Artesunate Suppositories for the Treatment of HIV-negative Patients With Intra-anal HSIL

Study Overview
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Brief Summary
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This is a phase II double blind, placebo-controlled, randomized study of Artesunate suppositories for the treatment of HIV-negative men and women who have anal high grade squamous intraepithelial lesions (anal HSIL)

Detailed Description
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Eligible participants in this study are randomized 2:1 to receive either artesunate or placebo suppositories for the treatment of anal HSIL. Both groups receive four 5-day cycles of suppositories, at weeks 0, 2, 4, and 6. At least two of the dosing visits are done in person. The remaining dosing visits may be done as telehealth visits (suppositories are mailed to the patient's home). Participants are followed closely with anoscopy or high resolution anoscopy (HRA) at weeks 8, 18, 30, and 42. After the week 18 HRA visit, participants who have at least partial response will be followed with HRA at week 30. Participants who are found to be non-responders at week 18 will undergo standard of care ablation. Participants who are found to have anal HSIL at weeks 30 or 42 will be followed according to standard of care procedures. Primary Objective: To evaluate the complete and partial histopathologic response to four 5-day cycles of artesunate suppositories in adult patients with biopsy-proven HPV-associated intra-anal HSIL (18 weeks). Secondary Objectives: Efficacy: To evaluate the viral clearance after four 5-day cycles of artesunate suppositories in adults with biopsy-proven HPV-associated intra-anal anal HSIL over the study window (42 weeks) To evaluate complete and partial intra-anal histopathologic response after the week 18 time point but over the study window (30 weeks). To evaluate complete and partial peri-anal histopathologic response following artesunate suppositories over the course of the study (42 weeks). To evaluate persistence of response throughout the study window (42 weeks) Safety: To evaluate the safety of artesunate suppositories for the treatment of intra-anal HSIL.

Official Title
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A Phase II Double Blind, Placebo-controlled, Randomized Trial of Artesunate Suppositories for the Treatment of HIV-negative Patients With Anal High-grade Squamous Intraepithelial Lesions (Anal HSIL)

Conditions
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HPV Infection, Anal Dysplasia, HPV Disease, Anal High Grade Squamous Intraepithelial Lesion, Anal Precancerous Condition, AIN 2/3

Intervention / Treatment
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* Drug: Artesunate
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult men and women age ≥ 18 years Capable of informed consent Biopsy-confirmed intra-anal high-grade dysplasia (AIN 2, AIN 3, anal HSIL) by HRA. Patients must have residual anal HSIL lesions after diagnostic biopsies, as documented by HRA. This includes patients who are newly diagnosed with anal HSIL as well as those who have recurrent anal HSIL after medical therapy or surgical therapy. Patients who have intra-anal HSIL and also have peri-anal HSIL may be enrolled in the study. Women of childbearing potential agree to use birth control for the duration of the study. Laboratory values at Screening of: Serum alanine transaminase (SGPT/ALT) < 5 x upper limit of normal (ULN) Serum aspartate transaminase (SGOT/AST) < 5 x ULN Serum Bilirubin (total) < 2.5 x ULN Serum Creatinine ≤ 1.5 x ULN Electrocardiogram (ECG) with no clinically significant findings as assessed by the Investigator. Weight ≥ 50kg Exclusion Criteria: Pregnant and nursing women Diagnosis of low-grade anal dysplasia (AIN 1, LSIL), without the concomitant diagnosis of anal HSIL, by HRA Concurrent anal, vulvar, cervical, or penile cancer HIV seropositivity Currently receiving systemic chemotherapy or radiation therapy for another cancer. Patients who are on medical treatment with systemic immunosuppressants or steroids (e.g., active autoimmune disease) Concomitant use of strong Uridine glucuronyl transferases (UGT) inhibitors Concomitant use of imiquimod or 5-fluorouracil (5-FU) for the duration of the study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Double blind, placebo controlled randomized trial
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Artesunate suppositories<br>Four 5-day cycles of artesunate suppositories | Drug: Artesunate<br>* artesunate formulated as intra-anal suppositories<br>* Other names: artemisinin;|
| Placebo Comparator: Placebo suppositories<br>Four 5-day cycles of placebo suppositories | Drug: Placebo<br>* placebo intra-anal suppository<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of subjects with complete and partial response by week 18 | Number of participants who achieve complete or partial response after 4 5-day cycles of artesunate as determined by HRA-directed biopsy(ies) | 18 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of participants who have achieved clearance of detectable human papilloma virus (HPV) over the study window | Number of participants who had HPV strains detected at study entry which become undetectable within the study window | 42 weeks | 
| Number of participants with complete and partial response after week 18 but over the study window | Number of participants who achieve complete or partial response after week 18, as documented by HRA-directed biopsy(ies) | 30 weeks | 
| Number of participants who achieve complete and partial response of peri-anal HSIL, following 4 cycles of intra-anal artesunate suppositories, as determined by HRA-directed biopsy | Number of participants who had both peri-anal and intra-anal HSIL, whose peri-anal HSIL achieves complete or partial response following 4 cycles of intra-anal artesunate suppositories | 42 weeks | 
| Number of participants who undergo complete response who maintain their response over the study window | Number of participants who complete or partial response who maintain this response over the study window | 42 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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human papillomavirus, non-surgical, topical treatment, anal HSIL, anal cancer prevention, treatment study, cancer prevention, high-risk HPV, HPV16, suppository