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Safety & Efficacy Study of Gemcitabine...With High Dose IV Vit. C (HDIVC)

Primary Purpose

Metastatic Adenocarcinoma of the Pancreas

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Gemcitabine, Intravenous and oral Ascorbic Acid (Vitamin C)
Sponsored by
Eastern Regional Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Adenocarcinoma of the Pancreas

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient ≥ 18 years of age
  • Biopsy proven adenocarcinoma of the pancreas
  • Evidence of metastatic disease
  • Received at least 1 prior chemotherapy treatment regimen with disease progression
  • May have had any prior chemotherapy regimen including any gemcitabine based regimen or FOLFIRINOX
  • May have participated in a prior study protocol
  • May have had prior treatment with HDIVC
  • Anticipated survival of at least 3 months
  • Eastern Cooperative Oncology Group (ECOG) performance status = 0,1, or 2
  • The patient must have screening laboratory: ANC ≥ 1,500/mm3, Hemoglobin > 8g/dL, Platelets ≥ 100,000/mm3, Total Bilirubin < 1.5mg/dL, Creatinine ≤ 1.5mg/dL, Transaminases < 2.5 x upper limit of normal, Urine Uric Acid < 1.000 mg/d, Urine pH < 6, Urine microscopic negative for oxalates (if positive, reflex urinary oxalates < 60mg/d), PT INR ≤ 1.5, unless patient is on full dose warfarin
  • Glucose-6-phosphate dehydrogenase deficiency (G6PD) normal status via blood test The fluorescent spot test is the simplest, most reliable, and most sensitive of the G6PD screening tests
  • Willingness to undergo central line placement and able to manage care of the entry site safely
  • Willingness to adhere to supplemental oral dose regimen of ascorbic acid 500mg taken twice daily
  • All other nutritional supplements would be discontinued for the duration of the trial except for pancreatic enzymes and probiotics
  • Patients must be able to take food orally or have a peg tube for feeding
  • Able to give consent for protocol participation

Exclusion Criteria:

  • Glucose-6-phosphate dehydrogenase deficiency (G6PD)
  • Renal insufficiency : serum creatinine of > 1.5 mg /dl or evidence of oxalosis by urinalysis prior to enrollment and prior to each HDIVC infusion
  • Documentation or report of history of kidney stones or urinary oxalosis.
  • Co-morbid condition that would affect survival: congestive heart failure, unstable angina, myocardial infarction within 6 weeks of study, uncontrolled blood sugars of > 300 mg / dl, patients with known chronic active hepatitis or cirrhosis
  • Currently active second malignancy
  • Chronic hemodialysis
  • Iron overload/ Hemochromatosis: Ferritin > 500 ng / ml
  • Wilson's disease
  • Pregnant or lactating female (pre- menopausal females will undergo pregnancy test prior to administration of protocol drugs throughout treatment cycles during this study)
  • Aspirin use exceeding 81 mg per day
  • Acetaminophen use exceeding 2 g per day
  • Known brain metastasis
  • Active tobacco smokers
  • Treatment with the combination of HDIVC and gemcitabine previously

Sites / Locations

  • Eastern Regional Medical Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

HDIVC

Arm Description

Gemcitabine (Gemzar), Intravenous and oral Ascorbic Acid (Vitamin C).

Outcomes

Primary Outcome Measures

Adverse Events as a Measure of Safety and Tolerability
Adverse events, whether volunteered by the study subject, discovered by the investigators during questioning, or detected by physical examination, laboratory tests, or other means will be collected and recorded at each visit. Events will be recorded from the time the consent is signed until 4 weeks after the study protocol is discontinued. Subjects experiencing Grade 4 neutropenia, Grade ≥3 thrombocytopenia, or Grade 2 peripheral neuropathy who do not recover will have treatment protocol discontinued.

Secondary Outcome Measures

Anti-Tumor Response
CT and PET scans will be performed at baseline and then every two months. Target and Non-Target Lesions will be identified and recorded at baseline. When subsequent scans are performed, anti-tumor responses will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST).

Full Information

First Posted
July 13, 2012
Last Updated
July 24, 2018
Sponsor
Eastern Regional Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT01654861
Brief Title
Safety & Efficacy Study of Gemcitabine...With High Dose IV Vit. C (HDIVC)
Official Title
Evaluation of the Safety and Efficacy of Standard Dose Gemcitabine Combined With High Dose Intravenous Vitamin C (HDIVC) Treatment for Patients With Metastatic Adenocarcinoma of the Pancreas.
Study Type
Interventional

2. Study Status

Record Verification Date
January 2018
Overall Recruitment Status
Terminated
Why Stopped
recruiting or enrolling participants has halted prematurely and will not resume
Study Start Date
June 2012 (undefined)
Primary Completion Date
June 2014 (Actual)
Study Completion Date
June 2014 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Eastern Regional Medical Center

