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Cutaneous T Cell LymphomaPhase 1/2NCT01676831

Topical Resiquimod for the Treatment of Early Stage Cutaneous T Cell Lymphoma (CTCL)

A Phase 1/2 study testing Topical resiquimod 0.06% and topical resiquimod 0.03% in people with Cutaneous T Cell Lymphoma, run by Abramson Cancer Center at Penn Medicine at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The objective of this study is to explore the safety and the preliminary efficacy of two concentrations (0.06% and 0.03%)gel that is applied to lesions of early stage (IA, IB,IIA) Cutaneous T Cell Lymphoma patients. This study is supported by grant 1R01FD004092-01A1 from the Office of Orphan Products Development, FDA. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Cutaneous T Cell Lymphoma
What is being tested?
Topical resiquimod 0.06% and topical resiquimod 0.03%
Could I receive a placebo?
No, everyone receives an active treatment
How many people
13 participants
Where
1 siteUnited States
Study dates
Feb 2012to 28 Sep 2015
Phase
Phase 1/2
Are there results?
Yes, posted in the registrySummary in the doctors' view

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

  • Males or female ≥18 years of age at the time of study enrollment
  • Have a clinical diagnosis of cutaneous T cell lymphoma CTCL, including documentation of a skin biopsy with histological findings consistent with CTCL (atypical epidermotrophic or folliculocentric T-cells). Unconfirmed diagnosis of CTCL must have a biopsy to confirm at screening
  • Have Stage IA, IB or IIA: T1 or T2 (patches or plaques) with measurable lesions.
  • Previous treatment with at least one standard therapy used to treat Stage IA, IB or IIA CTCL including but not limited to oral corticosteroids, high-potency topical corticosteroids, topical mechlorethamine, topical bexarotene, PUVA, UVB, total body electron beam radiation, biological response or oral methotrexate.
  • Have measurable skin disease with at least 1 to 4 eligible baseline target lesions with a total area >25 cm2 but <100 cm2. Eligible lesions must be below the neck and may not involve the genitalia, intertriginous areas, internally, or to frankly ulcerated or infected skin.
  • Generally healthy other than for CTCL, or with other stable diseases/conditions that are adequately controlled.
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  • Willing and able to provide written informed consent.
  • Willing and able to adhere to the protocol requirements, including but not limited to study drug dosing, study drug visits, medication and treatment restrictions, and laboratory tests.
  • Willing and able to discontinue concomitant medications or treatments for CTCL during the study.
  • If a female of child bearing potential, willing to use adequate contraception (defined as double-method contraception, e.g. oral contraceptive usage by subject and condom by partner). Non-child bearing potential is defined as being at least 2 years post-menopausal or being surgically sterile.
  • Willing to abstain from therapeutic sunbathing, tanning beds, etc. for the duration of the study.

Who cannot join

  • Have a known allergy to resiquimod or any of the excipients in the study drug.
  • Stage IIB or greater CTCL.
  • Require immediate treatment for progressive CTCL.
  • Are unable to discontinue current treatment for CTCL due to risk of progression.
  • Within 8 weeks of treatment initiation (Day 0), have received treatment with:
  • Total body electron beam radiation
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  • Investigational drugs or treatments
  • Within 4 weeks of treatment initiation (Day 0), have received treatment with:
  • Local radiation therapy
  • UVB therapy
  • PUVA
  • Any topical chemotherapy
  • Photopheresis
  • Systemic retinoids, corticosteroids, immune response modifiers including imiquimod, interferon inducers, chemotherapeutic agents, biologic agents including interferon
  • Topical corticosteroids or retinoids
  • Within 2 weeks of treatment initiation (Day 0), have received at or adjacent to the target treatment lesions.
  • Any surgical procedures other than biopsies related to CTCL diagnosis or follow-up
  • Any topical treatment other than bland moisturizers (creams, lotions, emollients, etc).
  • Have other concurrent cutaneous conditions in the treatment area or immediately adjacent to the treatment area that would be exacerbated by resiquimod or interfere with assessments.
  • Have a grade 2 or greater laboratory abnormalities (CTCAE v4) at baseline for any of the following:
  • Hemoglobin
  • White blood cell count
  • Platelet count
  • Alanine transferase
  • Aspartate transferase
  • Creatinine
  • Have a known history of or a positive serologic test for infection with human immunodeficiency virus or human T lymphotrophic virus.
  • Are pregnant or nursing, or intending to become pregnant within the duration of the study.
  • Have any clinically significant medical conditions that are unstable, progressive, or inadequately controlled in the opinion of the investigator, that would pose a potential risk for the subject, result in poor compliance with the study requirements, or require treatment with an excluded medication or treatment during the study.
  • Have an active chemical or alcohol dependency as assessed by the investigator.
  • Have systemic collagen vascular disorder, systemic autoimmune disease, an organ transplant or diagnosis of cancer within 5 years other than CTCL (not including basal cell carcinoma, non-invasive squamous cell cancer of the skin, malignant melanoma in situ, or cervical carcinoma in situ).

