This will be a proof-of-concept, single arm study with a maximum of 20 patients to evaluate preliminary analgesic efficacy and safety of Trichomylin® in patients with advanced cancer (male and female) who suffer from moderate to severe chronic pain and who are taking a stable dose of long-acting opioid therapy for at least 1 week prior to screening.
This study will consist of a screening visit, treatment, and safety follow-up period. There will be an initial patient determined titration phase, using escalated doses of Investigational Product, to reach a dose that achieves symptom relief with tolerable side effects. Each capsule of Trichomylin® contains a fixed ratio of 5 mg delta-9-tetrahydrocannabinol: 5 mg cannabidiol: 5 mg cannabichromene. Participants can titrate up to a maximum of 2 capsules twice daily (total of 4 capsules). This will be followed by a 5 day assessment period of the stable dose determined in collaboration with clinicians.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
Cancer patients meeting eligibility criteria will receive Trichomylin® and self-titrate to effective dose.
CancerCare Manitoba
Winnipeg, Manitoba, Canada
RECRUITINGCentre hospitalier de l'Université de Montréal
Montreal, Quebec, Canada
RECRUITINGThe Research Institute of the McGill University Health Centre
Montreal, Quebec, Canada
RECRUITINGNumber of Participants That Reach the Stable Dose during Dose Titration
Investigational Product will be titrated up incrementally until participants achieve their "optimal dose" that achieves symptom relief with tolerable side effects or to a maximum of 2 capsules twice daily. Once participants have had 2 full days (at minimum) of treatment at this dosage, this will then be considered their "stable dose".
Time frame: Baseline (i.e. Day 1 Dose Titration) and Stable Dose Day 1, up to 14 days
Change in Average Pain Scores from Baseline to Investigational Product Discontinuation
The Brief Pain Inventory Short Form (BPI-SF) is a standardized scale used for capturing participant reported symptom assessments related to pain severity and the resulting functional interference caused by pain. The BPI-SF has a numerical rating scale used by participants to indicate their level of pain. Participants are asked to assign a number that best describes their pain on average from 0 = no pain, to 10 = pain as bad as you can imagine, at the same time every day during the Screening period (Day -7 to Day -1) and enter this number in response to the BPI-SF Question #5 on the evaluation form.
Time frame: Baseline and Investigational Product Discontinuation, up to 23 days
Proportion of Responders to Average Pain from Baseline to Investigational Product Discontinuation
Average pain as entered in response to the BPI-SF Question #5, where response is defined as having a baseline of ≥30% from baseline at the Investigational Product discontinuation visit.
Time frame: Baseline and Investigational Product Discontinuation, up to 23 days
Number of Participants That Reach the Stable Dose during Dose Titration and Respond to Average Pain from Baseline to Investigational Product Discontinuation
Participants have reached their "stable dose" and respond to average pain as entered in response to the BPI-SF Question #5, where response is defined as having a baseline of ≥30% from baseline at the Investigational Product discontinuation visit.
Time frame: Baseline and Investigational Product Discontinuation, up to 23 days
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Change in Average Pain from Baseline to End of the Titration
Average pain as entered in response to the BPI-SF Question #5.
Time frame: Baseline and End of Dose Titration, up to 14 days
Change in Pain Interference from Baseline to End of the Titration
Pain interference is scored as the mean of the seven interference items and entered in response to the BPI-SF Question #9.
Time frame: Baseline and End of DoseTitration, up to 14 days
Change in Pain Interference from Baseline to Investigational Product Discontinuation
Pain interference as entered in response to the BPI-SF Question #9.
Time frame: Baseline and Investigational Product Discontinuation, up to 23 days
Incidence of Treatment Emergent Adverse Events
The severity of an adverse events (AE) is graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) v5.0 (NCI 2017). The incidence of AEs will be presented as the number (percentage) of participants with treatment emergent adverse events (TEAEs) by system organ class and Preferred Term using the most current Medical Dictionary for Regulatory Activities (MedDRA) available at the time of study commencement.
