- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04495894
Pre-Incisional Ketorolac for Patients Undergoing Surgery for Non-Small Cell Lung Cancer and Renal Cell Carcinoma
A Pilot Study of Biomarker Evaluation and Safety of Pre-Incisional Ketorolac for Patients Undergoing Surgical Resection for Non-Small Cell Lung Cancer and Renal Cell Carcinoma
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Surgical resection is a cornerstone of standard-of-care treatment for early-stage non-small cell lung carcinoma (NSCLC) and renal cell carcinoma (RCC). Yet despite optimal treatment, many of these patients will develop cancer recurrence within the first few years. For example, the 5-year survival rate for patients with stage I/II NSCLC is only around 55%. As a result, more effective treatments that decrease cancer recurrence and increase survival are still needed.
Surgery induces inflammation, immunosuppression and angiogenesis. Although these processes are important for wound healing in response to tissue injury caused by surgery, they also support the survival, growth and dissemination of any remaining cancer cells and can lead to systemic recurrence soon after surgery. Surgical trauma increases the production of prostaglandins and thromboxanes, which have tumor-promoting and immunosuppressive activities, and reduces the activity of natural killer cells, which impairs the ability of the immune system to keep cancer cells in check. However, if given just before tissue injury, non-steroidal anti-inflammatory drugs (NSAIDs) may be able to block the production of prostaglandins/thromboxanes and boost the activity of natural killer cells, and thereby decrease the risk of cancer recurrence. NSAIDs such as ketorolac are already routinely given to cancer patients postoperatively for pain management and are sometimes given intraoperatively (immediately before or during surgery) to prevent postoperative pain. A retrospective clinical analysis found that intraoperative intravenous ketorolac or diclofenac (another NSAID), when added to standard of care for patients with stage I/II NSCLC, was associated with decreased risks of distant recurrence and mortality.
There is significant promise in the use of preoperative ketorolac to decrease the inflammatory response after surgical resection of tumors, thereby potentially reducing the risk of distant metastatic tumor spread and improving survival.
Patients will be screened and recruited during the preoperative period by the responsible medical and surgical team. Blood will be drawn preoperatively and then at the end of the surgical procedure. Participants will be randomized to either preoperative ketorolac group or a concurrent control group who will not receive preincisional ketorolac. The concurrent control group is to obtain untreated biologic samples for biologic correlative studies and secondary endpoints. These patients will not be compared to the investigational cohort in regards to the primary endpoint of safety. Patients will be randomized on the day of surgery to either the experimental or control arms and participants will be followed or 28 days. Medical records will be reviewed at 1 and 2 years post-surgery for survival assessment.
Study Type
Enrollment (Estimated)
Phase
- Early Phase 1
Contacts and Locations
Study Contact
- Name: Viraj Master, MD, PhD
- Phone Number: 404-778-4898
- Email: vmaster@emory.edu
Study Locations
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Georgia
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Atlanta, Georgia, United States, 30308
- Recruiting
- Emory University Hospital Midtown
-
Atlanta, Georgia, United States, 30322
- Recruiting
- Emory Clinic
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Atlanta, Georgia, United States, 30322
- Recruiting
- Emory University Hospital
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Atlanta, Georgia, United States, 30322
- Recruiting
- Winship Cancer Institute
-
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Pathology-proven or suspected stage 1 or 2 NSCLC and Stage 3 tumor stage 3, node stage 0 (T3N0) RCC, that require surgical resection as the treatment of choice
- Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
- Ability to understand and the willingness to sign an informed written consent
Exclusion Criteria:
- Individuals with pure lung ground-glass opacity (GGO) lesions or mixed GGO with <50% solid component
- Patients undergoing pneumonectomy
- History of cancer in the 3 years prior to surgery (except for basal-cell carcinoma of the skin or cervical neoplasia).
- Contraindication for NSAIDs, including peptic ulcer disease, preoperative chronic kidney disease with estimated glomerular filtration rate (eGFR) <45, allergies or intolerance to NSAIDs, coagulation disorder, or age > 80 years
- Having taken an NSAID within 5 days prior to surgery
- Immunocompromised status
- Refusal or inability to understand the protocol and consent form or to receive follow-up in line with the recommendations
- Preoperative hemoglobin < 9.0
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Preoperative Ketorolac
Participants randomized to receive ketorolac prior to surgery for stage I/II NSCLC and stage III RCC.
Participants will receive standard-of-care surgery.
Open, video-assisted thoracic surgery, laparoscopy, or robotic surgery are allowed.
Standard anesthesia will be administered.
|
30 mg ketorolac will be administered intravenously 30 minutes prior to incision.
Other Names:
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No Intervention: Control Group
Participants randomized to the control group receiving the standard of care during surgery for stage I/II NSCLC and stage III RCC.
Open, video-assisted thoracic surgery, laparoscopy, or robotic surgery are allowed.
Standard anesthesia will be administered.