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Pennsylvania

    Philadelphia, Pennsylvania, 19104

Other trials in United States

About this study

Official title: A Phase I/IIa, Dose-Ranging Safety and Efficacy Study of Topical Resiquimod for the Treatment of Early Stage Cutaneous T Cell Lymphoma

The objective of this study is to explore the safety and the preliminary efficacy of two concentrations (0.06% and 0.03%)gel that is applied to lesions of early stage (IA, IB,IIA) Cutaneous T Cell Lymphoma patients.

This study is supported by grant 1R01FD004092-01A1 from the Office of Orphan Products Development, FDA.

Read the detailed description

This is an open-label, dose-ranging study in subjects with early stage (IA, IB, 2A) CTCL. Patients with early stage CTCL will be screened for eligibility. Eligible subjects will be enrolled in up to 2 treatment groups of up to 8 subjects each.

Treatment groups will be:

  1. Resiquimod 0.06% will be applied in dosing frequencies that are periodically adjusted according to tolerability. Subjects will begin dosing at 3 times per week (3x/wk), and will be evaluated at the clinic every two weeks. The dosing frequency (1, 2, 3, 5, or 7x/wk) may be adjusted in a stepwise manner after each two week interval based on the physician assessment of tolerability (maintained, increased, decreased with or without a dosing interruption [rest period]). Resiquimod will be applied for 8 weeks (COT1) followed by a 4 week no-treatment period. If the subject has not required permanent discontinuation from treatment, the subject will repeat a second course of treatment of 8 weeks (COT2) followed by a 4 week no-treatment period. Subjects will apply up to 500 mg of study drug per day based upon the total surface area that is treated (~250 mg of product / 50 cm2 of lesion surface area).
  2. Resiquimod 0.03% applied as described for Treatment Group 1. However, initial applications will be 5 times per week with the dosing frequency adjusted upward as tolerated every two weeks.

The initial cohort will be assigned to Treatment Group 1. After 4 subjects have completed at least 4 weeks of dosing, a safety review meeting will be conducted by a committee consisting of the P.I., a biostatistician, and at least one other physician familiar with CTCL responses. The Safety Review Committee (SRC) will determine, based on the review of the tolerability data, the starting concentration/frequency of the next group of 4 subjects.

For a given subject the concentration assignment (0.06% or 0.03%) will remain the same (only frequency may vary). It is planned that approximately 8 subjects will be enrolled in each group.

A treatment regimen will be considered inadequately tolerated if 2 or more subjects within the treatment cohort require protocol mandated permanent discontinuation. Treatment regimens for newly enrolled subjects and/or of current subjects on treatment will be adjusted accordingly per protocol. The Safety Review Committee (SRC) will determine the occurrence of any dose-limiting toxicities (DLTs), defined below in Section 6.4.6. A subsequent phase II study will further explore efficacy of the MTD in an expanded study.

Up to 2 subjects per Treatment Group who discontinue from the study due to reasons unrelated to safety reasons (e.g. personal, lost to follow-up, etc) may be replaced.

The investigator will determine the target CTCL lesions and treatment area. During each COT, subjects will treat at least 1 but no more than 4 target lesions in the 0.06% dosing group and no ,more than 5 target lesions in the 0.03% treatment group with a total combined treatment area that is ≥25 cm2 but ≤100 cm2. Unless a lesion is considered to have completely resolved by clinical assessment at 4 weeks post COT1 (PCOT1), subjects will treat the same baseline target lesions throughout the COT1 and COT2. The amount of drug applied per dose during each COT may vary depending on the total size of the target lesions but may not exceed 500 mg per day.

For COT1, subjects will be evaluated at baseline, Week 2, 4, 6, 8 and 12 (PCOT1). For COT2, subjects will be evaluated at Week 12 (PCOT1/COT2 baseline) 14, 16, 18, 20 and 24 (4 weeks post COT2, PCOT2). The End of study (EOS) will be at PCOT2, or if a subject permanently discontinues study drug prematurely, at 4 weeks after the last dose.

Rest periods from treatment may be instituted by the investigator as needed to manage tolerance, with resumption of treatment upon adequate resolution per investigator discretion.

Subjects in both treatment groups who experience a partial response but not a complete response at week 24 can continue treatment for up to another 12 weeks with the same concentration.

During this time they will be evaluated every 4 weeks up to 12 weeks. At that time they will have a 4 week rest period and then a final evaluation will be performed.

Being tested
Topical resiquimod 0.06%, topical resiquimod 0.03%
Medical subject headings
Lymphoma, T-Cell, Cutaneous

What participants receive

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

  • Topical resiquimod 0.06%Drug

    topical resiquimod 0.06% dosing frequency begins at 3 times per week and evaluated every two weeks. Will be applied for a total of 8 weeks followed by 4 weeks rest and then followed by another 8 weeks of application with another 4 weeks rest.

