Itraconazole in Advanced Ovarian Cancer

NCT05591560UNKNOWNNAINTERVENTIONAL

Summary

Key Facts

Lead Sponsor

Tanta University

Enrollment

66

Start Date

2022-10-01

Completion Date

2024-10-01

Study Type

INTERVENTIONAL

Official Title

The Possible Effect of Itraconazole as add-on Therapy to Paclitaxel and Carboplatin on the Treatment Outcome in Patients With Advanced Ovarian Cancer

Interventions

Itraconazole capsulePlacebo

Conditions

Ovarian Carcinoma

Eligibility

Age Range

18 Years – 65 Years

Sex

FEMALE

Inclusion Criteria:

* Female patients Age \>18 years old \< 65 years old.
* Patients with histopathological and radiological based diagnosis of III, IV epithelial ovarian carcinoma according to 8th edition AJCC, primary tumor, regional nodes, metastasis (TNM) staging system.11
* Patients with Eastern Cooperative Oncology Group Performance Status of 0 or 1. 13
* Patients able to swallow and retain oral medications (without crushing, dissolving, or chewing tablets).
* Patients with adequate hematologic and organ function within 14 days before the first Cycle which can be defined by the following:

  * Neutrophils (absolute neutrophil count (ANC) \>1.5 X 10\^9/L).
  * Hemoglobin \>9 g/dl.
  * Platelet count \>100,000/L.
  * Serum albumin \>3 g/dl.
  * Total bilirubin 1.5 ≤ of the upper limit of normal (ULN) and aspartate aminotransferase (AST) and alanine transaminase ( ALT) ≤ 2 of the upper limit of normal (ULN).
  * Serum creatinine ≤ 1.5 of the upper limit of normal (ULN) or estimated creatinine clearance \>50 mL/min based on Cockcroft-Gault glomerular filtration rate estimation.

Exclusion Criteria:

* Presence of 2nd primary malignancy
* History of allergic reactions attributed to paclitaxel, carboplatin, and itraconazole or to compounds of similar chemical or biologic composition to itraconazole.
* Concurrent use of medications significantly affecting metabolism of itraconazole (certain anti-convulsants).
* Patients with hyperthyroidism (which would increase metabolism of itraconazole).
* Patients with grade ≥ 2 neuropathy.
* Patients with Uncontrolled, concurrent medical illness.
* Patients with active hepatitis or symptomatic liver disease.
* History of or current evidence of uncontrolled cardiac ventricular dysfunction (congestive heart failure) or patients with class III and class IV heart failure according to New York Heart Association (NYHA).
* Pregnant or lactating female .

Outcome Measures

Primary Outcomes

The change between 2 groups in overall response rate and disease control rate

The change between 2 groups in overall response rate and disease control rate using the Response Evaluation Criteria in Solid Tumors (RECIST), version. 1.1.

Time frame: 1 week after the end of chemotherapy cycle 3 and 6 (each cycle is 21 days) and every 2 to 4 months after the end of 6 chemotherapy cycles (each cycle is 21 days) for 1 year

Secondary Outcomes

The change in the serum concentrations of the biological markers (CA-125, VEGFR-2, P-glycoprotein).

* Serum cancer antigen-125 (CA-125) level which will be assessed at baseline for all patients, after the third chemotherapy cycle and after the sixth chemotherapy cycle if it is positive at initial presentation. * Serum vascular endothelial growth factor receptor-2 (VEGFR-2) level by ELISA which will be assessed at baseline and after the sixth chemotherapy cycle. * Serum P-glycoprotein level by ELISA which will be assessed at baseline and after the sixth chemotherapy cycle.

