Vitamin C with Chemotherapy and Radiation for Lung Cancer

(XACT-LUNG Trial)

Overseen By Muhammad Furqan

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: Joseph J. Cullen, MD, FACS

Must be taking: Carboplatin, Paclitaxel

Must not be taking: Warfarin, Flecainide

Disqualifiers: Recurrent cancer, G6PD deficiency, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 16

Duration: 10-12 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether adding high-dose vitamin C to standard treatments can improve outcomes for people with non-small cell lung cancer. The standard treatments include radiation therapy and two chemotherapy drugs, carboplatin and paclitaxel. Participants with a confirmed diagnosis of non-small cell lung cancer, who are already recommended for this standard treatment and have tumors measurable by a CT scan, might be suitable candidates. The goal is to determine if vitamin C can enhance the effectiveness of the usual treatment. As a Phase 2 trial, this research focuses on measuring the treatment's effectiveness in an initial, smaller group of people.

Will I have to stop taking my current medications?

The trial requires that you stop taking certain medications like warfarin, flecainide, methadone, amphetamines, quinidine, and chlorpropamide unless a substitution is possible. If you are on these medications and cannot switch, you may not be eligible to participate.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that high-dose vitamin C, when combined with chemotherapy, is generally safe for patients. In one study, 8 out of 9 patients experienced tumor shrinkage with this combination, suggesting the treatment is both effective and safe for most individuals.

Patients who received high-dose vitamin C with chemotherapy reported manageable side effects. This indicates that adding vitamin C to lung cancer treatment might not cause major issues for participants. However, as with any treatment, side effects can occur, and individual experiences may vary. It is important to consult with a medical team to understand how this treatment might affect each person. ^{1 2 3 4 5}

Why do researchers think this study treatment might be promising for lung cancer?

Researchers are excited about combining Vitamin C with chemotherapy and radiation for lung cancer because it introduces a promising new element: high-dose intravenous Vitamin C, also known as pharmacological ascorbate. While standard treatments for lung cancer typically involve chemotherapy drugs like Carboplatin and Paclitaxel, along with radiation, this approach adds Vitamin C, which is thought to enhance the effectiveness of these traditional therapies. The belief is that Vitamin C could potentially make cancer cells more sensitive to chemotherapy and radiation, thereby improving treatment outcomes. This added component might not only boost the overall effectiveness of the treatment but also help to reduce side effects, making it a compelling area of research for lung cancer therapy.

What evidence suggests that adding high-dose vitamin C to chemotherapy and radiation therapy could be effective for lung cancer?

Research has shown that high-dose vitamin C, when combined with chemotherapy, yields promising results. In one study, 8 out of 9 patients experienced tumor shrinkage with the addition of vitamin C to their chemotherapy. Another study suggested that vitamin C might offer protection against lung cancer. Although some studies found no significant effect on cancer progression, researchers continue to explore how vitamin C might enhance chemotherapy's effects. In this trial, participants will receive a combination of radiation therapy, paclitaxel, carboplatin, and high-dose vitamin C (ascorbic acid) to assess its potential as a beneficial addition to lung cancer treatment. ^{2 6 7 8 9}

Who Is on the Research Team?

Joseph J Cullen, MD, FACS

Principal Investigator

University of Iowa

Are You a Good Fit for This Trial?

This trial is for adults with non-small cell lung cancer who are healthy enough for chemotherapy and radiation, have a measurable tumor of at least 1 cm by CT or MRI, and not pregnant. They must have normal platelet counts and kidney function, no severe pleural effusion, no G6PD deficiency, not on certain medications like warfarin or insulin, and not HIV positive on antiretroviral therapy.

Inclusion Criteria

My kidney function tests are within the required range.

I have a small fluid collection in my chest that can't be safely removed and isn't seen on an X-ray.

The tumor or cancer spread needs to be at least 1 cm in size as seen on a CT scan.

Exclusion Criteria

Enrolled in another therapeutic clinical trial

I am taking one of the specified drugs and cannot or will not switch to a different one.

