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TerminatedNCT01874119HDIL2/EmendUpdated Jun 7, 2018Results posted

Fosaprepitant for N/V With High-dose Interleukin-2 for Metastatic Melanoma and Renal Cell Carcinoma

A Phase 2 interventional study of Fosaprepitant in Chemotherapy-induced Nausea and Vomiting, sponsored by St. Louis University. Terminated at 1 site in United States. Open to participants aged 18 Years to 90 Years. Per ClinicalTrials.gov, last updated 2018-06-07.

Sponsored by St. Louis University · Phase 2, Interventional, and Treatment

Why this study was terminated
Enrollment issues
Phase
Phase 2
Study type
Interventional
Enrollment
13
Allocation
Randomized
Ages
18 Years to 90 Years
Sex
All
01

Study summary

The purpose of this study is to investigate the effectiveness of intravenous fosaprepitant therapy to reduce nausea and vomiting during the treatment of high dose interleukin-2 (HD IL-2) therapy for metastatic melanoma or metastatic renal cell carcinoma. Fosaprepitant is an intravenous (IV) medication that is FDA- approved for use in adults for the prevention of nausea and vomiting during chemotherapy. Fosaprepitant works by blocking the neurokinin-1 receptor, which is a receptor in the brain that is known to cause nausea and vomiting. Past studies estimate that up to 70% of patients undergoing treatment with HD IL-2 will have nausea and/or vomiting. While fosaprepitant has been used in clinical practice to treat nausea and vomiting during HD IL-2, there have not been any studies done to see how well it works. All patients will receive treatment (IV fosaprepitant) during the study during either the first or second hospital admission for HD IL-2. On the admission that the subject is not receiving IV fosaprepitant, the subject will receive placebo (a medicine that looks like fosaprepitant, but is not active). The study is double-blinded, which means neither the subject, nor the study doctor will know to which group you have been assigned to that admission (IV fosaprepitant or placebo). This study design was chosen to limit the potential for bias, which means the trial was designed to try to ensure that unknown factors do not affect trial results. When patients start the study, patients will be randomly assigned to one of two groups: those who receive treatment (IV fosaprepitant) first and those who receive placebo first. During the first admission, subjects will be given the IV fosaprepitant or IV placebo during admission. During the second admission, subjects will 'crossover' and receive the other treatment that they did not receive during the first admission. Improvement in nausea and vomiting will be assessed by counting the number of nausea and vomiting episodes, recording if the subject needs additional medication for nausea and vomiting, and by using patient questionnaires.

Read the detailed description

This is a Phase 2B double-blind placebo-controlled crossover study evaluating the efficacy of intravenous fosaprepitant for chemotherapy-induced nausea and vomiting in patients undergoing high-dose interleukin-2 (HD IL-2) therapy (720,000 IU/kg per dose intravenously; 14 doses, 2 cycles per course) for metastatic melanoma and metastatic renal cell carcinoma. A total of 22 subjects will be enrolled in the study. On study entry, patients will be randomized to receive either IV fosaprepitant (150 mg on Day 1, Day 3, or Day 5) or matched placebo during first admission of HD IL-2 therapy (cycle 1). All subjects will crossover and receive the opposite treatment during cycle 2. All patients will receive ondansetron 24 mg by mouth daily per standard protocol every 24 hours during Days 1-5 of admission starting 30 minutes prior to first dose of HD IL-2. During the treatment phase, subjects will receive Patients will receive IV fosaprepitant 30 minutes before first dose of HD IL-2 therapy and every 48 hours until completion of HD IL-2 therapy. Upon study entry, the subjects will be given a dairy to report episodes of vomiting, use of rescue therapy, and nausea assessments using the 1-100 scale within the visual analogue scale (VAS). The subject will be instructed to complete entries from baseline assessment (prior to first dose) until 5 days after last dose of HD IL-2 for endpoint analysis. During inpatient admissions, subjects will complete diary entries before each dose (q8 hours). As an outpatient, subjects will complete diary entries on a daily basis. Recording of whether or not pruritus was observed will also be collected within the subject diary. If a patient reports pruritus, the severity of pruritus on the 1-100 scale visual analogue scale (VAS) will also be collected. The study team will record any episodes of vomiting and the use of rescue therapy and ensure completion of patient diary during inpatient portion. Assessments will be made via telephone contact to determine onset of any episodes of CINV during outpatient portion. Safety assessments including adverse events (AEs) monitoring will be performed and assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.

