.

The investigators conducted the first study evaluating the role of curcumin on oral mucositis in transplant setting. In this pilot study (n=40), patients who received curcumin lozenges (n=30) had decreased levels of salivary TGF-β, IL-17 and serum PGE2 compared to patients who did not receive the curcumin lozenges (n=10). Patients who received the curcumin lozenges had higher levels of serum IL-8 which is a prohealing cytokine. The incidence of grade 3 and 4 oral mucositis and diarrhea was less in those who received curcumin lozenges. Curcumin lozenges were also well tolerated and none of the 30 patients who were administered curcumin developed any treatment related grade 3/4 toxicity. This encouraging data is the basis of the current phase III randomized study comparing curcumin lozenges to placebo, to assess the ability of curcumin to reduce the incidence and duration of oral mucositis in patients undergoing autologous bone marrow transplantation.

The formulation being used is a Solip Lipid Curcumin microParticle (SLCP). The formulation is developed by Pharmanza Herbals Pvt. Ltd., Gujarat, India. Gota et al reported a phase I clinical trial of SLCP where upto 4 grams of the formulation containing 20-30% curcumin was evaluated for safety and pharmacokinetics in patients with high-risk osteosarcoma (Ref). The SLCP formulation showed oral bioavailability of curcumin with linear pharmacokinetics. Average peak plasma concentration of 41 ng/mL was observed at the highest dose level of 4g. All doses were well tolerated and no adverse events were observed. Based on these observations (on safety and bioavailability), and the reported anti-inflammatory properties of curcumin, it was envisaged that it could be potentially useful for the prophylaxis and treatment of oral mucositis following high-dose chemotherapy.

Being tested
Curcumin Lozenges, Placebo Lozenges
Keywords
Curcumin, Mucositis, Autologous stem cell transplant
Medical subject headings
Stomatitis, Ulcer, Mucositis

What participants receive

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

  • Curcumin LozengesDrug

    Also called Longvida (Pharmanza Herbal Pvt Ltd.)

    Curcumin lozenges (each containing 100 mg of curcumin) will be given at a dose of 4 lozenges (total dose 400 mg curcumin) BD. Formulation is Solid Lipid Curcumin Particle (SLCP). Oral curcumin lozenges will be given from two days prior to receiving high dose chemotherapy till day+28 of transplant.

  • Placebo LozengesOther

    Placebo lozenges will be given from two days prior to receiving high dose chemotherapy till day+28 of transplant.

Study groups in NCT04896164
Study groupRoleWhat they receive
Investigational armExperimentalPatients in the investigational arm will receive curcumin lozenges (4 gm BD containing 400 mg curcumin BD) as prophylaxis from two days prior to receiving high dose chemotherapy .
Receives: Drug: Curcumin Lozenges
Control armPlacebo comparatorpatients in the control arm will receive matching placebo lozenges from two days prior to receiving high dose chemotherapy
Receives: Other: Placebo Lozenges

What is being measured

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

  1. Incidence of grade 3 and 4 oral mucositis

    In both groups, patients will be evaluated clinically for oral mucositis. The incidence of grade III/IV oral mucositis will be recorded as per WHO grading criteria.

    Measured: Day+28

Secondary outcomes (28)
  1. Incidence of any grade of oral mucositis.

    In both groups, patients will be evaluated clinically for oral mucositis and grade will be recorded as per WHO grading criteria.

    Measured: Day+28

  2. Duration of grade 3 and 4 oral mucositis in both groups

    In both groups, duration of oral mucositis will be recorded.

    Measured: Day+28

  3. Incidence of use of Total Parenteral Nutrition

    Incidence of use of Total Parenteral Nutrition in both groups.

    Measured: Day+28

  4. Duration of use of Total Parenteral Nutrition

    The duration of use of total parenteral nutrition will be recorded in both groups.

