Clinical Trial of High-dose Vitamin C for Advanced Pancreatic Cancer
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Purpose
This is a phase II study. It is designed to provide information about if high-dose ascorbate (vitamin C) increases survival for pancreatic cancer patients. The hypothesis is that vitamin C is well tolerated and increases cancer treatment effectiveness, lengthening survival time for patients with advanced pancreatic cancer.
| Condition | Intervention | Phase |
|---|---|---|
|
Pancreatic Neoplasms Pancreatic Cancer |
Drug: Gemcitabine with escalating ascorbic acid |
Phase 2 |
| Study Type: | Interventional |
| Study Design: | Endpoint Classification: Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Pharmacological Ascorbate for the Control of Metastatic and Node-Positive Pancreatic Cancer (PACMAN): A Phase II Trial |
- Overall survival [ Time Frame: up to 5 years ] [ Designated as safety issue: No ]Time to event outcome measure (death), measured in days from cycle 1 day 1.
- Progression Free Survival [ Time Frame: up to 5 years ] [ Designated as safety issue: No ]Time-to-event outcome measure (initial disease progression) measured in days from cycle 1 day 1 to day of first progression as defined by RECIST criteria from NCI
- Number of drug-related adverse events per cycle [ Time Frame: every 28 days up to 5 years ] [ Designated as safety issue: Yes ]Adverse events linked to ascorbate will be categorized and quantified using CTCAE v4 at the bottom of each cycle. Incidence and frequency will be compared to scientific literature
- F2-isoprostane levels [ Time Frame: Once every 28 days for up to 5 years ] [ Designated as safety issue: Yes ]F2-isoprostane is a marker of systemic oxidative stress.
- Ascorbate levels [ Time Frame: Once every 28 days up to 5 years ] [ Designated as safety issue: No ]Ascorbate levels will be taken at the bottom of each cycle to assess therapeutic dose window.
| Enrollment: | 1 |
| Study Start Date: | September 2012 |
| Estimated Study Completion Date: | July 2016 |
| Estimated Primary Completion Date: | July 2015 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Gemcitabine with escalating IV ascorbate
Gemcitabine (1000 mg/m2) weekly for three weeks and then one week off. Ascorbic Gemcitabine (1000 mg/m2) weekly for three weeks and then one week off. Ascorbate (vitamin C) given twice weekly, escalating doses weekly. Week 1: 15 grams ascorbate / infusion for two infusions. Doses are then escalated in 25 gram increments until therapeutic window is achieved (350 mg/dL or above). Dose is then held at that level for the full cycle. |
Drug: Gemcitabine with escalating ascorbic acid
Gemcitabine 1000 mg/m2 weekly for 3 weeks with one week off (this is 1 cycle) Ascorbate dose is targeted to achieve plasma level of 350 mg/dL. Infusions are given twice weekly, each week of a cycle (4 weeks to a cycle) Other Names:
|
Detailed Description:
Adenocarcinoma of the pancreas is the fourth leading cause of cancer death in the United States and is increasing in incidence; the prognosis remains dismal. We propose to investigate an entirely new approach, using pharmacological ascorbate, combined with Gemcitabine, to treat this cancer. Intravenous ascorbate (i.e., ascorbic acid, vitamin C), but not oral ascorbate, produces high plasma concentrations, which are in the range that can be cytotoxic to tumor cells. Though ascorbate has been utilized in cancer therapy, few studies have investigated intravenous deliver of ascorbate. Preliminary studies from our group have demonstrated that ascorbate induces oxidative stress and cytotoxicity in pancreatic cancer cells; this cytotoxicity appears to be greater in tumor vs. normal cells. We hypothesize that production of H2O2 mediates the increased susceptibility of pancreatic cancer cells to ascorbate-induced metabolic oxidative stress. Gemcitabine is the standard chemotherapy drug used to treat pancreatic cancer.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Patients must have a cytological or histological diagnosis of adenocarcinoma arising in the pancreas. Diagnosis from metastatic sampling is acceptable.
- Disease must be measured radiologically.
- Failed initial therapy or ineligible for definitive curative therapy.
- If prior treatment included radiation therapy, recurrent disease must be outside of the targeted volume.
- Age ≥ 18 years
- ECOG performance status 0-2 (Karnofsky > 50%, see Appendix A).
-
Patients must have normal organ and marrow function as defined below:
- leukocytes ≥ 3,000/mm3
- absolute neutrophil count ≥ 1,500/mm3
- platelets ≥ 100,000/mm3
- total bilirubin < 2x institutional upper limit of normal
- AST(SGOT) < 3x institutional upper limit of normal OR < 5x institutional upper limit of normal for patients presenting with liver metastases
- ALT (SGPT) < 3x institutional upper limit of normal OR < 5x institutional upper limit of normal for patients presenting with liver metastases
- PT/INR within normal institutional limits, unless patient is on warfarin or other antithrombotic agents
- creatinine < 1.5 X institutional upper limit of normal OR creatinine clearance ≥ 60 mL/min/1.73 m2 for patients with creatinine levels above institutional normal.
- Not pregnant. Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
- Ability to understand and the willingness to sign a written informed consent document.
Exclusion Criteria:
- Prior chemotherapy to treat metastatic disease.
- Adjuvant therapy (including radiation therapy) within 4 calendar weeks.
- Unresolved toxicities from prior therapy for the malignancy.
- G6PD (glucose-6-phosphate dehydrogenase) deficiency.
- Second malignancy other than non-melanoma skin cancers within the past 5 years.
- Excess consumption of alcohol where an excess of alcohol is defined as more than four of any one of the following per day: 30 mL distilled spirits, 340 mL beer, or 120 mL wine.
- Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, psychiatric illness/social situations, or any other condition that would limit compliance with study requirements as determined by study team members.
- Pregnant or lactating women: The risks of chemotherapy to a fetus/infant are well documented.
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT01515046
| United States, Iowa | |
| The Holden Comprehensive Cancer Center | |
| Iowa City, Iowa, United States, 52242 | |
| Principal Investigator: | Joseph J Cullen, MD | The University of Iowa | |
| Study Chair: | Joseph J Cullen, MD | The University of Iowa |
More Information
Publications:
| Responsible Party: | Joseph J. Cullen, Professor of Surgery, University of Iowa |
| ClinicalTrials.gov Identifier: | NCT01515046 History of Changes |
| Other Study ID Numbers: | PACMAN-II, P30CA086862 |
| Study First Received: | January 18, 2012 |
| Last Updated: | June 19, 2013 |
| Health Authority: | United States: Food and Drug Administration United States: Institutional Review Board |
Keywords provided by University of Iowa:
|
Vitamins Complementary medicine Pancreatic cancer Ascorbate |
Ascorbic Acid Antioxidants Gemcitabine Pharmacologic actions |
Additional relevant MeSH terms:
|
Pancreatic Neoplasms Digestive System Diseases Digestive System Neoplasms Endocrine Gland Neoplasms Endocrine System Diseases Neoplasms Neoplasms by Site Pancreatic Diseases Ascorbic Acid Gemcitabine Anti-Infective Agents Antimetabolites Antimetabolites, Antineoplastic Antineoplastic Agents |
Antioxidants Antiviral Agents Enzyme Inhibitors Growth Substances Immunologic Factors Immunosuppressive Agents Micronutrients Molecular Mechanisms of Pharmacological Action Pharmacologic Actions Physiological Effects of Drugs Protective Agents Radiation-Sensitizing Agents Therapeutic Uses Vitamins |
ClinicalTrials.gov processed this record on February 27, 2015