This is a multicenter, single arm, 3-cohort, open-label trial of high dose Vitamin C
intravenous infusion in subjects with solid tumor malignancies who are eligible for resection
(cohort A) or with extended RAS (e.g.KRAS or NRAS) or BRAF mutation metastatic cancer who
have received prior systemic treatment (cohort B). Cohort C will involve patients with
colorectal cancer having an extended RAS or BRAF mutation who are amenable for localregional
therapy of hepatic metastases with Yttrium-90 radioembolization.
This clinical trial is for men and women with resectable or metastatic solid tumor
malignancies. The objective of the study is to investigate whether high dose vitamin C
infusion leads to pathological tumor response in resectable colorectal, pancreatic, and lung
cancer (cohort A) or objective tumor response in KRAS or BRAF mutant solid tumors (cohort B).
For Cohort C, the primary objective is to determine that maximal tolerated dose of the
combination of high dose vitamin C with Y90 radioembolization for patients solid tumor
malignancies and liver metastases amenable to local-regional therapy
Patients in cohort A receive a high dose vitamin C infusion for 4 days per week for 2-4
consecutive weeks prior to surgery. Patients in cohort B receive high dose vitamin C infusion
for 4 days per week for up to 6 months or disease progression. Cohort C will receive high
dose vitamin C for 1-2 weeks prior to and following Y90 radioembolization of hepatic
metastases
A tumor sample will be resected after completion of study drug (high dose vitamin C infusion)
treatment to examine the effects of study drug (Cohort A only). In addition, organoids will
be grown in vitro and continue to be treated with vitamin C added in culture medium to
examine tumor response. The resected tumor in this study will
Key eligibility:
- Men and women age 18 and older
- Patients with histologically proven early stage or locally advanced colorectal
adenocarcinoma, lung cancer or pancreatic cancer, who are eligible for resection, and
have not received chemotherapy or radiotherapy (cohort A) Patients with inoperable,
metastatic, KRAS or BRAF mutant colorectal adenocarcinoma, lung cancer and pancreatic
cancer, who have received at least 1 line of treatment for metastatic disease (cohort B)
- Patients with metastatic cancer with an extended RAS (e.g. KRAS or NRAS) or BRAF
mutation with liver metastases amenable to Y90 radioembolization (cohort C).
Inclusion Criteria
1. Male or female ≥ 18 years of age.
2. Patients with histologically proven early stage or locally advanced colorectal
adenocarcinoma, lung cancer or pancreatic cancer, who are eligible for resection
(cohort A).
3. Patients with inoperable, metastatic extended RAS (e.g. KRAS or NRAS) or BRAF mutant
colorectal adenocarcinoma,lung cancer and pancreatic cancer, or other solid tumor, who
have received at least 1 line of treatment for metastatic disease (cohort B).
Note: If subject refuses chemotherapy and therefore has no prior chemotherapy, they
can be eligible for the trial with approval from the primary investigator.
3.1 Patients with metastatic cancer with an extended RAS (e.g. KRAS or NRAS) or BRAF
mutation with liver metastases amenable to Y90 radioembolization (cohort C).
4. ECOG performance status 0-1.
5. Life expectancy of at least 6 months.
6. All women of child-bearing potential and all sexually active male patients must agree
to use effective contraception.
7. Patient with adequate organ and marrow function as follows:
- ANC ≥ 1000 mm3, platelets ≥ 100,000/mm3, hemoglobin ≥ 9 g/dL,
- serum creatinine ≤1.8 mg/dL or creatinine clearance > 50 mL/min (Appendix C:
Estimating Creatinine Clearance);
- bilirubin ≤ 1.5 mg/dL; alanine aminotransferase (ALT), aspartate transaminase
(AST) ≤ 2.5 times the upper limit of normal if no liver involvement or ≤ 5 times
the upper limit of normal with liver involvement.
8. Patients with serum electrolytes (including calcium, magnesium, phosphorous, sodium
and potassium) within normal limits (supplementation to maintain normal electrolytes
is allowed).
9. Patients taking Vitamin C will have stopped taking oral vitamin C more than 1 week
before planned study treatment.
10. Patients capable of understanding and complying with the protocol and who have signed
the informed consent document.
Exclusion Criteria:
1. Patients with uncontrolled intercurrent illness including, but not limited to
uncontrolled infection, symptomatic congestive heart failure (NYHA class III and IV),
uncontrolled cardiac arrhythmia, or psychiatric illness/social situations that would
limit compliance with study requirements (Appendix B: New York Heart Association
(NYHA) Classifications).
2. Patients with active heart disease including myocardial infarction within previous 3
months, symptomatic coronary artery disease, arrhythmias not controlled by medication,
unstable angina pectoris, or uncontrolled congestive heart failure (NYHA class III and
IV) (Appendix B: New York Heart Association (NYHA) Classifications).
4. Patients who have received an investigational drug within 21 days of the first dose of
study drug.
5. Patient who have not recovered to grade ≤ 1 from adverse events (AEs) due to
investigational drugs or other medications, which were administered more than 4 weeks prior
to the first dose of study drug.
6. Patients who are pregnant or lactating.
7. Patients who are known to be positive for the human immunodeficiency virus (HIV). The
effect of Vitamin C on HIV medications is unknown. Note: HIV testing is not required for
eligibility, but if performed previously and was positive, the patient is ineligible for
the study.
8. Patients who have the inability or unwillingness to abide by the study protocol or
cooperate fully with the investigator or designee.
9. Patient who are receiving drugs which are known to interact with Vitamin C, potential
risk and eligibility will be evaluated individually by the investigator. a. Most of the
known interactions with vitamin C are from oral use and acidification of the stomach
lining. There are few known interactions with high dose intravenous vitamin C. We recommend
not using deferoxamine as there may be an association with ventricular dysfunction (unknown
mechanism).
10. Patients who have uncontrolled or severe hyponatremia, hypernatremia, SIADH,
hypokalemia, hyperkalemia, hypomagnesemia, or hypermagnesemia
11. Patients who have uncontrolled or severe coagulopathies or a history of clinically
significant bleeding within the past 6 months, such as hemoptysis, epistaxis, hematochezia,
hematuria, or gastrointestinal bleeding.
12. Patients who require therapeutic doses of warfarin is prohibited.
13. Patients who have uncontrolled seizure disorder, ascites, iron overload, edema, or
dehydration.
14. Patients who have glucose-6-phosphate dehydrogenase (G6PD) deficiency, hereditary
spherocytosis, or other conditions predisposing patient to hemolysis.
15. Patients who have a known history of recurrent oxalate renal calculi or multiple
oxalate.