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Pilot Study of Rosuvastatin and Enoxaparin Thromboprophylaxis Following Ovarian Cancer Surgery (O-STAT Study)

Primary Purpose

Ovarian Cancer

Status
Active
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Enoxaparin
Enoxaparin + Rosuvastatin
Thromboprophylaxis
Sponsored by
Beth Israel Deaconess Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Ovarian Cancer focused on measuring Ovarian Cancer

Eligibility Criteria

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

Inclusion Criteria:

  • Histologic diagnosis of ovarian, fallopian or primary peritoneal cancer (excluding borderline histologies). Preliminary pathology results based on frozen section findings are acceptable.
  • The interval between pelvic or abdominal surgery and first dose of study treatment must be no more than 10 days.
  • Age ≥ 18 years.
  • ECOG performance status ≤2 (see Appendix A)
  • Life expectancy of greater than 6 months
  • Participants must have normal organ and marrow function as defined below:

    • Platelets ≥ 100,000/mcL
    • Total Bilirubin <1.5 mg/dL (or direct bilirubin <1.0 mg/dL)
    • AST(SGOT) ≤ 1.5 × institutional upper limit of normal
    • ALT(SGPT) ≤ 1.5 × institutional upper limit of normal
    • Creatinine < 1.5 mg/dL OR
    • Estimated creatinine clearance ≥60 mL/min/1.73 m2
  • The effects of rosuvastatin on the developing human fetus are unknown. For this reason and because statins used in this trial are thought to be teratogenic, 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 she or her partner is 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:

  • Participants who are receiving any other investigational agents.
  • Participants with known brain metastases should be excluded from this clinical trial because of their poor prognosis and increased risk of intracranial hemorrhage
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to enoxaparin or atorvastatin
  • Active bleeding or high risk of bleeding (e.g. known acute gastrointestinal ulcer)
  • History of heparin-induced thrombocytopenia.
  • Any history of significant hemorrhage (requiring hospitalization or transfusion) outside of a surgical setting within the last year.
  • Presence of coagulopathy defined as:

    • PT > 1.3 x upper limit of normal
    • PTT > 1.3 x upper limit of normal
  • Uncontrolled hypothyroidism (defined as TSH below lower limit of normal). Qualifying TSH may be within 60 days prior to enrollment. If screening TSH is low, patients are eligible if free T4 is within normal limits.
  • Familial bleeding diathesis
  • Known diagnosis of disseminated intravascular coagulation
  • Currently taking statin (i.e. rosuvastatin, atorvastatin, simvastatin) or fibrates
  • Currently receiving anticoagulant therapy
  • Current use of aspirin (>81 mg daily), Clopidogrel (Plavix), cilostazol (Pletal), aspirin-dipyridamole (Aggrenox).
  • Known Asian descent (including Filipino, Chinese, Japanese, Korean, Vietnamese or Asian-Indian origin) due to altered metabolism of statins.
  • Concomitant use of the following drugs: cyclosporine, fibrates, niacin, gemfibrozil, ketoconazole, spironolactone, cimetidine, warfarin, erythromycin, or protease inhibitors
  • Known recent history of heavy alcohol use
  • History of rhabdomyolysis while on statin therapy.
  • Known active Hepatitis C or active Hepatitis B infection.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Pregnant women are excluded from this study due to the potential for teratogenic effects on the human fetus. Because there is an unknown but potential risk of adverse events in nursing infants secondary to the treatment of the mother with rosuvastatin, breastfeeding should be discontinued. These potential risks may also apply to other agents used in this study.

Sites / Locations

  • Massachusetts General Hospital
  • Beth Israel Deaconess Medical Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Enoxaparin

Enoxaparin + Rosuvastatin

Thromboprophylaxis

Arm Description

-Enoxaparin is administered subcutaneous daily

Enoxaparin is administered subcutaneous daily. Rosuvastatin is administered daily orally starting on day 15

-Thromboprophylaxis is administered per clinician discretion

Outcomes

Primary Outcome Measures

Comparison of differences in circulating tissue factor bearing microparticles between study arms
Concentration of tissue factor bearing microparticles

