A Study of Pre-operative Metformin in Prostate Cancer (ANIMATE)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00881725
Recruitment Status : Terminated (Slow Accrual)
First Posted : April 15, 2009
Last Update Posted : June 19, 2012
Jewish General Hospital
Information provided by:
University Health Network, Toronto

Brief Summary:
This study will investigate the effect of neoadjuvant metformin therapy in the inhibition of growth and proliferation of prostate cancer cells prior to radical prostatectomy.

Condition or disease Intervention/treatment Phase
Prostate Cancer Drug: Metformin Phase 2

Detailed Description:

Prostate cancer is the most commonly diagnosed malignancy in men in North America, with close to a quarter of a million cases diagnosed in 2007 alone (Joshua et al, 2007). The activation of the PTEN/ AKT pathway is thought to be of importance in prostatic carcinogenesis as it correlates with a poor prognosis (Yoshimoto et al, 2007) (Schmitz et al, 2007). Components of this cellular pathway have pleiotropic targets including the mTOR complex. In model systems, tumours exhibiting activation of PI3K/AKT kinase are sensitive to mTOR inhibitors.

Metformin (1,1-dimethylbiguanide hydrochloride) belongs to the biguanide class of oral hypoglycaemic agents and is a commonly prescribed medication for a number of conditions. It is the first-line drug of choice for the treatment of type 2 diabetes. Its mechanism of action is thought to be the primary inhibition of hepatic glucose output through inhibition of gluconeogenesis. Subsequently, metformin causes a decline in the circulating insulin level (Hundal et al, 2000).

Metformin causes inhibition of the mTOR complex. The mTOR complex is primarily inhibited through activation of AMPK (a component of the PTEN/AKT pathway). Metformin causes reduced hepatic glucose output leading to decreased levels of circulating insulin which causes the secondary inhibition of the mTOR complex. Metformin has also been shown to inhibit cyclin D1 expression and retinoblastoma protein (Rb) phosphorylation. Inhibition of Cyclin D1 and Rb phosphorylation cause inhibition of G1/S phase transition of the cell cycle. This results in the inhibition of cell proliferation (Matsushime et al, 1994).

This study will investigate the effect of neoadjuvant metformin therapy in the inhibition of growth and proliferation of prostate cancer cells prior to radical prostatectomy.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 24 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II, Open Label Assessment of Neoadjuvant Intervention With Metformin Against Tumour Expression of Signaling
Study Start Date : June 2009
Actual Primary Completion Date : March 2011
Actual Study Completion Date : June 2012

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Prostate Cancer

Arm Intervention/treatment
Experimental: Metformin
500mg t.i.d. for 4-12 weeks prior to Radical Prostatectomy
Drug: Metformin
500mg tablets t.i.d. for 4-12 weeks prior to Radical Prostatectomy

Primary Outcome Measures :
  1. Difference in Ki67 staining [ Time Frame: Pre-Surgery ]

Secondary Outcome Measures :
  1. Other immunohistochemical assays: IR, IGF-1R, p70S6K, AMPK, MVD, Cleaved caspase 3, PTEN, c-Myc [ Time Frame: Pre-Surgery ]
  2. Differences in measures of insulin resistance: waist/hip ratio, fasting blood glucose, post-prandial blood glucose, weight [ Time Frame: Pre-Surgery, Post-Surgery ]
  3. Differences in PSA levels [ Time Frame: Pre-Surgery, Post-Surgery ]
  4. Incidence of adverse events, serious adverse events, and grade 3-4 toxicities [ Time Frame: Pre-Surgery, Post-Surgery ]

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. 1. Patients with histologically confirmed prostate cancer involving at least 20% of at least one unfragmented biopsy core;
  2. Over the age of 18 and under the age of 75;
  3. Ability to read and understand the consent form, either alone or with the aid of a translator
  4. ECOG performance status less than or equal to 2 (Karnofsky greater than or equal to 60%);
  5. Patients must have their TRUS biopsy performed at UHN (or at an outside institution if tissue accession can be arranged) in the last 3 months;
  6. Patients must have normal organ and marrow function as defined by the following criteria:

    1. Absolute neutrophil count greater than or equal to 1,500/uL
    2. Platelets greater than or equal to 100,000/uL
    3. Total bilirubin less than or equal to 1.5 X institutional ULN
    4. AST(SGOT)/ALT(SGPT) less than or equal to 1.5 X institutional ULN
    5. Creatinine less than or equal to 1.4 X institutional ULN

Exclusion Criteria:

  1. Patients who on initial assessment are found to be on treatment with any drug used for the treatment of any form of diabetes, or patients that begin treatment for any form of diabetes during the course of the study;
  2. Patients may not be receiving any other investigational, herbal or anticancer agents while on study;
  3. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, congestive heart failure (NYHA Class 3 or greater), cirrhosis with a Child-Pugh level of B or greater or evidence of cardiac dysfunction, unstable angina pectoris, cardiac arrhythmia, active peptic ulcer disease, clinically significant gastrointestinal conditions (e.g. Crohns disease, ulcerative colitis), COPD or psychiatric illness/social situations that would limit compliance with study requirements;
  4. Active malignancy at any other site excluding squamous cell or basal cell carcinomas of the skin
  5. Radiotherapy within the past 4 weeks;
  6. Patients with a current history of alcohol intake (>2 standard drinks/day) or binge drinking (5 or more drinks (male), or 4 or more drinks (female)) in one session of 1-3 hours;
  7. Past history of lactic acidosis or risk factors for lactic acidosis such as congestive heart failure (NYHA Class 3 or greater), hypoxia (resting PO2 < 91%) or renal insufficiency (eGFR < 60 mls/min)
  8. Patients taking systemic glucocorticoids or estrogenic compounds.
  9. Patients with known hypersensitivity or allergy to metformin or any of its excipients.
  10. Patients with a history of impaired liver or kidney function.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00881725

Canada, Ontario
University Health Network
Toronto, Ontario, Canada, M5G2M9
Sponsors and Collaborators
University Health Network, Toronto
Jewish General Hospital
Principal Investigator: Anthony Joshua, M.D. University Health Network, Toronto

Responsible Party: Dr. Anthony Joshua, University Health Network Identifier: NCT00881725     History of Changes
Other Study ID Numbers: PMH-ANIMATE-001
First Posted: April 15, 2009    Key Record Dates
Last Update Posted: June 19, 2012
Last Verified: June 2012

Keywords provided by University Health Network, Toronto:
Prostate Cancer
Radical Prostatectomy
Neoadjuvant Intervention
PTEN/AKT Pathway
Tumour Expression
Ki67 Expression

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Genital Diseases, Male
Prostatic Diseases
Hypoglycemic Agents
Physiological Effects of Drugs