Rosuvastatin in the Treatment of Rectal Cancer

July 18, 2022 updated by: AHS Cancer Control Alberta

Phase 2 Trial of Rosuvastatin (Crestor®) Combined With Standard Chemoradiation Therapy in the Treatment of High-Risk Locally Advanced Rectal Cancer

This study will evaluate whether the addition of Rosuvastatin to standard chemoradiation therapy for the treatment of locally advanced rectal cancer may improve the pathological response rate and survival compared to standard chemoradiation therapy alone.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

The standard treatment of locally advanced rectal cancer involves neoadjuvant chemoradiation therapy (CRT) followed by surgery and further adjuvant chemotherapy. The pathologic complete responses associated with neoadjuvant CRT are 10-20%. The prognosis of patients undergoing neoadjuvant CRT is associated to the extent of post-treatment tumour regression, the final primary tumour stage and presence of involved lymph nodes in the surgical specimen. This data suggests that treatments that enhance the pathological response may result in improvements in survival.

Overwhelming preclinical and clinical evidence suggests that statins demonstrate anticancer properties and sensitize cancer tissues and protects normal tissues to the effects of radiation. Hence, the investigators hypothesize that the addition of rosuvastatin to standard CRT for the treatment of locally advanced rectal cancer may improve the pathological response rate. This protocol describes an open-label single-arm phase 2 study designed to test this hypothesis. Moreover, this study will also identify genetic, serological, and pathological biomarkers that may be both prognostic and predictive of response and toxicity to treatment.

Study Type

Interventional

Enrollment (Actual)

45

Phase

  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Alberta
      • Calgary, Alberta, Canada, T2N 4N2
        • Tom Baker Cancer Centre

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  1. Clinical stage 2-3 rectal adenocarcinoma, cT3/4N0/M0 or Tx N1-2/M0, within 5 cm of anal verge or less than 12cm from anal verge and threatened circumferential resection margin (≤3mm). Patients must have histological confirmation of rectal adenocarcinoma prior to registration.
  2. Patients must be 18 years or older.
  3. Able to swallow oral medication.
  4. Previous surgery, not for primary treatment of current rectal cancer, is permitted provided that wound healing has occurred and at least 14 days have elapsed prior to registration if surgery was major.
  5. ECOG 2 or less.
  6. Laboratory Requirements (must be done within 7 days prior to registration):

    a. Hematology: i. Hemoglobin ≥90 g/L ii. Granulocytes (AGC) ≥ 1.5 x 109/L iii. Platelets ≥ 100 x 109/L b. Chemistry: i. Bilirubin ≤1.5 x UNL ii. ALT or AST ≤ 1.5 x UNL iii. Proteinuria ≤ grade 1 iv. Thyroid function within normal limits (TSH or free T4 within normal limits after correction) v. CPKs ≤ ULN, vi. Urinary myoglobin within normal limits Note: If serum creatinine is abnormal, a creatinine clearance should be calculated and be ≥ 60 ml/min.

  7. Women must be post-menopausal, surgically sterile or use two reliable forms of contraception if of child-bearing potential. Women of childbearing potential must have a urine pregnancy test taken and proven negative within 7 days prior to registration. Men must be surgically sterile or use an effective barrier method of contraception if sexually active with a woman of child-bearing potential. Acceptable methods of contraception are condoms with contraceptive foam, oral, implantable or injectable contraceptives, contraceptive patch, intrauterine device, diaphragm with spermicidal gel, or a sexual partner who is surgically sterilized or post-menopausal. For both male and female patients, effective methods of contraception must be used throughout the study and for three months following the last dose.
  8. Patient consent must be obtained according to local Institutional and/or University Human Experimentation Committee requirements. It will be the responsibility of the local participating investigators to obtain the necessary local clearance. The patient must sign the consent form prior to registration. The consent form for this study must contain a statement, which gives permission for the sponsor and monitoring agencies to review patient records.
  9. Patients must be accessible for treatment and follow-up. Patients registered on this trial must be treated and followed at the participating centre. This implies there must be reasonable geographical limits (for example: 1 1⁄2 hours driving distance) placed on patients being considered for this trial. Investigators must assure themselves the patients registered on this trial will be available for complete documentation of the treatment, adverse events, and follow-up.

Exclusion Criteria:

