Digoxin Induced Dissolution of CTC Clusters

Effect of Digoxin on Clusters of Circulating Tumor Cells (CTCs) in Breast Cancer Patients

Sponsors

Lead Sponsor: University Hospital, Basel, Switzerland

Source University Hospital, Basel, Switzerland
Brief Summary

This single arm therapeutic exploratory study of digoxin in patients with advanced or metastatic breast cancer investigates whether cardiac glycosides are able to disrupt CTC clusters in breast cancer patients.

Detailed Description

Circulating tumor cells (CTCs) are considered to be precursors of metastasis in various cancer types and are found in the blood of cancer patients as single CTCs and CTC clusters, with the latter featuring a higher ability to seed metastasis. CTC cluster share several properties that commonly feature stem cell biology which drive metastases formation. Preclinical data shows that CTC clusters can be disaggregated into single cells by the treatment with cardiac glycosides such as digoxin. This single arm therapeutic exploratory study of digoxin in patients with advanced or metastatic breast cancer investigates whether cardiac glycosides are able to disrupt CTC clusters in breast cancer patients. Patients with advanced or metastatic breast cancer in whom CTC clusters could be identified will receive an individualized daily maintenance dose of digoxin adapted to their kidney function. Blood samples for analyses of digoxin serum level and mean CTC cluster size will be drawn at specified time points.

Overall Status Recruiting
Start Date 2020-07-08
Completion Date 2021-06-01
Primary Completion Date 2021-05-01
Phase Early Phase 1
Study Type Interventional
Primary Outcome
Measure Time Frame
Change in mean CTC cluster size (in ng/ml) Blood samples drawn at Screening, on day 0 (2 hours after first oral intake of digoxin), on day 3, on day 7, on day 10, on day 14, on day 17 and on day 21 after first oral intake of digoxin
Secondary Outcome
Measure Time Frame
Change in mean CTC cluster number Blood samples drawn at Screening, on day 0 (2 hours after first oral intake of digoxin), on day 3, on day 7, on day 10, on day 14, on day 17 and on day 21 after first oral intake of digoxin
Average time to dissolution of CTC Clusters (in days) Blood samples drawn at Screening, on day 0 (2 hours after first oral intake of digoxin), on day 3, on day 7, on day 10, on day 14, on day 17 and on day 21 after first oral intake of digoxin
Enrollment 9
Condition
Intervention

Intervention Type: Drug

Intervention Name: Digoxin

Description: Patients will receive a daily maintenance dose of digoxin. The daily dose of digoxin will be calculated according to the renal function and the target serum digoxin concentration and applied in an adjusted regimen based on the availability of 0.125 mg and 0.25 mg pills in the morning (before 10 am). Blood samples for analyses of mean CTC cluster size will be drawn at screening, on day 0 (2 hrs after first oral intake), on day 3 and on day 7. Depending on the digoxin serum level maintenance therapy with digoxin will be continued up to 3 weeks if the digoxin serum level on day 7 or day 14 is below 0.70 ng/ml. For the third week of maintenance therapy individual dose adjustments will be carried out as needed.

Arm Group Label: Digoxin

Eligibility

Criteria:

Inclusion Criteria: - Informed Consent as documented by signature - Diagnosis of adenocarcinoma of the breast with evidence of locoregionally recurrent or metastatic disease not amenable to resection, radiation therapy or systemic therapy with curative intent - Adequate organ and marrow function Exclusion Criteria: - Patients on treatment with digoxin or digitoxin - Patients with atrial fibrillation or atrial flutter - Ventricular Fibrillation or ventricular tachycardia, - Atrioventricular heart block 2nd or 3rd degree, sick sinus syndrome or sinus bradycardia, - Wolff-Parkinson-White Syndrome - Hypokalemia, hypercalcemia, hypomagnesemia, hypoxia, - Hypertrophic cardiomyopathy, aortic aneurysm - Simultaneous intravenous application of calcium salts - Known hypersensitivity to Digoxin, other cardiac glycosides or included compounds - Known drug interactions of ongoing cancer therapy with digoxin - Women who are pregnant or breast feeding, - Intention to become pregnant during the course of the study, - Lack of safe contraception - Other clinically significant concomitant disease states (e.g., renal failure, hepatic dysfunction, cardiovascular disease) - Known or suspected non-compliance, drug or alcohol abuse - Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant - Participation in another study with investigational drug within the 30 days preceding and during the present study, - Previous enrolment into the current study, - Enrolment of the investigator, his/her family members, employees and other dependent persons

Gender: All

Minimum Age: 18 Years

Maximum Age: N/A

Healthy Volunteers: No

Overall Official
Last Name Role Affiliation
Christian Kurzeder, PD Dr. med Principal Investigator Breast Cancer Center, University Hospital Basel
Overall Contact

Last Name: Christian Kurzeder, PD Dr. med

Phone: +41 61 26 52525

Email: [email protected]

Location
Facility: Status: Contact: Investigator: Breast Cancer Center, University Hospital Basel Christian Kurzeder, PD Dr. med +41 61 265 2525 [email protected] Marcus Vetter, PD Dr. med Principal Investigator
Location Countries

Switzerland

Verification Date

2020-09-01

Responsible Party

Type: Sponsor

Keywords
Has Expanded Access No
Condition Browse
Number Of Arms 1
Arm Group

Label: Digoxin

Type: Experimental

Study Design Info

Allocation: N/A

Intervention Model: Single Group Assignment

Primary Purpose: Treatment

Masking: None (Open Label)

Source: ClinicalTrials.gov

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