Trial Review

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Trial registered on ANZCTR


Registration number
ACTRN12618001220257
Ethics application status
Approved
Date submitted
3/07/2018
Date registered
20/07/2018
Date last updated
10/05/2023
Date data sharing statement initially provided
9/01/2019
Date results provided
10/05/2023
Type of registration
Prospectively registered

Titles & IDs
Public title
A study that evaluates the effectiveness of oral medicinal cannabis for people with advanced cancer experiencing a range of symptoms.
Scientific title
Oral Medicinal Cannabinoids to Relieve Symptom Burden in the Palliative Care of Patients with Advanced Cancer: a double-blind, placebo controlled, randomised clinical trials of efficacy and safety of cannabidiol (CBD)
Secondary ID [1] 294778 0
NIL
Universal Trial Number (UTN)
NIL
Trial acronym
MedCan 1 - CBD
Linked study record
NIL

Health condition
Health condition(s) or problem(s) studied:
Cancer 307689 0
Fatigue 307690 0
Nausea 307691 0
Breathlessness 307692 0
Appetite 307693 0
Psychological effects 307694 0
Condition category
Condition code
Cancer 306755 306755 0 0
Any cancer

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
Patients with advanced cancer will participate in a double-blind, placebo controlled, and randomisation clinical trial. Each participant will follow a dose titration schedule for 14 days and a follow on stable dose for a further 14 days. Participants will be allocated into a treatment arm according to a block randomisation schedule held by a central registry. There will be one active arm (CBD) and an inert oral oily liquid (placebo).
Concentration of medication:
CBD (Cannabidiol) 100mg/ml oral oily liquid (dose range 50mg – 600mg/day
Dosing schedule:
Dose titration (days 0 – 14) will be confirmed by the treating doctor with doses starting at:
Arm 1
Days 0 & 1 – 1 dose/day = total daily dose 50mg (0.5ml)
Day 2 & 3 – 1 dose/day = total daily dose 100mg (1ml)
Day 4 & 5 – 2 dose/day = total daily dose 200mg (2ml)
Day 6 & 7 – 3 doses/day = total daily dose 300mg (3ml)
Day 8 & 9 – 3 doses/day = total daily dose 400mg (4ml)
Day 10 & 11 – 3 doses/day = total daily dose 500mg (5ml)
Day 12 & 13 – 3 doses/day = total daily dose 600mg (6ml)
Day 14 – 28 – Continue on final dose reached
Each participant will be advised to increase their dose according to the dosing schedule until they are satisfied with symptom improvement and no unacceptable side effects (according to the CTCAE graded >4 (confusion, somnolence, personality change, paranoia, anxiety, mood change, psychosis, hypertension, tachycardia, sweating, nausea, vomiting, abdominal pain)). The patient then will be given the option of remaining on the cannabinoid preparation for continuing assessment of efficacy and adverse events for a further 14 days totaling 28 days on the study drug.
Patients will have the choice of lowering their dose according to symptom improvement. Dose titration downwards will be in consultation with the doctor.
Participants will be required to return empty/unused bottles each clinic visit to receive a further supply.
Intervention code [1] 301555 0
Treatment: Drugs
Comparator / control treatment
The placebo will be an excipient-matched oral oil solution with no active drug in a 25mL bottle
Control group
Placebo

Outcomes
Primary outcome [1] 306331 0
Change from baseline of total composite ESAS TSDS
Timepoint [1] 306331 0
Assessed at baseline and day 14
Secondary outcome [1] 348215 0
Patient determined effective doses of CBD
Timepoint [1] 348215 0
Defined as the dose that achieves symptom relief with acceptable side-effects by day 14
Secondary outcome [2] 348217 0
Combined physical and emotional (pain, tiredness, nausea, shortness of breath, drowsy, appetite, anxiety, depression, wellbeing) will be totalled together at each time point. Each symptom will be rated from 0-10 on the ESAS. Scores will be collected at each time point
Timepoint [2] 348217 0
Assessed at days 2, 4, 7, 9, 11, 14, 16, 18, 21, 23, 25 and day 28.
Secondary outcome [3] 349224 0
Oral morphine equivalent (OME). Conversion of various opioids to an equianalgesic dose of oral morphine (mg/24hr). OME will be assessed by review of medical records. 24hr opioid consumption will be measured as oral morphine equivalents. Opioid conversion e.g. Oxycodone multiplication of a factor 1.5; fentanyl is a multiplication of a factor of 0.3
Timepoint [3] 349224 0
Average used assessed at baseline and days 7, 14, 21 and day 28
Secondary outcome [4] 349226 0
Clinical Global Impressions (CGI) scales
Timepoint [4] 349226 0
Assessed at baseline and compared at days 7, 14, 21 and 28
Secondary outcome [5] 349227 0
DASS-21 score assessing combines depression, anxiety and stress
Timepoint [5] 349227 0
Assessed at baseline and compared at days 7, 14, 21 and 28
Secondary outcome [6] 349228 0
Quality of Life using questionnaire EORTC QLQ-C15 PAL
Timepoint [6] 349228 0
Assessed at baseline and compared at days 7, 14 and 28
Secondary outcome [7] 349229 0
Adverse Events (AE) recorded using Common Terminology Criteria for Adverse Events v4.0 (CTCAE v4.0) All AE's will be recorded at baseline until end of study (day 28).Particular attention will be given to: confusion, somnolence, personality change, paranoia, anxiety, mood change, psychosis, hypertension, tachycardia, sweating, nausea, vomiting, abdominal pain
Timepoint [7] 349229 0
Assessed at baseline and compared at days 2, 4, 7, 9, 11, 14, 16, 18, 21, 23, 25 and day 28