02

Conditions studied

  • Chemotherapy-induced Nausea and Vomiting

Keywords

  • melanoma
  • renal cell carcinoma
  • interleukin-2
03

In context

Carcinoma

6,741 studies on the registry are indexed under Carcinoma; 1,161 are open to participants now.

This study's enrollment of 13 is below the median of 45 across 5,170 interventional studies indexed under Carcinoma.

Browse Carcinoma studies →

Lead sponsor

St. Louis University is the lead sponsor of 152 studies on the registry; 17 are open to participants now.

Of its 19 completed or terminated interventional studies of FDA-regulated products, 15 (79%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 90 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Subjects must meet all of the following inclusion criteria to be eligible for enrollment into the study:

    1. Evidence of a personally signed and dated informed consent document indicating that the subject (or legally acceptable representative) has been informed of all pertinent aspects of the trial.
    2. Subjects who are willing to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.
    3. Be at least 18 years of age at the time of informed consent.
    4. Has a diagnosis of metastatic melanoma or metastatic renal cell carcinoma and who will undergo high-dose interleukin-2 (HD IL-2) therapy
    5. Have an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or less at Baseline/Day 1 visit. (See Appendix 6 on p. 51, ECOG Performance Status)
    6. Female of reproductive potential must agree use non-hormonal methods to avoid pregnancy during study participation and for 1 month after last dose of study drug

Exclusion criteria

Exclusion Criteria:

  • Subjects presenting with any of the following will not be included in the study:

    1. Women who are pregnant or lactating, or planning pregnancy
    2. Women of childbearing potential who refuse to use non-hormonal methods to avoid pregnancy
    3. Known hypersensitivity to any component of fosaprepitant or aprepitant
    4. Have taken pimozide or cisapride \<4 weeks, cytochrome P450 3A4 inducers within 30 days, strong CYP3A4 inhibitors within 7 days, or antiemetics within 48 hours prior to treatment initiation (See Appendix 7 on p. 52 for list of CYP3A4 inducers and strong CYP3A4 inhibitors)
    5. Have evidence of clinically significant and unstable diseases or conditions such as cardiovascular, immunosuppressive, hematologic, hepatic, neurologic, renal, endocrine, collagen-vascular, or gastrointestinal abnormalities that the investigator thinks may interfere with study participation
    6. Participation in other study using an investigational or experimental therapy or procedure within 4 weeks or 5 half-lives (whichever is longer) before study entry
    7. Subjects cannot participate in studies of other investigational or experimental therapies or procedures at any time during their participation in this study.
    8. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the subject inappropriate for entry into this study.
    9. Subjects who are investigational site staff members or who are Sponsor employees directly involved in the conduct of the trial.
    10. A subject who, in the opinion of the investigator or sponsor, will be uncooperative or unable to comply with study procedures.
05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Crossover assignment
Masking
Triple (Participant, Investigator, Outcomes assessor)
Enrollment
13 participants (actual)

Study arms

  • Experimental
    Fosaprepitant

    During treatment admission, intravenous fosaprepitant 150 mg every 48 hours during 6-day hospital admission

    Drug: Fosaprepitant

  • Placebo comparator
    Placebo

    During placebo admission, intravenous 0.9% saline every 48 hours during 6-day hospital admission

    Drug: Fosaprepitant

Interventions

  • DrugFosaprepitant

    During treatment admission, intravenous fosaprepitant 150 mg every 48 hours during 6-day hospital admission

    Also known as: Emend

06

What researchers measure

Primary outcomes

  1. Number of Patients With Complete Response During Inpatient Admission

    No vomiting from the initiation of through 48 hours following the final dose of HD IL-2

    Time frame: From the initiation of through 48 hours following the final dose of Interleukin-2

07

Results

Posted May 4, 2018
Limitations and caveats
Early termination leading to small numbers of subjects analyzed. Caution is advised for any future investigation with this combination in regards to toxicity.

Participant flow

First Intervention (6 Days)
Participant flow — First Intervention (6 Days)
MilestoneFosaprepitant First, Then PlaceboPlacebo First, Then Fosaprepitant
Started85
Completed75
Not completed10
Washout (7 Days)
Participant flow — Washout (7 Days)
MilestoneFosaprepitant First, Then PlaceboPlacebo First, Then Fosaprepitant
Started75
Completed43
Not completed32
Second Intervention (6 Days)
Participant flow — Second Intervention (6 Days)
MilestoneFosaprepitant First, Then PlaceboPlacebo First, Then Fosaprepitant
Started43
Completed43
Not completed00