  • topical resiquimod 0.03%Drug

    topical resiquimod 0.03% applied initially 5 times weekly for 8 weeks with adjustments up or down based upon tolerability followed by 4 weeks rest followed by another 8 weeks of treatment followed by another 4 week rest period.

Study groups in NCT01676831
Study groupRoleWhat they receive
topical resiquimod 0.06%ExperimentalTopical resiquimod 0.06% will be applied in dosing frequencies that are periodically adjusted to tolerability. Dosing frequency will be 3 times a week. The dosing frequency may be adjusted (1,2,3,5,or 7times per week) based on the physician assessment of tolerability. Treatment will occur for 8 weeks followed by 4 weeks rest followed by another 8 weeks of treatment with 4 weeks rest. At 24 weeks a final evaluation will be performed. Those with a partial response at week 24 will have the option to continue therapy for up to another 12 weeks.
Receives: Drug: Topical resiquimod 0.06%
topical resiquimod 0.03%ExperimentalTopical resiquimod 0.03% will be applied in dosing frequencies that are periodically adjusted to tolerability. Dosing frequency will begin 5 times a week. The dosing frequency may be adjusted (1,2,3,5,or 7times per week) based on the physician assessment of tolerability. Treatment will occur for 8 weeks followed by 4 weeks rest followed by another 8 weeks of treatment with 4 weeks rest. At 24 weeks a final evaluation will be performed. Those with a partial response at week 24 will have the option to continue therapy for up to another 12 weeks.
Receives: Drug: topical resiquimod 0.03%

What is being measured

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

  1. The Number of Participants That Tolerated the Maximum Drug Dose

    After four subjects have completed at least four weeks of study drug dosing a safety review meeting will be conducted by a safety review committee. No subjects will be enrolled in the next concentration (0.03%)group until all eight have been evaluated in the 0.06% group.

    The safety review committee reviews all patient data including adverse events to indicate whether the patient can escalate to the highest dose.

    Measured: after 4 subjects have completed 4 weeks of study drug

Secondary outcomes (2)
  1. Secondary End Points: Efficacy- CAILDS SCORE

    The secondary endpoint is:

    • The Response Rate (Complete or Partial Response) based on Composite Assessment of Index Lesions Disease Severity (CAILDS) score at EOS for the baseline target lesions. Complete Response is defined as a score of '0' on the CAILDS scale. Partial response is defined as a reduction of at least 50% in the CAILDS. The outcome measure will indicate how many received complete response (CR), partial response (PR), and stable disease (SD).

    Measured: Up to 24 weeks or At the conclusion of patient therapy

  2. Secondary End Points: Efficacy- SWAT SCORE

    The secondary endpoint is:

    The total surface area of involvement will also be assessed (SWAT score). A partial response will represent improvement in 50% or greater of the skin surface area with regression of lesions. A complete response will represent complete clear clearing of skin lesions and in the case of stage IIA patients, resolution of lymphadenopathy. The outcome measure will indicate how many received complete response (CR), partial response (PR), and stable disease (SD).

    Measured: Up to 24 weeks or At the conclusion of patient therapy

Timeline

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

  1. First posted31 Aug 2012 (estimated)
  2. Study startFeb 2012
  3. Primary completionJan 2015
  4. Study completion28 Sep 2015

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 1/2
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
13 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01676831
Sponsor's protocol ID
813320(UPCC03411)
Other IDs
1R01FD004092-01A1
Status last verified
Jul 2019
First submitted
15 Jul 2012
Last updated
13 Aug 2019
Data monitoring committee
Yes

Publications

  • Rook AH, Gelfand JM, Wysocka M, Troxel AB, Benoit B, Surber C, Elenitsas R, Buchanan MA, Leahy DS, Watanabe R, Kirsch IR, Kim EJ, Clark RA. Topical resiquimod can induce disease regression and enhance T-cell effector functions in cutaneous T-cell lymphoma. Blood. 2015 Sep 17;126(12):1452-61. doi: 10.1182/blood-2015-02-630335. Epub 2015 Jul 30.

    PubMed 26228486

Questions about this trial

What is this clinical trial studying?

A Phase 1/2 study testing Topical resiquimod 0.06% and topical resiquimod 0.03% in people with Cutaneous T Cell Lymphoma, run by Abramson Cancer Center at Penn Medicine at 1 site in United States.

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 11 inclusion and 31 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: finished, as of the sponsor's last update on 13 Aug 2019. 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 United States. 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. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

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?

Yes. Results are posted in the registry (first posted 13 Aug 2019). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

The Number of Participants That Tolerated the Maximum Drug Dose (time frame: after 4 subjects have completed 4 weeks of study drug). 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 NCT01676831, which also lists 1 linked publication.

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 13 Aug 2019.

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