Tinzaparin And Biomarkers After Neoadjuvant Treatment of Ovarian Cancer

Sponsor
University Hospital, Linkoeping (Other)
Overall Status
Not yet recruiting
CT.gov ID
NCT05284552
Collaborator
Region Jönköping County (Other), Kalmar County Hospital (Other), Västervik Hospital (Other)
40
7
2
32
5.7
0.2

Study Details

Study Description

Brief Summary

Background:

Previous findings have indicated antineoplastic properties of tinzaparin (Innohep®), a commonly used anti-coagulant. Earlier studies have mainly investigated the antineoplastic effects of tinzaparin in animal models and in human cell-lines. In this pilot study the aim is to examine the potential antitumoral effects of tinzaparin in vivo in women with epithelial ovarian cancer (EOC).

Study objectives:

Primary objective: The primary objective of the study is to evaluate the effects of tinzaparin on changes in levels of CA-125 in EOC patients who receive neoadjuvant chemotherapy (NACT).

Secondary objectives: The secondary objective of the study is to explore the impact of tinzaparin on the dynamic of a spectrum of immunological and coagulation factors in EOC patients who receive NACT. Besides, the compliance of tinzaparin injections and adverse events caused by tinzaparin will be described.

Condition or Disease Intervention/Treatment Phase
  • Drug: Tinzaparin Injectable Solution
Phase 2

Detailed Description

This is an open randomized controlled clinical pilot trial (Phase II). The study includes women with the International Federation of Obstetrics and Gynecology (FIGO) stage III-IV EOC selected for neoadjuvant chemotherapy (NACT) and without signs of thromboembolic disease or ongoing treatment of thromboembolic disease. The women will be allocated 1:1 to treatment with tinzaparin 4500 IU/8000 IU (dose depending on woman's weight) subcutaneously once daily or no tinzaparin. The treatment group starts tinzaparin when the primary treatment (chemotherapy) starts. The control group will not receive tinzaparin or other low molecular weight heparin preparations. The NACT consists of carboplatin and paclitaxel, given according to the standard regimen with cycle repeats every 21 days. Pre-treatment, before every cycle of chemotherapy, before delayed primary debulking surgery (DPDS) and three weeks after the last cycle of chemotherapy venous blood samples will be taken for measuring the biomarkers hemoglobin, platelets, leucocytes, C-reactive protein (CRP), albumin, cancer antigen-125 (CA-125), Tissue Factor, D-dimer, soluble P-selectin, thrombin-antithrombin complex and thrombin generation potential. Furthermore, a panel of 92 inflammation-associated proteins will be analyzed by a by a high-sensitivity Proximity Extension Assay at baseline, visit 5 and visit 8 or 9. After three cycles of NACT, the patient will be evaluated clinically and with imaging diagnostics in order to determine whether the patient should undergo DPDS. In the investigators´ setting, > 80% of patients receiving NACT for EOC undergo DPDS. After DPDS, all patients will be treated with tinzaparin for 28 days according to clinical practice concerning postoperative thromboembolic prophylaxis and thereafter continue the chemotherapy for additional two-three courses. The participants who were allocated to tinzaparin during the NACT will continue the tinzaparin after ending the postoperative thromboembolic prophylactic tinzaparin treatment for additional 2-3 courses. The biomarkers will be measured preoperatively and four weeks postoperatively after DPDS and then before each course of chemotherapy given during the primary treatment. The women who do not undergo surgery will remain included in the study for the following three cycles of chemotherapy. Thus, the total study period constitutes 22-29 weeks.

Study Design

Study Type:
Interventional
Anticipated Enrollment :
40 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Treatment
Official Title:
The Effect of Tinzaparin on Biomarkers in FIGO Stage III-IV Ovarian Cancer Patients Undergoing Neoadjuvant Chemotherapy - A Randomized Pilot Study
Anticipated Study Start Date :
May 1, 2022
Anticipated Primary Completion Date :
Dec 31, 2024
Anticipated Study Completion Date :
Dec 31, 2024

Arms and Interventions

Arm Intervention/Treatment
Experimental: Intervention Arm

Drug: Tinzaparin (Innohep®), solution for injection. Administration form: Subcutaneous injection. Dosage: 4500 IU (for subjects weighing below 90 kg) or 8000 IU (for subjects weighing 90 kg and above) daily for 21-28 weeks.