The concurrent control group is to obtain untreated biologic samples for biologic correlative studies and secondary endpoints.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of Blood Transfusion Among Ketorolac Group
Time Frame: Prior to Hospital Discharge (generally up to 7 days post surgery)
|
Hemorrhagic side effects among participants receiving ketorolac preoperatively will be assessed as the need for blood transfusions before being discharged from the hospital after surgery.
The need for a blood transfusion is defined as greater than two units of blood, which are not related to vascular injury due to technical considerations or complications, as determined by the operating surgeon.
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Prior to Hospital Discharge (generally up to 7 days post surgery)
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Incidence of Clinically Significant Hematoma Development Among Ketorolac Group
Time Frame: Prior to Hospital Discharge (generally up to 7 days post surgery)
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Significant hematoma development will be assessed among participants receiving ketorolac.
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Prior to Hospital Discharge (generally up to 7 days post surgery)
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Incidence of Return to the Operating Room for Bleeding Among Ketorolac Group
Time Frame: Prior to Hospital Discharge (generally up to 7 days post surgery)
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The need for returning to the operating room for bleeding, as determined by the treating surgeon, will be assessed among participants receiving ketorolac.
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Prior to Hospital Discharge (generally up to 7 days post surgery)
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Incidence of Postoperative Renal Failure Among Ketorolac Group
Time Frame: Prior to Hospital Discharge (generally up to 7 days post surgery)
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Postoperative renal failure among participants receiving ketorolac will be assessed.
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Prior to Hospital Discharge (generally up to 7 days post surgery)
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Incidence of Postoperative Morbidity Rate Among Ketorolac Group
Time Frame: Prior to Hospital Discharge (generally up to 7 days post surgery)
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Postoperative morbidity among participants receiving ketorolac will be assessed.
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Prior to Hospital Discharge (generally up to 7 days post surgery)
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Interleukin-1 alpha (IL-1alpha) Levels
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
IL-1alpha levels will be compared between study arms.
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Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
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Change in Interleukin-1beta (IL-1β) Levels
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
IL-1beta levels will be compared between study arms.
|
Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
Change in Interleukin-2 (IL-2) Levels
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
IL-2 levels will be compared between study arms.
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Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
Change in Interleukin-6 (IL-6) Levels
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
IL-6 levels will be compared between study arms.
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Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
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Change in Interleukin-8 (IL-8) Levels
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
IL-8 levels will be compared between study arms.
|
Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
Change in Interleukin-10 (IL-10) Levels
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
IL-10 levels will be compared between study arms.
|
Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
Change in Interleukin-12p70 (IL-12p70) Levels
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
IL-12p70 levels will be compared between study arms.
|
Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
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Change in Tumor Necrosis Factor-alpha (TNF-alpha) Levels
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
TNF-alpha levels will be compared between study arms.
|
Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
Change in Interferon (INF)-gamma Levels
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
INF-gamma levels will be compared between study arms.
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Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
Change in Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) Levels
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
GM-CSF levels will be compared between study arms.
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Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
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Change in Monocyte Chemotactic and Activating Factor (MCAF) Levels
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
MCAF levels will be compared between study arms.
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Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Transcriptome Analysis
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
Transcriptome analysis will be performed to evaluate the effects of ketorolac on immune response pathways.
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Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
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Change in Flow Cytometry
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
Flow Cytometry will be performed to evaluate the effects of ketorolac on immune response pathways.
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Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
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Change in T-Cell Receptor (TCR) Sequencing
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
T-Cell receptor (TCR) sequencing will be performed to evaluate the effects of ketorolac on immune response pathways.
|
Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
Change in Single Cell RNA Sequencing
Time Frame: Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
Single cell RNA sequencing will be performed to evaluate the effects of ketorolac on immune response pathways.
|
Baseline, Day 1, Day 3 (if admitted to hospital), Day 7, Day 28
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Viraj Master, MD, PhD, Emory University
- Principal Investigator: Onkar Khullar, MD, Emory University
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Respiratory Tract Diseases
- Neoplasms by Histologic Type
- Neoplasms
- Lung Diseases
- Urologic Neoplasms
- Urogenital Neoplasms
- Neoplasms by Site
- Kidney Diseases
- Urologic Diseases
- Adenocarcinoma
- Neoplasms, Glandular and Epithelial
- Respiratory Tract Neoplasms
- Thoracic Neoplasms
- Carcinoma, Bronchogenic
- Bronchial Neoplasms
- Kidney Neoplasms
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Male Urogenital Diseases
- Carcinoma, Renal Cell
- Lung Neoplasms
- Carcinoma, Non-Small-Cell Lung
- Carcinoma
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Peripheral Nervous System Agents
- Enzyme Inhibitors
- Analgesics
- Sensory System Agents
- Anti-Inflammatory Agents, Non-Steroidal
- Analgesics, Non-Narcotic
- Anti-Inflammatory Agents
- Antirheumatic Agents
- Cyclooxygenase Inhibitors
- Ketorolac
Other Study ID Numbers
- STUDY00000205
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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