I have fluid buildup in the lining of my lungs.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive high-dose ascorbate with standard chemotherapy and radiation therapy

10-12 weeks

3 visits per week (in-person)

Consolidation Chemotherapy

Participants receive 2 extra cycles of chemotherapy after combined therapy

6-8 weeks

1 visit per cycle (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

2 years

Every 6 months (in-person)

Long-term Follow-up

Participants have life-long follow-up for the study

Up to 20 years

Every 6 months (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Ascorbic Acid
• Carboplatin
• Paclitaxel
• Radiation Therapy

Trial Overview The study tests adding high-dose vitamin C (ascorbate) to the standard treatment regimen of carboplatin and paclitaxel chemotherapy combined with radiation therapy. All participants will receive this additional ascorbate alongside their prescribed treatments.

How Is the Trial Designed?

Group I: ChemoRT + Ascorbate Experimental Treatment 4 Interventions

Radiation therapy, intravenous paclitaxel, intravenous carboplatin, intravenous ascorbic acid (pharmacological ascorbate)

Carboplatin is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Paraplatin for:

• Ovarian cancer
• Testicular cancer
• Lung cancer
• Head and neck cancer
• Brain cancer

Approved in European Union as Carboplatin for:

• Ovarian cancer
• Small cell lung cancer

Approved in Canada as Carboplatin for:

• Ovarian cancer
• Small cell lung cancer
• Testicular cancer

Who Is Running the Clinical Trial?

Joseph J. Cullen, MD, FACS

Lead Sponsor

Trials

4

Recruited

110+

National Institutes of Health (NIH)

Collaborator

Trials

2,896

Recruited

8,053,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Holden Comprehensive Cancer Center

Collaborator

Trials

27

Recruited

710+

Published Research Related to This Trial

In a phase III trial involving 200 patients with stage III non-small cell lung cancer, the chemotherapy regimen of etoposide and cisplatin (EP) showed a significantly higher 3-year overall survival rate compared to carboplatin and paclitaxel (PC), with a difference of 15% (P = 0.024).

While EP demonstrated better overall survival, it was associated with a higher incidence of severe esophagitis (20% vs. 6.3% for PC), whereas PC had a higher rate of radiation pneumonitis (33.3% vs. 18.9% for EP), indicating a trade-off in safety profiles between the two regimens.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Etoposide and cisplatin versus paclitaxel and carboplatin with concurrent thoracic radiotherapy in unresectable stage III non-small cell lung cancer: a multicenter randomized phase III trial. Liang, J., Bi, N., Wu, S., et al.[2020]

The combination of paclitaxel and carboplatin followed by thoracic radiation therapy (TRT) has shown promising efficacy in treating locally advanced non-small-cell lung cancer (NSCLC), with a 60% partial response rate to combined therapy and a median survival of 15.3 months for all patients.

The treatment was well-tolerated, with manageable side effects, and the chemotherapy doses were safely escalated, indicating that this approach can be an effective option for patients with locally advanced NSCLC.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Induction and concurrent paclitaxel/carboplatin every 3 weeks with thoracic radiotherapy in locally advanced non-small-cell lung cancer: an interim report. Movsas, B., Hudes, RS., Schol, J., et al.[2019]

A systematic review of 31 studies involving 3090 patients treated with cisplatin-etoposide and 48 studies with 3728 patients treated with carboplatin-paclitaxel showed that both chemotherapy regimens had similar efficacy in treating unresectable stage III non-small-cell lung cancer, with no significant differences in overall survival or progression-free survival.

However, carboplatin-paclitaxel was associated with fewer severe hematological toxic effects compared to cisplatin-etoposide, making it a safer option for patients undergoing concurrent thoracic radiation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of Concurrent Use of Thoracic Radiation With Either Carboplatin-Paclitaxel or Cisplatin-Etoposide for Patients With Stage III Non-Small-Cell Lung Cancer: A Systematic Review. Steuer, CE., Behera, M., Ernani, V., et al.[2022]

In a study of 15 patients with inoperable locally advanced non-small cell lung cancer (NSCLC), the combination of paclitaxel, carboplatin, and concurrent radiation therapy resulted in a high overall response rate of 73%, with 13% achieving a complete response and 60% a partial response.

