A Phase 2 Study Adding Ascorbate to Chemotherapy and Radiation Therapy for NSCLC

Non-Small Cell Lung Cancer Clinical Trial

— XACT-LUNG  

Official title:

A Phase 2 Trial of Pharmacological Ascorbate With Concurrent Chemotherapy and Radiation Therapy for Non-small Cell Lung Cancer

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT02905591
• Other study ID #: 201712770
• Secondary ID: 3P30CA0868625U01
• Status: Recruiting
• Phase: Phase 2
• Start date: November 16, 2018
• Est. completion date: December 31, 2027

Study information

• Verified date: August 2023
• Source: University of Iowa
• Contact: Bryan G Allen, MD, PhD
• Phone: 319-353-8836
• Email: bryan-allen[@]uiowa.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This clinical trial evaluates adding high-dose ascorbate (vitamin C) to a standard therapy for non-small cell lung cancer. The standard therapy is radiation therapy combined with carboplatin and paclitaxel (types of chemotherapy). All subjects will receive high-dose ascorbate in addition to the standard therapy.

Description:

For selected stages of non-small cell lung cancer (NSCLC), standard treatment involves radiation therapy and chemotherapy. The chemotherapy regimen typically used is paclitaxel and carboplatin. Both of these chemotherapeutic drugs are administered intravenously, using a vein in the arm. Radiation is administered using a machine external to the body (usually a linear accelerator). After combined therapy, NSCLC patients receive 2 extra cycles of chemotherapy, called "consolidation chemotherapy."

This study adds 75 grams of ascorbate (vitamin C, sometimes called pharmacological ascorbate because the dose is so high) at specific timepoints in the therapy. The ascorbate is administered intravenously - through a vein in your arm.

Participants will:

• receive 75 grams of intravenous ascorbate 3 times per calendar week while they are receiving radiation therapy. The IV will be running while the radiation therapy is administered.

• undergo imaging which is standard for their cancer and therapy. This can include CT scans, PET scans, and X-rays.

• provide blood samples to determine the biological effects, if any, the ascorbate has on the body during therapy

This active therapy portion lasts for about 10 to 12 weeks. After that is done, participants go back to standard follow-up for their cancer and any additional therapy their doctors believe they need.

However, it is very important the investigators remain in contact with participants; they will have life-long follow-up for this study.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 46
• Est. completion date: December 31, 2027
• Est. primary completion date: December 1, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

Note: patients who have a small pleural effusion that is too small to safety tap and is not visible on a chest x-ray are still eligible

• Pathologic diagnosis (i.e., cell sample, biopsy, tissue swap, bronchoscopy) of non-small cell lung cancer.

• Recommended to receive carboplatin & paclitaxel with radiation therapy as a treatment

• Tumor or metastatic disease must measure at least 1 cm using a CT scan (CAT scan)

• Physician determined the patient is healthy enough for chemotherapy and radiation therapy

• At least part of the lung cancer must be viewable and measurable by CT or MRI

• A platelet count of at least 100,000 cells per mililiter

• A creatinine level of less than 1 1/2 times the upper limit of normal for the local lab test, or, a creatinine clearance of at least 60 mL/(min*1.73m2)

• Not pregnant, and commit to using birth control during the study

Exclusion Criteria:

• Exudative pleural effusion

• Recurrent non-small cell lung cancer

• Glucose-6-phosphate dehydrogenase (G6PD) deficiency

• Patients actively receiving insulin or patients whose doctors have recommended current insulin use

• Patients requiring daily finger-stick blood glucose measurements

• Patients who are on the following drugs and cannot have a substitution or who decline the substitution:

• warfarin

• flecainide

• methadone

• amphetamines

• quinidine

• chlorpropamide

• Prior radiation therapy that would result in a field overlap

• Enrolled in another therapeutic clinical trial

• Uncontrolled, intercurrent illness

• Lactating women

• HIV positive individuals undergoing therapy due to known drug:drug interaction between antiretroviral drugs and high-dose ascorbate therapy

If all the above are met, the potential participant will receive a 15 gram challenge dose of ascorbate via intravenous infusion. This is the final screening procedure.

