Kumar Nagi B, Pow-Sang Julio, Spiess Philippe E, Park Jong, Salup Raoul, Williams Christopher R, Parnes Howard, Schell Michael J
H. Lee Moffitt Cancer Center & Research Institute, Inc., Cancer Epidemiology, Tampa, FL 33612-9497, USA.
H. Lee Moffitt Cancer Center & Research Institute, Inc., Genitourinary Oncology, Tampa, FL 33612-9497, USA.
Oncotarget. 2016 Oct 25;7(43):70794-70802. doi: 10.18632/oncotarget.12222.
Although preclinical, epidemiological and prior clinical trial data suggest that green tea catechins (GTCs) may reduce prostate cancer (PCa) risk, several preclinical studies and case reports have reported liver toxicities and acute gastrointestinal bleeding. Based on these observations, regulatory bodies have required stringent inclusion criteria with frequent, excessive toxicity monitoring and early stopping rules in clinical trials. These requirements have impeded recruitment and retention of subjects in chemoprevention trials and subsequent progress in agent development efforts.
We conducted a placebo-controlled, randomized clinical trial of Polyphenon E® (PolyE®), a proprietary mixture of decaffeinated GTCs, containing 400 mg (-)-epigallocatechin-3-gallate (EGCG) per day, in 97 men with high-grade prostatic intraepithelial neoplasia (HGPIN) and/or atypical small acinar proliferation (ASAP). PolyE® containing 200 mg EGCG was administered with food, BID. A secondary study endpoint in this trial was a comparison of the overall one-year treatment related adverse events and grade 3 or higher adverse event on the two study arms. Monthly assessments of toxicity (CTCAE 4.0), concomitant medications and organ function, including hepatic panel, PT/PTT and LDH, were performed.
Daily intake of a standardized, decaffeinated, catechin mixture containing 200 mg EGCG BID taken with food for 1 year accumulated in plasma and was well tolerated and did not produce treatment related adverse effects in men with baseline HGPIN or ASAP.
The current data provides evidence of safety of decaffeinated, catechin mixture containing 200 mg EGCG BID to be further tested for prostate cancer prevention or other indications.
尽管临床前、流行病学及既往临床试验数据表明,绿茶儿茶素(GTCs)可能降低前列腺癌(PCa)风险,但多项临床前研究及病例报告显示其存在肝脏毒性及急性胃肠道出血。基于这些观察结果,监管机构要求在临床试验中采用严格的纳入标准,频繁进行过度的毒性监测及早期终止规则。这些要求阻碍了化学预防试验中受试者的招募与留存,以及后续药物研发工作的进展。
我们开展了一项安慰剂对照的随机临床试验,对97名患有高级别前列腺上皮内瘤变(HGPIN)和/或非典型小腺泡增生(ASAP)的男性,给予含400毫克(-)-表没食子儿茶素-3-没食子酸酯(EGCG)的脱咖啡因GTCs专利混合物Polyphenon E®(PolyE®)。含200毫克EGCG的PolyE®与食物同服,每日两次。该试验的次要研究终点是比较两个研究组的总体一年治疗相关不良事件及3级或更高等级不良事件。每月进行毒性评估(CTCAE 4.0)、伴随用药及器官功能评估,包括肝功能检查、PT/PTT及LDH。
每日两次随食物服用含200毫克EGCG的标准化脱咖啡因儿茶素混合物,持续1年,其在血浆中蓄积,耐受性良好,且在基线为HGPIN或ASAP的男性中未产生治疗相关不良反应。
目前的数据提供了含200毫克EGCG的脱咖啡因儿茶素混合物每日两次安全性的证据,有待进一步针对前列腺癌预防或其他适应症进行测试。