Perioperative Use of a Beta-adrenergic Blocker and a COX-2 Inhibitor in Patients Undergoing Surgery With Primary Pancreatic Cancer: Intervention Aiming to Reduce Pro-metastatic Processes

Who is this study for? Patients undergoing surgery with primary pancreatic cancer
What treatments are being studied? Propranolol+Etodolac
Status: Recruiting
Location: See all (3) locations...
Intervention Type: Other, Drug
Study Type: Interventional
Study Phase: Phase 2
SUMMARY

In Israel, of the \ 1000 patients diagnosed annually with pancreatic cancer (PC), approximately 250 (25 percent) will be eligible for curative surgery, of which 80 percent will succumb to post-surgical metastatic disease. A reduction in post-surgical metastatic disease will save dozens of patients in Israel annually, and tens-of thousands-around the world. The short perioperative period (days to weeks around surgery) is characterized by stress-inflammatory responses, including catecholamines (CAs, e.g., adrenaline) and prostaglandins (PGs, e.g., prostaglandin-E2) release, and induce deleterious pro-metastatic effects. Animal studies implicated excess perioperative release of CAs and PGs in facilitating cancer progression by affecting the malignant tissue, its local environment, and anti-metastatic immune functions. Congruently, our animal studies indicate that combined use of the beta-adrenergic blocker, propranolol, and the prostaglandins inhibitor, etodolac - but neither drug separately - efficiently prevented post-operative metastatic development. We recently conducted two clinical trials in three medical centers in Israel, recruiting breast (n=38) and colorectal (n=34) cancer patients, assessing the safety and short-term efficacy of perioperative propranolol and etodolac treatment. Drugs were well tolerated, without severe adverse events. Importantly, molecular/biological analyses of the excised primary tumor indicated that drug treatment caused promising anti-metastatic transformations, as well as improvements in immune and inflammatory indices. These included (i) decreased tumor cell capacity to migrate, (ii) reduced pro-metastatic capacity of the malignant tissue, and (iii) improvement in immune infiltrating into the tumor (Paper published in Clinical Cancer Research, 2017). Herein, we propose to conduct a double-blind placebo-controlled two-arm Phase II clinical trial in 210 pancreatic cancer patients undergoing curative surgery in Israel. A perioperative 35-day drug treatment will be initiated 5 days before surgery. Primary outcomes will include (i) 1-year disease-free-survival (DFS), and 5-year overall survival (OS); and (ii) biological markers in blood samples, and in the excised tumor tissue. Secondary outcomes will include safety indices and psychological measures of depression, anxiety, distress, and fatigue.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 20
Maximum Age: 80
Healthy Volunteers: f
View:

• Newly diagnosed Stage I or II adenocarcinoma of the head, neck, or uncinated- process of the pancreas.

• Surgically resectable disease (R0 or R1) by spiral CT chest and abdomen scan, No distant metastases

• Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 to 1

• Signed informed consent form

• Willing and able to comply with study procedures

• Men and women from age 20 up to age 80

Locations
Other Locations
Israel
Sourasky Medical Center
NOT_YET_RECRUITING
Tel Aviv
Sheba Medical Center
RECRUITING
Tel Litwinsky
Asaf Harofeh Medical Center
RECRUITING
Ẕerifin
Contact Information
Primary
Oded Zmora, MD
ozmora@post.tau.ac.il
+97289779202
Time Frame
Start Date: 2019-11-20
Estimated Completion Date: 2026-01
Participants
Target number of participants: 210
Treatments
Active_comparator: Propranolol and etodolac
Both study medications will be given orally for an intervention phase of 35 days as follows. Etodolac:400mg PO bid for the entire intervention period,Propranolol:20 mg PO bid for 5 preoperative days, 80 mg PO bid on the day of surgery and the following morning, 40 mg PO bid for following 6.5 days, and 20 mg PO bid for next 22 days.
Placebo_comparator: Placebo
Same schedule as in the active comparator arm
Related Therapeutic Areas
Sponsors
Leads: Assaf-Harofeh Medical Center
Collaborators: Sheba Medical Center

This content was sourced from clinicaltrials.gov