Drug: Tinzaparin Injectable Solution
Subcutaneous injection
Other Names:
  • Innohep®
  • No Intervention: Control Arm

    Outcome Measures

    Primary Outcome Measures

    1. Changes in serum levels of CA-125 [14 weeks]

      kIU/L

    Secondary Outcome Measures

    1. Changes in serum levels of CA-125 [21-28 weeks]

      kIU/L

    2. Changes in blood levels of hemoglobin [21-28 weeks]

      g/L

    3. Changes in blood levels of platelets [21-28 weeks]

      x10^9/L

    4. Changes in blood levels of leucocytes [21-28 weeks]

      x10^9/L

    5. Changes in plasma levels of CRP [21-28 weeks]

      mg/L

    6. Changes in plasma levels of albumin [21-28 weeks]

      g/L

    7. Changes in plasma levels of interleukin 6 [21-28 weeks]

      ng/L

    8. Changes in plasma levels of vascular endothelial growth factor [21-28 weeks]

      µg/L

    9. Self reported compliance to tinzaparin injections [22-29 weeks]

      Percent

    10. Number of participants with treatment-related adverse events as assessed by CTCAE v4.0 [22-29 weeks]

      Number

    11. Proportion of participants with treatment-related adverse events as assessed by CTCAE v4.0 [22-29 weeks]

      Proportion constitutes the relative number in the group in percent

    12. Objectively confirmed venous thromboembolism (VTE), i.e. pulmonary embolism, lower-limb deep vein thrombosis or upper extremity deep vein thrombosis. Death due to VTE. [22-29 weeks]

      Number

    13. Objectively confirmed venous thromboembolism (VTE), i.e. pulmonary embolism, lower-limb deep vein thrombosis or upper extremity deep vein thrombosis. Death due to VTE. [22-29 weeks]

      Percent

    Other Outcome Measures

    1. Plasma levels of tissue factor [21-28 weeks]

      µg/L

    2. Plasma levels of D-dimer [21-28 weeks]

      mg/L

    3. Plasma levels of soluble P-selectin [21-28 weeks]

      µg/L

    4. Plasma levels of thrombin-antithrombin complex [21-28 weeks]

      µg/L

    5. Thrombin generation potential [21-28 weeks]

      lag time (min)

    6. Thrombin generation potential [21-28 weeks]

      endogenous thrombin generation potential (nmolar*min)

    7. Thrombin generation potential [21-28 weeks]

      peak nmol/L

    8. Olink Target 96 Inflammation - plasma levels a panel of 92 inflammation associated proteins [21-28 weeks]

      All 92 inflammation associated proteins are measured in pg/mL

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    18 Years and Older
    Sexes Eligible for Study:
    Female
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • The subject has given written consent to participate in the study.

    • Age 18 and above

    • Epithelial ovarian, fallopian tube or peritoneal cancer, or abdominal cancer where a biopsy indicates an origin from the ovary, fallopian tube or peritoneum.

    • Histology diagnosis of either high grade serous carcinoma, endometrioid carcinoma or clear cell carcinoma.

    • FIGO stage III-IV disease.

    • Selected for NACT with platinum double regimen at a multidisciplinary conference at Department of Oncology at Linköping University Hospital

    • Receive treatment at either of the University Hospital in Linköping, or the hospitals in Jönköping (Ryhov Hospital), Eksjö (Highland Hospital, Eksjö), Västervik (Västervik hospital), Kalmar (County Hospital, Kalmar), Värnamo (Värnamo hospital).

    • Planned for platinum doublet regimen.

    • Prior to start of NACT pregnancy should be ruled out by menstrual history or in unclear cases by a urine human chorionic gonadotropin (hCG) test.

    • Women of childbearing potential should use a safe birth control method (combined hormonal contraception, progesterone only hormonal contraception, intra uterine device, bilateral tubal occlusion, vasectomized partner, sexual abstinence, male or female condom, diaphragm with spermicide).

