Ropidoxuridine In Treating Patients With Advanced Gastrointestinal Cancer Undergoing Radiation Therapy

Study Overview

Ropidoxuridine in Treating Patients With Advanced Gastrointestinal Cancer Undergoing Radiation Therapy

This phase I trial studies the side effects and best dose of ropidoxuridine in treating patients with gastrointestinal cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment undergoing radiation therapy. Ropidoxuridine may help radiation therapy work better by making tumor cells more sensitive to the radiation therapy.

PRIMARY OBJECTIVES: I. To conduct a phase I dose escalation trial, to determine the safety and the maximum tolerated dose (MTD), of oral (po) IPdR (ropidoxuridine) given daily for 28 consecutive days with concurrent intensity-modulated radiation therapy (IMRT) in patients with advanced gastrointestinal cancers treated with palliative radiation. SECONDARY OBJECTIVES: I. To observe and record anti-tumor activity. II. To establish the pharmacokinetics of daily po dosing of IPdR x 28 days. III. To assess, for patients treated at the MTD, for biochemical evidence of IPdR effect in normal tissue (circulating granulocytes) and tumor tissue (in patients with accessible tumor tissue) by measuring %iododeoxyuridine (IUdR)-deoxyribonucleic acid (DNA) cellular incorporation by flow cytometry and high-pressure liquid chromatography (HPLC) analyses. IV. To assess the use of %IUdR-DNA cellular incorporation (measured by the investigational laboratory assays of flow cytometry and HPLC) as an exploratory biomarker of IPdR for the following effects: the %IUdR-DNA tumor cell incorporation from day 8 tumor biopsies in gastrointestinal (GI) cancer patients receiving MTD doses of IPdR as an exploratory biomarker of tumor radiosensitization using Response Evaluation Criteria in Solid Tumors (RECIST) criteria. V. To assess the use of %IUdR-DNA cellular incorporation (measured by the investigational laboratory assays of flow cytometry and HPLC) as an exploratory biomarker of IPdR for the following effects: the %IUdR-DNA cellular incorporation in patients' circulating granulocytes taken weekly during the 28-day IPdR MTD dose, on day 29, and week 8 as an exploratory biomarker of IPdR systemic toxicities to bone marrow as measured by complete blood count (CBC)/differential values. OUTLINE: This is a dose-escalation study of ropidoxuridine. Beginning 30 minutes to 2 hours before radiation therapy, patients receive ropidoxuridine PO once daily (QD) on days 1-28 in the absence of disease progression or unacceptable toxicity. Beginning on day 8, patients undergo IMRT 5 days a week for 3 weeks in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up for 4 weeks.

Advanced Bile Duct Carcinoma
Stage II Esophageal Cancer AJCC v7
Stage II Pancreatic Cancer AJCC v6 and v7
Stage IIA Esophageal Cancer AJCC v7
Stage IIA Pancreatic Cancer AJCC v6 and v7
Stage IIB Esophageal Cancer AJCC v7
Stage IIB Pancreatic Cancer AJCC v6 and v7
Stage III Colon Cancer AJCC v7
Stage III Esophageal Cancer AJCC v7
Stage III Gastric Cancer AJCC v7
Stage III Liver Cancer
Stage III Pancreatic Cancer AJCC v6 and v7
Stage III Rectal Cancer AJCC v7
Stage III Small Intestinal Cancer AJCC v7
Stage IIIA Colon Cancer AJCC v7
Stage IIIA Esophageal Cancer AJCC v7
Stage IIIA Gastric Cancer AJCC v7
Stage IIIA Rectal Cancer AJCC v7
Stage IIIA Small Intestinal Cancer AJCC v7
Stage IIIB Colon Cancer AJCC v7
Stage IIIB Esophageal Cancer AJCC v7
Stage IIIB Gastric Cancer AJCC v7
Stage IIIB Rectal Cancer AJCC v7
Stage IIIB Small Intestinal Cancer AJCC v7
Stage IIIC Colon Cancer AJCC v7
Stage IIIC Esophageal Cancer AJCC v7
Stage IIIC Gastric Cancer AJCC v7
Stage IIIC Rectal Cancer AJCC v7
Stage IV Colon Cancer AJCC v7
Stage IV Esophageal Cancer AJCC v7
Stage IV Gastric Cancer AJCC v7
Stage IV Liver Cancer
Stage IV Pancreatic Cancer AJCC v6 and v7
Stage IV Rectal Cancer AJCC v7
Stage IV Small Intestinal Cancer AJCC v7
Stage IVA Colon Cancer AJCC v7
Stage IVA Liver Cancer
Stage IVA Rectal Cancer AJCC v7
Stage IVB Colon Cancer AJCC v7
Stage IVB Liver Cancer
Stage IVB Rectal Cancer AJCC v7

RADIATION: Intensity-Modulated Radiation Therapy
OTHER: Laboratory Biomarker Analysis
OTHER: Pharmacological Study
DRUG: Ropidoxuridine

NCI-2015-00258
NCI-2015-00258 (REGISTRY Identifier) (REGISTRY: CTRP (Clinical Trial Reporting Program))
BRUOG 265
9882 (OTHER Identifier) (OTHER: Rhode Island Hospital)
9882 (OTHER Identifier) (OTHER: CTEP)

Study Record Dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Registration Dates	Results Reporting Dates	Study Record Updates
First Submitted 2015-03-05	Results First Submitted N/A	Last Update Submitted that met QC Criteria 2025-09-16
First Submitted that Met QC Criteria 2015-03-05	Results First Submitted that Met QC Criteria N/A	Last Update Posted (ESTIMATED) 2025-09-17
First Posted (ESTIMATED) 2015-03-06	Results First Posted N/A	Last Verified 2025-09

