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    Clinical Trial Results:
    Nitroglycerin's effect on perfusion and hypoxia in human non small cell lung cancer: proof of principle, a phase II trial

    Summary
    EudraCT number
    2010-023120-24
    Trial protocol
    NL  
    Global end of trial date
    18 Jun 2018

    Results information
    Results version number
    v1(current)
    This version publication date
    12 Apr 2023
    First version publication date
    12 Apr 2023
    Other versions
    Summary report(s)
    2010-023120-24 Result

    Trial information

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    Trial identification
    Sponsor protocol code
    Nitro1
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01210378
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Maastro
    Sponsor organisation address
    Dr. Tanslaan 29, Maastricht, Netherlands, 6229 ET
    Public contact
    Chantal Overhof, Maastro, 0031 884455863, chantal.overhof@maastro.nl
    Scientific contact
    Chantal Overhof, Maastro, 0031 884455863, chantal.overhof@maastro.nl
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    29 Nov 2019
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    18 Jun 2018
    Global end of trial reached?
    Yes
    Global end of trial date
    18 Jun 2018
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Demonstrate an absolute increase in 2 year overall survival of 15 % vs historical controls with a nitroglycerin patch by enhancement of tumor perfusion
    Protection of trial subjects
    - Patient had a minimum of three days to think about participating in the trial; - Independent physician, who can be consulted with questions; - Annual safety reporting; - Monitoring.
    Background therapy
    Patients enrolled in the trial will be requested to undergo repeat scanning with perfusion CT (DCE-CT) scans and hypoxia PET-scans at 2 separate occasions before treatment start; “Baseline” scans: 1 DCE-CT and 1 HX4-PET-scan “Nitroglycerin” scans: 1 DCE-CT and 1 HX-4 PET-scan after administration of nitroglycerin After the first 40 patients completing all scans, the subsequently included 20 patients will only be requested to undergo the baseline scans to evaluate the prognostic value of DCE-CT and hypoxia scanning. The number of 40 patients is chosen to have a sample size which gives a flavour of the normal Gaussian distribution in our patient population.
    Evidence for comparator
    If no clear improvement of the OS is observed compared to historical controls, there is no need to embark a more complex randomized phase II and subsequent phase III trial.
    Actual start date of recruitment
    01 Dec 2011
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    Netherlands: 42
    Worldwide total number of subjects
    42
    EEA total number of subjects
    42
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    28
    From 65 to 84 years
    14
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    In the Netherlands, patients were included in the period from November 2011 until June 2016. From 47 patients enrolled, 42 were eligible. Three patients withdrew their consent and 2 patients were included incorrectly.

    Pre-assignment
    Screening details
    Inclusion criteria: - Non-small cell lung cancer stage IB-IV amenable for radiotherapy with curative intent. - Patients not included in PET-boost trial - WHO performance status 0-2 - Willing and able to comply with the study prescriptions - 18 years or older

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded
    Blinding implementation details
    Not blinded

    Arms
    Arm title
    Nitroglycerin patch
    Arm description
    Patient underwent repeated scans, before and after placing a nitroglycerin patch
    Arm type
    Experimental

    Investigational medicinal product name
    HX4
    Investigational medicinal product code
    PR1
    Other name
    Pharmaceutical forms
    Infusion
    Routes of administration
    Intravenous bolus use
    Dosage and administration details
    Step I: 15ug HX-4 Step II: 27 ug HX-4

    Number of subjects in period 1
    Nitroglycerin patch
    Started
    42
    Completed
    42

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Overall trial
    Reporting group description
    From 47 patients enrolled, 42 were eligible

    Reporting group values
    Overall trial Total
    Number of subjects
    42 42
    Age categorical
    Age (mean, range; years) 60 (36–82)
    Units: Subjects
        In utero
    0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0
        Newborns (0-27 days)
    0 0
        Infants and toddlers (28 days-23 months)
    0 0
        Children (2-11 years)
    0 0
        Adolescents (12-17 years)
    0 0
        Adults (18-64 years)
    28 28
        From 65-84 years
    14 14
        85 years and over
    0 0
    Gender categorical
    Units: Subjects
        Female
    18 18
        Male
    24 24
    Age continuous
    Units: years
        median (standard deviation)
    61.14 ( 11.39 ) -

