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A Phase 1 Study of 1-Methyl-D-tryptophan in Patients With Advanced Malignancies
This study is currently recruiting participants.
Verified by H. Lee Moffitt Cancer Center and Research Institute, August 2009
First Received: February 5, 2008   Last Updated: August 3, 2009   History of Changes
Sponsors and Collaborators: H. Lee Moffitt Cancer Center and Research Institute
National Cancer Institute (NCI)
Information provided by: H. Lee Moffitt Cancer Center and Research Institute
ClinicalTrials.gov Identifier: NCT00617422
  Purpose

The purpose of this study is to:

  • see if 1-Methyl-D-tryptophan is safe
  • collect information on how the patient's body responds to this study drug
  • find the highest dose of the drug that can be given safely without serious side effects
  • Cancer is typically treated with surgery, chemotherapy drugs, and/or radiation. These treatments while effective sometimes fail to completely cure patients of their cancer and pose a significant burden on them.

Another strategy being investigated involves using the body's own disease fighting immune system to attack cancer cells and kill them. It is hoped that this will allow the body to rid itself of cancer more effectively with less severe treatment related side effects. Many cancers have developed ways to avoid being targeted by your immune system. The drug 1-methyl-D-tryptophan (shortened to 1-MT) is being studied for the first time in humans as a way to stop the ability of these cancers to avoid being targeted by your immune system. Experiments with cancer cells and animals with tumors suggest that this drug is well tolerated and is able to boost the ability of the immune system to kill cancer cells. This study will figure out how safe the drug is in humans and what dose should be given in later trials that see how effective the drug is in achieving its goal.


Condition Intervention Phase
Advanced Malignancies
Drug: 1-Methyl-D-tryptophan
Phase I

Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Single Group Assignment, Safety/Efficacy Study
Official Title: A Phase 1 Study of 1-Methyl-D-tryptophan in Patients With Advanced Malignancies

Resource links provided by NLM:


Further study details as provided by H. Lee Moffitt Cancer Center and Research Institute:

Primary Outcome Measures:
  • Assess the toxicity, safety, pharmacokinetics of escalating doses of 1-methyl-D-tryptophan in subjects with advanced malignancies; establish maximally tolerated dose or maximally biological effective dose of 1-MT for future trials. [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Analyze the IDO expression of different tumor types through IDO IHC staining of paraffin preserved specimens, and perform HPLC on patient urine samples to assess how 1-MT is cleared renally. [ Time Frame: 24 months ] [ Designated as safety issue: Yes ]

Estimated Enrollment: 24
Study Start Date: October 2007
Estimated Study Completion Date: March 2010
Estimated Primary Completion Date: March 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
A: Experimental
Phase I Dose Escalation
Drug: 1-Methyl-D-tryptophan
  • Level 1 = 200 mg
  • Level 2 = 400 mg
  • Level 3 = 800 mg
  • Level 4 = 1600 mg
  • Level 5 = 3200 mg

Detailed Description:

Treatment will be administered on an outpatient basis. The medication will be orally administered once daily an hour prior to breakfast with water. Each treatment cycle is comprised of 28 days. The treatment is continuous with no breaks in between cycles. Patients will be monitored during administration of their first dose by clinical research nursing staff while pharmacokinetics tests are performed over the initial 12 hours. This includes documenting vital signs and clinical status in hourly intervals for the first 4 hours after administration then every 4 hours thereafter if the patient is stable. Any acute change in patient status will be evaluated and treated by the research medical staff. In order to collect reliable single dose pharmacokinetic data, patients will take their first dose of 1-MT and not take another dose until day 3 of the first cycle. All doses will be recorded by the patient using the pill diary form and confirmed using pill counts by the research staff at each biweekly visit. The pill diary forms will be turned into the research staff at the end of each treatment cycle. Patients who demonstrate radiologically confirmed progressive disease will be removed from the study. Those with stable disease will be treated for 4 cycles. Those with partial or complete responses will continue on the study medication (also dependent on study drug availability) for up to 2 more cycles. No investigational or commercial agents or therapies other than those described may be administered with the intent to treat the patient's malignancy. The evaluations and tests will be performed on the schedule outlined in the schema and study calendar sections. An autoimmunity symptom checklist will be completed at each visit by the evaluating medical staff.

