The primary objective of this study is to evaluate the safety of Autologous Muscle Derived Cells for Gastro-Intestinal Repair (AMDC-GIR) during the 12 months following treatment of tongue dysphagia in male and female patients who have undergone surgery and/or chemo- and/or radiotherapy for squamous cell cancer of the oropharynx.
This preliminary, prospective, dose escalating clinical study will evaluate the safety and potential efficacy of Autologous Muscle Derived Cells for Gastro-Intestinal Repair (AMDC-GIR) for the treatment of tongue dysphagia (TD) that develops following treatment for head and neck cancer. Surgery, chemo- and radiotherapy can induce significant TD resulting in long-term TD. Therefore, augmenting tongue muscle function may be beneficial to patients. Autologous muscle cell therapy, which involves isolation of cells from skeletal muscle biopsies, ex vivo expansion, and subsequent injection into the tongue, may serve as a potential durable therapy. In animal studies, muscle derived cells have successfully integrated within tissue to improve tongue strength and function. Intramuscular injection of AMDC-GIR is expected to produce localized tissue changes near the injection site and is not expected to produce a systemic effect. Patients will receive a single treatment intramuscular injection of 1 of 2 doses of AMDC-GIR. Patients will have quantitative and qualitative measures of dysphagia assessed before treatment and at various times after treatment. The study will treat up to 20 patients at 1 clinical site. Enrollment is expected to be completed within 2 years of initiating the study. Patients will be followed for 24 months post-treatment. The first 3 patients at each dose must reach 1-month follow-up before subsequent patients can be treated. Male and female patients at least 18 years of age who have undergone surgery and/or chemo- and or radiotherapy for primary treatment of oropharyngeal squamous cell cancer and who present with symptoms and findings of TD will be eligible for participation. Eligible patients will have muscle tissue harvested using a needle biopsy technique during an outpatient procedure. The harvested muscle tissue will be transported to the manufacturer for cell processing. The muscle derived cells (MDC) will be isolated and expanded in culture over several weeks. After reaching the desired concentration, the isolated and expanded AMDC-GIR will be frozen and shipped back to the investigating physician. The physician will thaw the AMDC-GIR and dilute the sample with an approximately equal volume of physiological saline. Under direct vision, the resulting suspension will be injected into the patient's tongue in a brief outpatient procedure. Patients will be assessed for improvement in TD symptoms at 3 months, 6 months, 12 months and 24 months following treatment. Adverse events will be assessed at those visits, as well as during follow-up calls at 1-2 days, 1 week, 15 months, 18 months and 21 months.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
18
Autologous muscle derived stem cells
UC Davis Medical Center, Department of Otolaryngology, Head and Neck Surgery
Sacramento, California, United States
Study product-related Serious Adverse Events (SAEs)
Evaluate the safety of AMDC-GIR following treatment of tongue dysphagia
Time frame: 24 months
Study product-related, biopsy procedure-related, and injection procedure-related adverse events
Safety will be determined by the frequency and severity of adverse events related to study procedures and study product
Time frame: 24 months
Penetration-Aspiration scale rating from swallowing fluoroscopy
Efficacy of AMDC-GIR in the improvement of objective fluoroscopic swallowing parameters
Time frame: 24 months
Pharyngeal Constriction Ratio measurement from swallowing fluoroscopy
Efficacy of AMDC-GIR in the improvement of objective fluoroscopic swallowing parameters
Time frame: 24 months
Upper Esophageal Sphincter opening measurement from swallowing fluoroscopy
Efficacy of AMDC-GIR in the improvement of objective fluoroscopic swallowing parameters
Time frame: 24 months
Pharyngeal transit time measurement from swallowing fluoroscopy
Efficacy of AMDC-GIR in the improvement of objective fluoroscopic swallowing parameters
Time frame: 24 months
Peak pharyngeal pressure measurement from high-resolution manometry
Efficacy of AMDC-GIR in the improvement of objective manometric swallowing parameters
Time frame: 24 months
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Anterior tongue pressure measurement from Iowa Oral Performance Instrument (IOPI)
Efficacy of AMDC-GIR in the improvement of objective Anterior Tongue Pressure Measurement (IOPI)
Time frame: 24 months
Patient-reported dysphagia symptoms based on Eating Assessment Tool- EAT10 score
Effect of AMDC-GIR on patient-reported dysphagia symptoms \[Eating Assessment Tool- EAT10\]
Time frame: 24 months
Patient-reported quality of life based on SF-12 survey score
Effect of AMDC-GIR on patient-reported dysphagia symptoms quality of life (QOL) \[SF-12\]
Time frame: 24 months
Patient-reported voice symptoms based on Voice Handicap Index - VHI10 score
Effect of AMDC-GIR on patient-reported dysphagia symptoms and voice symptoms \[Voice Handicap Index - VHI10\]
Time frame: 24 months