A Study of Pre-operative Metformin in Prostate Cancer (ANIMATE)

This study has been terminated.
(Slow Accrual)
Sponsor:
Collaborator:
Jewish General Hospital
Information provided by:
University Health Network, Toronto
ClinicalTrials.gov Identifier:
NCT00881725
First received: April 14, 2009
Last updated: June 18, 2012
Last verified: June 2012
  Purpose

This study will investigate the effect of neoadjuvant metformin therapy in the inhibition of growth and proliferation of prostate cancer cells prior to radical prostatectomy.


Condition Intervention Phase
Prostate Cancer
Drug: Metformin
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase II, Open Label Assessment of Neoadjuvant Intervention With Metformin Against Tumour Expression of Signaling

Resource links provided by NLM:


Further study details as provided by University Health Network, Toronto:

Primary Outcome Measures:
  • Difference in Ki67 staining [ Time Frame: Pre-Surgery ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Other immunohistochemical assays: IR, IGF-1R, p70S6K, AMPK, MVD, Cleaved caspase 3, PTEN, c-Myc [ Time Frame: Pre-Surgery ] [ Designated as safety issue: No ]
  • Differences in measures of insulin resistance: waist/hip ratio, fasting blood glucose, post-prandial blood glucose, weight [ Time Frame: Pre-Surgery, Post-Surgery ] [ Designated as safety issue: Yes ]
  • Differences in PSA levels [ Time Frame: Pre-Surgery, Post-Surgery ] [ Designated as safety issue: No ]
  • Incidence of adverse events, serious adverse events, and grade 3-4 toxicities [ Time Frame: Pre-Surgery, Post-Surgery ] [ Designated as safety issue: Yes ]

Enrollment: 24
Study Start Date: June 2009
Study Completion Date: June 2012
Primary Completion Date: March 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Metformin
500mg t.i.d. for 4-12 weeks prior to Radical Prostatectomy
Drug: Metformin
500mg tablets t.i.d. for 4-12 weeks prior to Radical Prostatectomy

Detailed Description:

Prostate cancer is the most commonly diagnosed malignancy in men in North America, with close to a quarter of a million cases diagnosed in 2007 alone (Joshua et al, 2007). The activation of the PTEN/ AKT pathway is thought to be of importance in prostatic carcinogenesis as it correlates with a poor prognosis (Yoshimoto et al, 2007) (Schmitz et al, 2007). Components of this cellular pathway have pleiotropic targets including the mTOR complex. In model systems, tumours exhibiting activation of PI3K/AKT kinase are sensitive to mTOR inhibitors.

Metformin (1,1-dimethylbiguanide hydrochloride) belongs to the biguanide class of oral hypoglycaemic agents and is a commonly prescribed medication for a number of conditions. It is the first-line drug of choice for the treatment of type 2 diabetes. Its mechanism of action is thought to be the primary inhibition of hepatic glucose output through inhibition of gluconeogenesis. Subsequently, metformin causes a decline in the circulating insulin level (Hundal et al, 2000).

Metformin causes inhibition of the mTOR complex. The mTOR complex is primarily inhibited through activation of AMPK (a component of the PTEN/AKT pathway). Metformin causes reduced hepatic glucose output leading to decreased levels of circulating insulin which causes the secondary inhibition of the mTOR complex. Metformin has also been shown to inhibit cyclin D1 expression and retinoblastoma protein (Rb) phosphorylation. Inhibition of Cyclin D1 and Rb phosphorylation cause inhibition of G1/S phase transition of the cell cycle. This results in the inhibition of cell proliferation (Matsushime et al, 1994).

This study will investigate the effect of neoadjuvant metformin therapy in the inhibition of growth and proliferation of prostate cancer cells prior to radical prostatectomy.

  Eligibility

Ages Eligible for Study:   18 Years to 75 Years
Genders Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. 1. Patients with histologically confirmed prostate cancer involving at least 20% of at least one unfragmented biopsy core;
  2. Over the age of 18 and under the age of 75;
  3. Ability to read and understand the consent form, either alone or with the aid of a translator
  4. ECOG performance status less than or equal to 2 (Karnofsky greater than or equal to 60%);
  5. Patients must have their TRUS biopsy performed at UHN (or at an outside institution if tissue accession can be arranged) in the last 3 months;
  6. Patients must have normal organ and marrow function as defined by the following criteria:

    1. Absolute neutrophil count greater than or equal to 1,500/uL
    2. Platelets greater than or equal to 100,000/uL
    3. Total bilirubin less than or equal to 1.5 X institutional ULN
    4. AST(SGOT)/ALT(SGPT) less than or equal to 1.5 X institutional ULN
    5. Creatinine less than or equal to 1.4 X institutional ULN

Exclusion Criteria:

  1. Patients who on initial assessment are found to be on treatment with any drug used for the treatment of any form of diabetes, or patients that begin treatment for any form of diabetes during the course of the study;
  2. Patients may not be receiving any other investigational, herbal or anticancer agents while on study;
  3. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, congestive heart failure (NYHA Class 3 or greater), cirrhosis with a Child-Pugh level of B or greater or evidence of cardiac dysfunction, unstable angina pectoris, cardiac arrhythmia, active peptic ulcer disease, clinically significant gastrointestinal conditions (e.g. Crohns disease, ulcerative colitis), COPD or psychiatric illness/social situations that would limit compliance with study requirements;
  4. Active malignancy at any other site excluding squamous cell or basal cell carcinomas of the skin
  5. Radiotherapy within the past 4 weeks;
  6. Patients with a current history of alcohol intake (>2 standard drinks/day) or binge drinking (5 or more drinks (male), or 4 or more drinks (female)) in one session of 1-3 hours;
  7. Past history of lactic acidosis or risk factors for lactic acidosis such as congestive heart failure (NYHA Class 3 or greater), hypoxia (resting PO2 < 91%) or renal insufficiency (eGFR < 60 mls/min)
  8. Patients taking systemic glucocorticoids or estrogenic compounds.
  9. Patients with known hypersensitivity or allergy to metformin or any of its excipients.
  10. Patients with a history of impaired liver or kidney function.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00881725

Locations
Canada, Ontario
University Health Network
Toronto, Ontario, Canada, M5G2M9
Sponsors and Collaborators
University Health Network, Toronto
Jewish General Hospital
Investigators
Principal Investigator: Anthony Joshua, M.D. University Health Network, Toronto
  More Information

Publications:
Responsible Party: Dr. Anthony Joshua, University Health Network
ClinicalTrials.gov Identifier: NCT00881725     History of Changes
Other Study ID Numbers: PMH-ANIMATE-001
Study First Received: April 14, 2009
Last Updated: June 18, 2012
Health Authority: Canada: Health Canada

Keywords provided by University Health Network, Toronto:
Metformin
Prostate Cancer
Radical Prostatectomy
Neoadjuvant Intervention
PTEN/AKT Pathway
Tumour Expression
Ki67 Expression

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Diseases, Male
Genital Neoplasms, Male
Neoplasms
Neoplasms by Site
Prostatic Diseases
Urogenital Neoplasms
Metformin
Hypoglycemic Agents
Pharmacologic Actions
Physiological Effects of Drugs

ClinicalTrials.gov processed this record on October 29, 2014