    Measured: Day+28

  5. Serum TNF alpha AUC (0-14)

    This will be calculated using serum TNF alpha levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  6. Salivary TNF alpha AUC (0-14)

    This will be calculated using Salivary TNF alpha levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  7. Serum Interleukin 1 AUC (0-14)

    This will be calculated using Serum Interleukin 1 levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  8. Salivary Interleukin 1 AUC (0-14)

    This will be calculated using Salivary Interleukin 1 levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  9. Serum Interleukin 6 AUC (0-14)

    This will be calculated using Serum Interleukin 6 levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  10. Salivary Interleukin 6 AUC (0-14)

    This will be calculated using Salivary Interleukin 6 levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  11. Serum Interleukin 8 AUC (0-14)

    This will be calculated using Serum Interleukin 8 levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  12. Salivary Interleukin 8 AUC (0-14)

    This will be calculated using Salivary Interleukin 8 levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  13. Serum Interleukin 17 AUC (0-14)

    This will be calculated using Serum Interleukin 17 levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  14. Salivary Interleukin 17 AUC (0-14)

    This will be calculated using Salivary Interleukin 17 levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  15. Serum TGF-beta AUC (0-14)

    This will be calculated using Serum TGF-beta levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  16. Salivary TGF-beta AUC (0-14)

    This will be calculated using Salivary TGF-beta levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  17. Serum Interferon gamma AUC (0-14)

    This will be calculated using Serum Interferon gamma levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  18. Salivary Interferon gamma AUC (0-14)

    This will be calculated using Salivary Interferon gamma levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  19. Serum Prostaglandin E2 AUC (0-14)

    This will be calculated using Serum Prostaglandin E2 levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  20. Salivary Prostaglandin E2 AUC (0-14)

    This will be calculated using Salivary Prostaglandin E2 levels measured at baseline, day 0, then Monday, Wednesday and Friday till day +14. Using these values, AUC (0-14) will be calculated using linear trapezoidal model.

    Measured: Day+14

  21. Plasma curcumin AUC (0-12 hr)

    This will be done using plasma curcumin levels measured within 1 hr of dosing, 0.5-3 hr, 4-6 hr, and 8 - 12 hr post dose on day 7 of starting curcumin or placebo.

    Measured: Up to 12 hours from 1st dose

  22. Plasma Bis-demethoxycurcumin AUC (0-12 hr)

    This will be done using plasma Bis-demethoxycurcumin levels measured within 1 hr of dosing, 0.5-3 hr, 4-6 hr, and 8 - 12 hr post dose on day 7 of starting curcumin or placebo.

    Measured: Up to 12 hours from 1st dose

  23. Plasma demethoxycurcumin AUC (0-12 hr)

    This will be done using plasma demethoxycurcumin levels measured within 1 hr of dosing, 0.5-3 hr, 4-6 hr, and 8 - 12 hr post dose on day 7 of starting curcumin or placebo.

    Measured: Up to 12 hours from 1st dose

  24. Duration of use of analgesics for pain due to oral mucositis

    Duration of use of analgesics for pain due to oral mucositis in both groups will be recorded.The severity of pain will be measured using the visual analog pain scale.

    Measured: Day+28

  25. Incidence of grade 3 and 4 nausea

    In both groups, grade of nausea will be recorded as per CTCAE v 4.0 grading criteria.

    Measured: Day+28

  26. Incidence of grade 3 and 4 vomiting

    In both groups, grade of vomiting will be recorded as per CTCAE v 4.0 grading criteria.

    Measured: Day+28

  27. Incidence of grade 3 and 4 diarrhea

    In both groups, grade of diarrhea will be recorded as per CTCAE v 4.0 grading criteria.

    Measured: Day+28

  28. Duration of hospital stay

    The duration of hospital stay will be recorded in both groups.

    Measured: From date of hospital admission until date of hospital discharge assessed up to day +28

Timeline

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

  1. First posted21 May 2021
  2. Study start16 Dec 2018
  3. Primary completion16 May 2025 (estimated)
  4. Study completion16 May 2025 (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 3
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Model description
Patients receiving high dose chemotherapy with any of the conditioning regimens specified in the inclusion criteria will be randomized in two arms. Central telephonic randomization will be carried out with the help of a computer generated random sequence using permuted blocks.
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
190 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04896164
Sponsor's protocol ID
900503
Other IDs
CTRI/2018/09/015846
Status last verified
Nov 2023
First submitted
15 May 2021
Last updated
24 Nov 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Curcumin Lozenges in people with Oral Mucositis (Ulcerative), run by Tata Memorial Centre at 1 site in India.

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 9 inclusion and 2 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 24 Nov 2023. 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 India. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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?

Contact Navin Khattry, MD, DM (022-27405000 ext. 5034, nkhattry@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of grade 3 and 4 oral mucositis (time frame: Day+28). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 24 Nov 2023.

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