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Clinical Trial of High-dose Vitamin C for Advanced Pancreatic Cancer (PACMAN-II)

Primary Purpose

Pancreatic Neoplasms, Pancreatic Cancer

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Gemcitabine with escalating ascorbic acid
Sponsored by
Joseph J. Cullen
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pancreatic Neoplasms focused on measuring Vitamins, Complementary medicine, Pancreatic cancer, Ascorbate, Ascorbic Acid, Antioxidants, Gemcitabine, Pharmacologic actions

Eligibility Criteria

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

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.

Sites / Locations

  • The Holden Comprehensive Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Gemcitabine with escalating IV ascorbate

Arm Description

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.

Outcomes

Primary Outcome Measures

Overall Survival
Time to event outcome measure (death), measured in days from cycle 1 day 1.

Secondary Outcome Measures

Progression Free Survival
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
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
F2-isoprostane is a marker of systemic oxidative stress.
Ascorbate Levels
Ascorbate levels will be taken at the bottom of each cycle to assess therapeutic dose window.

Full Information

First Posted
January 18, 2012
Last Updated
May 11, 2017
Sponsor
Joseph J. Cullen
Collaborators
Susan L Bader Foundation of Hope, Holden Comprehensive Cancer Center, National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT01515046
Brief Title
Clinical Trial of High-dose Vitamin C for Advanced Pancreatic Cancer
Acronym
PACMAN-II
Official Title
Pharmacological Ascorbate for the Control of Metastatic and Node-Positive Pancreatic Cancer (PACMAN): A Phase II Trial
Study Type
Interventional

2. Study Status

Record Verification Date
May 2017
Overall Recruitment Status
Terminated
Why Stopped
Standard of care changed to FOLFIRINOX; poor accrual.
Study Start Date
September 2012 (undefined)
Primary Completion Date
July 2015 (Actual)
Study Completion Date
December 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Joseph J. Cullen
Collaborators
Susan L Bader Foundation of Hope, Holden Comprehensive Cancer Center, National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
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.
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.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pancreatic Neoplasms, Pancreatic Cancer
Keywords
Vitamins, Complementary medicine, Pancreatic cancer, Ascorbate, Ascorbic Acid, Antioxidants, Gemcitabine, Pharmacologic actions

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Gemcitabine with escalating IV ascorbate
Arm Type
Experimental
Arm Description
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.
Intervention Type
Drug
Intervention Name(s)
Gemcitabine with escalating ascorbic acid
Other Intervention Name(s)
Gemzar, Ascorbic Acid for Infusion, USP
Intervention Description
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)
Primary Outcome Measure Information:
Title
Overall Survival
Description
Time to event outcome measure (death), measured in days from cycle 1 day 1.
Time Frame
up to 5 years
Secondary Outcome Measure Information:
Title
Progression Free Survival
Description
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.
Time Frame
up to 5 years
Title
Number of Drug-related Adverse Events Per Cycle
Description
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
Time Frame
every 28 days up to 5 years
Title
F2-isoprostane Levels
Description
F2-isoprostane is a marker of systemic oxidative stress.
Time Frame
Once every 28 days for up to 5 years
Title
Ascorbate Levels
Description
Ascorbate levels will be taken at the bottom of each cycle to assess therapeutic dose window.
Time Frame
Once every 28 days up to 5 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
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.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joseph J Cullen, MD
Organizational Affiliation
University of Iowa
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Joseph J Cullen, MD
Organizational Affiliation
University of Iowa
Official's Role
Study Chair
Facility Information:
Facility Name
The Holden Comprehensive Cancer Center
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
20400857
Citation
Cullen JJ. Ascorbate induces autophagy in pancreatic cancer. Autophagy. 2010 Apr;6(3):421-2. doi: 10.4161/auto.6.3.11527. Epub 2010 Apr 15.
Results Reference
background
PubMed Identifier
20068072
Citation
Du J, Martin SM, Levine M, Wagner BA, Buettner GR, Wang SH, Taghiyev AF, Du C, Knudson CM, Cullen JJ. Mechanisms of ascorbate-induced cytotoxicity in pancreatic cancer. Clin Cancer Res. 2010 Jan 15;16(2):509-20. doi: 10.1158/1078-0432.CCR-09-1713. Epub 2010 Jan 12.
Results Reference
background
PubMed Identifier
23381814
Citation
Welsh JL, Wagner BA, van't Erve TJ, Zehr PS, Berg DJ, Halfdanarson TR, Yee NS, Bodeker KL, Du J, Roberts LJ 2nd, Drisko J, Levine M, Buettner GR, Cullen JJ. Pharmacological ascorbate with gemcitabine for the control of metastatic and node-positive pancreatic cancer (PACMAN): results from a phase I clinical trial. Cancer Chemother Pharmacol. 2013 Mar;71(3):765-75. doi: 10.1007/s00280-013-2070-8. Epub 2013 Feb 5.
Results Reference
background

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Clinical Trial of High-dose Vitamin C for Advanced Pancreatic Cancer

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