There will be two planned interim analysis points with a temporary pause in new patient accrual until the analysis is complete. An analysis of the available PK data and toxicities will be performed upon completion of the 800 mg dose level. This will provide investigators an opportunity to use early PK data to anticipate future study drug needs, alter the dose of 1-MT capsules as necessary, change the dosing schedule, or the dose escalation of 1-MT based on observed serum drug levels for later cohorts. A second analysis after completion of the 1600 mg dose level will analyze oral tolerance of the drug using once daily dosing prior to escalation to higher dose levels. If there is significant oral intolerance due to the quantity of pills ingested, the protocol may be amended to allow twice daily dosing for later dose level cohorts. Also at both analysis points the PK data will be analyzed to see if saturation has been achieved. If saturation has clearly been reached, accrual to the next higher dose level will be suspended until the sponsor and the FDA can assess the need to expand the current dose cohort or modify the dose escalation scheme.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Confirmed solid malignancy; metastatic or unresectable; for which standard effective anti-neoplastic therapy does not exist or is no longer effective
  • Eligibility is regardless of types of previous therapies administered. Should have recovered from acute toxicities associated with most recent regimen and have been off treatment with investigational agents for 4 weeks (6 weeks min. for nitrosoureas or mitomycin C).
  • ECOG performance status < 2
  • Life expectancy > 4 months.
  • Normal organ and marrow function: 1eukocytes >3,000/mcL; absolute neutrophil count >1,500/mcL; platelets >100,000/mcL; total bilirubin <1.5 X institutional ULN; AST(SGOT)/ALT(SGPT) <2.5 X institutional ULN; creatinine within normal institutional ULN; OR, creatinine clearance >60 mL/min/1.73 m2 for patients with creatinine levels above ULN.
  • Patients with known brain metastases will only be eligible after tumors have been treated with definitive resection and/or radiotherapy and they are neurologically stable for at least 1 month off steroids.
  • No history of gastrointestinal disease causing malabsorption or obstruction.
  • Women of child-bearing potential must agree to use two forms of acceptable contraception prior to study entry, for duration of participation, and for a minimum of 1 month after completion of the study. Women who know or suspect that they have become pregnant during the study, should discontinue the study drug and inform treating physician immediately. Pregnancy test is required prior to study enrollment and monthly while on treatment with 1-MT. Men should be discouraged from fathering children while on treatment.
  • Signed written consent document.

Exclusion Criteria:

  • Chemotherapy or radiotherapy treatment within 2 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier.
  • May not be receiving any other investigational agents.
  • Known untreated brain metastases, because of their poor prognosis and they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events. Patients with previously treated lesions as specified in protocol will not be excluded.
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to

    1-Methyl-D-tryptophan.

  • 1-MT is not metabolized through the p450 cytochrome, so there are no specific exclusions for such medications that are metabolized through this pathway. No supplements containing L-tryptophan or derivatives thereof are allowed to be taken while on study. Antacid compounds should be timed a minimum of 2 hours before or after ingestion of 1-MT.
  • Active autoimmune disease, chronic inflammatory condition, conditions requiring concurrent use of any systemic immunosuppressants or steroids. Patients with an allo-transplant of any kind. Mild-intermittent asthma requiring only occasional beta-agonist inhaler use or mild localized eczema will not be excluded.
  • Uncontrolled concurrent illness or social situations that would limit compliance with study requirements as judged by primary investigator. Those with well controlled, chronic medical conditions under the supervision of patient's primary physician (hypertension, hyperlipidemia, coronary heart disease, diabetes mellitus...) would not be excluded.
  • Women pregnant or breastfeeding.
  • HIV-positive patients and those with other acquired/inherited immunodeficiencies are ineligible.
  • Having more than 1 active malignancy at time of enrollment.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00617422

Contacts
Contact: Scott Antonia, M.D., PhD. 813-745-3883 scott.antonia@moffitt.org
Contact: Leticia Tetteh, R.N. 813-745-4617 leticia.tetteh@moffitt.org

Locations
United States, Florida
H. Lee Moffitt Cancer Center and Research Institute Recruiting
Tampa, Florida, United States, 33612
Contact: Scott Antonia, M.D., PhD.     813-745-3883     scott.antonia@moffitt.org    
Contact: Anne Dellaportas, R.N.     813-745-4616     anne.dellaportas@moffitt.org    
Principal Investigator: Scott Antonia, M.D., PhD.            
Sub-Investigator: Alberto Chiappori, M.D.            
Sub-Investigator: Richard Lush, PhD.            
Sub-Investigator: Susan Minton, D.O.            
Sub-Investigator: Hatem Soliman, M.D.            
Sub-Investigator: Daniel Sullivan, M.D.            
Sub-Investigator: Gregory Springett, M.D., Ph.D.            
United States, Virginia
VCU Massey Cancer Center Recruiting
Richmond, Virginia, United States, 23298
Contact: Christine Birdsell, R.N.     804-828-0422     cbirdsell@vcu.edu    
Sub-Investigator: John Roberts, M.D.            
Sponsors and Collaborators
H. Lee Moffitt Cancer Center and Research Institute
Investigators
Principal Investigator: Scott Antonia, M.D., PhD. H. Lee Moffitt Cancer Center and Research Institute
  More Information

Additional Information:
No publications provided

Responsible Party: H. Lee Moffitt Cancer Center and Research Institute ( Scott Antonia, M.D., PhD. )
Study ID Numbers: MCC-15267, USFIRB#103007c, NCI-8045
Study First Received: February 5, 2008
Last Updated: August 3, 2009
ClinicalTrials.gov Identifier: NCT00617422     History of Changes
Health Authority: United States: Institutional Review Board

Keywords provided by H. Lee Moffitt Cancer Center and Research Institute:
IDO expression
active solid tumor
immune system
Immunomodulatory

Study placed in the following topic categories:
Tryptophan
Psychotropic Drugs
Antidepressive Agents, Second-Generation
Antidepressive Agents

Additional relevant MeSH terms:
Tryptophan
Neoplasms
Therapeutic Uses
Psychotropic Drugs
Antidepressive Agents, Second-Generation
Central Nervous System Agents
Pharmacologic Actions
Antidepressive Agents

ClinicalTrials.gov processed this record on September 10, 2009