    End points

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    End points reporting groups
    Reporting group title
    Nitroglycerin patch
    Reporting group description
    Patient underwent repeated scans, before and after placing a nitroglycerin patch

    Primary: 2-year overall survival

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    End point title
    2-year overall survival [1]
    End point description
    2-year overall survival
    End point type
    Primary
    End point timeframe
    2-year overall survival
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: As discussed with Sjennie Daelmans, as the study was prematurely ended and has only one group. The analysis is not possible/mandatory.
    End point values
    Nitroglycerin patch
    Number of subjects analysed
    42
    Units: mortality
        mortality
    21
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    2 years
    Adverse event reporting additional description
    Physician assessment of CTCAE 4.0, WHO performance status, weight, blood pressure before radiotherapy (RT), weekly during RT, one month after RT, every 3 months thereafter
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    4.0
    Reporting groups
    Reporting group title
    all patients
    Reporting group description
    all patients

    Serious adverse events
    all patients
    Total subjects affected by serious adverse events
         subjects affected / exposed
    21 / 42 (50.00%)
         number of deaths (all causes)
    21
         number of deaths resulting from adverse events
    2
    Vascular disorders
    Hypotension
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Transient ischaemic attack
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Pancytopenia
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences causally related to treatment / all
    1 / 1
         deaths causally related to treatment / all
    0 / 0
    Thrombocytopenia
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Anal haemorrhage
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Dysphagia
         subjects affected / exposed
    4 / 42 (9.52%)
         occurrences causally related to treatment / all
    0 / 6
         deaths causally related to treatment / all
    0 / 0
    Pain
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Vomiting
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    Dyspnoea
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Epidermolysis
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Herpes ophthalmic
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Neutropenic infection
         subjects affected / exposed
    4 / 42 (9.52%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 1
    Pneumonia
         subjects affected / exposed
    2 / 42 (4.76%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 1
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    all patients
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    42 / 42 (100.00%)
    Injury, poisoning and procedural complications
    Contrast media allergy
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Nervous system disorders
    Amnesia
         subjects affected / exposed
    2 / 42 (4.76%)
         occurrences all number
    2
    Dizziness
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Headache
         subjects affected / exposed
    4 / 42 (9.52%)
         occurrences all number
    6
    Memory impairment
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Sensory level abnormal
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Hyponatraemia
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Neutropenia
         subjects affected / exposed
    2 / 42 (4.76%)
         occurrences all number
    2
    General disorders and administration site conditions
    Fatigue
         subjects affected / exposed
    2 / 42 (4.76%)
         occurrences all number
    2
    Night sweats
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Fever neonatal
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    2
    Pain
         subjects affected / exposed
    16 / 42 (38.10%)
         occurrences all number
    22
    Rib fracture
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Sight disability
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Hypotension
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Weight decreased
         subjects affected / exposed
    9 / 42 (21.43%)
         occurrences all number
    9
    Gastrointestinal disorders
    Abdominal discomfort
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Anal haemorrhage
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Appetite disorder
         subjects affected / exposed
    7 / 42 (16.67%)
         occurrences all number
    7
    Dyspepsia
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Dysphagia
         subjects affected / exposed
    27 / 42 (64.29%)
         occurrences all number
    41
    Nausea
         subjects affected / exposed
    2 / 42 (4.76%)
         occurrences all number
    2
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    24 / 42 (57.14%)
         occurrences all number
    32
    dyspnea
         subjects affected / exposed
    25 / 42 (59.52%)
         occurrences all number
    33
    Haemoptysis
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Skin and subcutaneous tissue disorders
    Erythema
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Rash
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1
    Infections and infestations
    Cystitis
         subjects affected / exposed
    1 / 42 (2.38%)
         occurrences all number
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    08 Dec 2011
    Logistical change (timpoint of the scans)
    15 Feb 2012
    Adding the HX-4 administration protocol to the study protocol
    29 Aug 2012
    Adaptation of the inclusion criteria and adding a voluntary scan
    12 Mar 2014
    Reduction of HX-4, reduction of scanning time, new IB.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported

    Online references

    http://www.ncbi.nlm.nih.gov/pubmed/32021913
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