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The combination of gemcitabine and HDIVC is safe and may favorably change the clinical course for an individual patient. The combination of gemcitabine and HDIVC is synergistic in anti-tumor effect as seen in preclinical models, where HDIVC creates a pro-oxidative effect that adds to the anti-tumor effect of gemcitabine. The combination of gemcitabine and HDIVC may improve Progression Free Survival (PFS). The dosage schema of 1.2 g /kg bolus infusion followed by lower dose of 0.3 g / kg infusion may create sustained elevation in Vitamin C plasma levels for increased cytotoxic effect. The addition of HDIVC & oral supplementation of Vitamin C to standard treatment with gemcitabine may improve quality of life for patients with comparison to prior to treatment start of this protocol. CA 19-9 and inflammatory markers may show trends for patients in this trial.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Adenocarcinoma of the Pancreas

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
3 (Actual)

8. Arms, Groups, and Interventions

Arm Title
HDIVC
Arm Type
Experimental
Arm Description
Gemcitabine (Gemzar), Intravenous and oral Ascorbic Acid (Vitamin C).
Intervention Type
Drug
Intervention Name(s)
Gemcitabine, Intravenous and oral Ascorbic Acid (Vitamin C)
Intervention Description
Weeks 1,2,3: IV Gemcitabine 1000 mg / m² over 30 minutes followed by HDIVC 1.2 g / kg: 1.2 g/kg over 90 minutes for a dose ≤90 g and over 120 minutes for a dose >90g followed by 0.3 g / kg over 120 minutes; Week 4: no treatment.
Primary Outcome Measure Information:
Title
Adverse Events as a Measure of Safety and Tolerability
Description
Adverse events, whether volunteered by the study subject, discovered by the investigators during questioning, or detected by physical examination, laboratory tests, or other means will be collected and recorded at each visit. Events will be recorded from the time the consent is signed until 4 weeks after the study protocol is discontinued. Subjects experiencing Grade 4 neutropenia, Grade ≥3 thrombocytopenia, or Grade 2 peripheral neuropathy who do not recover will have treatment protocol discontinued.
Time Frame
Weekly for up to 6 months.
Secondary Outcome Measure Information:
Title
Anti-Tumor Response
Description
CT and PET scans will be performed at baseline and then every two months. Target and Non-Target Lesions will be identified and recorded at baseline. When subsequent scans are performed, anti-tumor responses will be assessed using Response Evaluation Criteria in Solid Tumors (RECIST).
Time Frame
Every 2 months for up to 6 months.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient ≥ 18 years of age Biopsy proven adenocarcinoma of the pancreas Evidence of metastatic disease Received at least 1 prior chemotherapy treatment regimen with disease progression May have had any prior chemotherapy regimen including any gemcitabine based regimen or FOLFIRINOX May have participated in a prior study protocol May have had prior treatment with HDIVC Anticipated survival of at least 3 months Eastern Cooperative Oncology Group (ECOG) performance status = 0,1, or 2 The patient must have screening laboratory: ANC ≥ 1,500/mm3, Hemoglobin > 8g/dL, Platelets ≥ 100,000/mm3, Total Bilirubin < 1.5mg/dL, Creatinine ≤ 1.5mg/dL, Transaminases < 2.5 x upper limit of normal, Urine Uric Acid < 1.000 mg/d, Urine pH < 6, Urine microscopic negative for oxalates (if positive, reflex urinary oxalates < 60mg/d), PT INR ≤ 1.5, unless patient is on full dose warfarin Glucose-6-phosphate dehydrogenase deficiency (G6PD) normal status via blood test The fluorescent spot test is the simplest, most reliable, and most sensitive of the G6PD screening tests Willingness to undergo central line placement and able to manage care of the entry site safely Willingness to adhere to supplemental oral dose regimen of ascorbic acid 500mg taken twice daily All other nutritional supplements would be discontinued for the duration of the trial except for pancreatic enzymes and probiotics Patients must be able to take food orally or have a peg tube for feeding Able to give consent for protocol participation Exclusion Criteria: Glucose-6-phosphate dehydrogenase deficiency (G6PD) Renal insufficiency : serum creatinine of > 1.5 mg /dl or evidence of oxalosis by urinalysis prior to enrollment and prior to each HDIVC infusion Documentation or report of history of kidney stones or urinary oxalosis. Co-morbid condition that would affect survival: congestive heart failure, unstable angina, myocardial infarction within 6 weeks of study, uncontrolled blood sugars of > 300 mg / dl, patients with known chronic active hepatitis or cirrhosis Currently active second malignancy Chronic hemodialysis Iron overload/ Hemochromatosis: Ferritin > 500 ng / ml Wilson's disease Pregnant or lactating female (pre- menopausal females will undergo pregnancy test prior to administration of protocol drugs throughout treatment cycles during this study) Aspirin use exceeding 81 mg per day Acetaminophen use exceeding 2 g per day Known brain metastasis Active tobacco smokers Treatment with the combination of HDIVC and gemcitabine previously
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Eiko Klimant, MD, FACP
Organizational Affiliation
Eastern Regional Medical Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Heather Wright, ND, FABNO
Organizational Affiliation
Eastern Regional Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Eastern Regional Medical Center
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19124
Country
United States

12. IPD Sharing Statement

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Safety & Efficacy Study of Gemcitabine...With High Dose IV Vit. C (HDIVC)

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