Time frame: 1 week after the end of chemotherapy cycle 3 and 6 (each cycle is 21 days) and every 2 to 4 months after the end of 6 chemotherapy cycles (each cycle is 21 days) for 1 year

Locations

Tanta University, Faculty of Pharmacy, Tanta, Egypt

Linked Papers

Use of “Repurposed” Drugs in the Treatment of Epithelial Ovarian Cancer

Epithelial ovarian cancer has poor outcomes with standard therapy and limited options for treatment of recurrent disease. This systematic review summarizes the data on the clinical use of repurposed drugs. We searched for clinical studies using “repurposed” agents for the treatment of ovarian cancer in the following databases: PubMed, clinicaltrials.gov, Clinical Trial Registry of India, European Clinical Trials Registry, and Chinese Clinical Trial Registry. We excluded reviews, preclinical studies, and non-English language studies. We assessed the quality of included studies. The following agents/class of agents were included: statins, hydroxychloroquine, metformin, itraconazole, nonsteroidal anti-inflammatory drugs, vitamin D, proton pump inhibitors, beta-blockers, and sodium valproate. Only one randomized controlled trial investigated metformin, which found no benefit of metformin. However, this had a high risk of bias (no details of randomization). Among the observational studies, 70% were of high quality (Newcastle-Ottawa scale ≥7). Clinical benefit was seen for itraconazole, beta-blockers, metformin, statins, and proton pump inhibitors. Though multiple studies aim to repurpose agents in epithelial ovarian cancer, the most published literature is observational, and none are practice-changing. Given the solid preclinical data regarding the anticancer efficacy of these agents, well-designed clinical trials are urgently required.

Linked Investigators

Sara Ricardo

Sara Ricardo completed their PhD degree in Molecular Pathology and Genetics in 2011 at Universidade do Porto Instituto de Ciências Biomédicas Abel Salazar. She has a solid background in the pathology field and developed an MSc and Ph.D. degree as a researcher in the Breast Pathology field. After completing the PhD degree, she worked as a post-doc researcher in the Differentiation and Cancer group at i3s (Instituto de Investigação e Inovação da Universidade do Porto). She shifted from breast to ovary cancer research and now leads a research line in ovarian cancer metastization, focused on malignant ascites characterization and patient-derived organoids to perform drug tests. The most impactful research outputs are (1) the Identification of the synergistic effect of the combinatory therapies in ovarian cancer cell lines; (2) the Generation of two high-grade serous carcinoma cell lines, with a double-chemoresistant phenotype; (3) the Identification of a Mucin and truncated O-glycan footprint of ovarian cancer cell lines; (4) Definition of glycol-mucin profiles with higher specificity level than CA125 assay. She is now recognized as an expert in molecular pathology of ovarian tumours, participating as an evaluator in national and European research project calls (e.g., ERC grants), reviewer of high-impact journals (e.g., Nature Communications, Frontiers in Oncology, Cancers) and Guest Editor in the journal of the oncology field. She has been involved as a supervisor of many graduated/undergraduate students and a jury member of several academic thesis/dissertations. She currently is the supervisor of, 3 BSc students, 2 MSc students and 5 PhD students, 3 of them with projects with fellowships awarded by nationally funded (Ref. 2021.05081.BD; Ref. 2020.04720.BD; Ref. 2022.12584.BD). She is the PI of two research projects (Ref. HOPE and Ref. GI2-CESPU_2022), and participates as a member in two (Ref. LA/P/0070/2020 and upPTXovcar-GI2-CESPU-2022). Se submitted several projects to funding agencies as a PI, namely 2 large funding projects as a PI (FCT ref. PTDC/MEC-ONC/2047/2020, PTDC/MEC-ONC/3600/2021, 2022.01567.PTDC and Caixa Research Health 2022 ref. HR22-00170), which had a very good evaluation by the evaluator panel but unfunded. Besides her position as a researcher, Sara Ricardo is an associate professor at IUCS-CESPU, coordinating the Histology (BSc programme), Laboratory Rotations (PhD programme) curricular units, and professor of biomedical investigation (PhD Programme), Histology (Integrated Master programmes). She is also a coordination board member of the Biomedical Sciences BSc programme and the Biomedical Sciences PhD program. She integrates a national commission for assessing and accreditation of higher education programmes at the Agency for Assessment and Accreditation of Higher Education as committee president. She has authored or co-authored 72 publications in international peer-reviewed journals and has an H-index of 21 (Scopus).

Itraconazole in Advanced Ovarian Cancer