Locally Advanced Rectal AdenocarcinomaPhase 1NCT06834126
Papaverine in Combination With Radiation Therapy for the Treatment of Locally Advanced Rectal Cancer, DINOMITE Trial
A Phase 1 study testing Biospecimen Collection, Computed Tomography and Consolidation Therapy in people with Locally Advanced Rectal Adenocarcinoma and Stage II Rectal Cancer AJCC v8, run by City of Hope Medical Center at 1 site in United States.
Trial summary
This phase I trial studies the side effects and best dose of papaverine (PPV) when given together with radiation therapy (RT) and tests how well it works in treating patients with rectal cancer that has spread to nearby tissue or lymph nodes (locally advanced). Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Locally Advanced Rectal Adenocarcinoma, Stage II Rectal Cancer AJCC v8, Stage III Rectal Cancer AJCC v8
- What is being tested?
- Biospecimen Collection, Computed Tomography and Consolidation Therapy
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 36 participants
- Where
- 1 siteUnited States
- Study dates
- 7 Apr 2025to 19 Sep 2028
- Phase
- Phase 1
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
- Documented informed consent of the participant and/or legally authorized representative
- Willingness to participate in all correlative studies: fMRI, and tissue collection of tumor and normal rectum (ribonucleic acid [RNA]/deoxyribonucleic acid [DNA]/protein), blood (plasma/peripheral blood mononuclear cell [PBMC]) draws and stool collection
- Age: ≥ 18 years
- Eastern Cooperative Oncology Group (ECOG) ≤ 2
- Histologically confirmed rectal adenocarcinoma
- Patient wants to pursue an organ preservation/non-operative management (NOM) approach after completion of total neoadjuvant therapy (TNT)
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- Locally advanced rectal cancer (T3-4 or node+, M0)
- Tumor is microsatellite stable (MSS) (defined as not microsatellite instability-high [MSI-H] or mismatch repair deficient [dMMR])
- Absolute neutrophil count (ANC) ≥ 1,500/mm^3 (within 30 days of start). NOTE: Growth factor is not permitted within 14 days of ANC assessment unless cytopenia is secondary to disease involvement
- Platelets ≥ 100,000/mm^3 (within 30 days of start). NOTE: Platelet transfusions are not permitted within 14 days of platelet assessment unless cytopenia is secondary to disease involvement
- Hemoglobin ≥ 9g/dL (within 30 days of start). NOTE: Red blood cell transfusions are not permitted within 14 days of hemoglobin assessment unless cytopenia is secondary to disease involvement
- Total bilirubin ≤ 1.5 X upper limit of normal (ULN) (within 30 days of start)
- Aspartate aminotransferase (AST) =< 2.5 x ULN (within 30 days of start)
- Alanine aminotransferase (ALT) =< 2.5 x ULN (within 30 days of start)
- Creatinine clearance of ≥ 50 mL/min per 24 hour urine test or the Cockcroft-Gault formula (within 30 days of start)
- For patients with known infections only: seropositive for HIV, hepatitis C virus (HCV) or hepatitis B virus (HBV), nucleic acid quantitation must be performed. Viral load must be undetectable. HIV-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial (within 28 days of start)
- Women of childbearing potential (WOCBP): negative urine or serum pregnancy test. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required (within 30 days of start)
- Agreement by females and males of childbearing potential to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 4 months after the last dose of protocol therapy
- Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for > 1 year (women only)
Who cannot join
- Chemotherapy, biological therapy, immunotherapy within 14 days or five half-lives (whichever is shorter) prior to day 1 of protocol therapy
- Prior pelvic irradiation resulting in overlapping fields
- Use of levodopa in the last 30 days
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to study agent
- Unable to undergo MRI and endoscopic procedures
- History of complete atrioventricular block, hepatic dysfunction (e.g. cirrhosis), or priapism
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- Other active malignancy. Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
- Females only: Pregnant or breastfeeding
- Any other condition that would, in the investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures
- Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
United States1 site, 1 recruiting
- Recruiting
City of Hope Medical Center
Duarte, California, 91010
Terence M. Williams, 626-218-2332, terwilliams@coh.org
Terence M. Williams
About this study
Official title: DINOMITE (Decreasing Hypoxia With Mitochondrial Inhibition in Locally Advanced Rectal Cancer): Phase 1 Trial of Papaverine in Combination With Radiation
This phase I trial studies the side effects and best dose of papaverine (PPV) when given together with radiation therapy (RT) and tests how well it works in treating patients with rectal cancer that has spread to nearby tissue or lymph nodes (locally advanced). PPV is an enzyme inhibitor, and it may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. RT uses high energy x-rays, particles, or radioactive seeds to kill tumor cells and shrink tumors. Giving PPV with RT may be safe, tolerable, and/or effective in treating patients with locally advanced rectal cancer.
Read the detailed description
PRIMARY OBJECTIVES:
- Determine the maximum tolerated dose (MTD) and the recommended phase II dose (RP2D) of papaverine (PPV) in combination with radiation therapy (RT) for locally advanced rectal cancer (LARC).