Eligibility
Key inclusion criteria
Patients with advanced histologically proven cancer (metastatic or locally advanced) known to the palliative care team:
-have an ESAS TSDS greater than 10
-at least one individual ESAS score greater than 3
-AKPS score >30
-aged >25yrs and above. English speaking (or have interpreter available)
--have a negative pregnancy urine test at eligibility (only if of reproductive potential) and agree to avoid pregnancy during the study and 12 weeks following the last dose of the study drug. Males must agree to avoid fathering a child and to not donate sperm during the study and for at least 12 weeks following the last dose of the study drug
-have a negative THC urine test
-able to tolerate oral medication and comply with trial requirments
-agree to use no other cannabis based products for the duration of the trial
-comply with trial requirements: agree to attend scheduled clinical appointments, adhere to dose titration schedule as directed
-understand it is illegal to take cannabinoid products outside of Australia
-understand that it is illegal to drive whilst taking cannabis products
-able to provide fully informed consent
Minimum age
25 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
-a history of hypersensitivity to any cannabinoid product
-unstable untreated cardiovascular disease (hypertension, ischemic heart disease, congestive cardiac failure)
-severe hepatic impairment (total bilirubin >1.5 times the upper limit of the institution's normal range. Asparate aminotransferase (AST), and alanne aminotransferase (ALT) >3.0 time the upper limit of the institution's normal range; subjects with liver metastasis may have an AST and ALT of >5.0 times the upper limit of normal
-severe renal impairment (eGFR <20mls/min/1.73m2)
-history of psychiatric disorders (severe depression or anxiety, personality disorder, psychosis, schizophrenia, first degree relative with schizophrenia and/or suicidal ideation)
-cognitive impairment (SLUMS - St Louis University Mental Status) examination <20/30
-known substance use disorder (ASSIST - Alcohol, Smoking and Substance Involvement Screening Test) examination score >27+
-history that drug diversion may be a risk for them or their family/carers
-females who are pregnant or lactating
-concurrent or participation of a new clinical entity with the last 28 dyas
treatment with a new specific anticancer agent (chemotherapy, targeted or hormonal therapy) or radiation within the last 7 days

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
An independent centre (Mater Research Office) will establish a randomisation schedule. Randomisation will be allocated according to a block randomisation schedule held by the central registry. Block randomisation within each centre will ensure even allocation across each treatment arm. Active and placebo treatments will be labeled and coded by Mater Research Office and will not be revealed to investigators or the participants.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using a randomisation table created by computer software (i.e. computerised sequence generation)
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
Intervention assignment
Parallel
Other design features
Each participant will complete a 28 day period of treatment, receiving either the active or placebo drug.
Phase
Phase 2
Type of endpoint/s
Safety/efficacy
Statistical methods / analysis
The sample size is based on previous work by Hui et al., who determined the minimal clinically important difference in the TSDS to be 5.7 (2). As such we have elected to use an improvement of =6 in the TSDS as the primary outcome measure. Allowing 20% for attrition, and with improvement of =6 for CBD compared to placebo, it is anticipated that 144 participants (72 per arm) should be randomized to achieve a sample size of 60 participants per arm, assuming 80% power, a simple random sampling scheme and a Type 1 error of 5% (two-tailed), and a standard deviation of 11.6. The superiority of each medicinal cannabis arm compared to placebo will be tested by comparing the response to each arm after 14 days, relative to baseline.

Descriptive analyses and frequency distributions will be generated from participants’ demographic and clinical characteristics, with all variables explored using graphical methods and summary statistics. In univariate analysis, T tests or the corresponding non-parametric tests (Wilcoxon Rank Sum) will be used to test for differences in change in total symptom distress scores of CBD versus placebo. Generalised estimating equation models with the appropriate link function will be developed to assess the effect of treatment and confounders and/or modifying factors on the primary and secondary outcomes and account for within subject correlation where required. This study is powered to detect superiority of CBD over placebo. If the CBD is shown to be superior to placebo, subsequent studies will need to be undertaken to determine which particular combination (or dose) is superior.