Secondary Outcome Measures

Point estimate of the rates of VTE following ovarian surgery in each study arm
VTE rate
Comparison of D-dimer values across study arms
D-dimer concentration
Compare the rates of VTE between study arms
VTE rate in arm A and B
Compare CRP between study arms
CRP concentration
Compare concentrations of TFMP, D-dimer, CRP at study timepoints.
Baseline vs day 60 comparison for TFMP, D-dimer, CRP on each arm
Assess incidence of major hemorrhage and clinically relevant bleeding as defined by the International Society of Thrombosis and Haemostasis
Major and clinically relevant non-major bleeding rates
Estimate the overall rate of any VTE
Overall VTE rates

Full Information

First Posted
April 27, 2018
Last Updated
June 14, 2023
Sponsor
Beth Israel Deaconess Medical Center
Collaborators
National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI)
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1. Study Identification

Unique Protocol Identification Number
NCT03532139
Brief Title
Pilot Study of Rosuvastatin and Enoxaparin Thromboprophylaxis Following Ovarian Cancer Surgery (O-STAT Study)
Official Title
Pilot Study of Rosuvastatin and Enoxaparin Thromboprophylaxis Following Ovarian Cancer Surgery (O-STAT Study)
Study Type
Interventional

2. Study Status

Record Verification Date
June 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
July 25, 2018 (Actual)
Primary Completion Date
December 31, 2023 (Anticipated)
Study Completion Date
May 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Beth Israel Deaconess Medical Center
Collaborators
National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This research study is studying a combination of two drug interventions called rosuvastatin and enoxaparin as a possible preventative measure against developing venous blood clots (such deep vein thrombosis or pulmonary embolism). . The drugs involved in this study are: Rosuvastatin, also known as Crestor Enoxaparin
Detailed Description
This is a randomized pilot trial to estimate the effect of rosuvastatin on levels of tissue factor bearing microparticles (TFMP) in patients undergoing surgery for presumed ovarian cancer (including primary peritoneal and fallopian tube carcinoma). Women will either be randomized to enoxaparin subcutaneously once daily (Arm A) or enoxaparin in combination with rosuvastatin (Arm B). Arm C will receive thromboprophylaxis according to standard of care and not be randomized. Levels of circulating TFMP will be assessed in all patients on Day 1 and following surgery (days 15, 30 and day 60). A bilateral lower extremity ultrasound will be performed on days 30 and 60 for all participants to estimate the rate of VTE in the 3 arms.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ovarian Cancer
Keywords
Ovarian Cancer

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Patients will be randomized to Arm Enoxaparin and Arm Enoxaparin + Rosuvastatin, and those requesting no randomization willl be directly assigned to Arm Standard-of-care Thromboprophylaxis
Masking
None (Open Label)
Allocation
Randomized
Enrollment
24 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Enoxaparin
Arm Type
Experimental
Arm Description
-Enoxaparin is administered subcutaneous daily
Arm Title
Enoxaparin + Rosuvastatin
Arm Type
Experimental
Arm Description
Enoxaparin is administered subcutaneous daily. Rosuvastatin is administered daily orally starting on day 15
Arm Title
Thromboprophylaxis
Arm Type
Experimental
Arm Description
-Thromboprophylaxis is administered per clinician discretion
Intervention Type
Drug
Intervention Name(s)
Enoxaparin
Intervention Description
Enoxaparin is used for prevention of blood clots following abdominal or orthopedic surgery and in medical patients with restricted mobility during acute illness
Intervention Type
Drug
Intervention Name(s)
Enoxaparin + Rosuvastatin
Intervention Description
Rosuvastatin is an anti-cholesterol medication that is FDA (the U.S. Food and Drug Administration) approved to lower cholesterol and reduce the risk of arterial blood clots. There is evidence that rosuvastatin can lower the risk of venous blood clots in healthy individuals Enoxaparin is used for prevention of blood clots following abdominal or orthopedic surgery and in medical patients with restricted mobility during acute illness
Intervention Type
Other
Intervention Name(s)
Thromboprophylaxis
Intervention Description
standard of care therapy
Primary Outcome Measure Information:
Title
Comparison of differences in circulating tissue factor bearing microparticles between study arms
Description
Concentration of tissue factor bearing microparticles
Time Frame
60 days
Secondary Outcome Measure Information:
Title
Point estimate of the rates of VTE following ovarian surgery in each study arm
Description
VTE rate
Time Frame
60 days
Title
Comparison of D-dimer values across study arms
Description
D-dimer concentration
Time Frame
60 days
Title
Compare the rates of VTE between study arms
Description
VTE rate in arm A and B
Time Frame
60 days
Title
Compare CRP between study arms
Description
CRP concentration
Time Frame
60 days
Title
Compare concentrations of TFMP, D-dimer, CRP at study timepoints.
Description
Baseline vs day 60 comparison for TFMP, D-dimer, CRP on each arm
Time Frame
60 days
Title
Assess incidence of major hemorrhage and clinically relevant bleeding as defined by the International Society of Thrombosis and Haemostasis
Description
Major and clinically relevant non-major bleeding rates
Time Frame
60 days
Title
Estimate the overall rate of any VTE
Description
Overall VTE rates
Time Frame
60 days

