新辅助二甲双胍对胰腺导管腺癌肿瘤细胞增殖和肿瘤进展的影响 (Metformin 001)
这是一项在可切除 PDAC 中新辅助二甲双胍的单臂、非随机 II 期研究。 将招募 20 名患者并用二甲双胍 500 mg BD 治疗至少 7 天,直至手术前 2 天。 患者将在基线、手术前和手术后 4-10 周接受实验室检查。 符合条件并同意可选 MRI 子研究的患者将在手术前 1 至 14 天接受弥散加权 MRI。
在手术中,将收集并储存切除的肿瘤和正常组织。 FFPE 标本将用于 Ki67(细胞增殖标记)、pAMPK、ACC 靶标、p53 和 mTOR 靶标、凋亡标记(Bax、Bcl-2、caspases 3、8 和 9)的切片、组织学分析和 IHC。 新鲜冷冻肿瘤和匹配的正常组织样本将用于胰岛素和 IGF 受体的蛋白质印迹分析、总和活化的 ERK 和 Akt,以及 RNAseq 分析。 将取回二甲双胍前活检样本用于分子分析。
将分析基线和手术前的空腹血样的葡萄糖和胰岛素水平。 血浆和全血也将被处理和储存用于循环肿瘤 DNA 分析。 尿样将被送去进行代谢组学分析。
研究概览
研究类型
注册 (预期的)
阶段
- 阶段2
联系人和位置
学习地点
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British Columbia
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Vancouver、British Columbia、加拿大、V5Z 4E6
- BC Cancer Agency - Vancouver Cancer Centre
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
纳入标准:
- 研究同意之日年龄大于或等于 18 岁
- PDAC 的病理诊断,其中 2 个治疗前核心活检样本可用于分析。 没有病理诊断的疑似 PDAC 患者必须在内镜超声引导下进行确证性活检。
- 基于标准影像学标准的可切除疾病
- 计划在进入研究后 ≥ 2 周进行手术
- 东部合作肿瘤组 (ECOG) 表现状态 0-2
在开始研究治疗之前 7 天内进行的以下实验室评估所衡量的足够的血液学、肾脏和肝脏功能:
- 总胆红素 < 正常上限 (ULN) 的 1.5 倍
- 丙氨酸转氨酶 (ALT) 和天冬氨酸转氨酶 (AST) < ULN 的 2.5 倍
- 脂肪酶 < ULN 的 1.5 倍
- 血清肌酐 < ULN 的 1.5 倍
- 肾小球滤过率 > 30 mL/min/1.73 m2 根据肾病简式改良饮食
- 国际标准化比值 (INR) 或凝血酶原时间 (PT; PT-INR) 和部分凝血活酶时间 (PTT) < ULN 的 1.5 倍
- 血小板计数 > 100000 /mm3,血红蛋白(> 9 g/dL,中性粒细胞绝对计数 > 1500/mm3。
- 基线空腹血糖 <13.9 mmol/L
- PDAC 之前没有化疗或放疗
- 研究治疗开始前 7 天内评估的血清乳酸水平在正常范围内
MRI 子研究:
- 为可选的 MRI 子研究签署知情同意书
- MRI 无禁忌症
排除标准:
- 存在局部不可切除的疾病或远处转移
- 在过去 6 个月内使用二甲双胍或任何其他抗高血糖药物治疗
- 已知对二甲双胍过敏或禁忌
- 不适合做手术
- 计划或接受任何类型的新辅助治疗
学习计划
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:北美
- 介入模型:单组
- 屏蔽:没有任何
武器和干预
参与者组/臂 |
干预/治疗 |
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实验性的:二甲双胍
所有患者将每天两次口服二甲双胍 500 毫克,随餐服用至少 7 天,直至手术前 2 天。
应在手术前 2 天停止二甲双胍治疗,以降低与禁食相关的乳酸性酸中毒的风险。
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如果出现任何 2 级毒性(高血糖除外),将停用二甲双胍,直至改善至≤ 1 级,然后以每天 500 mg 的剂量重新开始。
如果与二甲双胍相关的 ≥ 3 级毒性,将停止治疗。
如果血清乳酸水平高于正常值,也将停止二甲双胍治疗。
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
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新辅助二甲双胍治疗对PDAC肿瘤细胞增殖的影响
大体时间:6个月
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通过 IHC 评估二甲双胍前后肿瘤样本的 Ki-67 分数。
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6个月
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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接受治愈性 PDAC 切除术的患者的 R0 切除率
大体时间:6个月
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R0 切除患者的比例。
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6个月
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通过血清标志物空腹 GGT (mmol/L) 评估二甲双胍对葡萄糖和胰岛素代谢的影响
大体时间:6个月
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将报告葡萄糖和胰岛素代谢的标志物,并与二甲双胍前后的值进行比较。
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6个月
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通过血清标志物空腹血糖 (mmol/L) 评估二甲双胍对葡萄糖和胰岛素代谢的影响
大体时间:6个月
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将报告葡萄糖和胰岛素代谢的标志物,并与二甲双胍前后的值进行比较。
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6个月
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通过血清标志物空腹胰岛素 (mU/L) 评估二甲双胍对葡萄糖和胰岛素代谢的影响
大体时间:6个月
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将报告葡萄糖和胰岛素代谢的标志物,并与二甲双胍前后的值进行比较。
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6个月
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通过血清标志物、HOMA指数评估二甲双胍对葡萄糖和胰岛素代谢的影响
大体时间:6个月
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HOMA 指数由血糖和胰岛素计算得出。
将报告葡萄糖和胰岛素代谢的标志物,并与二甲双胍前后的值进行比较。
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6个月
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二甲双胍对葡萄糖和胰岛素代谢的影响,通过临床标志物、体重(kg)评估
大体时间:6个月
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将报告临床标志物,并比较二甲双胍前后的值。
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6个月
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二甲双胍对二甲双胍前后样本代谢组学特征的影响
大体时间:6个月
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血清和尿液代谢组学概况。 二甲双胍前后样品中代谢物水平的比较。 |
6个月
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治疗前和治疗后肿瘤样本的转录组测序 (RNAseq)。
大体时间:6个月
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研究与二甲双胍反应相关的分子特征 二甲双胍前活检样本和二甲双胍后切除肿瘤样本中基因表达的比较。 肿瘤切片中待通过 IHC 验证的改变基因的表达。 |
6个月
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血浆 ctDNA,测量为血浆中突变体占总 DNA 片段的百分比
大体时间:6个月
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评估可切除 PDAC 中 ctDNA 的存在,以及二甲双胍治疗和手术切除后的动态变化 基线时具有可检测血浆 ctDNA 的患者比例。 比较二甲双胍前后和手术后 4-10 周的数值。 |
6个月
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影像学与病理参数的相关性
大体时间:6个月
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探讨 MRI 表观扩散系数 (ADC) 与病理结果之间的相关性。 ADC 值将分别与病理检查中的肿瘤分化和 Ki-67 分数进行比较。 |
6个月
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合作者和调查者
出版物和有用的链接
一般刊物
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