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

Design Details

Primary Purpose:
Treatment

Allocation:
Na

Interventional Model:
Single Group

Masking:
None

Arms and Interventions

Participant Group/Arm	Intervention/Treatment
EXPERIMENTAL: Treatment (ropidoxuridine, IMRT) Beginning 30 minutes to 2 hours before radiation therapy, patients receive ropidoxuridine PO QD on days 1-28 in the absence of disease progression or unacceptable toxicity. Beginning on day 8, patients undergo IMRT 5 days a week for 3 weeks in the absence	RADIATION: Intensity-Modulated Radiation Therapy Undergo IMRT OTHER: Laboratory Biomarker Analysis Correlative studies OTHER: Pharmacological Study Correlative studies DRUG: Ropidoxuridine Given PO

Participant Group/Arm

Intervention/Treatment

EXPERIMENTAL: Treatment (ropidoxuridine, IMRT)

Beginning 30 minutes to 2 hours before radiation therapy, patients receive ropidoxuridine PO QD on days 1-28 in the absence of disease progression or unacceptable toxicity. Beginning on day 8, patients undergo IMRT 5 days a week for 3 weeks in the absence

RADIATION: Intensity-Modulated Radiation Therapy

Undergo IMRT

OTHER: Laboratory Biomarker Analysis

Correlative studies

OTHER: Pharmacological Study

Correlative studies

DRUG: Ropidoxuridine

Given PO

Primary Outcome Measures	Measure Description	Time Frame
Maximum tolerated dose (MTD) defined as the dose below which 2 or more of 6 patients experience dose-limiting toxicity		Up to 28 days

Secondary Outcome Measures	Measure Description	Time Frame
%iododeoxyuridine (IUdR)-deoxyribonucleic acid (DNA) incorporation in tumor biopsies	Correlate %IUdR-DNA incorporation in human gastrointestinal (GI) tumor biopsies in the proposed phase I and pharmacokinetic (PK) clinical trial in GI cancer patients receiving palliative abdominal and/or pelvic radiation therapy (RT) by linear regression.	Up to 2 weeks
Pharmacokinetic (PK) incorporation in tumor biopsies	Correlate %IUdR-DNA incorporation in human GI tumor biopsies in the proposed phase I and PK clinical trial in GI cancer patients receiving palliative abdominal and/or pelvic RT by linear regression.	Days 1, 15 and 22 before drug administration, at 30, 60, 120, and 240 minutes (and 24 hours on day 1 only) following drug administration
%iododeoxyuridine (IUdR)-deoxyribonucleic acid (DNA) incorporation in peripheral (circulating) granulocytes	Correlate %IUdR-DNA incorporation in human GI tumor biopsies in the proposed phase I and PK clinical trial in GI cancer patients receiving palliative abdominal and/or pelvic RT by linear regression.	Up to 4 weeks after completion of study treatment
Pharmacokinetic (PK) incorporation in peripheral (circulating) granulocytes	Correlate %IUdR-DNA incorporation in human GI tumor biopsies in the proposed phase I and PK clinical trial in GI cancer patients receiving palliative abdominal and/or pelvic RT by linear regression.	Days 1, 15 and 22 before drug administration, 30, 60, 120, and 240 minutes (and 24 hours on day 1 only) following drug administration
Tumor response relationship to the %iododeoxyuridine (IUdR)-deoxyribonucleic acid (DNA) incorporation using Response Evaluation Criteria in Solid Tumors (RECIST) criteria based on high-pressure liquid chromatography (HPLC) and flow cytometry measurements	Tumor response is the dependent variable and can be binomial (i.e. response versus [vs.] no response) or multinomial (i.e. complete response, partial response, stable disease or progressive disease) and the %IUdR-DNA incorporation is the independent variable.	Day 8

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person’s general health condition or prior treatments.

Ages Eligible for Study:
ALL

Sexes Eligible for Study:
18 Years

Accepts Healthy Volunteers:

Patients must have histologically or cytologically confirmed advanced, incurable cancers of the esophagus, liver, stomach, small bowel, pancreas, bile duct, colon or rectum and be eligible to receive chest, abdominal and/or pelvic radiation therapy (RT) for palliation; documentation of this is required in physician note; concomitant systemic therapy is not allowed during administration of palliative RT; palliative RT can be considered for advanced primary tumors or metastatic disease as above
Patients must not have received systemic chemotherapy for at least 4 weeks, and must not have received prior radiation therapy to the tumor site being irradiated on this study
Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
Life expectancy of greater than 12 weeks
Leukocytes >= 3,000/mcL
Absolute neutrophil count >= 1,500/mcL
Platelets >= 100,000/mcL
Total bilirubin within normal institutional limits
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional upper limit of normal
Creatinine within normal institutional limits OR creatinine clearance >= 60 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal
Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately; men and women treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 4 months after completion of IPdR administration
Ability to understand and the willingness to sign a written informed consent document
Human immunodeficiency virus (HIV) positive (+) patients with cluster of differentiation 4 (CD4) counts >= 250 cells/mm^3 on anti-viral therapy
Women of child-bearing potential must have a negative pregnancy test

Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
Patients who are receiving any other investigational agents
Patients with known brain metastases should be excluded from this clinical trial
History of allergic reactions attributed to compounds of similar chemical or biologic composition to IPdR
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Pregnant women are excluded from this study; breastfeeding should be discontinued if the mother is treated with IPdR

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Investigators

PRINCIPAL_INVESTIGATOR: Timothy J Kinsella, Rhode Island Hospital

Publications

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General Publications

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Clinical Trial Record