Compassionate Use of Omegaven® in the Treatment of Parenteral Nutrition Induced Hepatic Injury
Compassionate Use of Omegaven® in the Treatment of Parenteral Nutrition Induced Hepatic Injury
The purposes of this study are to make Omegaven® available to cancer patients with liver
 disease and to determine if Omegaven® can improve or prevent further liver disease. The study
 will also look at the effects Omegaven® has on immune function.
This compassionate use study will include patients with advanced cancer requiring PN for
 long-term nutrition support who have developed PN-induced hepatic injury or who have existing
 hepatic dysfunction. Therapy with Omegaven will be provided at an initial dose of 0.1 g/kg
 body weight (1ml/kg) and increased to 0.2 g/kg body weight (2ml/kg) on day 2 or 3 of
 treatment. For patients > 120% ideal body weight, adjusted body weight will be used. The
 infusion rate will not exceed 0.5mL Omegaven/kg body weight/hr (corresponding to 0.05g fish
 oil/kg/hr). Omegaven will be co-administered via a y-site infusion, with containers being
 changed every 12 hours. The patient may receive other lipids to meet Essential Fatty Acid
 (EFA) and/or additional calorie needs. Patients will receive the initial infusion of PN
 containing Omegaven at Midwestern Regional Medical Center (MRMC) in the infusion center to
 observe for adverse reactions. If an adverse reaction is observed, IV steroids & benadryl
 will be administered & Omegaven will be discontinued. Patients will continue to receive
 infusions at CTCA for the first 2 to 3 days of dosing. After tolerance is established,
 patients will receive treatment at home with Coram. All study patients will have a Screening
 Visit; Day 1, Day 2 and Day 3 visits; and weekly visits for one month (see Table 2).
Inclusion Criteria:

 1. Male or Female; ages 18 to 80 years old

 2. Receiving treatment at Cancer Treatment Centers of America

 3. Receiving PN (either in the infusion center or at home)

 4. Have existing hepatic dysfunction defined as Elevation of > 3x the normal level of one
 or more of the following:Alkaline Phosphatase (ALP), Aspartate Aminotransferase (AST),
 or Alanine Aminotransferase ALT) and/or Bilirubin > 2 mg/dl in the absence of biliary
 obstruction

 5. Able to provide informed written consent

 Exclusion Criteria:

 1. Hypertriglyceridemia (triglycerides [TG] > 400)

 2. Allergy to fish or egg protein

 3. Currently on therapeutic doses of Coumadin, heparin, or low molecular eight heparin

 4. Hemodynamically unstable

 5. Bilirubin > 5 mg/dL

 6. Documented liver metastases

 7. Unstable diabetes with known diabetic ketoacidosis within 7 days of screening

 8. Recent cardiac infarction (within 6 months) and taking plavix

 9. Severe hemorrhagic disorders

 10. Current anticoagulation therapy for deep venous thromboembolism or pulmonary embolism

 11. Active sepsis

 12. Undefined coma status

 13. In patients with abnormal kidney function, renal insufficiency with calculated
 creatinine clearance < 30 mL/min

 14. Pregnancy or lactation