Group Retreat Psilocybin Therapy for the... — Clinical Trial Details

Group Retreat Psilocybin Therapy for the Treatment of Anxiety and Depression in Patients With Metastatic Solid Tumors or Incurable Hematologic Malignancies

This Phase II, single-group trial (n=18) will evaluate the safety and efficacy of group retreat psilocybin therapy for treating anxiety and depression in patients with metastatic solid tumours or incurable hematologic malignancies. The study aims to address the profound suffering caused by unrelieved anxiety and existential distress in this population by using psilocybin, which is believed to disrupt negative thought patterns and enhance mood regulation. Participants will receive a pharmaceutical-grade psilocybin orally, with a potential booster dose administered based on clinical judgement. Participants will engage in a series of preparatory and integration therapy sessions, both virtual and in-person, leading up to and following the psilocybin administration. The treatment regimen includes group preparation sessions on days -14, -7, and -1, an individual preparation session on day -1, and integration sessions on days 1, 8, 15, and 22. Following the treatment, patients will be monitored for adverse events over a period of up to 6 months, with follow-up assessments at 8, 12, and 24 weeks post-treatment. The study is set to begin in April 2026 and aims to provide insights into the therapeutic potential of psilocybin in this vulnerable patient group.

Detailed Description

This phase II trial tests the safety, side effects and how well group retreat psilocybin therapy works for the treatment of anxiety and depression in patients with solid tumors that have spread from where they first started (primary site) to other places in the body (metastatic) or with hematologic cancers for which no treatment is currently available (incurable). For patients with metastatic, incurable cancer, unrelieved anxiety and existential distress can cause profound suffering. Psilocybin therapy can relieve anxiety and existential distress by disrupting patterns of thinking that contribute to anxiety and depression. Psilocybin is a substance being studied in the treatment of anxiety or depression in patients with cancer. In this study, a pharmaceutical grade of psilocybin will be used that has been approved by the FDA for research, provided by Filament Health. Psilocybin acts on the brain by resetting the brain's activity and increasing connections between brain regions, particularly those involved in mood regulation and self-perception. In this study psilocybin is combined with structured discussions and reflections that enable patients to have new insights about their situation. In a prior study, group retreat psilocybin therapy was proven to be safe and this study tests a refined dosing regimen for symptoms of anxiety and depression in patients with metastatic solid tumors or incurable hematologic malignancies.

A diagnosis of metastatic solid tumor, or incurable hematologic malignancy that has been accepted by a physician in a medical record
Measurable disease is not required
Previous treatment with chemotherapy: There are no minimum or maximum prior lines of chemotherapy
18-85 years of age
Required performance status, including the appropriate scale. Eastern Cooperative Oncology Group (ECOG) 0-2
Hematocrit \> 20
Platelets (plt) \> 20K
Liver function tests 1.5 x normal
Creatinine 1.5 x normal
Subjects of childbearing potential must be willing to use an effective contraceptive method from study enrollment until at least 1 month after receiving the investigational agent(s)
Must be at least 4 weeks after surgery or radiotherapy at study entry, but can be receiving oral or intravenous (IV) chemotherapy if those schedules can be adjusted around the medication session date
Motivated to participate in a group study and able in the research team's judgment to participate in the small group effectively
On pre-enrollment screening tests, they will have clinically significant anxiety or depressive symptoms as defined by a score of 11 or greater on the Hospital and Anxiety Depression Scale-Anxiety (HADS)-total
English speaking - able to understand the process of consent and the risk and benefits associated with the study, and able to give written informed consent. This is a pilot study, and if future larger studies are designed, consideration will be given for non-english-speaking subjects
Must be willing to sign a medical release for the investigators to communicate directly with their treating clinicians (mental health professional or oncologist) and doctors to confirm a medication and/or medical history
Must provide at least one adult who is in contact with the participant at least once a day when the participant is at home who is able to verbally monitor participant-reported changes in the behavior and able to notify research staff of behavior changes that may require research staff assessment
Must provide a review of any selective serotonin reuptake inhibitor (SSRI) use
Must avoid taking any psychiatric medications or starting a new psychiatric medication during the study. Should participant's doctor recommend starting a new psychiatric medication, participant will be required to notify the study team and the subject would withdraw from the study. (Use of as needed \[prn\] benzodiazepines is allowed but high dose chronic benzodiazepine use must be reviewed by the principal investigator \[PI\]. Use of prn gabapentoids is allowed but high dose chronic gabapentoid use must be reviewed by the PI.)
Must provide a contact (relative, spouse, close friend, or other caregiver) who is willing and able to be reached by the research team in the event that the participant becomes suicidal
If the potential participant is of childbearing potential, they must have a negative pregnancy test at baseline and prior to the medication dosing session, and must agree to use highly effective birth control. Highly effective birth control is defined as birth control methods, alone or in combination, that result in a low failure rate (i.e., less than 1 percent per year, which does NOT include condoms or abstinence
Are willing to commit to preparation sessions, medication dosing sessions, integration sessions, to complete evaluation instruments and commit to be contacted for all necessary telephone contacts

Brain metastases that have not been treated
Uncontrolled or concurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Pregnancy, breastfeeding, or expecting to conceive or father children for the duration of the trial through 30 days after receipt of investigational agent(s)
Personal or immediate family history of schizophrenia, bipolar affective disorder, delusion disorder, paranoid disorder, or schizoaffective disorder
Suicidal ideation with a Columbia-Suicide Severity Rating Scale (C-SSRS) measurement of 'low risk' or no risk
Current substance abuse disorder (although prospective subjects will not be excluded for reasonable alcohol use that does not meet criteria for alcohol use disorder or marijuana use that does not meet criteria for substance use disorder)
Unstable neurological or medical condition; history of seizure, chronic/severe headaches
Any use of psychedelic drugs in high doses (psilocybin \> 2 grams of dried mushrooms, lysergic acid diethylamide \[LSD\] \> 200 micrograms) within the prior 3 months (microdosing will not require exclusion but participants would have to agree to discontinue microdosing 1 month before study entry)
Use of tramadol, due to the potential for serotonin syndrome with concomitant use of psilocybin
Individuals who are on MAOI (monoamine oxidase inhibitors) or who have a known sensitivity to the drug or its metabolites. Psilocybin is contraindicated in medications that are known UDP-glucuronosyltransferase (UGT) enzyme modulators
Baseline prolongation of QT/corrected QT (QTc) interval (e.g., demonstration on a 12-lead electrocardiogram \[ECG\] of a QTc interval \> 450 milliseconds \[ms\])
A history of additional risk factors for Torsade de Points (including but not limited to: heart failure, hypokalemia, family history of Long QT Syndrome)
The use of concomitant medications that prolong the QT/QTc interval
Any history of cardiovascular disease such as history of myocardial infarction or congestive heart failure or cardiac arrhythmia
The use of concomitant medications that prolong the QT/QTc interval.
Concomitant use of efavirenz (an antiviral) which cannot be tapered

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Group Retreat Psilocybin Therapy for the Treatment of Anxiety and Depression in Patients With Metastatic Solid Tumors or Incurable Hematologic Malignancies

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