An interim analysis will be performed after one third of the participants have completed 14 days of the trial. The analysis will be performed by a biostatistician blinded for the treatment allocation and reported to the investigators and the DSMB. The purpose of the interim analysis is primarily to monitor and ensure safety of participants rather than evidence of such benefit that early stopping of the trial is justified. AEs and SAEs will be stratified by type and severity. The frequency of AEs and SAEs will be compared between treatment groups using chi-square test and logistic regression if indicated to adjust for any baseline differences between groups.

Recruitment
Recruitment status
Completed
Date of first participant enrolment
Anticipated
1/03/2019
Actual
13/02/2019
Date of last participant enrolment
Anticipated
1/03/2022
Actual
12/11/2021
Date of last data collection
Anticipated
1/05/2022
Actual
5/01/2022
Sample size
Target
144
Accrual to date
Final
144
Recruitment in Australia
Recruitment state(s)
QLD
Recruitment hospital [1] 11285 0
Mater Adult Hospital - South Brisbane
Recruitment hospital [2] 11286 0
Mater Private Hospital - South Brisbane
Recruitment hospital [3] 11287 0
St Vincent's Hospital Brisbane - Kangaroo Point
Recruitment hospital [4] 11288 0
Royal Brisbane & Womens Hospital - Herston
Recruitment hospital [5] 11289 0
Princess Alexandra Hospital - Woolloongabba
Recruitment hospital [6] 11301 0
Gold Coast Hospital - Southport
Recruitment postcode(s) [1] 23174 0
4101 - South Brisbane
Recruitment postcode(s) [2] 23175 0
4169 - Kangaroo Point
Recruitment postcode(s) [3] 23176 0
4029 - Herston
Recruitment postcode(s) [4] 23177 0
4102 - Woolloongabba
Recruitment postcode(s) [5] 23199 0
4215 - Southport

Funding & Sponsors
Funding source category [1] 299385 0
Government body
Name [1] 299385 0
National Health and Medical Research Council (NHMRC)/Medical Research Future Fund (MRFF)
Country [1] 299385 0
Australia
Primary sponsor type
Hospital
Name
Mater Misericordiae Limited
Address
Mater Misericordiae Limited
Raymond Terrace
South Brisbane Qld 4101
Country
Australia
Secondary sponsor category [1] 298663 0
Hospital
Name [1] 298663 0
Mater Misericordiae Limited
Address [1] 298663 0
Mater Misericordiae Ltd
Raymond Terrace
South Brisbane Qld 4101
Country [1] 298663 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 300286 0
Mater Misericordiae Ltd Human Research Ethics Committee (MML HREC)
Ethics committee address [1] 300286 0
Ethics committee country [1] 300286 0
Australia
Date submitted for ethics approval [1] 300286 0
03/04/2018
Approval date [1] 300286 0
20/06/2018
Ethics approval number [1] 300286 0
HREC/18/MHS/43

Summary
Brief summary
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 83166 0
Prof Janet Hardy
Address 83166 0
Medical Director Mater Cancer Care Centre
Director Palliative and Supportive Care Services
Mater Misericordiae Ltd
Raymond Terrace
South Brisbane, Qld 4101
Country 83166 0
Australia
Phone 83166 0
+61 7 3163 2775
Fax 83166 0
+61 7 3163 2701
Email 83166 0
[email protected]
Contact person for public queries
Name 83167 0
Georgie Huggett
Address 83167 0
Clinical Trial Coordinator
Palliative and Supportive Care
Mater Misericordiae Ltd
Raymond Terrace
South Brisbane, Qld 4101
Country 83167 0
Australia
Phone 83167 0
+61 7 6163 6057
Fax 83167 0
+61 7 3163 1588
Email 83167 0
[email protected]
Contact person for scientific queries
Name 83168 0
Janet Hardy
Address 83168 0
Medical Director Mater Cancer Care Centre
Director Palliative and Supportive Care Services
Mater Misericordiae Ltd
Raymond Terrace
South Brisbane, Qld 4101
Country 83168 0
Australia
Phone 83168 0
+61 7 3163 2775
Fax 83168 0
+61 7 3163 2701
Email 83168 0
[email protected]

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
No/undecided IPD sharing reason/comment
This is a double blinded trial, nil data will be provided at this time


What supporting documents are/will be available?

No Supporting Document Provided



Results publications and other study-related documents

Documents added manually
No documents have been uploaded by study researchers.

Documents added automatically
SourceTitleYear of PublicationDOI
EmbaseOral medicinal cannabinoids to relieve symptom burden in the palliative care of patients with advanced cancer: A double-blind, placebo controlled, randomised clinical trial of efficacy and safety of cannabidiol (CBD).2019https://dx.doi.org/10.1186/s12904-019-0494-6
Dimensions AIAn Open-Label Pilot Study Testing the Feasibility of Assessing Total Symptom Burden in Trials of Cannabinoid Medications in Palliative Care2019https://doi.org/10.1089/jpm.2019.0540
N.B. These documents automatically identified may not have been verified by the study sponsor.