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologic diagnosis of ovarian, fallopian or primary peritoneal cancer (excluding borderline histologies). Preliminary pathology results based on frozen section findings are acceptable. The interval between pelvic or abdominal surgery and first dose of study treatment must be no more than 10 days. Age ≥ 18 years. ECOG performance status ≤2 (see Appendix A) Life expectancy of greater than 6 months Participants must have normal organ and marrow function as defined below: Platelets ≥ 100,000/mcL Total Bilirubin <1.5 mg/dL (or direct bilirubin <1.0 mg/dL) AST(SGOT) ≤ 1.5 × institutional upper limit of normal ALT(SGPT) ≤ 1.5 × institutional upper limit of normal Creatinine < 1.5 mg/dL OR Estimated creatinine clearance ≥60 mL/min/1.73 m2 The effects of rosuvastatin on the developing human fetus are unknown. For this reason and because statins used in this trial are thought to be teratogenic, 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 she or her partner is 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: Participants who are receiving any other investigational agents. Participants with known brain metastases should be excluded from this clinical trial because of their poor prognosis and increased risk of intracranial hemorrhage History of allergic reactions attributed to compounds of similar chemical or biologic composition to enoxaparin or atorvastatin Active bleeding or high risk of bleeding (e.g. known acute gastrointestinal ulcer) History of heparin-induced thrombocytopenia. Any history of significant hemorrhage (requiring hospitalization or transfusion) outside of a surgical setting within the last year. Presence of coagulopathy defined as: PT > 1.3 x upper limit of normal PTT > 1.3 x upper limit of normal Uncontrolled hypothyroidism (defined as TSH below lower limit of normal). Qualifying TSH may be within 60 days prior to enrollment. If screening TSH is low, patients are eligible if free T4 is within normal limits. Familial bleeding diathesis Known diagnosis of disseminated intravascular coagulation Currently taking statin (i.e. rosuvastatin, atorvastatin, simvastatin) or fibrates Currently receiving anticoagulant therapy Current use of aspirin (>81 mg daily), Clopidogrel (Plavix), cilostazol (Pletal), aspirin-dipyridamole (Aggrenox). Known Asian descent (including Filipino, Chinese, Japanese, Korean, Vietnamese or Asian-Indian origin) due to altered metabolism of statins. Concomitant use of the following drugs: cyclosporine, fibrates, niacin, gemfibrozil, ketoconazole, spironolactone, cimetidine, warfarin, erythromycin, or protease inhibitors Known recent history of heavy alcohol use History of rhabdomyolysis while on statin therapy. Known active Hepatitis C or active Hepatitis B infection. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements. Pregnant women are excluded from this study due to the potential for teratogenic effects on the human fetus. Because there is an unknown but potential risk of adverse events in nursing infants secondary to the treatment of the mother with rosuvastatin, breastfeeding should be discontinued. These potential risks may also apply to other agents used in this study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rushad Patell, MD
Organizational Affiliation
Beth Israel Deaconess Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Massachusetts General Hospital
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02214
Country
United States
Facility Name
Beth Israel Deaconess Medical Center
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Pilot Study of Rosuvastatin and Enoxaparin Thromboprophylaxis Following Ovarian Cancer Surgery (O-STAT Study)

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