  1. Patients of Asian ethnicity (having Filipino, Chinese, Japanese, Korean, Vietnamese, or South Asian origin) will be excluded due to increased risk of toxicity.
  2. Previous and concurrent, experimental, chemotherapy, or radiotherapy treatment for primary rectal carcinoma.
  3. Statin exposure in the last 5 years.
  4. Known evidence of distant metastatic disease on staging investigation, including a CT of the chest, abdomen, and pelvis performed within 6 weeks prior to registration.
  5. Known history of previous malignancy, except adequately treated non-melanoma skin cancer or other solid tumour treated curatively with no evidence of disease for >5 years.
  6. Patients with malabsorption syndrome, ulcerative colitis, inflammatory bowel disease, resection of the stomach or small bowel, or other disease significantly affecting gastrointestinal (GI) function.
  7. Patients with a known history of documented upper GI bleeding or upper GI ulcerative disease.
  8. Patients with hyperlipidemia with clinical indication for statin therapy or other prescribed medication (determination of acceptable fasting lipid values should be in accordance with current dyslipidemia management guidelines).
  9. Patients with inadequately treated hypothyroidism, as determined by the investigator.
  10. Patients with a known history of myopathy or rhabdomyolysis.
  11. Patients who have experienced untreated and/or uncontrolled cardiovascular conditions and/or have symptomatic cardiac dysfunction.
  12. Deemed by the physician to be at low risk for recurrence.
  13. No other non-malignant systemic disease that would preclude rosuvastatin administration or prolonged follow-up.
  14. Concurrent chronic use of NSAIDs.
  15. Concurrent chronic drug therapy with cyclosporine, colchicine, coumarin anticoagulants, amiodarone, gemfibrozil, other lipid-lowering therapies (e.g., fibrates or niacin), lopinavir/ritonavir, azole antifungals, and macrolide antibiotics.
  16. Known personal or family history of hereditary neuromuscular disorders.
  17. Known previous history of muscular toxicity with another HMG-CoA reductase inhibitor.
  18. Known history of alcohol abuse.
  19. Any known condition that could affect absorption of study oral drugs (capecitabine and rosuvastatin).
  20. Known contraindication to statin.
  21. Pregnant or nursing.
  22. Patients with symptomatic inflammatory bowel disease.
  23. Patients with uncontrolled hypothyroidism.
  24. Patients with chronic liver or disease.
  25. Patients with unexplained elevated serum transaminases exceeding 3x ULN.
  26. Patients known to be suffering from infection with HIV, Tuberculosis, Hepatitis C or Hepatitis B.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Single Arm - Rosuvastatin
This is a single arm, of Rosuvastatin (Crestor®) 40 mg orally daily starting 2 weeks prior to the initiation of radiation at week 1 and stopped 4 weeks after the completion of radiation at the start of week 12 or 13, depending on whether 25 or 30 fractions of radiotherapy are given.
40 mg rosuvastatin orally once per day with or without food, swallowed whole (not chewed, crushed or divided) starting 2 weeks prior to the initiation of radiation therapy and stopped at 4 weeks after the completion of radiation. Total duration of Rosuvastatin is 11 weeks if 25 fractions of radiotherapy are given, or 12 weeks if 30 fractions of radiotherapy are given.
Other Names:
  • Crestor

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
To determine the pathological complete response rate in patients with high-risk locally advanced rectal cancer treated with standard neo-adjuvant chemotherapy and radiation in combination with rosuvastatin.
Time Frame: Up to 3 years
The rate of post-surgical specimens that demonstrate absence of any residual invasive disease or Grade 4 (complete) histological regression using the Dworak classification.
Up to 3 years

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
To determine the Ro resection rate
Time Frame: Up to 3 years
The rate that the surgical margins are negative of any invasive disease.
Up to 3 years
To determine the pathological near-complete or complete tumour response rate
Time Frame: Up to 3 years
Grade 3 (near-complete) or 4 (complete) histological regression using the Dworak classification.
Up to 3 years
To determine the sphincter preservation rate
Time Frame: Up to 3 years
The proportion of patients that undergo a sphincter preservation surgery versus abdominoperineal resection.
Up to 3 years
To determine the down staging rate
Time Frame: Up to 3 years
Proportion of patients that have a down staging of the primary tumour and/or lymph nodes; i.e. comparison between cT/N and ypT/N
Up to 3 years
To determine 3-year disease free survival
Time Frame: Up to 3 years
The proportion of patients alive with no clinical, radiological, or pathological evidence of rectal cancer recurrence at 3 years, starting at the time treatment was initiated. This definition includes, recurrence or relapse of rectal cancers, second primary cancer or death as events
Up to 3 years
To determine 3-year overall survival
Time Frame: Up to 3 years
The proportion of patients alive at 3 years, starting at the time treatment was initiated.
Up to 3 years
To determine the neoadjuvant rectal cancer (NAR) score
Time Frame: Up to 3 years
A surrogate endpoint of overall survival following neoadjuvant rectal cancer therapy.
Up to 3 years
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0.
Time Frame: Up to 3 years
Up to 3 years
To identify the genetic biomarkers that may be both prognostic and predictive of response and toxicity to treatment.
Time Frame: up to 3 years
BRAF and KRAS genetic testing. Direct exon sequencing.
up to 3 years
To identify serological biomarkers that may be both prognostic and predictive of response and toxicity to treatment.
Time Frame: up to 3 years
Changes in the levels of HMG CoA reductase pathway metabolites (Mevalonate, Ubiquinone) will also be performed using pre- and post-treatment serological markers.
up to 3 years
To identify pathological biomarkers that may be both prognostic and predictive of response and toxicity to treatment.
Time Frame: up to 3 years
IHC using pre- and post FFPE tumour tissue samples. (Ki67, phopsorylated AKT, HMG CoA reductase, GGPS1 and ApopTag, p21, p27 and rhoA)
up to 3 years
Tmax will be collected as pharmacokinetic data
Time Frame: up to 3 years
up to 3 years
Cmax will be collected as pharmacokinetic data
Time Frame: up to 3 years
up to 3 years
T1/2 will be collected as pharmacokinetic data
Time Frame: up to 3 years
up to 3 years
Dose normalized Cmax will be collected as pharmacokinetic data
Time Frame: up to 3 years
up to 3 years
Area under the curve (AUC) will be collected as pharmacokinetic data
Time Frame: up to 3 years
up to 3 years
Dose normalized AUC will be collected as pharmacokinetic data
Time Frame: up to 3 years
up to 3 years

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Collaborators

Investigators

  • Principal Investigator: Jose Monzon, PhD MD FRCPC, Tom Baker Cancer Centre

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

November 1, 2015

Primary Completion (Actual)

September 24, 2021

Study Completion (Actual)

September 24, 2021

Study Registration Dates

First Submitted

September 24, 2015

First Submitted That Met QC Criteria

October 5, 2015

First Posted (Estimate)

October 7, 2015

Study Record Updates

Last Update Posted (Actual)

July 20, 2022

Last Update Submitted That Met QC Criteria

July 18, 2022

Last Verified

July 1, 2022

More Information

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.

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