This phase I/II trial is studying the side effects and best dose of gene therapy and to see how well it works in preventing cancer in patients with premalignant carcinoma of the oral cavity or pharynx. Inserting the p53 gene into a person's tumor cells may improve the body's ability to kill the tumor cells
OBJECTIVES: I. Determine the acute toxic effects of Ad5CMV-p53 gene administered as an oral rinse and as an intramucosal injection in patients with diffuse premalignant carcinoma of the oral cavity or oral pharynx. II. Determine the maximum tolerated dose of this drug in these patients. III. Determine the topical transduction efficiency of adenoviral-mediated wild type p53 gene transfer in patients treated with this drug. IV. Determine the efficacy of this drug in reversing the histology of oral premalignancies in these patients. V. Determine the distribution of transgenic protein within the area of the premalignant lesion in patients treated with this drug. OUTLINE: This is an open-label, dose-escalation study of Ad5CMV-p53 gene administered as an oral rinse. Phase I: Patients receive Ad5CMV-p53 gene by intramucosal injection into the area of the lesion followed at least 2 hours later by Ad5CMV-p53 gene as an oral rinse on day 1. Patients then receive Ad5CMV-p53 gene as an oral rinse twice daily on days 2-5. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of Ad5CMV-p53 gene as an oral rinse until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Phase II: Patients receive treatment with intramucosal Ad5CMV-p53 gene as in phase I and Ad5CMV-p53 gene as an oral rinse at the MTD. Patients are followed every 3 months for 1 year, every 6 months for 1 year, and then annually for 3 years. Patients then receive long-term follow-up annually for an additional 10 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
51
Given intramucosally or as oral rinse
Correlative studies
M D Anderson Cancer Center
Houston, Texas, United States
Frequency of adverse events
Time frame: Up to 15 years
Severity of adverse events graded using the CTCAE version 3.0
Time frame: Up to 15 years
Maximum tolerated dose of Ad5CMV-p53 gene
Evaluated by the frequency and relationship of dose-limiting toxicities, if any, experienced by patients during dose escalation.
Time frame: 6 months
Pharmacodynamics evaluated by examining the injected precancerous lesion for induction of apoptosis and expression of the p53 protein
Presented using descriptive statistics, frequency tabulations, and graphical displays over time by treatment cohort.
Time frame: 168 days
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