Time frame: Baseline and End of Safety Follow-Up, up to 56 days
Incidence of Serious Adverse Events
The incidence of serious adverse events (SAE) will be presented as the number (percentage) of participants with SAEs by system organ class and Preferred Term using the most current Medical Dictionary for Regulatory Activities (MedDRA) available at the time of study commencement.
Time frame: Baseline and End of Safety Follow-Up, up to 56 days
Incidence of Adverse Events of Special Interest
The incidence of adverse events of special interest (AESI) will be presented as the number (percentage) of participants with AESIs by system organ class and Preferred Term using the most current Medical Dictionary for Regulatory Activities (MedDRA) available at the time of study commencement.
Time frame: Baseline and End of Safety Follow-Up, up to 56 days
Incidence of Adverse Events leading to Discontinuation of Study Treatment
The incidence of adverse events (AE) leading to discontinuation of study treatment will be presented as the number (percentage) of participants with AEs by system organ class and Preferred Term using the most current Medical Dictionary for Regulatory Activities (MedDRA) available at the time of study commencement.
Time frame: Baseline and End of Safety Follow-Up, up to 56 days
Change in Electrocardiogram From Baseline to Investigational Product Discontinuation
A triplicate 12-lead electrocardiogram (ECG) will be obtained using an ECG machine that automatically calculates the heart rate and measures PR, QRS, QT, and \[QTc\] intervals.
Time frame: Baseline and Investigational Product Discontinuation, up to 23 days
Change in Brief Pain Inventory Short Form from Baseline to Investigational Product Discontinuation
The BPI-SF is a standardized scale used for capturing participant reported symptom assessments related to pain severity and the resulting functional interference caused by pain. The BPI-SF has a numerical rating scale used by participants to indicate their level of pain.
Time frame: Baseline and Investigational Product Discontinuation, up to 23 days
Proportion of responders in Brief Pain Inventory Short Form from Baseline to Investigational Product Discontinuation
The BPI-SF is a standardized scale used for capturing participant reported symptom assessments related to pain severity and the resulting functional interference caused by pain. The BPI-SF has a numerical rating scale used by participants to indicate their level of pain. Response is defined as having a decrease in pain from baseline by ≥30% at the Investigational Product discontinuation visit.
Time frame: Baseline and Investigational Product Discontinuation, up to 23 days
Change in Depression, Anxiety and Stress Scale - 21 Items from Baseline to Investigational Product Discontinuation
The Depression, Anxiety and Stress Scale- 21 Items (DASS-21) is a set of three self-report scales designed to measure the emotional states of depression, anxiety and stress. By examining these subscales separately, DASS-21 provides a comprehensive picture of an individual's emotional state, aiding therapists, and researchers in identifying the primary areas of concern.
Time frame: Baseline and Investigational Product Discontinuation, up to 23 days
Change in Quality of Life and Functional Status from Baseline to Investigational Product Discontinuation
The European Organization for Research and Treatment of Cancer core Quality of Life (EORTC QLQ-C30) is designed to measure cancer patients' physical, psychological, and social functions. The questionnaire is composed of multi-item scales and single items (Version 3.0).
Time frame: Baseline and Investigational Product Discontinuation, up to 23 days
Change in Subjective Measures of Symptom Change from Baseline to Investigational Product Discontinuation
The Patient Global Impression of Change (PGIC) is a subjective measure of symptom change. Participants rate their change on a 7-point scale that ranges from "very much improved" to "very much worse", with "no-change" as the mid-point.
Time frame: Baseline and Investigational Product Discontinuation, up to 23 days
Use of Oral Morphine Equivalents from Baseline to Investigational Product Discontinuation
Rescue analgesia requirements, specifically use of opioid medications, both prescription and over the counter (OTC), will be documented at baseline and for the duration of the study. Opioid medications will be converted to morphine equivalent doses (MEDD) for comparison and evaluation purposes.
Time frame: Baseline and Investigational Product Discontinuation, up to 23 days