Sulfasalazine in Patients With Metastatic Colorectal Cancer

Metastatic Colorectal Cancer Clinical Trial

Official title:

Clinical Study Evaluating the Efficacy and Safety of Sulfasalazine in Patients With Metastatic Colorectal Cancer

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06134388
• Other study ID #: Sulfasalazine 2023
• Status: Recruiting
• Phase: Phase 3
• Start date: September 1, 2023
• Est. completion date: September 2026

Study information

• Verified date: November 2023
• Source: Tanta University
• Contact: Reham A. El-Ghoneimy, M.Sc in Clinical Pharmacy
• Phone: +201151896761
• Email: reham.elghonemy[@]pharm.tanta.edu.eg
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The aim of this study is to evaluate the potential efficacy and safety of sulfasalazine in patients with metastatic colorectal cancer.

Description:

Sulfasalazine is an anti-inflammatory drug that is indicated for treatment of ulcerative colitis and rheumatoid arthritis. Sulfasalazine decreased the risk of ulcerative colitis-related colorectal cancer through its anti-inflammatory effect and induction of oxidative stress in cancer cells. Furthermore, intact sulfasalazine, but not its metabolites, inhibited the growth and metastasis various cancers.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 50
• Est. completion date: September 2026
• Est. primary completion date: September 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

1. Histologically confirmed diagnosis of stage IV (metastatic) colorectal cancer. Staging will be performed according to the American Joint Committee on Cancer (AJCC) 8th edition and will be documented by all investigating parameters of metastatic colorectal cancer

2. Male or female patients with age range from 18-65 years old

3. Women of childbearing age will be required to be on acceptable forms of contraception

4. Performance status < 2 according to the Eastern Cooperative Oncology Group (ECOG) score

5. No contraindication to chemotherapy (absence of myelosuppression)

6. Adequate liver function (alanine aminotransferase (ALT) and aspartate aminotransferase (AST) < grade 2) according to the National Cancer Institute-Common Terminology Criteria for Adverse Events, version 5.0 (NCI-CTCAE v 5.0)

7. Adequate renal function (estimated creatinine clearance (eCrCl), serum creatinine (SCr) < grade 2) according to NCI-CTCAE, v 5.0

8. Adequate hematological parameters (hemoglobin, erythrocytes, platelets, leukocytes and absolute neutrophil count (ANC) < grade 2 according to NCI-CTCAE, v 5.0

Exclusion Criteria:

1. Pregnant or lactating women

2. Patients with concurrent active cancer originating from a primary site other than the colon or rectum

3. Patients who have known allergy to sulfasalazine or its metabolites

4. Patients with nephrolithiasis, severe vomiting or severe diarrhea

5. Patients who are receiving highly plasma protein-bound drugs or drugs with extensive hepatic metabolism such as; coumarin anti-coagulants

6. Patients with intestinal or urinary obstruction

7. Patients with known glucose-6-phosphate dehydrogenase deficiency or porphyria

8. Ongoing treatment with sulfasalazine or mesalamine for ulcerative colitis or rheumatoid arthritis

Related Conditions & MeSH terms

• Colorectal Neoplasms
• Metastatic Colorectal Cancer

Intervention

Drug:
• Sulfasalazine
Sulfasalazine is an anti-inflammatory drug that is indicated for treatment of ulcerative colitis and rheumatoid arthritis.

Locations

Country	Name	City	State
Egypt	Tanta University Hospital	Tanta	El-Gharbia Governorate

Sponsors (1)

Lead Sponsor	Collaborator
Tanta University

Country where clinical trial is conducted

Egypt, 

References & Publications (3)

Ma MZ, Chen G, Wang P, Lu WH, Zhu CF, Song M, Yang J, Wen S, Xu RH, Hu Y, Huang P. Xc- inhibitor sulfasalazine sensitizes colorectal cancer to cisplatin by a GSH-dependent mechanism. Cancer Lett. 2015 Nov 1;368(1):88-96. doi: 10.1016/j.canlet.2015.07.031. Epub 2015 Aug 5. — View Citation

Narang VS, Pauletti GM, Gout PW, Buckley DJ, Buckley AR. Sulfasalazine-induced reduction of glutathione levels in breast cancer cells: enhancement of growth-inhibitory activity of Doxorubicin. Chemotherapy. 2007;53(3):210-7. doi: 10.1159/000100812. Epub 2007 Mar 15. — View Citation

Yin L, Liu P, Jin Y, Ning Z, Yang Y, Gao H. Ferroptosis-related small-molecule compounds in cancer therapy: Strategies and applications. Eur J Med Chem. 2022 Dec 15;244:114861. doi: 10.1016/j.ejmech.2022.114861. Epub 2022 Oct 22. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Evaluating the change in the serum level of Ferritin	Blood samples will be collected at baseline and 3 months after treatment.	3 months
Primary	Evaluating the change in the serum level of Superoxide dismutase (SOD)	Blood samples will be collected at baseline and 3 months after treatment.	3 months
Primary	Evaluating the change in the serum level of Nuclear factor-kappa B (NF-kB)	Blood samples will be collected at baseline and 3 months after treatment.	3 months
Primary	Evaluating the change in the serum level of Bcl-2 associated X protein (Bax)	Blood samples will be collected at baseline and 3 months after treatment.	3 months
Primary	Investigating the possible efficacy of sulfasalazine through evaluation of its impact on overall response rate (ORR).	Abdominal, pelvic and chest CT scanning will be performed at baseline and after 3 months. ORR will be evaluated and categorized according to the RECIST 1.1 criteria. ORR includes patients with both complete response and partial response. ORR will be determined as number and percentage.	3 months
Primary	Investigating the possible efficacy of sulfasalazine through evaluation of its impact on disease control rate (DCR).	Abdominal, pelvic and chest CT scanning will be performed at baseline and after 3 months. DCR will be evaluated and categorized according to the RECIST 1.1 criteria. DCR includes patients with complete response, partial response and stable disease. DCR will be determined as number and percentage.	3 months
Secondary	Evaluating the progression free survival (PFS)	PFS is defined as the time from randomization to investigator- assessed tumor progression. PFS will be determined as mean and median in months.	12 months
Secondary	Evaluating the one-year overall survival (1-year OS)	OS is defined as the time from randomization to death from any cause is OS. One-year OS will be determined as mean and median in months.	12 months
Secondary	Evaluating the safety and tolerability of sulfasalazine through investigating Hematological parameters (hemoglobin (mg/dL), erythrocytes (cells/µL), leukocytes (cells/µL), platelets (cells/µL) and absolute neutrophil count (cells/µL)).	These parameters will be followed up at baseline and 3 months after treatment. The reported adverse effects will be graded according to the National Cancer Institute- Common Terminology Criteria for Adverse Effects ( NCI-CTCAE) version 5.	3 months
Secondary	Evaluating the safety and tolerability of sulfasalazine through investigating Liver function test.	These parameters will be followed up at baseline and 3 months after treatment. The reported adverse effects will be graded according to the National Cancer Institute- Common Terminology Criteria for Adverse Effects ( NCI-CTCAE) version 5.	3 months
Secondary	Evaluating the safety and tolerability of sulfasalazine through investigating Renal function test (serum creatinine (mg/dL), blood urea nitrogen (mg/dL) and creatinine clearance (mL/min)).	These parameters will be followed up at baseline and 3 months after treatment. The reported adverse effects will be graded according to the National Cancer Institute- Common Terminology Criteria for Adverse Effects ( NCI-CTCAE) version 5.	3 months