Related Conditions & MeSH terms

• Carcinoma
• Carcinoma, Non-Small-Cell Lung
• Lung Neoplasms
• Non-Small Cell Lung Cancer
• Non-Small-Cell Lung Carcinoma
• Nonsmall Cell Lung Cancer
• NSCLC

Intervention

Drug:
• Radiation Therapy
Conformal radiation administered daily, Monday through Friday Total dose is 60 Gray (Gy) and is delivered in 2 Gy fractions. One fraction is delivered daily for a total of 30 fractions in 30 days
• Paclitaxel
Administered intravenously (IV) Given the same day as carboplatin, but given before the carboplatin is administered the dose is 45 mg/m2 (standard dose) Administered weekly 6 to 7 weeks of therapy, depending on when radiation starts Standardized dose reductions are used
• Carboplatin
Administered intravenously (IV) GIven the same day as paclitaxel, immediately after the paclitaxel infusion is done. Prescribed at area-under-the-curve (AUC) = 2 using the Cockroft-Gault formula (standard) Administered weekly 6 to 7 weeks of therapy, depending on when radiation starts Standard dose reductions are used
• Ascorbic Acid
Administered intravenously 75 grams per infusion; each infusion is about 2 hours 3 infusion per calendar week The infusion is actively running for at least 20 minutes when radiation begins May be given while chemotherapy is delayed due to low counts Dose reductions are not used Given for 6 to 7 weeks, depending on when radiation starts

Locations

Country	Name	City	State
United States	Holden Comprehensive Cancer Cener	Iowa City	Iowa

Sponsors (4)

Lead Sponsor	Collaborator
Joseph J. Cullen, MD, FACS	Holden Comprehensive Cancer Center, National Cancer Institute (NCI), National Institutes of Health (NIH)

Country where clinical trial is conducted

United States, 

References & Publications (1)

Schoenfeld JD, Sibenaller ZA, Mapuskar KA, Wagner BA, Cramer-Morales KL, Furqan M, Sandhu S, Carlisle TL, Smith MC, Abu Hejleh T, Berg DJ, Zhang J, Keech J, Parekh KR, Bhatia S, Monga V, Bodeker KL, Ahmann L, Vollstedt S, Brown H, Shanahan Kauffman EP, Schall ME, Hohl RJ, Clamon GH, Greenlee JD, Howard MA, Schultz MK, Smith BJ, Riley DP, Domann FE, Cullen JJ, Buettner GR, Buatti JM, Spitz DR, Allen BG. O2·- and H2O2-Mediated Disruption of Fe Metabolism Causes the Differential Susceptibility of NSCLC and GBM Cancer Cells to Pharmacological Ascorbate. Cancer Cell. 2017 Apr 10;31(4):487-500.e8. doi: 10.1016/j.ccell.2017.02.018. Epub 2017 Mar 30. Erratum In: Cancer Cell. 2017 Aug 14;32(2):268. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Progression rate at completion of radiation and chemotherapy	Tumor measurement from CT scan, using the RECIST criteria to define progression	3 to 4 weeks after last radiation treatment
Secondary	Tumor response	From radiation day 1 to documented disease progression as described by RECIST criteria. Results are provided in nominal categories (CR, PR, SD, PD) as per RECIST.	Every six months for up to 20 years post-treatment
Secondary	Progression free survival (PFS)	Time, measured in days, it takes for disease to progress, where disease progression is defined by the RECIST criteria (v1.1). Timeframe is from radiation day 1 to date of disease progression	Every six months for up to 20 years post-treatment
Secondary	Overall survival (OS)	Time, measured in months, from start of radiation to death from any cause.	Every three months for up to 20 years post-treatment
Secondary	Adverse event frequency and categorization	Categorize and quantify adverse events using the Common Terminology Criteria for Adverse Events (CTCAE, v 4) as follows: Through radiation, weekly assessment of adverse events; Consolidation chemotherapy, assessment day 1 of each cycle; Post-treatment, every 6 months through 2 years post-therapy	Weekly for the first 7 weeks, then monthly for 3 months, then every 6 months through 2 years post-treatment