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About
This phase I/II trial is studying the side effects and best dose of gene therapy and to see how well it works in preventing cancer in patients with premalignant carcinoma of the oral cavity or pharynx. Inserting the p53 gene into a person's tumor cells may improve the body's ability to kill the tumor cells
Full description
OBJECTIVES:
I. Determine the acute toxic effects of Ad5CMV-p53 gene administered as an oral rinse and as an intramucosal injection in patients with diffuse premalignant carcinoma of the oral cavity or oral pharynx.
II. Determine the maximum tolerated dose of this drug in these patients. III. Determine the topical transduction efficiency of adenoviral-mediated wild type p53 gene transfer in patients treated with this drug.
IV. Determine the efficacy of this drug in reversing the histology of oral premalignancies in these patients.
V. Determine the distribution of transgenic protein within the area of the premalignant lesion in patients treated with this drug.
OUTLINE: This is an open-label, dose-escalation study of Ad5CMV-p53 gene administered as an oral rinse.
Phase I: Patients receive Ad5CMV-p53 gene by intramucosal injection into the area of the lesion followed at least 2 hours later by Ad5CMV-p53 gene as an oral rinse on day 1. Patients then receive Ad5CMV-p53 gene as an oral rinse twice daily on days 2-5. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of Ad5CMV-p53 gene as an oral rinse until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
Phase II: Patients receive treatment with intramucosal Ad5CMV-p53 gene as in phase I and Ad5CMV-p53 gene as an oral rinse at the MTD. Patients are followed every 3 months for 1 year, every 6 months for 1 year, and then annually for 3 years. Patients then receive long-term follow-up annually for an additional 10 years.
Enrollment
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Inclusion and exclusion criteria
Inclusion Criteria:
Histologically confirmed mild to moderate dysplasia OR severe dysplasia/carcinoma in situ of the oral cavity or oral pharynx
Clinically evident diffuse premalignant disease, defined by 1 of the following mucosal abnormalities:
Meets 1 of the following criteria:
No active squamous cell carcinoma of the head and neck
Performance status - Karnofsky 70-100%
Absolute granulocyte count at least 2,000/mm^3
Platelet count at least 100,000/mm^3
Bilirubin no greater than 1.0 mg/dL
Creatinine no greater than 1.5 mg/dL
No hypertension (baseline blood pressure 140/90 mm Hg or higher)
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective barrier contraception during and for 1 year after study participation
HIV-1 negative
No known contact with former tissue or organ transplantation recipients or individuals with severe immunodeficiency disease (acquired or congenital) during and for 28 days after study treatment
No prior malignancy within the past 2 years except nonmelanoma skin cancer or aerodigestive cancer
No active systemic viral, bacterial, or fungal infections requiring treatment
No serious concurrent illness that would preclude study compliance and follow-up
No psychological, familial, sociological, geographical, or other condition that would preclude study compliance and follow-up
See Disease Characteristics
More than 21 days since prior chemotherapy (42 days for mitomycin and nitrosoureas)
No concurrent systemic chemotherapy
No concurrent prednisone or the equivalent, including corticosteroids of more than 10 mg/day
See Disease Characteristics
More than 3 months since prior radiotherapy involving the lesion selected for this study
No concurrent radiotherapy
See Disease Characteristics
More than 8 weeks since prior investigational agents
No prior experimental therapy (i.e., oral, systemic, topical, or direct injection) for the lesion selected for treatment in this study
No other concurrent immunosuppressive therapy
No other concurrent investigational agents
No concurrent aspirin dose greater than 175 mg/day
Primary purpose
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51 participants in 1 patient group
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Data sourced from clinicaltrials.gov
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