Study of Psilocybin Assisted Psychotherapy to Address Fear of Recurrence

University of Colorado Denver (CU Denver)

Status and phase

Enrolling

Phase 1

Conditions

Breast Cancer

Ovarian Cancer

Treatments

Drug: Psilocybin

Study type

Interventional

Funder types

Other

Identifiers

NCT06430541

23-1455.cc

Details and patient eligibility

About

The goal of this clinical trial is to test whether psilocybin along with therapy in women with early breast cancer and ovarian cancer in remission can improve their fear of recurrence. The main question[s] it aims to answer [is/are]:

Does psilocybin assisted therapy improve fear of cancer recurrence? Does psilocybin assisted therapy improve anxiety, depression, and quality of life?

Participants will complete a series of survey measures, participate in preparatory therapy. After prep therapy is complete, they will receive a moderately high dose of psilocybin in a monitored and supportive environment. After the dosing day, they will complete 4 sessions of integrative therapy and complete survey measures.

Enrollment

20 estimated patients

Sex

Female

Ages

21+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

1, Aged ≥ 21 2. Diagnosis of:

early-stage breast cancer at low risk of recurrence
- defined as clinical stage 1 or 2
- completed primary treatment (surgery, chemotherapy [adjuvant, patients may continue to be treated with neoadjuvant], and/or radiation) > 6 months ago
- oncologist reported risk of recurrence at 10 years < 20%
late-stage ovarian cancer at high risk of recurrence
- defined as Clinical stage 3 or 4
- currently in remission
- oncologist reported risk of recurrence at 10 years > 80% 2. Functional Status defined as:
Eastern Cooperative Oncology Group (ECOG) ≤1
Palliative Performance Scale (PPS) ≥60%
Ability to tolerate PO medication administration 4. Fear of recurrence at screening and baseline 5. Have an identified support person
Agree to be accompanied home (or to an otherwise safe destination) by the support person, or another responsible party, following dosing 6. Participants of childbearing potential must agree to practice an effective means of birth control throughout the duration of the study.

Exclusion criteria

Unstable medical conditions or serious abnormalities of complete blood count, chemistries, or EKG that in the opinion of the study physician would preclude safe participation in the trial. Some examples include:
- Congestive heart failure
- Valvular heart disease
- Clinically significant arrhythmias (e.g., ventricular fibrillation, torsades) or clinically significant EKG abnormality (i.e., QTC interval > 450)
- Recent acute myocardial infarction or evidence of ischemia
- Malignant hypertension
- Congenital long QT syndrome
- Acute renal failure
- Severe hepatic impairment
- Respiratory failure
- eGFR < 50 mL/min/1.73m2
- LFTs > 1.5 x ULN
- WBC < 5 x 10*9/L
- Hemoglobin < 8.0 g/dL
- Platelets < 150 x 10*9/L
Risk for hypertensive crisis defined as:

Screening, Baseline, Medication session (predose) blood pressure >140/90 mmHg
Significant central nervous system (CNS) pathology

Examples include:
- Primary or secondary cerebral neoplasm
- Epilepsy
- History of stroke
- Cerebral aneurysm
- Dementia
- Delirium
Primary psychotic or affective psychotic disorders Examples include current or past DSM-5 criteria for:
- Schizophrenia spectrum disorders
- Schizoaffective disorder
- Bipolar I or bipolar II disorder
- Major Depressive Disorder with psychotic features
- Prior history of psychosis due to medical condition or substance use
Family history of psychotic or serious bipolar spectrum illnesses.

Examples include first-degree relative with:
- Schizophrenia spectrum disorders
- Schizoaffective disorder
- Bipolar I disorder with psychotic features
High risk of adverse emotional or behavioral reaction based on investigator's clinical evaluation and judgement. Examples include:
- Agitation
- Violent behavior
Active substance use disorders (SUDs) defined as:
- DSM-5 criteria for moderate or severe alcohol or drug use disorder (excluding caffeine and nicotine) within the past year
- DAST-10 score of 3 or higher
- Two or more "yes" responses to CAGE screening questionnaire
Extensive use of serotonergic hallucinogens (e.g., LSD, psilocybin) defined as:
- Any use in the last 12 months
- >25 lifetime uses
Clinically significant suicidality or high risk of completed suicide defined as:
- 'Yes' to C-SSRS Suicidal Ideation items 4 or 5 within the last 2 months at Screening or 'since last visit' at Baseline
- Any C-SSRS Suicidal Behavior item within the past 12 months at Screening or 'since last visit' at Baseline, as defined by 'Yes' to any of the following on the C-SSRS: actual attempt, interrupted attempt, aborted attempt, or preparatory acts
- Have any suicidal ideation or thoughts, in the opinion of the study physician or PI, that presents a serious risk of suicidal or self-injurious behavior
History of hallucinogen persisting perception disorder (HPPD)
Pregnancy/lactation
Cognitive impairment as defined by:

• Montreal Cognitive Assessment Test (MoCA) < 23
Concurrent Medications
- Antidepressants
- Centrally-acting serotonergic agents (e.g., MAO inhibitors)
- Serotonin-acting dietary supplements (such as 5-hydroxy-tryptophan or St. John's wort)
- Antipsychotics (e.g., first and second generation)
- Mood stabilizers (e.g., lithium, valproic acid)
- Aldehyde dehydrogenase inhibitors (e.g., disulfiram)
- Significant inhibitors of UGT 1A0 or UGT
  
  1A10
- Efavirenz
Have a positive urine drug test including Amphetamines, Barbiturates, Buprenorphine, Benzodiazepines, Cocaine, Cannabis, Methamphetamine, MDMA, Methadone, Opiates (Morphine, Oxycodone), and Phencyclidine (PCP).
Have a psychiatric condition judged to be incompatible with establishment of rapport with the study therapists or safe exposure to psilocybin
Have any psychological or physical symptom, medication, or other relevant finding , based on the clinical judgment of the PI or relevant clinical study staff that would make a participant unsuitable for the study.
Have an allergy or intolerance to any of the materials contained in the drug product
Non-English speaking individual
Be enrolled in another clinical trial assessing intervention(s) for anxiety, depression, and/or existential distress (e.g., pharmacologic or psychotherapeutic interventions)