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

Primary Purpose

Prostate Cancer

Status
Terminated
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Metformin
Sponsored by
University Health Network, Toronto
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prostate Cancer focused on measuring Metformin, Prostate Cancer, Radical Prostatectomy, Neoadjuvant Intervention, PTEN/AKT Pathway, Tumour Expression, Ki67 Expression

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)MaleDoes not accept healthy volunteers

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.

Sites / Locations

  • University Health Network

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Metformin

Arm Description

500mg t.i.d. for 4-12 weeks prior to Radical Prostatectomy

Outcomes

Primary Outcome Measures

Difference in Ki67 staining

Secondary Outcome Measures

Other immunohistochemical assays: IR, IGF-1R, p70S6K, AMPK, MVD, Cleaved caspase 3, PTEN, c-Myc
Differences in measures of insulin resistance: waist/hip ratio, fasting blood glucose, post-prandial blood glucose, weight
Differences in PSA levels
Incidence of adverse events, serious adverse events, and grade 3-4 toxicities

Full Information

First Posted
April 14, 2009
Last Updated
June 18, 2012
Sponsor
University Health Network, Toronto
Collaborators
Jewish General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT00881725
Brief Title
A Study of Pre-operative Metformin in Prostate Cancer
Acronym
ANIMATE
Official Title
A Phase II, Open Label Assessment of Neoadjuvant Intervention With Metformin Against Tumour Expression of Signaling
Study Type
Interventional

2. Study Status

Record Verification Date
June 2012
Overall Recruitment Status
Terminated
Why Stopped
Slow Accrual
Study Start Date
June 2009 (undefined)
Primary Completion Date
March 2011 (Actual)
Study Completion Date
June 2012 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
University Health Network, Toronto
Collaborators
Jewish General Hospital

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

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.
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.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prostate Cancer
Keywords
Metformin, Prostate Cancer, Radical Prostatectomy, Neoadjuvant Intervention, PTEN/AKT Pathway, Tumour Expression, Ki67 Expression

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
24 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Metformin
Arm Type
Experimental
Arm Description
500mg t.i.d. for 4-12 weeks prior to Radical Prostatectomy
Intervention Type
Drug
Intervention Name(s)
Metformin
Intervention Description
500mg tablets t.i.d. for 4-12 weeks prior to Radical Prostatectomy
Primary Outcome Measure Information:
Title
Difference in Ki67 staining
Time Frame
Pre-Surgery
Secondary Outcome Measure Information:
Title
Other immunohistochemical assays: IR, IGF-1R, p70S6K, AMPK, MVD, Cleaved caspase 3, PTEN, c-Myc
Time Frame
Pre-Surgery
Title
Differences in measures of insulin resistance: waist/hip ratio, fasting blood glucose, post-prandial blood glucose, weight
Time Frame
Pre-Surgery, Post-Surgery
Title
Differences in PSA levels
Time Frame
Pre-Surgery, Post-Surgery
Title
Incidence of adverse events, serious adverse events, and grade 3-4 toxicities
Time Frame
Pre-Surgery, Post-Surgery

10. Eligibility

Sex
Male
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 1. Patients with histologically confirmed prostate cancer involving at least 20% of at least one unfragmented biopsy core; Over the age of 18 and under the age of 75; Ability to read and understand the consent form, either alone or with the aid of a translator ECOG performance status less than or equal to 2 (Karnofsky greater than or equal to 60%); 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; Patients must have normal organ and marrow function as defined by the following criteria: Absolute neutrophil count greater than or equal to 1,500/uL Platelets greater than or equal to 100,000/uL Total bilirubin less than or equal to 1.5 X institutional ULN AST(SGOT)/ALT(SGPT) less than or equal to 1.5 X institutional ULN Creatinine less than or equal to 1.4 X institutional ULN Exclusion Criteria: 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; Patients may not be receiving any other investigational, herbal or anticancer agents while on study; 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; Active malignancy at any other site excluding squamous cell or basal cell carcinomas of the skin Radiotherapy within the past 4 weeks; 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; 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) Patients taking systemic glucocorticoids or estrogenic compounds. Patients with known hypersensitivity or allergy to metformin or any of its excipients. Patients with a history of impaired liver or kidney function.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Anthony Joshua, M.D.
Organizational Affiliation
University Health Network, Toronto
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Health Network
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G2M9
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
18166163
Citation
Joshua AM, Evans A, Van der Kwast T, Zielenska M, Meeker AK, Chinnaiyan A, Squire JA. Prostatic preneoplasia and beyond. Biochim Biophys Acta. 2008 Apr;1785(2):156-81. doi: 10.1016/j.bbcan.2007.12.001. Epub 2007 Dec 8.
Results Reference
background
PubMed Identifier
17700571
Citation
Yoshimoto M, Cunha IW, Coudry RA, Fonseca FP, Torres CH, Soares FA, Squire JA. FISH analysis of 107 prostate cancers shows that PTEN genomic deletion is associated with poor clinical outcome. Br J Cancer. 2007 Sep 3;97(5):678-85. doi: 10.1038/sj.bjc.6603924. Epub 2007 Aug 14.
Results Reference
background
PubMed Identifier
17163422
Citation
Schmitz M, Grignard G, Margue C, Dippel W, Capesius C, Mossong J, Nathan M, Giacchi S, Scheiden R, Kieffer N. Complete loss of PTEN expression as a possible early prognostic marker for prostate cancer metastasis. Int J Cancer. 2007 Mar 15;120(6):1284-92. doi: 10.1002/ijc.22359.
Results Reference
background
PubMed Identifier
11118008
Citation
Hundal RS, Krssak M, Dufour S, Laurent D, Lebon V, Chandramouli V, Inzucchi SE, Schumann WC, Petersen KF, Landau BR, Shulman GI. Mechanism by which metformin reduces glucose production in type 2 diabetes. Diabetes. 2000 Dec;49(12):2063-9. doi: 10.2337/diabetes.49.12.2063.
Results Reference
background
PubMed Identifier
8114738
Citation
Matsushime H, Quelle DE, Shurtleff SA, Shibuya M, Sherr CJ, Kato JY. D-type cyclin-dependent kinase activity in mammalian cells. Mol Cell Biol. 1994 Mar;14(3):2066-76. doi: 10.1128/mcb.14.3.2066-2076.1994.
Results Reference
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A Study of Pre-operative Metformin in Prostate Cancer

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