Description:
Study the effect of metformin when added to definitive locoregional radiotherapy on
locoregional control and relapse rate in stage III non-small cell lung cancer patients
receiving sequential chemoradiotherapy. Try to identify subsets of patients who derive
maximum benefit of adding metformin to radiotherapy using innovative biomarkers.
Title
- Brief Title: The Addition of Metformin to Definitive Radiotherapy in Patients With Stage III NSCLC
- Official Title: Randomized Phase II Trial of Definitive Radiotherapy With or Without metFORMin in Patients With Inoperable Stage III Non-small Cell Lung Cancer
Clinical Trial IDs
- ORG STUDY ID:
OPM-RADFORMIN-1801
- NCT ID:
NCT04170959
Conditions
- Carcinoma, Non-Small-Cell Lung
Interventions
Drug | Synonyms | Arms |
---|
Metformin | | C: Interventional arm |
Purpose
Study the effect of metformin when added to definitive locoregional radiotherapy on
locoregional control and relapse rate in stage III non-small cell lung cancer patients
receiving sequential chemoradiotherapy. Try to identify subsets of patients who derive
maximum benefit of adding metformin to radiotherapy using innovative biomarkers.
Detailed Description
The administration of oral metformin during radiotherapy is thought to decrease the hypoxic
fraction of tumour cells, improving radiosensitivity and promoting apoptosis, resulting in
better outcome. This hypothesis will be evaluated in a trial with randomized design. All
patients willing to participate will receive definitive radiotherapy, either in combination
with metformin (arm C) or without metformin (arm B). Patients who refuse to participate in
the randomized part can be included in the observational arm of the study (arm A). In
addition, the validated biomarker of tumour hypoxia (18F-HX4 PET/CT scintigraphy
(18F-flortanidazole positron emission computed tomography) and biomarkers of resistance,
apoptosis and glucose metabolism will be evaluated for their potential predictive value.
Trial Arms
Name | Type | Description | Interventions |
---|
A: Observational arm | No Intervention | Radiotherapy as per standard of care without metformin, no additional biomarkers/imaging will be performed | |
B: Control arm | Other | Radiotherapy as per standard of care without metformin, with additional biomarkers/imaging | |
C: Interventional arm | Active Comparator | Radiotherapy as per standard of care with metformin, with additional biomarkers/imaging | |
Eligibility Criteria
Inclusion Criteria:
- Provision of signed and dated informed consent form.
- Stated willingness to comply with all study procedures and availability for the
duration of the study.
- Ability to take oral medication and willing to adhere to the RADFORMIN-regimen.
- Male or female, ≥ 18 years of age.
- Histological or cytological proven stage III NSCLC after adequate staging with at
least 18F-2-fluoro-2-deoxy-D-glucose (FDG) PET/CT, contrast enhanced CT-thorax and
contrast-enhanced CT/MRI brain. (According to 8th edition of TNM classification (=
tumor, node, metastasis))
- Absence of diabetes, (diabetes is defined as fasting plasma glucose >126 mg/dL or
random plasma glucose >200 mg/dL).
- Eastern Cooperative Oncology Group (ECOG) performance score (= World Health
Organization (WHO) score) of 0-1.
- Adequate hematologic, hepatic and renal function as clinically acceptable in the
opinion of the Primary Investigator.
- Adequate pulmonary function in order to be administered definitive radiotherapy. With
Forced Expiratory Volume (FEV) > 1.2 litres per second or more than 50% of predicted,
and diffusion capacity of lung for carbon monoxide (DLCO) > 40% predicted. (Values
without administration of medical bronchodilation. In case of Tiffeneau < 70%
bronchodilation will be administered)
- Having received at least 2 cycles of platinum-based chemotherapy. This according to
institutional standards and without progression (on a restaging CT-scan within 3 weeks
after day 1 of the last given cycle, according to RECIST criteria).
Exclusion Criteria:
- Current use of metformin, insulin or other oral antidiabetic drugs
(thiazolidinediones, sulfonylureas, mitiglinides, alpha-glucosidase inhibitors,
incretin mimetics, dipeptidyl peptidase-4 inhibitors, amylin analogues,
sodium-glucose-cotransporter-2 (SGLT-2)-inhibitors) for any reason.
- Evidence for metastatic disease.
- Conditions associated with increased risk of metformin-associated lactic acidosis: New
York Heart Association class III or IV congestive heart failure, history of acidosis
of any type, known kidney injury or disease, alcoholic liver disease or habitual
intake of 3 or more alcoholic beverages per day.
- Known pregnancy or lactating female patients.
- Known allergic reactions to components of metformin.
- Prior invasive malignancy within the past year (in remission, without evidence for
current active disease and without maintenance therapy). Except non-melanomatous skin
cancer, non-invasive carcinoma in-situ of the breast, oral cavity or cervix.
- Known acquired immune deficiency syndrome.
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Loco regional progression-free survival rate |
Time Frame: | 1 year after start of treatment |
Safety Issue: | |
Description: | (LPFS) |
Secondary Outcome Measures
Measure: | Overall survival |
Time Frame: | time until death; assessed up to 60 months after treatment start |
Safety Issue: | |
Description: | (OS) |
Measure: | Progression-free survival |
Time Frame: | earliest date of disease progression (local or distant), assessed up to 24 months after treatment start |
Safety Issue: | |
Description: | (PFS) |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Terminated |
Lead Sponsor: | ethisch.comite@uza.be |
Trial Keywords
- Tumor Hypoxia
- Metformin
- Radiotherapy
Last Updated
January 15, 2021