II. Describe the safety and tolerability of PPV in combination with standard of care (SOC) RT for LARC.
SECONDARY OBJECTIVES:
- Determine the clinical complete response rate (cCR), and local-regional control rate of PPV in combination with RT for LARC.
II. Determine the total mesorectal excision (ToME)-free survival, local-regional recurrence free survival (LRRFS), disease-free survival (DFS), distant-metastasis-free survival (DMFS) and overall survival (OS) of PPV in combination with RT for LARC.
EXPLORATORY OBJECTIVES:
- Determine whether PPV in combination with RT for LARC directly results in reduced tumor hypoxia.
II. Explore whether RT with and without mitochondrial oxygen consumption (MOC) inhibition alters the tumor immune microenvironment (TIME) in patients receiving SOC RT for LARC.
III. Explore whether molecular profiling (changes in hypoxia-induced gene expression, immune cell tumor infiltrates and peripheral immune profiling) can predict which patients may respond best to PPV in combination with SOC RT for LARC.
IV. Explore whether stool microbial signatures are associated with response to or progression after PPV in combination with SOC RT for LARC.
OUTLINE: This is a dose escalation study of PPV in combination with RT followed by a dose-expansion study. Patients are randomized to 1 of 2 cohorts.
COHORT 1: Patients undergo RT once daily (QD) on days 1-5 (Monday-Friday) of week 1. Starting at week 5, patients receive SOC consolidation chemotherapy (CC) with either modified leucovorin, fluorouracil, oxaliplatin-6 (mFOLFOX6) or capecitabine-oxaliplatin (CAPOX) for 3-4 months in the absence of disease progression or unacceptable toxicity. As early as four weeks following completion of CC, patients with persistent disease (non-cCR) or disease recurrence in the rectum during disease evaluation may undergo ToME. Additionally, patients undergo one functional magnetic resonance imaging (fMRI) on study as well as computed tomography (CT), magnetic resonance imaging (MRI), endoscopy, and blood and tissue sample collection throughout the trial.
COHORT 2: Patients receive PPV intravenously (IV) over 15-30 minutes on day -3 of week 0 and days 1-5 of week 1. Patients also undergo RT QD on days 1-5 (Monday-Friday) of week 1, 1-2 hours after PPV. Starting at week 5, patients receive SOC CC with either mFOLFOX6 or CAPOX for 3-4 months in the absence of disease progression or unacceptable toxicity. As early as four weeks following completion of CC, patients with persistent disease (non-cCR) or disease recurrence in the rectum during disease evaluation may undergo ToME. Additionally, patients undergo two fMRI on study as well as CT, MRI, endoscopy, and blood and tissue sample collection throughout the trial.
After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for an additional 3 years.
- Conditions
- Locally Advanced Rectal Adenocarcinoma, Stage II Rectal Cancer AJCC v8, Stage III Rectal Cancer AJCC v8
- Being tested
- Biospecimen Collection, Computed Tomography, Consolidation Therapy, Functional Magnetic Resonance Imaging, Gastrointestinal Endoscopy
- Medical subject headings
- Rectal Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Biospecimen CollectionProcedure or surgery
Also called Biological Sample Collection, Biospecimen Collected, Specimen Collection
Undergo blood and tissue sample collection
Computed TomographyProcedure or surgery
Also called CAT, CAT Scan, Computed Axial Tomography, Computerized Axial Tomography
Undergo CT
Consolidation TherapyDrug
Also called Consolidation, intensification therapy, Post Remission Therapy, Postremission Therapy
Receive CC with mFOLFOX6 or CAPOX
Functional Magnetic Resonance ImagingProcedure or surgery
Also called fMRI, Functional MRI
Undergo fMRI
Gastrointestinal EndoscopyProcedure or surgery
Also called Enteroscopy
Undergo endoscopy
Magnetic Resonance ImagingProcedure or surgery
Also called Magnetic Resonance, Magnetic Resonance Imaging (MRI), Magnetic resonance imaging (procedure), Magnetic Resonance Imaging Scan
Undergo MRI
PapaverineDrug
Also called Cerebid, Cerespan, Pavabid, Pavacap
Given IV
Radiation TherapyRadiation
Also called Cancer Radiotherapy, Energy Type, ENERGY_TYPE, Irradiate
Undergo RT
Total Mesorectal ExcisionProcedure or surgery
Also called TME
Undergo ToME
| Study group | Role | What they receive |
|---|---|---|
| Cohort 1 (RT, CC) | Active comparator | Patients undergo RT QD on days 1-5 (Monday-Friday) of week 1. Starting at week 5, patients receive SOC CC with either mFOLFOX6 or CAPOX for 3-4 months in the absence of disease progression or unacceptable toxicity. As early as four weeks following completion of CC, patients with persistent disease (non-cCR) or disease recurrence in the rectum during disease evaluation may undergo ToME. Additionally, patients undergo one fMRI on study as well as CT, MRI, endoscopy, and blood and tissue sample collection throughout the trial. Receives: Procedure: Biospecimen Collection; Procedure: Computed Tomography; Drug: Consolidation Therapy; Procedure: Functional Magnetic Resonance Imaging; Procedure: Gastrointestinal Endoscopy; Procedure: Magnetic Resonance Imaging; Radiation: Radiation Therapy; Procedure: Total Mesorectal Excision |
| Cohort 2 (PPV, RT, CC) | Experimental | Patients receive PPV IV over 15-30 minutes on day -3 of week 0 and days 1-5 of week 1. Patients also undergo RT QD on days 1-5 (Monday-Friday) of week 1, 1-2 hours after PPV. Starting at week 5, patients receive SOC CC with either mFOLFOX6 or CAPOX for 3-4 months in the absence of disease progression or unacceptable toxicity. As early as four weeks following completion of CC, patients with persistent disease (non-cCR) or disease recurrence in the rectum during disease evaluation may undergo ToME. Additionally, patients undergo two fMRI on study as well as CT, MRI, endoscopy, and blood and tissue sample collection throughout the trial. Receives: Procedure: Biospecimen Collection; Procedure: Computed Tomography; Drug: Consolidation Therapy; Procedure: Functional Magnetic Resonance Imaging; Procedure: Gastrointestinal Endoscopy; Procedure: Magnetic Resonance Imaging; Drug: Papaverine; Radiation: Radiation Therapy; Procedure: Total Mesorectal Excision |
What is being measured
The primary outcome is the main question the study is designed to answer.
