Study of Intratumoral Hypoxia Using Pre-operative Administration of Pimonidazole

Study Overview
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Brief Summary
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This study involves the administration of a hypoxia marker, pimonidazole hydrochloride, taken orally approximately 24 hours before surgical resection of a pancreatic tumor in order to identify areas of lower oxygen content on tumor samples.

Detailed Description
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Intratumoral hypoxia (low oxygen concentration or pO2) occurs when oxygen consumption exceeds its delivery by the vascular system. Hypoxia is associated with adverse patient outcome in many human cancers and this association is hypothesized to be due to a combination of treatment resistance and aggressive tumor biology. The study of hypoxia is also important as new cancer drugs are being developed that are specifically active on cancer cells in area of tumors with lower oxygen levels. his study involves administering the hypoxia probe pimonidazole hydrochloride to patients prior to resection of pancreatic adenocarcinoma to evaluate the extent, molecular context and clinical relevance of hypoxia in clinical pancreatic cancer samples and the subsequently derived primary xenograft tumors. We propose accrual of patients over a 5-year period to evaluate hypoxia within 100 clinical tumor specimens and corresponding primary xenograft tumours where available. The complementary techniques of wide-field multicolor fluorescence image analysis microscopy and high level flow cytometry will be used to identify potential relationships between intratumoral hypoxia and cell proliferation, differentiation, and the expression of putative cancer stem cell markers.

Official Title
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A Clinical Trial of Intratumoral Hypoxia and Its Biologic Correlates in Patients Undergoing Surgical Resection of Localized Pancreatic Cancer, Using Pre-operative Administration of the Hypoxia Marker Pimonidazole.

Conditions
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Pancreatic Cancer

Intervention / Treatment
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* Drug: Pimonidazole hydrochloride


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age > 18 provisional diagnosis of pancreatic cancer scheduled resection at UHN consented to ICGC Pancreatic Cancer Genome Project surgery planned for >2 days away (drug administration has to be 16-20hrs before surgery) Exclusion Criteria: not participating in ICGC contraindications to pimonidazole (allergy) surgery scheduled for same or next day (not enough time to arrange for drug administration)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pimonidazole hydrochloride<br>Oral pimonidazole is administered at a dose of 0.5gm/m2 once approximately 24 hrs prior to surgery | Drug: Pimonidazole hydrochloride<br>* Pimonidazole is a 2-nitroimidazole that is selectively reduced and covalently binds to intracellular macromolecules in areas of hypoxia (by definition, p02 <= 10mm Hg) within normal and tumour tissue. Pimonidazole adducts can then be detected by immunolabelling techniques (microscopy, ELISA, flow cytometry etc). In this study, pimonidazole will be administered orally as a one time dose of 0.5gm/m2 24hrs prior to surgery. Since the drug has a half-life of approximately 5 hrs, this time-frame ensures low circulating levels at the time of surgery and therefore reduces the confounding effects of surgical hypoxia on tumour analysis.<br>* Other names: Hypoxyprobe-1;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| characterization of intratumoral hypoxia in pancreatic cancer | estimation of tumoral hypoxic fraction by immunodetection of pimonidazole adducts. | 5 Years | 
| correlation of intratumoral hypoxia with patient survival rate | evaluation of correlation of tumoral hypoxia with disease-free survival using Cox proportional hazards analysis | 5 Years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| correlation of hypoxia with molecular markers | colocalization of molecular markers using immunofluorescence microscopy: Stem-cell like populations markers of EMT Endogenous markers of hypoxia (HIF1a, CAIX) | 5 Years | 
| to assess utility of circulating osteopontin and miR-210 for identifying hypoxia | correlation of tumoral hypoxic fraction with plasma levels of osteopontin and miR-210 | 5 Years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pancreas, pancreatic cancer, pancreatic tumor, pimonidazole, hypoxia, whipple's resection