Patient case: 68-year-old male with non-small cell carcinoma; genetic feature: MET

Clinical trial: A Phase 2 Study Adding Ascorbate to Chemotherapy and Radiation Therapy for NSCLC

Summary: This clinical trial evaluates adding high-dose ascorbate (vitamin C) to a standard therapy for non-small cell lung cancer. The standard therapy is radiation therapy combined with carboplatin and paclitaxel (types of chemotherapy). All subjects will receive high-dose ascorbate in addition to the standard therapy.

Detailed description: For selected stages of non-small cell lung cancer (NSCLC), standard treatment involves radiation therapy and chemotherapy. The chemotherapy regimen typically used is paclitaxel and carboplatin. Both of these chemotherapeutic drugs are administered intravenously, using a vein in the arm. Radiation is administered using a machine external to the body (usually a linear accelerator). After combined therapy, NSCLC patients receive 2 extra cycles of chemotherapy, called "consolidation chemotherapy."
  This study adds 75 grams of ascorbate (vitamin C, sometimes called pharmacological ascorbate because the dose is so high) at specific timepoints in the therapy. The ascorbate is administered intravenously - through a vein in your arm.
  Participants will:
  -  receive 75 grams of intravenous ascorbate 3 times per calendar week while they are receiving radiation therapy. The IV will be running while the radiation therapy is administered. This portion of the study is about 6 to 7 weeks.
  -  receive 75 grams of intravenous ascorbate 2 times per calendar week while they are receiving consolidation chemotherapy. Each cycle of consolidation chemotherapy is 3 weeks, so this portion of the study is about 6 weeks.
  -  undergo imaging which is standard for their cancer and therapy. This can include CT scans, PET scans, and X-rays.
  -  provide blood samples to determine the biological effects, if any, the ascorbate has on the body during therapy
  This active therapy portion lasts for about 15 to 17 weeks. After that is done, participants go back to standard follow-up for their cancer and any additional therapy their doctors believe they need.
  However, it is very important the investigators remain in contact with participants; they will have life-long follow-up for this study.

Eligibility: Inclusion Criteria:
  Note: patients who have a small pleural effusion that is too small to safety tap and is not visible on a chest x-ray are still eligible
  -  Pathologic diagnosis (i.e., cell sample, biopsy, tissue swap, bronchoscopy) with non-small cell lung cancer.
  -  Diagnosed within the past 4 weeks
  -  Physician determined the patient is healthy enough for chemotherapy and radiation therapy
  -  At least part of the lung cancer must be viewable and measurable by CT or MRI
  -  A platelet count of at least 100,000 cells per mL
  -  A creatinine level of less than 1 1/2 times the upper limit of normal for the local lab test, or, a creatinine clearance of at least 60 mL/(min*1.73m2)
  -  Not pregnant, and commit to using birth control during the study
  Exclusion Criteria:
  -  Exudative pleural effusion
  -  Recurrent non-small cell lung cancer
  -  Glucose-6-phosphate dehydrogenase (G6PD) deficiency
  -  Patients actively receiving insulin
  -  Patients requiring daily finger-stick blood glucose measurements
  -  Patients who are on the following drugs and cannot have a substitution or who decline the substitution:
  -  warfarin
  -  flecainide
  -  methadone
  -  amphetamines
  -  quinidine
  -  chlorpropamide
  -  Prior radiation therapy that would result in a field overlap
  -  Enrolled in another therapeutic clinical trial
  -  Uncontrolled, intercurrent illness
  -  Lactating women
  -  HIV positive individuals undergoing therapy due to known drug:drug interaction between antiretroviral drugs and high-dose ascorbate therapy
  If all the above are met, the potential participant will receive a 15 gram challenge dose of ascorbate via intravenous infusion. This is the final screening procedure.

Relevance to patient case: not relevant