Outcome measures

PrimaryNumber of Patients With Complete Response During Inpatient Admission

No vomiting from the initiation of through 48 hours following the final dose of HD IL-2

Time frame:
From the initiation of through 48 hours following the final dose of Interleukin-2
Reported as:
Count of participants · Participants
Number of Patients With Complete Response During Inpatient Admission
ParticipantsFosaprepitantPlacebo
Number of Patients With Complete Response During Inpatient Admission10

Adverse events

Collected over From the initiation of through 48 hours following the final dose of HD IL-2. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Fosaprepitant2/11 (18.2%)3/11 (27.3%)11/11 (100%)
Placebo2/9 (22.2%)4/9 (44.4%)9/9 (100%)
Most frequent serious events
Most frequent serious events
EventFosaprepitantPlacebo
Cardiac arrestCardiac disorders1/113/9
SepsisInfections and infestations0/111/9
Autoimmune disorder - MyocarditisImmune system disorders0/111/9
HypoxiaRespiratory, thoracic and mediastinal disorders0/111/9
Upper GI hemorrhageGastrointestinal disorders1/110/9
Other - Uncal herniationNervous system disorders1/110/9
BradycardiaCardiac disorders1/110/9
Most frequent other events
Showing 10 of 18
Most frequent other events
EventFosaprepitantPlacebo
HypoalbunemiaMetabolism and nutrition disorders8/116/9
HypophosphatemiaMetabolism and nutrition disorders7/116/9
Urine output decreasedInvestigations3/114/9
Lymphocyte count decreasedInvestigations2/113/9
Weight gainInvestigations3/113/9
AnemiaBlood and lymphatic system disorders2/112/9
Blood bilirubin increasedInvestigations2/112/9
HyponatremiaMetabolism and nutrition disorders1/112/9
Platelet count decreasedInvestigations2/111/9
HypoxiaRespiratory, thoracic and mediastinal disorders2/111/9

Baseline characteristics

Age, Categorical
Age, Categorical(Participants)Study Participants Completing All Cycles
<=18 years0
Between 18 and 65 years7
>=65 years0
Age, Continuous
Age, Continuous(years)Study Participants Completing All Cycles
Median61 (37 to 64)
Sex: Female, Male
Sex: Female, Male(Participants)Study Participants Completing All Cycles
Female1
Male6
Region of Enrollment
Region of Enrollment(Participants)Study Participants Completing All Cycles
United States7
08

Study locations

1 site
  • Saint Louis University Hospital
    Saint Louis, Missouri 63101, United States
09

References and documents

Publications

  • Grunberg S, Chua D, Maru A, Dinis J, DeVandry S, Boice JA, Hardwick JS, Beckford E, Taylor A, Carides A, Roila F, Herrstedt J. Single-dose fosaprepitant for the prevention of chemotherapy-induced nausea and vomiting associated with cisplatin therapy: randomized, double-blind study protocol--EASE. J Clin Oncol. 2011 Apr 10;29(11):1495-501. doi: 10.1200/JCO.2010.31.7859. Epub 2011 Mar 7. PubMed 21383291 ↗
  • Van Laere K, De Hoon J, Bormans G, Koole M, Derdelinckx I, De Lepeleire I, Declercq R, Sanabria Bohorquez SM, Hamill T, Mozley PD, Tatosian D, Xie W, Liu Y, Liu F, Zappacosta P, Mahon C, Butterfield KL, Rosen LB, Murphy MG, Hargreaves RJ, Wagner JA, Shadle CR. Equivalent dynamic human brain NK1-receptor occupancy following single-dose i.v. fosaprepitant vs. oral aprepitant as assessed by PET imaging. Clin Pharmacol Ther. 2012 Aug;92(2):243-50. doi: 10.1038/clpt.2012.62. Epub 2012 Jun 27. PubMed 22739139 ↗
10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jun 7, 2018, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT01874119
Lead sponsor
St. Louis University
Collaborators
Merck Sharp & Dohme LLC
Responsible party
John Richart, M.D. (Associate Professor, Dept. of Internal Medicine, Hematology and Oncology, St. Louis University) — Principal investigator
First posted
Jun 10, 2013
Start date
Sep 2013
Primary completion
Dec 3, 2015
Completion
Dec 3, 2015
Results posted
May 4, 2018
Last update
Jun 7, 2018

Study contacts

John M Richart, M.D.
principal investigator · Saint Louis University, Department of Internal Medicine, Division of Hematology and Oncology

Oversight

Data monitoring committee
No
View the source record on ClinicalTrials.gov ↗

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