Phase II Trial of Disulfiram With Copper in Metastatic Breast Cancer (DISC)
Phase II Open Labeled Trial of Disulfiram With Copper in Metastatic Breast Cancer
The aim of the study is to establish clinical evidence for introducing disulfiram and cooper as an active therapy for metastatic breast cancer upon failure of conventional systemic and/or locoregional therapies.
Analyses of the following objectives will be performed in the population of patients with metastatic breast cancer:
Primary efficacy objective:
To evaluate the efficacy of the treatment by assessment of:
- clinical response rate (RR)
- clinical benefit rate (CBR)
Secondary efficacy objectives:
To evaluate the efficacy of the treatment by assessment of:
- time to progression (TTP)
- overall survival (OS)
Pharmacokinetic objectives:
• to determine pharmacokinetic parameters for disulfiram and its active metabolites administered in combination with copper supplements in cancer patient population
Safety objectives:
• to describe safety profile of disulfiram administered in combination with copper supplements
Exploratory objectives:
Parallel analysis to assess (identify) potential candidate surrogate biomarkers of disulfiram efficacy, as well as identification (using proteomic, biochemical and molecular genetic studies) of potential predictive biomarkers of disulfiram sensitivity or resistance will be performed. Surrogate biomarker analysis will focus on in vivo ubiquitin-proteosomal system inhibition, cell cycle and DNA damage.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Inclusion criteria:
- Patients with stage IV breast cancer with metastases demonstrated by appropriate imaging techniques
- Histologically or cytologically confirmed tumor
- Age of 18 years or more
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 - 2
- Patients have failed, untolerated or refused standard therapeutic modalities
- Not received systemic anticancer therapy or radiation or had major surgery in last 2 weeks
- Not currently participating in another study
- Anticipated survival of at least 2 months
- Baseline aspartate aminotransferase (AST) and alanine aminotransferase (ALT) not greater than 2.5 X upper institutional limit
- Serum copper within normal limits
- Serum ceruloplasmin > 17 mg/dL
- Able and willing to sign informed consent and to comply with study procedures
- Able to ingest oral medications
- No known allergy to disulfiram or copper
- Willing to refrain from ingestion of alcoholic beverages while on the study
Exclusion criteria:
- Participation in another clinical trial of a therapeutic drug during the past 14 days
- Addiction to alcohol or drugs
- Baseline AST or ALT greater than 2.5 X upper institutional limit
- Unable to ingest oral medications
- Unable to undergo CT/SPECT scanning because of inability to lie recumbent in the scanner
- Actively receiving cytotoxic cancer chemotherapy agents
- Anticipated survival of less than 2 months
- Women of child-bearing potential who are not using a commonly accepted effective means of contraception; women of child-bearing potential will have negative pregnancy test before enrollment
- History of active liver disease, including chronic active hepatitis, viral hepatitis (hepatitis B, C and CMV), cholestatic jaundice of any etiology, toxic hepatitis, or cholestatic hepatitis or jaundice with bilirubin greater than 2.0 X upper institutional limit
- History of Wilson's disease or family member with Wilson's disease
- History of hemochromatosis or family member with hemochromatosis
- History of other iron overload syndrome such as hemochromatosis
- Need for metronidazole, warfarin and/or theophylline medication, the metabolism of which is likely influenced by disulfiram
- Pregnant women and nursing mothers are not allowed to enroll on this study
- Patients who are taking medications metabolized by cytochrome P450 2E1, including chlorzoxazone or halothane and its derivatives
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Phase 2
Contacts and Locations
Study Contact
Study Contact
- Name: Marian Hajduch, MD., PhD.
- Phone Number: +420 585632111
- Email: marian.hajduch@upol.cz
Study Locations
-
-
-
Olomouc, Czechia, 77900
- Recruiting
- University Hospital Olomouc
-
Contact:
- Bohuslav Melichar, MD., PhD.
- Phone Number: +420588444295
- Email: bohuslav.melichar@fnol.cz
-
Contact:
- Lucie Stejskalova, MSc.
- Phone Number: +420588444295
- Email: lucie.stejskalova@fnol.cz
-
Principal Investigator:
- Bohuslav Melichar, MD., PhD.
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients with stage IV breast cancer with metastases demonstrated by appropriate imaging techniques (computer tomography - CT, positron emission tomography - PET or PET/CT, MRI, ultrasound, etc.)
- Histologically or cytologically confirmed tumor
- Age of 18 years or more
- ECOG performance status of 0 - 2
- Patients have failed, untolerated or refused standard therapeutic modalities
- Not received systemic anticancer therapy or radiation or had major surgery in last 2 weeks
- Not currently participating in another study
- Anticipated survival of at least 2 months
- Baseline AST and ALT not greater than 2.5 X upper institutional limit
- Serum copper within normal limits
- Serum ceruloplasmin > 17 mg/dL
- Able and willing to sign informed consent and to comply with study procedures
- Able to ingest oral medications
- No known allergy to disulfiram or copper
- Willing to refrain from ingestion of alcoholic beverages while on the study
Exclusion Criteria:
- Participation in another clinical trial of a therapeutic drug during the past 14 days
- Addiction to alcohol or drugs
- Baseline AST or ALT greater than 2.5 X upper institutional limit
- Unable to ingest oral medications
- Unable to undergo CT/SPECT scanning because of inability to lie recumbent in the scanner
- Actively receiving cytotoxic cancer chemotherapy agents
- Anticipated survival of less than 2 months
- Women of child-bearing potential who are not using a commonly accepted effective means of contraception; women of child-bearing potential will have negative pregnancy test before enrollment
- History of active liver disease, including chronic active hepatitis, viral hepatitis (hepatitis B, C and CMV), cholestatic jaundice of any etiology, toxic hepatitis, or cholestatic hepatitis or jaundice with bilirubin greater than 2.0 X upper institutional limit
- History of Wilson's disease or family member with Wilson's disease
- History of hemochromatosis or family member with hemochromatosis
- History of other iron overload syndrome such as hemochromatosis
- Need for metronidazole, warfarin and/or theophylline medication, the metabolism of which is likely influenced by disulfiram
- Pregnant women and nursing mothers are not allowed to enroll on this study
- Patients who are taking medications metabolized by cytochrome P450 2E1, including chlorzoxazone or halothane and its derivatives
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Disulfiram with copper
Patients will take one pill of disulfiram (Antabus) daily at a dose of 400 mg continually during the treatment phase (from day 0 till End of treatment Visit). In case of intolerance, lower dose up to 200 mg per day is allowed. Patients will take disulfiram after their evening meal. Patients will avoid alcohol and other disulfiram-drug interactions will be considered. Copper supplementation will be given separately from disulfiram; in the morning with patients´breakfast. Patients will take one pill of copper dietary supplement (for instance Copper Star, STARLIFE) corresponding to 2 mg of elementary copper. |
Patients will take one pill of disulfiram (Antabus) daily at a dose of 400 mg continually during the treatment phase (from day 0 till End of treatment Visit). In case of intolerance, lower dose up to 200 mg per day is allowed. Copper supplementation will be given separately from disulfiram; in the morning with patients´breakfast. Patients will take one pill of copper dietary supplement (for instance Copper Star, STARLIFE) corresponding to 2 mg of elementary copper.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Clinical response rate (RR)
Time Frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
|
sum of complete and partial responses (CR+PR)
|
From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
|
|
Clinical benefit rate (CBR)
Time Frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
|
sum of complete, partial responses and stable diseases (CR+PR)CR+PR+SD)
|
From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Time to progression (TTP)
Time Frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
|
time to progression (TTP) in months
|
From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
|
|
Overall survival (OS)
Time Frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
|
overall survival (OS) in months
|
From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
|
|
The pharmacokinetic (PK) characteristics
Time Frame: Day 0 = at first administration of the drug
|
Cmax
|
Day 0 = at first administration of the drug
|
|
The pharmacokinetic (PK) characteristic - Area Under Curve (AUC)
Time Frame: Day 0 = at first administration of the drug
|
AUC - The area under the plasma concentration over the time
|
Day 0 = at first administration of the drug
|
|
The pharmacokinetic (PK) characteristic - T-max
Time Frame: Day 0 = at first administration of the drug
|
T-max - Time to reach maximum concentration
|
Day 0 = at first administration of the drug
|
|
The pharmacokinetic (PK) characteristic - T1/2
Time Frame: Day 0 = at first administration of the drug
|
T1/2 - Apparent terminal elimination half-life time
|
Day 0 = at first administration of the drug
|
|
The pharmacokinetic (PK) characteristic - λz
Time Frame: Day 0 = at first administration of the drug
|
λz (Lambda-z) - Individual estimate of the terminal elimination rate constant, calculated using log-linear regression of the terminal portions of the plasma concentration-versus-time curves
|
Day 0 = at first administration of the drug
|
|
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
Time Frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
|
Number of participants with treatment-related adverse events analyzed as cumulative burden at every 6 months until study termination.
|
From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Study Chair: Marian Hajduch, MD., PhD., Palacky University
Publications and helpful links
General Publications
- Askgaard G, Friis S, Hallas J, Thygesen LC, Pottegard A. Use of disulfiram and risk of cancer: a population-based case-control study. Eur J Cancer Prev. 2014 May;23(3):225-32. doi: 10.1097/CEJ.0b013e3283647466.
- Wickstrom M, Danielsson K, Rickardson L, Gullbo J, Nygren P, Isaksson A, Larsson R, Lovborg H. Pharmacological profiling of disulfiram using human tumor cell lines and human tumor cells from patients. Biochem Pharmacol. 2007 Jan 1;73(1):25-33. doi: 10.1016/j.bcp.2006.08.016. Epub 2006 Aug 26.
- Schweizer MT, Lin J, Blackford A, Bardia A, King S, Armstrong AJ, Rudek MA, Yegnasubramanian S, Carducci MA. Pharmacodynamic study of disulfiram in men with non-metastatic recurrent prostate cancer. Prostate Cancer Prostatic Dis. 2013 Dec;16(4):357-61. doi: 10.1038/pcan.2013.28. Epub 2013 Aug 20.
- Brar SS, Grigg C, Wilson KS, Holder WD Jr, Dreau D, Austin C, Foster M, Ghio AJ, Whorton AR, Stowell GW, Whittall LB, Whittle RR, White DP, Kennedy TP. Disulfiram inhibits activating transcription factor/cyclic AMP-responsive element binding protein and human melanoma growth in a metal-dependent manner in vitro, in mice and in a patient with metastatic disease. Mol Cancer Ther. 2004 Sep;3(9):1049-60.
- Lewison EF. Spontaneous regression of breast cancer. Prog Clin Biol Res. 1977;12:47-53. No abstract available.
- Lin J, Haffner MC, Zhang Y, Lee BH, Brennen WN, Britton J, Kachhap SK, Shim JS, Liu JO, Nelson WG, Yegnasubramanian S, Carducci MA. Disulfiram is a DNA demethylating agent and inhibits prostate cancer cell growth. Prostate. 2011 Mar 1;71(4):333-43. doi: 10.1002/pros.21247. Epub 2010 Aug 31.
- Robinson TJ, Pai M, Liu JC, Vizeacoumar F, Sun T, Egan SE, Datti A, Huang J, Zacksenhaus E. High-throughput screen identifies disulfiram as a potential therapeutic for triple-negative breast cancer cells: interaction with IQ motif-containing factors. Cell Cycle. 2013 Sep 15;12(18):3013-24. doi: 10.4161/cc.26063. Epub 2013 Aug 12.
- Cvek B, Milacic V, Taraba J, Dou QP. Ni(II), Cu(II), and Zn(II) diethyldithiocarbamate complexes show various activities against the proteasome in breast cancer cells. J Med Chem. 2008 Oct 23;51(20):6256-8. doi: 10.1021/jm8007807. Epub 2008 Sep 25.
- Chen D, Cui QC, Yang H, Dou QP. Disulfiram, a clinically used anti-alcoholism drug and copper-binding agent, induces apoptotic cell death in breast cancer cultures and xenografts via inhibition of the proteasome activity. Cancer Res. 2006 Nov 1;66(21):10425-33. doi: 10.1158/0008-5472.CAN-06-2126.
- Cvek B. Nonprofit drugs as the salvation of the world's healthcare systems: the case of Antabuse (disulfiram). Drug Discov Today. 2012 May;17(9-10):409-12. doi: 10.1016/j.drudis.2011.12.010. Epub 2011 Dec 16.
- Suh JJ, Pettinati HM, Kampman KM, O'Brien CP. The status of disulfiram: a half of a century later. J Clin Psychopharmacol. 2006 Jun;26(3):290-302. doi: 10.1097/01.jcp.0000222512.25649.08.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- 2016-1-DSF-MBC
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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