Acute dose limiting toxicity (DLT)
As assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version (v) 5.0. A defined adverse event considered to be possibly, probably, or definitely related to study treatment (radiation therapy or PPV). Will employ the time-to-event Bayesian optimal interval design (TITE-BOIN) to find the maximum tolerated dose (MTD).
Measured: From time of single-agent papaverine (PPV) week 0 treatment to start of consolidation chemotherapy (CC), assessed up to 4 weeks
Late DLT
As assessed by NCI CTCAE v5.0. A defined adverse event considered to be possibly, probably, or definitely related to study treatment (radiation therapy or PPV). Will employ the TITE-BOIN design to find the MTD.
Measured: From the start of CC week 5 treatment to 12 months from week 0
Incidence of treatment related adverse events during acute DLT period
As assessed by NCI CTCAE v5.0. Will be delineated by grade and attribution. A defined adverse event considered to be possibly, probably, or definitely related to study treatment (radiation therapy or PPV).
Measured: From time of single-agent PPV week 0 treatment to start of CC, assessed up to 4 weeks
Incidence of treatment related adverse events during late DLT period
As assessed by NCI CTCAE v5.0. Will be delineated by grade and attribution. A defined adverse event considered to be possibly, probably, or definitely related to study treatment (radiation therapy or PPV).
Measured: From the start of CC week 5 treatment to 12 months from week 0
Secondary outcomes (7)
Clinical complete response rate
Will be defined as percent of evaluable patients having no evidence of disease as assessed by magnetic resonance imaging/endoscopy. Will be summarized by cohort and dose level.
Measured: From time of single agent papaverine (PPV) week 0 treatment to completion of consolidation chemotherapy (CC), assessed up to 20 weeks.
Local-regional control rate
Will be defined as percent of evaluable patients having no evidence of pelvic recurrence in the areas of the primary tumor and regional lymph nodes.
Measured: From time of single agent papaverine (PPV) week 0 treatment to completion of consolidation chemotherapy (CC), assessed up to 20 weeks.
Local-regional recurrence free survival
Measured: From enrollment to date of first local regional recurrence, death as a result of any cause or being censored at last contact, assessed up to 5 years
Total mesorectal excision free survival
Measured: From enrollment to date of total mesorectal surgical excision, death as result of any cause or being censored at last contact, assessed up to 5 years
Disease-free survival
Measured: From enrollment to date of first disease recurrence, death as a result of any cause or being censored at last contact, assessed up to 5 years
Distant-metastasis-free survival
Measured: From enrollment to date of first distant metastases occurrence, death as a result of any cause or being censored at last contact, assessed up to 5 years
Overall survival
Measured: From enrollment to date of death as a result of any cause or being censored at last contact, assessed up to 5 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Feb 2025
- Study start7 Apr 2025
- Primary completion19 Sep 2028 (estimated)
- Study completion19 Sep 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Locally Advanced Rectal AdenocarcinomaStudies of the same condition, open and under way.
- More trials run by City of Hope Medical CenterThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 36 participants (estimated)
Sponsor and investigators
- Lead sponsor
- City of Hope Medical Center
- Sponsor type
- University, hospital or other
- Collaborators
- National Cancer Institute (NCI)
- Responsible party
- Sponsor
- Investigators
- Terence M Williams, Principal investigator, City of Hope Medical Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06834126
- Sponsor's protocol ID
- 24405
- Other IDs
- NCI-2024-10075, 24405, P30CA033572, R01CA297752
- Status last verified
- Jul 2026
- First submitted
- 27 Dec 2024
- Last updated
- 22 Jul 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No