    • World Health Organization (WHO) Performance Status 0-1

    • Weight 50-150 kg

    • CA-125-level ≥250 kIU/L at diagnosis

    Exclusion Criteria:
    • Concomitant treatment with heparins, low molecular weight heparins, warfarin or nonvitamin K antagonist oral anticoagulants. Platelet inhibitors are allowed.

    • Treatment with heparins, low molecular weight heparins or non-vitamin K antagonist oral anticoagulants within the last year.

    • Known or suspected allergies against any product included in the study

    • Ongoing pregnancy, independent of gestational age. Breastfeeding or planned pregnancy

    • EOC disclosed at Cesarean section

    • Abdominal surgery or other major surgery within the last year

    • Mental inability, reluctance or language difficulties that result in difficulty understanding the meaning of study participation

    • Treatment or disease which, according to the investigator, can affect treatment or study results

    • Known brain metastasis

    • Participation or recent participation (within the last 30 days) in a clinical study with an investigational product

    • Ongoing treatment of thromboembolic disease.

    • Thromboembolic disease within the last year.

    • Hypersensitivity to the active substance (tinzaparin) or any of the excipients.

    • Serious hemorrhage or conditions predisposing to serious hemorrhage. Serious hemorrhage is defined as fulfilling any one of these three criteria:

    1. occurs in a critical area or organ (e.g. intracranial, intraspinal, intraocular, retroperitoneal, intra-articular or pericardial, intra-uterine or intramuscular with compartment syndrome),

    2. causes a fall in hemoglobin level of 20 g/L (1.24 mmol/L) or more, or

    3. leads to transfusion of two or more units of whole blood or red blood cells.

    • Severe coagulation disorder.

    • Acute gastro duodenal ulcer.

    • Septic endocarditis.

    • Previous heparin-induced thrombocytopenia.

    • WHO Performance Status >1.

    • Platinum single regimen

    • Estimated glomerular filtration rate (E-GFR) <30ml/min (analyzed no more than 14 days before start of treatment with investigational product)

    • Platelets <100 x10^9/L (analyzed no more than 14 days before start of treatment with investigational product)

    • Treatment for other known malignancy within the last year (except basal cell carcinoma)

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 Department of Obstetrics and Gynecology, Highland Hospital Eksjö Sweden 575 81
    2 Department of Obstetrics and Gynecology, Ryhov County Hospital Jönköping Sweden 55305
    3 Department of Obstetrics and Gynecology, Kalmar County Hospital Kalmar Sweden 391 85
    4 Department of Oncology, Linköping University Hospital Linköping Sweden 58185
    5 Department of Obstetrics and Gynecology, Värnamo Hospital Värnamo Sweden 33152
    6 Department of Obstetrics and Gynecology, Västervik Hospital Västervik Sweden 593 81
    7 Department of Obstetrics and Gynecology, University Hospital Linköping Östergötland Sweden 58185

    Sponsors and Collaborators

    • University Hospital, Linkoeping
    • Region Jönköping County
    • Kalmar County Hospital
    • Västervik Hospital

    Investigators

    • Study Chair: Preben Kjölhede, MD, PhD, University Hospital, Linkoeping
    • Study Chair: Gabriel Lindahl, MD, PhD, University Hospital, Linkoeping
    • Study Chair: Anna-Clara Spetz Holm, MD, PhD, University Hospital, Linkoeping
    • Study Chair: Anna Karlsson, MD, University Hospital, Linkoeping

    Study Documents (Full-Text)

    More Information

    Publications

    None provided.
    Responsible Party:
    Preben Kjolhede, MD, professor, Professor, senior consultant, University Hospital, Linkoeping
    ClinicalTrials.gov Identifier:
    NCT05284552
    Other Study ID Numbers:
    • The TABANETOC-trial
    • 2021-000135-31
    First Posted:
    Mar 17, 2022
    Last Update Posted:
    Mar 17, 2022
    Last Verified:
    Mar 1, 2022
    Individual Participant Data (IPD) Sharing Statement:
    No
    Plan to Share IPD:
    No
    Studies a U.S. FDA-regulated Drug Product:
    No
    Studies a U.S. FDA-regulated Device Product:
    No
    Keywords provided by Preben Kjolhede, MD, professor, Professor, senior consultant, University Hospital, Linkoeping
    Additional relevant MeSH terms:

    Study Results

    No Results Posted as of Mar 17, 2022