A Phase II Study of Epigenetic Therapy to Overcome Chemotherapy Resistance in Refractory Solid Tumors - Full Text View

Sponsor:	National Institute of Cancerología
Collaborators:	Psicofarma S.A. de C.V. National Council of Science and Technology, Mexico
Information provided by:	National Institute of Cancerología
ClinicalTrials.gov Identifier:	NCT00404508

Purpose

Chemotherapy resistance, either innate or acquired requires for its development, expression changes on a large number of genes therefore, it has been hypothesized that epigenetic-mediated changes could be the responsible driving force for chemotherapy resistance. Aberrant DNA methylation and histone deacetylation are the main epigenetic alterations hence, their reversal by inhibitors of DNA methylation and histone deacetylases (HDACs) may overcome resistance in refractory solid tumors.

Patients will be treated with hydralazine and magnesium valproate starting from day -7 until chemotherapy ends which consists on the same pre-study protocol regimen on which patients progressed. Response and toxicity were evaluated. Global DNA methylation and HDAC activity were evaluated in the peripheral blood cells, as well as the plasma levels of valproic acid and hydralazine.

Condition	Intervention	Phase
Refractory Solid Tumors	Drug: Hydralazine and magnesium valproate	Phase II

Study Type:	Interventional
Study Design:	Allocation: Non-Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	A Phase II Study of Epigenetic Therapy With Hydralazine and Magnesium Valproate to Overcome Chemotherapy Resistance in Refractory Solid Tumors

Resource links provided by NLM:

MedlinePlus related topics: Cancer

Drug Information available for: Divalproex sodium Hydralazine Valproic acid Hydralazine hydrochloride Valproate Sodium Magnesium

U.S. FDA Resources

Further study details as provided by National Institute of Cancerología:

Primary Outcome Measures:

Clinical benefit (complete response, partial response and stable disease)
Safety

Secondary Outcome Measures:

Global DNA methylation
HDAC inhibition
Gene promoter demethylation from serum DNA

Estimated Enrollment:	15
Study Start Date:	September 2005
Estimated Study Completion Date:	October 2006

Detailed Description:

Eligible patients after signing informed consent will undergo study evaluation and acetylation status typing before being treated. Patients will begin treatment (day -7) with a daily dose of a slow-release formulation of hydralazine tablets containing either 182 mg for rapid-acetylators or 83 mg for slow-acetylators and slow-release tablets containing 700mg of magnesium valproate at a dose of 40mg/Kb t.i.d. Both hydralazine and magnesium valproate will be administered from day -7 until the last day of the last chemotherapy cycle. Chemotherapy will initiate at day 1 (after seven days of being taken hydralazine and magnesium valproate) with the same pre-study protocol regimen at which patients showed tumor progression. Toxicity will be evaluated after each course of chemotherapy. Response will be evaluated at the third course of chemotherapy. Promoter of selected genes will be evaluated by methylation-specific PCR in serum DNA before and after 7 days of treatment with hydralazine and valproate.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Aged18 years and older.
Histologically proven malignant solid tumors who were receiving their second, third or fourth line of palliative chemotherapy and who showed at the second or third course progressive disease as their maximum response according to the RECIST criteria or to the IGCG CA125 criteria in case of ovarian cancer patients.
Measurable disease defined by 1 of the following criteria: Any unidimensional measurable lesion ≥ 10 mm by standard MRI or CT scan for solid tumors; or at least 1 non-measurable lesion that is evaluable by nuclear medicine, tumor markers, or other reliable measures.
Eastern Cooperative Oncology Group (ECOG) performance status ≤2; Absolute leukocyte count (≥4000/mm3), platelets ≥100,000/mm3, hemoglobin ≥9.0 g/dL; total bilirubin, aspartate amino transferase (AST) and alanine amino transferase (ALT) <1.5 the upper normal limit (UNL), creatinine ≤1.2 mg/dL or a calculated creatinine clearance of ≥60 mL/min.
Life expectancy of more than three months,
Written informed consent.

Exclusion Criteria:

History of allergy to hydralazine or valproate.
Past or present condition of rheumatic disease, central nervous system disease, heart failure from aortic stenosis and postural hypotension as diagnosed by a physician.
Previous use of the experimental drugs (hydralazine and magnesium valproate)
Pregnancy or breast-feeding.
Uncontrolled systemic disease or infection.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00404508

Locations

Mexico
National Institute of Cancerologia
Mexico City, Tlalpan, Mexico, 14080

Sponsors and Collaborators

National Institute of Cancerología

Psicofarma S.A. de C.V.

National Council of Science and Technology, Mexico

Investigators

Study Director:

Alfonso Duenas-Gonzalez, MD PhD

National Institute of Cancerologia

More Information

No publications provided by National Institute of Cancerología

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Candelaria M, Gallardo-Rincón D, Arce C, Cetina L, Aguilar-Ponce JL, Arrieta O, González-Fierro A, Chávez-Blanco A, de la Cruz-Hernández E, Camargo MF, Trejo-Becerril C, Pérez-Cárdenas E, Pérez-Plasencia C, Taja-Chayeb L, Wegman-Ostrosky T, Revilla-Vazquez A, Dueñas-González A. A phase II study of epigenetic therapy with hydralazine and magnesium valproate to overcome chemotherapy resistance in refractory solid tumors. Ann Oncol. 2007 Sep;18(9):1529-38.

ClinicalTrials.gov Identifier:	NCT00404508 History of Changes
Other Study ID Numbers:	005/32/DII
Study First Received:	November 25, 2006
Last Updated:	November 27, 2006
Health Authority:	Mexico: Ethics Committee

Keywords provided by National Institute of Cancerología:

Hydralazine
Magnesium Valproate
Chemotherapy resistance
Epigenetic therapy

Additional relevant MeSH terms:

Neoplasms
Valproic Acid
Hydralazine
Anticonvulsants
Central Nervous System Agents
Therapeutic Uses
Pharmacologic Actions
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
GABA Agents

Neurotransmitter Agents
Physiological Effects of Drugs
Antimanic Agents
Tranquilizing Agents
Central Nervous System Depressants
Psychotropic Drugs
Antihypertensive Agents
Cardiovascular Agents
Vasodilator Agents

ClinicalTrials.gov processed this record on February 09, 2012