Conditions: Anxiety Disorder Cancer
Keywords: MDMA cancer anxiety psychotherapy quality of life
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 2
Healthy volunteers: no

Brief summary:
This is a pilot study intended to find out if 3,4-methylenedioxymethamphetamine (MDMA) is safe and can help people with advanced stage cancer and anxiety arising from the cancer diagnosis.

Detailed description:
People who learn they have cancer can feel frightened, upset and depressed, and a diagnosis of advanced stage cancer can generate intense anxiety. People with advanced stage cancer may be anxious about their deteriorating health and the nearness of death, disruption in their close relationships caused by current or future changes in health, and grief for the life planned and expected prior to learning they had advanced stage cancer. There are treatments for reducing intense anxiety, such as Valium and related drugs, but these drugs have unwanted side effects that may be especially distressing for people already taking medication for pain control and seeking to remain clear-headed.

3,4-methylenedioxymethamphetamine (MDMA) is a drug that can produce effects uniquely suited to reducing anxiety for people with anxiety arising from a cancer diagnosis. MDMA has been hypothesized to belong to a class of drugs, called entactogens, that produce feelings of closeness to others, empathy, wellbeing, and insightfulness. Currently, MDMA is scheduled (illegal) and cannot be used outside of research studies like this one. However, prior to its being made illegal, some psychotherapists treated people with cancer or other terminal illnesses with MDMA-assisted psychotherapy, and they reported a reduction in anxiety and improved quality of life.

This study will examine the effects of MDMA-assisted psychotherapy in 12 people aged 18 or older who have received a diagnosis of advanced stage cancer (usually meaning inoperable and with metastases) who have anxiety as a result of this diagnosis that is either not helped by conventional anti-anxiety medication (such as Xanax or Valium), or who do not wish to take these medications because of their side effects. In Stage 1, all study subjects will receive an initial dose of MDMA followed by a second (supplemental) dose approximately two and a half hours later if the initial dose does not produce any problems. Eight of twelve study subjects will get 83.3 mg MDMA followed by 47.1 mg the first time, and 125 mg followed by 67.5 mg the second time. Four of twelve study subjects will receive 25 mg followed by 12.5 mg MDMA. Whether a person receives low doses or full doses of MDMA will be decided at random, as if by coin toss, and none of the researchers will know which dose of MDMA a person will get in Stage 1. The four subjects who received the lower doses of MDMA in Stage 1 may continue to participate into Stage 2 in which they repeat the study except that they will receive open-label 83.3 mg MDMA followed by 47.1 mg the first time, and 125 mg followed by 67.5 mg the second time. The eight participants in Stage 1 who had MDMA-assisted psychotherapy sessions at these higher dose strengths will not continue into Stage 2. The Stage 2 study extension will provide potential additional data on the MDMA doses being evaluated without having to recruit additional subjects.

For Stage 1, the study will last 14 weeks (about three and a half months). All study participants will have six (6) hour-long psychotherapy sessions and two (2) MDMA-assisted psychotherapy sessions lasting six to eight hours and requiring an overnight stay at the treatment facilities. The ordinary and MDMA-assisted sessions will be conducted by the same therapists. For the four subjects continuing into Stage 2, the study will last an additional 10 weeks (about two and a half months) with additional six (6) hour-long psychotherapy sessions and two (2) MDMA-assisted psychotherapy sessions lasting six to eight hours and requiring an overnight stay at the treatment facilities.

People enrolled in the study can continue taking anti-anxiety medications, but cannot take any other psychiatric medications for the entire course of the study. They can take their usual pain control medications, but if they take more pain control medications than usual on the day of the MDMA-assisted session, they may have to delay or reschedule the session. People enrolled in this study will complete questionnaires about their anxiety and quality of life, and they will keep a daily diary where they write down how much anxiety and pain control medication they are using, and a daily record of the amount of pain they experience.

Anxiety and quality of life will be measured at the start of the study, before each sessions of MDMA-assisted therapy, one week after receiving MDMA-assisted therapy and once at the end of the study, 84 days after a person started the study (approximately two months after the second MDMA-assisted psychotherapy session; for Stages 1 and 2). All study subjects will also receive a second medical examination 36 days after the study has begun (and again 36 days after starting Stage 2). The medical examination will be performed at the Lahey Clinic Medical Center's Medical Oncology department or at McLean Hospital.

Study participants will not be paid for taking part in the study. We will pay for all tests and measures used to determine study eligibility. Transportation, if needed, will also be paid for by the study. MDMA-assisted sessions require overnight stay at McLean Hospital: we will provide overnight accommodations and all meals and snacks for the subject and a significant support person of the subject's choosing on those days.

Arms:
arm 1: 8 subjects will receive full or nearly full doses of MDMA in Stage 1 and do not continue to participate into Stage 2. arm 2: 4 individuals will receive sub-threshold to threshold minimal doses of MDMA in Stage I arm 3: The 4 subjects assigned in Stage I to the control arm will have the option to continue into Stage 2 to repeat the experimental procedures of Stage I but with open-label MDMA at the near-full to full dosage strength.

Interventions: intervention 1: Stage 1 Active Methylenedioxymethamphetamine intervention 2: Stage 1 Low dose Methylenedioxymethamphetamine intervention 3: Psychotherapy intervention 4: Stage 2 Active Methylenedioxymethamphetamine
Intervention descriptions: intervention 1: Dosage form: capsule

Dosage frequency and duration for the treatment arm (8 subjects in Stage 1 and the other 4 subjects in Stage 1 who may continue into Stage 2):

Session 1: 83.3mg followed 2.5 hours later with optional 41.7 mg for total of 125mg Session 2 (two to three weeks later): 125mg followed 2.5 hours later with optional 62.5mg for total of 187.5 mg. intervention 2: Drug:

Dosage form: capsule

Dosage frequency and duration for the control arm (4 subjects):

Session 1: 25 mg followed 2.5 hours later with optional 12.5 mg for total of 37.5 g Session 2 (two to three weeks later): 25 mg followed 2.5 hours later with optional 12.5mg for total of 37.5mg. intervention 3: Psychotherapy conducted with low or active dose MDMA intervention 4: Administered open label Dosage form: capsule

Dosage frequency and duration for the treatment arm (8 subjects in Stage 1 and the other 4 subjects in Stage 1 who may continue into Stage 2):

Session 1: 83.3mg followed 2.5 hours later with optional 41.7 mg for total of 125mg Session 2 (two to three weeks later): 125mg followed 2.5 hours later with optional 62.5mg for total of 187.5 mg.

Protocol document: