Hydralazine as a Demethylating Agent in Rectal Cancer
Clinically feasible dose of Hydralazine for ~ 3 months, by virtue of its demethylating effect, will:
- Result in re-expression of epigenetically silenced TSGs in rectal cancer specimens.
- Decrease the global methylation in primary cancer cells compared to pre-treatment
Study Overview
Detailed Description
This study will be conducted as a phase I/II clinical trial. In addition to determining the maximum tolerated dose (MTD) of hydralazine, the phase I trial will be performed to identify unexpected toxicities that may occur when hydralazine is used in conjunction with neoadjuvant chemotherapy in normotensive patients with rectal cancer. Once the phase I trial is successfully completed, the phase II trial to evaluate the efficacy of hydralazine in producing a demethylation effect will begin.
This phase I/II trial will require between 31 to 47 patients to complete.
• Phase I Study
The objective of this study is to determine the MTD for Hydralazine added to standard neoadjuvant chemotherapy for operable recta cancer. Four dose levels of hydralazine are planned:
Dose Level 1: 150 mg/d 50 mg PO TID Dose Level 2: 200 mg/d 50 mg PO QID Dose Level 3: 225 mg/d 75 mg PO TID
Study Type
Phase
- Phase 2
- Phase 1
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
The principal objective of this study is to perform a molecular evaluation for the reversal of methylation in clinical material collected at two different time points. The first sample representing untreated (the biopsy sample), and later a hydralazine-treated specimen (the resection specimen). Accordingly, we are not using routine inclusion criterion for enrollment (such as histology or clinical stage), but realize that the majority of operable rectal cancers will be stages II-III, and that treatment-again not specified or restricted-will very likely follow the standard therapy for this disease (infusional 5-Fluorouracil and radiation therapy). The accrual target at the phase II segment of this trial is small and that does not allow for any traditional clinical endpoints assessment (such as response rate, time to treatment failure or survival). Accordingly, we do not plan on following these endpoint as part of this study.
Patients referred to the surgery or gastroenterology services for diagnostic evaluation for rectal cancer will be candidates to participate in this study. Patients with history of elevated blood pressure and who are already on anti-hypertensive drugs would be ideal candidates for this project. In such situation, hydralazine will replace other anti-hypertensives for the duration of study only. There is no age limit for this study. Inclusion criteria are as follows:
- Operable rectal cancer (the overwhelming majority are Adenocarcinoma)
- Signed informed consent
- Baseline blood pressure OFF anti-hypertensives over 100/50 mmHg
Exclusion Criteria:
- Pre-existing hypotension (as defined in this protocol BP 100/50)
- Pre-existing liver disease (liver function tests over 2x upper limits of normal ULM).
- Pre-existing kidney (serum creatinine over 2 mg/dl).
- Medical necessity to remain on beta-blockers that cannot be met by other agents.
Coronary even in the preceding 2 months prior to enrollment. Coronary evens include any of the following:
- Acute Myocardial Infarction
- Cardiac catheterization regardless of outcome of procedure or need of intervention
- History of Valvular heart disease
- History of hypertrophic cardiomyopathy with left ventricular outflow tract obstruction.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Active Comparator: 1
The objective of this study is to determine the MTD for Hydralazine added to standard neoadjuvant chemotherapy for operable recta cancer. Four dose levels of hydralazine are planned: Dose Level 1: 150 mg/d 50 mg PO TID Dose Level 2: 200 mg/d 50 mg PO QID Dose Level 3: 225 mg/d 75 mg PO TID |
Dose Level 1: 150 mg/d 50 mg PO TID Dose Level 2: 200 mg/d 50 mg PO QID Dose Level 3: 225 mg/d 75 mg PO TID
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
|---|
|
The study design calls for an initial phase of dose-escalation in cohorts of 3 patients. There are no intra-patient changes in dose.
|
Secondary Outcome Measures
Outcome Measure |
|---|
|
Subsequent to this Phase I scheme, the study will continue with the selected dose-level (on toxicity and tolerability grounds) to accrue patients in a phase II scheme.
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Ahmed M Safar, MD, University of Arkansas
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2004-03
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.