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Comparing the Lozenge to the Patch for Smoking Cessation

Phase 4
18 Years
Not Enrolling
Bladder Cancer, Cervical Cancer, Esophageal Cancer, Gastric Cancer, Head and Neck Cancer, Kidney Cancer, Leukemia, Liver Cancer, Lung Cancer, Pancreatic Cancer, Tobacco Use Disorder

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Trial Information

Comparing the Lozenge to the Patch for Smoking Cessation



- Compare the efficacy of behavioral counseling and nicotine-replacement therapy with
either oral nicotine lozenge (NL) or transdermal nicotine patch (NP), in terms of
promoting rates of smoking cessation (e.g., continued abstinence), in adult smokers.

- Examine the degree to which nicotine replacement therapy (NRT) preference, desire to
control NRT dosing, irregular smoking schedules, and desire for oral preoccupation
moderates the relative efficacy of NL vs NP in promoting smoking cessation.

- Evaluate the impact of the NL on mediators of smoking cessation (i.e., reduced craving,
diminished withdrawal symptoms, cue reactivity, and increased perceived control over
withdrawal symptoms).


- Compare the rate of compliance with NRT across the 2 treatment arms and examine if
compliance rate mediates the effects of NRT on quit rates.

- Examine the potential role of genes related to nicotine dependence such as genes
related to nicotine metabolism enzymes (e.g., CYP1A1) or genes related to dopamine
concentrations (e.g., DRD2).

OUTLINE: This is a randomized, open-label, multicenter study. Participants are stratified
according to study center. Participants are randomized to 1 of 2 intervention arms.

All participants undergo smoking cessation counseling in weeks 1, 3, 5, 7, and 9. Beginning
in week 3, participants are asked to quit smoking for 12 weeks (weeks 3-14).

- Arm I: Participants apply a transdermal nicotine patch at 3 different time periods
during weeks 3-14; a higher-dose patch is applied for weeks 3-8, a medium-dose patch is
applied for weeks 9-10, and a lower-dose patch is applied for weeks 11-14.

- Arm II: Participants receive one oral nicotine lozenge every 1-2 hours in weeks 3-8 (≥
9 lozenges per day), one lozenge every 2-4 hours in weeks 9-11 (≥ 5 lozenges per day),
and 1 lozenge every 4-8 hours in weeks 12-14 (≥ 3 lozenges per day).

The moderating variables (e.g., nicotine replacement-therapy [NRT] preference and the
smoker's desire to control NRT dosing) are assessed at baseline. The mediating variables
(i.e., reduced craving, diminished withdrawal symptoms, cue reactivity, and increased
perceived control over withdrawal symptoms) are assessed at baseline and then at weeks 5, 7,
9, within weeks 14-16, and within weeks 26-28. Continuous abstinence will be measured at
week 27.

PROJECTED ACCRUAL: A total of 700 participants will be accrued for this study.

Inclusion Criteria


- Smokes at least 10 cigarettes a day on average for the past year

- No prior diagnosis of cancer (unless completed treatment AND no evidence of disease
within the past 5 years)

- Able to use nicotine replacement therapy


- Able to communicate in English

- Must reside in the geographic area for ≥ 6 months

- Current asthma, ulcer, or diabetes allowed provided medical clearance from the
participant's physician is obtained

- No evidence of drug or alcohol abuse

- No known HIV positivity

- No heart disease, including any of the following:

- Current diagnosis of coronary artery disease

- Abnormal heart rhythm or an arrhythmia

- Heart failure

- Heart valve disease

- Congenital heart disease

- Heart muscle disease or cardiomyopathy

- Pericardial disease

- Aorta disease

- Vascular disease

- Myocardial infarction

- High blood pressure (defined as blood pressure > 140/90 mm Hg) not receiving
antihypertensive medication

- History of or current high blood pressure controlled by antihypertensive
medication and having medical clearance from physician allowed

- No allergy to adhesive tape or latex

- Not pregnant or nursing

- Negative pregnancy test

- Fertile participants must use effective contraception during and for ≥ 1 month prior
to and after completion of study treatment


- At least 30 days since prior and no concurrent benzodiazepine (e.g., diazepam,
alprazolam, or lorazepam)

- At least 6 months since prior antiretroviral medications

- At least 6 months since prior and no concurrent medication for depression (e.g.,
phenelzine sulfate, pargyline hydrochloride, tranylcypromine sulfate, paroxetine
hydrochloride, sertraline hydrochloride, fluoxetine hydrochloride)

- No concurrent antipsychotics (e.g., lithium) or theophylline

- No concurrent substance abuse treatment

- No concurrent bupropion hydrochloride

- No other concurrent pharmacologic aid or any other form of formal assistance for
smoking cessation

Type of Study:


Study Design:

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Factorial Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

24-hour Point Prevalence Abstinence at the 6-month Follow up

Outcome Time Frame:


Safety Issue:


Principal Investigator

Robert A. Schnoll, PhD

Investigator Role:

Study Chair

Investigator Affiliation:

Fox Chase Cancer Center - Cheltenham


United States: Federal Government

Study ID:




Start Date:

February 2006

Completion Date:

August 2009

Related Keywords:

  • Bladder Cancer
  • Cervical Cancer
  • Esophageal Cancer
  • Gastric Cancer
  • Head and Neck Cancer
  • Kidney Cancer
  • Leukemia
  • Liver Cancer
  • Lung Cancer
  • Pancreatic Cancer
  • Tobacco Use Disorder
  • bladder cancer
  • cervical cancer
  • esophageal cancer
  • gastric cancer
  • renal cell carcinoma
  • adult primary liver cancer
  • non-small cell lung cancer
  • small cell lung cancer
  • pancreatic cancer
  • hypopharyngeal cancer
  • laryngeal cancer
  • lip and oral cavity cancer
  • nasopharyngeal cancer
  • oropharyngeal cancer
  • paranasal sinus and nasal cavity cancer
  • adult acute myeloid leukemia
  • tongue cancer
  • tobacco use disorder
  • Urinary Bladder Neoplasms
  • Carcinoma, Renal Cell
  • Kidney Neoplasms
  • Uterine Cervical Neoplasms
  • Esophageal Diseases
  • Esophageal Neoplasms
  • Head and Neck Neoplasms
  • Leukemia
  • Liver Neoplasms
  • Lung Neoplasms
  • Stomach Neoplasms
  • Pancreatic Neoplasms
  • Tobacco Use Disorder



CCOP - Mount Sinai Medical Center Miami Beach, Florida  33140
Don Monti Comprehensive Cancer Center at North Shore University Hospital Manhasset, New York  11030
Geisinger Cancer Institute at Geisinger Health Danville, Pennsylvania  17822-0001
Howard University Cancer Center Washington, District of Columbia  20060
Fox Chase Cancer Center - Philadelphia Philadelphia, Pennsylvania  19111-2497
CCOP - Main Line Health Wynnewood, Pennsylvania  19096
Hematology Oncology Associates of Central New York, PC - Northeast Center East Syracuse, New York  13057-4510
Medical College of Georgia Cancer Center Augusta, Georgia  30912-3500
Fox Chase Virtua Health Cancer Program at Virtua Memorial Hospital Burlington County Mount Holly, New Jersey  08060-2099
Nashville General Hospital at Meharry Nashville, Tennessee  37208