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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04368546
Other study ID # ChariteU-ECRC-TSS2
Secondary ID EA1/044/15
Status Completed
Phase
First received
Last updated
Start date November 1, 2015
Est. completion date March 1, 2020

Study information

Verified date January 2021
Source Charite University, Berlin, Germany
Contact n/a
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Here, it is investigated how sunitinib, a tyrosine kinase-inhibitor targeting vascular endothelial growth factor receptors, might influence sodium homeostasis in the skin and if this is related to a well-described treatment side-effect of sunitinib, hypertension.


Description:

Tyrosine kinases-inhibitors targeting vascular endothelial growth factor (VEGF)-receptors (RTKIs) are increasingly used in oncology in several metastatic tumor types. These agents are featured by toxicities including hypertension. According to a new insight, sodium in response to a high dietary sodium intake, is accumulated in a hyperosmolar way in the interstitial compartment. In response to this high sodium concentration cells of the mononuclear phagocytic system (MPS) are activated resulting in an increased production of VEGF-C, activation of VEGF type 3 receptors and formation of a lymphatic capillary network, involved in clearance of interstitial sodium. Blockade of stimulation of VEGF-C receptors or depletion of MPS cells in rodents has been associated with salt-sensitive hypertension. Sunitinib is an orally-active, multitarget RTKI mainly used for the treatment of patients with metastatic renal cancer and imatinib-resistant gastrointestinal stromal tumors. Sunitinib blocks all three VEGF receptors subtypes, including VEGF-receptor type 3. The investigators hypothesize that treatment of patients with sunitinib is associated with tissue sodium accumulation and this accumulation contributes to the rise in blood pressure. Tissue sodium is measured by using a newly developed 23Na magnetic resonance-imaging (MRI) technique which allows a non-invasive and contrast agent-free sodium content measurement in the muscle and skin of the lower leg.


Recruitment information / eligibility

Status Completed
Enrollment 6
Est. completion date March 1, 2020
Est. primary completion date February 1, 2019
Accepts healthy volunteers Accepts Healthy Volunteers
Gender Male
Age group 18 Years to 70 Years
Eligibility Inclusion Criteria: - Age men > 18 years - Life-expectation > 3 months - Stable weight - Blood pressure below 140/90 mmHg at baseline - Estimated glomerular filtration rate > 45 ml/min/1.73m2 - Willingness to give written informed consent Exclusion Criteria: - Heart failure - Liver disease with ascites - Nephrotic syndrome - Gastrointestinal complaints, preventing normal daily food intake or diarrhea - Any form of diabetes mellitus - Known autoimmune diseases - Acute or chronic infection - Alcohol or substance abuse

Study Design


Intervention

Drug:
Sunitinib


Locations

Country Name City State
Germany Experimental and Clinical Research Center, Clinical Research Unit Berlin

Sponsors (2)

Lead Sponsor Collaborator
Charite University, Berlin, Germany German Heart Institute

Country where clinical trial is conducted

Germany, 

References & Publications (4)

Kandula P, Agarwal R. Proteinuria and hypertension with tyrosine kinase inhibitors. Kidney Int. 2011 Dec;80(12):1271-7. doi: 10.1038/ki.2011.288. Epub 2011 Sep 7. Review. — View Citation

Kappers MH, van Esch JH, Sluiter W, Sleijfer S, Danser AH, van den Meiracker AH. Hypertension induced by the tyrosine kinase inhibitor sunitinib is associated with increased circulating endothelin-1 levels. Hypertension. 2010 Oct;56(4):675-81. doi: 10.1161/HYPERTENSIONAHA.109.149690. Epub 2010 Aug 23. — View Citation

Kopp C, Linz P, Dahlmann A, Hammon M, Jantsch J, Müller DN, Schmieder RE, Cavallaro A, Eckardt KU, Uder M, Luft FC, Titze J. 23Na magnetic resonance imaging-determined tissue sodium in healthy subjects and hypertensive patients. Hypertension. 2013 Mar;61(3):635-40. doi: 10.1161/HYPERTENSIONAHA.111.00566. Epub 2013 Jan 21. — View Citation

Machnik A, Neuhofer W, Jantsch J, Dahlmann A, Tammela T, Machura K, Park JK, Beck FX, Müller DN, Derer W, Goss J, Ziomber A, Dietsch P, Wagner H, van Rooijen N, Kurtz A, Hilgers KF, Alitalo K, Eckardt KU, Luft FC, Kerjaschki D, Titze J. Macrophages regulate salt-dependent volume and blood pressure by a vascular endothelial growth factor-C-dependent buffering mechanism. Nat Med. 2009 May;15(5):545-52. doi: 10.1038/nm.1960. Epub 2009 May 3. — View Citation

Outcome

Type Measure Description Time frame Safety issue
Primary Skin sodium Changes in sodium content measured by 23Na magnetic resonance-imaging (MRI) technique 3 months (before, 4 weeks on, 2 weeks off and 4 weeks on medication)
Secondary Plasma VEGF-C Concentration of VEGF-C in patients plasma 3 months (before, 4 weeks on, 2 weeks off and 4 weeks on medication)
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