The treatment was associated with manageable toxicity, primarily grade 2 esophagitis in 40% of patients and varying degrees of leukopenia, indicating that while effective, careful monitoring for side effects is necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[A phase I clinical trial of combination chemotherapy of paclitaxel with carboplatin and concurrent radiation therapy in locally advanced non-small cell lung cancer]. Zhu, Y., Zhang, H., Hu, F.[2010]

Combined chemotherapy with paclitaxel and carboplatin alongside thoracic radiation therapy has shown a clear survival benefit for patients with locally advanced, unresectable non-small cell lung cancer (NSCLC), as demonstrated in randomized trials and meta-analyses.

Ongoing and planned multicenter studies aim to refine treatment regimens and improve both local and systemic control of NSCLC, highlighting the need for a multidisciplinary approach to effectively manage this systemic disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Incorporation of paclitaxel and carboplatin in combined-modality therapy for locally advanced non-small cell lung cancer. Belani, CP.[2015]

Combination therapy using paclitaxel with carboplatin and radiation shows promise as a safer and more effective treatment for non-small cell lung cancer compared to the standard regimen of etoposide and cisplatin.

The use of paclitaxel, a novel taxane drug, in conjunction with radiation therapy may enhance local control of the cancer and improve overall response rates, suggesting a potential advancement in treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Concurrent paclitaxel, carboplatin, and radiation therapy for locally advanced non-small cell lung cancer. Choy, H., Akerley, W., DeVore, RF.[2015]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5381428/

Association between vitamin C intake and lung cancer Our analysis suggested that the higher intake of vitamin C might have a protective effect against lung cancer, especially in the United States.

2. sciencedirect.com sciencedirect.com/science/article/pii/S2352304225002314

High-dose vitamin C: A promising anti-tumor agent, insight ... A phase I single-arm study found that HDVC combined with chemotherapy (gemcitabine) resulted in primary tumor shrinkage in 8 out of 9 patients, ...

3. frontiersin.org frontiersin.org/journals/nutrition/articles/10.3389/fnut.2021.812394/full

Vitamin C Intake and Cancers: An Umbrella Review Increased intake of ascorbic acid could bring measurable benefits in prevention and treatment of cancer (38). It was generally demonstrated by ...

4. ascopubs.org ascopubs.org/doi/10.1200/jco.2013.31.15_suppl.e18523

The therapeutic effects of vitamin C on lung cancer cells. It is possible that lower dosages of vitamin C may still kill cancer cells selectively, and may also be more effective in cancers in ther tissues. Despite these ...

5. imrpress.com imrpress.com/journal/IJVNR/95/3/10.31083/IJVNR37372/pdf

A Systematic Review a Their results showed that intravenous vitamin C (IVC) combined with chemotherapy had no significant impact on progression- free survival (PFS) ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9079696/

Pharmacological ascorbate improves the response to ... Pharmacological Ascorbate improved the response of NSCLC to platinum-doublet chemotherapy. •. Cytokine and chemokines data suggest that protocol ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8812486/

Vitamin C Intake and Cancers: An Umbrella Review - PMC We identified 22 cancer outcomes within 3,562 articles. VC consumption was associated with lower incidence of bladder cancer, breast cancer, ...

8. clinicaltrials.gov clinicaltrials.gov/show/NCT02420314

NCT02420314 | Pharmacological Ascorbate for Lung Cancer These drugs are administered once every 21 days. This study adds high dose ascorbic acid (75g per infusion) twice per week for up to 4 cycles of therapy.

9. asco.org asco.org/abstracts-presentations/ABSTRACT114055

Do ascorbic acid and viscum album improve PFS in NSCLC? Ascorbate treatment depleted ATP and induced autophagy in prostate cancer cells; gemcitabine with ascorbate resulted in 50% inhibition of growth in ...