Radiosensitizing Effect of Nelfinavir in Locally Advanced Carcinoma of Cervix

NCT03256916CompletedPHASE3INTERVENTIONAL

Summary

Key Facts

Lead Sponsor

Tata Memorial Hospital

Enrollment

348

Start Date

2018-01-16

Completion Date

2024-05-28

Study Type

INTERVENTIONAL

Official Title

A Phase III Randomized Clinical Trial to Study the Radiosensitizing Effect of Nelfinavir in Locally Advanced Carcinoma of Uterine Cervix.

Interventions

NelfinavirCisplatinPelvic EBRT and Brachytherapy

Conditions

Carcinoma CervixStage III

Eligibility

Age Range

18 Years – 65 Years

Sex

FEMALE

Inclusion Criteria

* ECOG 0 to 2
* FIGO 2018 Stage IIIA (TNM stage T3a N0 M0) FIGO 2018 Stage IIIB (TNM stage T3b N0 M0) FIGO 2018 Stage IIIC (TNM stage Any T N1 M0)
* No previous irradiation to the pelvis or chemotherapy
* Age 18 years and above
* Ability to tolerate full course of pelvic radiotherapy and brachytherapy
* Adequate bone marrow, liver, and kidney function defined as neutrophil count ≥ 1500 platelet count ≥ 100,000, total bilirubin less than 1.5 x upper limit of normal (ULN), AST and ALT ≤ 2.5 x ULN, and creatinine less than 1.5 upper limit of normal or Creatinine clearance greater than 60 mL/min/1.73 m2
* No recent (less than 3 months) severe cardiac disease (arrhythmia, congestive heart failure, infarction)
* Ability to understand and the willingness to sign an informed consent document
* Should be willing to undergo extra biopsy and blood collection for pharmacokinetic studies

Exclusion criteria

* Patients with newly diagnosed diabetes , uncontrolled DM (patient with HbA1c of \> 6.5% or FBS value or BSF\>=126 mg/dL respectively on primary evaluation)
* Pts on any drugs which has pharmacological interaction with nelfinavir:

  * Terfenadine, cisapride, sildenafil, lovastatin or simvastatin and medication that are metabolized by the CYP3A4 isoenzyme.
  * Antiarrhythmics (amiodarone, quinidine).
  * Neuroleptics (pimozide).
  * Sedative/Hypnotic agents (midazolam, triazolam).
  * Ergot derivatives.
  * HMG-CoA reductase inhibitors (atorvastatin).
  * Rifampicin, Rifabutin.
  * Felodipine, Nifedipine.
* Pregnant or lactating
* Active co existing malignancy.
* HIV positive patients will be excluded.
* Patients with hemophilia.
* Patients with reduced creatinine clearance ( less than 50 ml/ min) or unilateral or bilateral hydronephrosis will be excluded.
* History of psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule.

Outcome Measures

Primary Outcomes

Improvement in 3 year disease free survival

Improvement in 3 year disease free survival by the addition of Nelfinavir to patients with advanced carcinoma of cervix and receiving standard chemoradiation (Cisplatin and Radiotherapy).

Time frame: 3 years

Secondary Outcomes

Change in locoregional control rates at 3 years

Change in locoregional control rates at 3 years by the addition of Nelfinavir to patients with advanced carcinoma of cervix and receiving standard chemoradiation (Cisplatin and Radiotherapy).

Time frame: 3 years

Overall survival at 5 years

Overall survival at 5 years in test and control arms.

Time frame: 5 years

Incidence of grade 3/4 adverse events

Incidence of grade 3/4 adverse events in patients with advanced carcinoma of cervix and receiving Nelfinavir along with standard chemoradiation (Cisplatin and Radiotherapy)

Time frame: 5 years

Changes in Akt levels in the tumor

Changes in Akt levels in the tumor from pre Nelfinavir to post EBRT.

Time frame: 5 years

Change in tumour hypoxia using multifunctional PET/ MRI.

Change in tumour hypoxia using multifunctional PET/ MRI.

Time frame: 5 years

Interindividual variability of Volume of distribution

Cmax (Maximum concentration) will be estimated

Time frame: 5 years

Interindividual variability of Clearance of nelfinavir.

Clearence (litres per hour)

Time frame: 5 years

Interindividual variability of Clearence of Nelfinavir

Half Life (hrs)

Time frame: 5 years

Locations

Tata Memorial Centre, Mumbai, India

Linked Papers

2022-04-06

Concurrent chemoradiation and brachytherapy alone or in combination with nelfinavir in locally advanced cervical cancer (NELCER): study protocol for a phase III trial

Introduction In locally advanced cervical cancer, nodal, local and distant relapse continue to be significant patterns of relapse. Therefore, strategies to improve the efficacy of chemoradiation are desirable such as biological pathway modifiers and immunomodulating agents. This trial will investigate the impact of nelfinavir, a protease inhibitor that targets the protein kinase B (AKT) pathway on disease-free survival (DFS). Methods and analysis Radiosensitising effect of nelfinavir in locally advanced carcinoma of cervix is a single-centre, open-label, parallel-group, 1:1 randomised phase-III study. Patients aged over 18 years with a diagnosis of carcinoma cervix stage III are eligible for the study. After consenting, patients will undergo randomisation to chemoradiation and brachytherapy arm or nelfinavir with chemoradiation and brachytherapy arm. The primary aim of the study is to compare the difference in 3-year DFS between the two arms. Secondary aims are locoregional control, overall survival, toxicity and quality of life between the two arms. Pharmacokinetics of nelfinavir and its impact on tumour AKT, programmed cell death ligand 1, cluster of differentiation 4, cluster of differentiation 8 and natural killer 1.1 expression will be investigated. The overall sample size of 348 with 1 planned interim analysis achieves 80% power at a 0.05 significance level to detect a HR of 0.66 when the proportion surviving in the control arm is 0.65. The planned study duration is 8 years. Ethics and dissemination The trial is approved by the Institutional Ethics Committee-I of Tata Memorial Hospital, Mumbai (reference number: IEC/0317/1543/001) and will be monitored by the data safety monitoring committee. The study results will be disseminated via peer-reviewed scientific journals, and conference presentations. Study participants will be accrued after obtaining written informed consent from them. The confidentiality and privacy of study participants will be maintained. Trial registration number The trial is registered with Clinical Trials Registry-India (CTRI/2017/08/009265) and ClinicalTrials.gov ( NCT03256916 ).

Linked Investigators