Phase II Study of Single Agent Pre-operative Metformin in Patients With Clinical Stage I - IIIA NSCLC Proceeding to Surgical Resection. 'Lung Metcore Study'
This is a phase II single centre open label single arm pre-operative window of metformin
treatment in stage I-IIIa Non small cell lung cancer.
In which patients will be invited to participate by receiving Metformin treatment during 14
to 21 days at 850 mg BID until the day before surgery.
They will be followed closely for any Adverse Events during treatment and 30 days after
surgery. During treatment there will be no follow up tests except 1 fasting blood glucose at
week 2 of treatment.
Survival data will be prospectively gathered after study treatment has ended until death.
Title of study: Phase II study of single agent pre-operative metformin in patients with clinical stage I - IIIA NSCLC proceeding to surgical resection. 'Lung Metcore Study'
To evaluate the effects of short-term pre-operative exposure to metformin in operable stages I to IIIA NSCLC.
Number of patients: Thus, the total expected sample size is approximately 50 patients, anticipating minimal loss of eligible participants through treatment intolerance or acceleration of surgery. Accrual is estimated at 1.5 to 2 patients per month for 25 to 33 months, based on accrual rates for a recent pre-operative window thoracic surgical study at UHN.
• Metformin will be started at a dose of 850mg daily then increased to 850mg b.i.d. (morning and evening) after 5 days as tolerated. Treatment will be given from the time of enrollment till the evening prior to surgery.
The following molecular and serological correlative biomarkers will be considered covariates in the analysis of primary endpoints of the phase II study. Covariate pretreatment values and changes in covariate values (where applicable) will be used to estimate the relationship between covariates and patient's Ki67 or apoptotic response using logistic regression. It is noted that several covariates are being tested and the number of patients being analyzed is small, thus, some tests may be statistically significant due to chance even if no association exists.
Genetic Mutations in NSCLC (On pre-treatment biopsies by molecular techniques):
Protein Marker of Resistance To Metformin (On pre-treatment biopsies by immunohistochemistry
VASCULARITY IN NSCLC (Comparison between pre-treatment biopsies and post-resection specimens by immunohistochemistry):
SERUM LIGANDS TO SIGNALLING PATHWAYS IN NSCLC (Comparison between pre-treatment biopsies and post-resection specimens by ELISA):
Patients who completed metformin treatment will have the Ki67 and apoptosis scores compared between samples obtained pre and post-metformin treatment. Changes in Ki67 and apoptotic scores with metformin treatment will be correlated with the biomarkers of various pathways hypothesized to mediate an effect of metformin on NSCLC development.
View this trial on ClinicalTrials.gov
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