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Phase II Lung Metcore - Preoperative Metformin for Lung Cancer (Metcore)

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT03086733
Recruitment Status : Recruiting
First Posted : March 22, 2017
Last Update Posted : October 11, 2018
Information provided by (Responsible Party):
University Health Network, Toronto

Brief Summary:

This is a phase II single centre open label single arm pre-operative window of metformin treatment in stage I-IIIa Non small cell lung cancer.

In which patients will be invited to participate by receiving Metformin treatment during 14 to 21 days at 850 mg BID until the day before surgery.

They will be followed closely for any Adverse Events during treatment and 30 days after surgery. During treatment there will be no follow up tests except 1 fasting blood glucose at week 2 of treatment.

Survival data will be prospectively gathered after study treatment has ended until death.

Condition or disease Intervention/treatment Phase
Non Small Cell Lung Cancer Lung Cancer Drug: Metformin Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 50 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: single center, open label, single arm Phase II study of a pre-operative window of metformin treatment in stages I - IIIA NSCLC
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase II Study of Single Agent Pre-operative Metformin in Patients With Clinical Stage I - IIIA NSCLC Proceeding to Surgical Resection. 'Lung Metcore Study'
Actual Study Start Date : December 5, 2016
Estimated Primary Completion Date : December 2020
Estimated Study Completion Date : December 2020

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Metformin
14 to 21 days of pre-operative Metformin tablets First 5 days 850 mg OD v/o 850 mg BID thereafter until 21 days are completed.
Drug: Metformin
850 mg tablets v/o OD for first 5 days 850 mg tablets v/o BID until day 21
Other Name: Glucophage

Primary Outcome Measures :
  1. Ki67 [ Time Frame: 45 days after surgery ]
    • The difference in the proportion of proliferating NSCLC cells (measured by comparing Ki67 levels) prior to and after metformin treatment.

  2. Apoptosis [ Time Frame: 45 days after surgery ]
    • The rate of apoptosis of NSCLC (measured by the TUNEL assay) prior to and after metformin treatment.

Secondary Outcome Measures :
  1. Number of participants with treatment-related adverse events as assessed by CTCAE v4.0 [ Time Frame: During a minimum of 14 days and maximum of 21 days patients will be assessed every 5 days during treatment and 30 days after surgery ]
    • The safety and tolerability of preoperative metformin administration in NSCLC, as assessed by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE [version 4.0])

  2. Pathology [ Time Frame: 45 days after surgery ]
    • Pathologic changes in lung tissue after metformin administration

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 90 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • Have biopsy-proven non-small cell lung carcinoma (NSCLC) of any histological variant except for neuroendocrine tumors. Patients must not have mixed NSCLC and small cell lung cancer (SCLC).
  • Be of clinical stage I to IIIA (according to the 7th lung cancer TNM classification and staging system) by radiologic and/or pathologic criteria where appropriate (e.g. mediastinoscopic staging). Baseline CT-chest scan must be within 4 weeks of study entry.
  • Be deemed appropriate candidates for surgical resection by the treating surgeon and assessing team.
  • Be aged - 18 years or more.
  • Have ECOG performance status - 2.
  • Have organ and marrow function as defined below for safe lung biopsy and administration of metformin:

    • Platelets -100 000
    • Total bilirubin -1.5 X institutional upper limit of normal
    • AST/ALT -2 X institutional upper limit of normal
    • Creatinine clearance -60 mL/min/1.73 m2
  • Have the ability to understand and the willingness to sign a written informed consent document.
  • Not require emergency surgery within 14 days of staging investigations.
  • Not have received anticancer treatment with chemotherapy, radiotherapy or Epidermal - - Growth Factor Receptor (EGFR) inhibitor therapy for the current lung cancer.
  • Not have a concomitant active malignancy or be receiving any other investigational or anticancer agents while on the study, to avoid the influence of alternative anti-cancer therapy. Otherwise, those with a past history of cancer are eligible.

Exclusion Criteria:

  • Not have a past history of an allergic reaction to metformin.
  • Not have a past history of diabetes mellitus or fasting glucose ≥ 7.0 mmol/L.
  • Not have a past history of lactic acidosis or metabolic acidosis.
  • Not have consumption of ≥ 3 alcoholic beverages per day (average).
  • Not have had regular use of agents that may influence insulin sensitivity/levels within 4 weeks of study entry.
  • Not have uncontrolled intercurrent illness (es) including but not limited to: ongoing or active:

    • Infection,
    • Symptomatic congestive
    • Cardiac failure or evidence of cardiac dysfunction,
    • Unstable angina pectoris,
    • Cardiac arrhythmia,
    • Active peptic ulcer disease or gastrointestinal conditions (e.g. Inflammatory bowel disease) or
    • Psychiatric illness/social situations that would limit compliance with study requirements.
  • Not be on a loop diuretic due to their potential to cause renal impairment and predispose to lactic acidosis.
  • Not have contrast-enhanced imaging (except when clinically indicated) while on the study. Iodinated contrast agents can cause renal failure, leading to metformin accumulation and lactic acidosis.
  • Women should not be pregnant or become pregnant during study.

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): NCT03086733

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Contact: Natasha Leighl, MD 1416-946-2858
Contact: Thomas Waddell, MD 1416-340-3432

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Canada, Ontario
Toronto General Hospital Recruiting
Toronto, Ontario, Canada, M5G 2C4
Contact: Alexandra Salvarrey, MD MSc    1-416-340-4800 ext 6992   
Contact: Jennifer Lister, BSc    1-416-340-4800 ext 4857   
Principal Investigator: Thomas Waddell, MD FRCSC         
Princess Margaret Hospital Recruiting
Toronto, Ontario, Canada, M5G 2M9
Contact: Alexandra Salvarrey, MD MSc    1-416-946-4501 ext 5444   
Contact: Jennifer Lister, BSc    1-416-340-4800 ext 4857   
Principal Investigator: Natasha Leighl, MD MSc FRCPC         
Sponsors and Collaborators
University Health Network, Toronto
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Principal Investigator: Tom Waddell, MD Head of Thoracic Surgery Division
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Responsible Party: University Health Network, Toronto Identifier: NCT03086733    
Other Study ID Numbers: 15-9560.0 - Lung Metcore Study
First Posted: March 22, 2017    Key Record Dates
Last Update Posted: October 11, 2018
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: Yes
Keywords provided by University Health Network, Toronto:
Lung Cancer
Non small cell lung cancer
Pre-operative treatment
Neoadjuvant treatments
Phase II
Additional relevant MeSH terms:
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Lung Neoplasms
Carcinoma, Non-Small-Cell Lung
Respiratory Tract Neoplasms
Thoracic Neoplasms
Neoplasms by Site
Lung Diseases
Respiratory Tract Diseases
Carcinoma, Bronchogenic
Bronchial Neoplasms
Hypoglycemic Agents
Physiological Effects of Drugs