The investigators will explore the chemopreventive role of metformin. The purpose of this study is to determine whether, among patients with endometrial cancer, treatment with the currently approved insulin sensitizing drug metformin increases or decreases pathway activation distal to the insulin receptor in endometrial cancer tissue. This is a phase IIa study of metformin to be used to the pre-operative period of women diagnosed with endometrial cancer by comparing their endometrial biopsy specimens taken at their initial visit and after 4-6 weeks of treatment of metformin on the day of their surgical staging.
Aim 1 To determine whether, among patients with endometrial cancer, treatment with the currently approved insulin sensitizing drug metformin increases or decreases pathway activation distal to the insulin receptor in endometrial cancer tissue. Aim II To compare specified biomarkers in each endometrial cancer patient before and after receiving metformin. Our goal is to compare the following biomarkers in each patient before and after metformin administration: Ki-67, TUNEL assay for apoptosis level, phosphor-AMPK, phosphor-IGF-1R, phosphor-IRS1, phospho-Akt, phospho-S6, phosphor-mTOR, pACC. All patients diagnosed with endometrial cancer presenting to the Jewish General Hospital for surgical treatment will be invited to participate.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Jewish General Hospital
Montreal, Quebec, Canada
Change in phosphorylated-S6
Paired-t test will be used to determine the effect of oral metformin on the phosphorylated-S6 in pre-treatment and post-treatment endometrial samples.
Time frame: 4-6 weeks
Effects of metformin on activation pathways downstream of the insulin receptor in endometrial samples by testing Ki-67
Additional biomarker tested: * Ki-67
Time frame: 4-6 weeks
Assess each patients insulin resistive state using the HOMA (homeostatic model assessment) index
Assess the effect of metformin on pre-treatment and post-treatment biomarkers in serum to determine the HOMA index * fasting IGF-I * fasting insulin * fasting IGFBP-1 * fasting glucose levels
Time frame: 4-6 weeks
Effects of metformin on activation pathways downstream of the insulin receptor in endometrial samples by testing the TUNEL assay
Additional biomarker tested: * TUNEL assay for apoptosis level
Time frame: 4-6 weeks
Effects of metformin on activation pathways downstream of the insulin receptor in endometrial samples by testing phosphorylated AMPK
Additional biomarker tested: * phosphorylated-AMPK
Time frame: 4-6 weeks
Effects of metformin on activation pathways downstream of the insulin receptor in endometrial samples by testing phosphorylated IGF-1R
Additional biomarker tested: * phosphorylated-IGF-1R
Time frame: 4-6 weeks
Effects of metformin on activation pathways downstream of the insulin receptor in endometrial samples by testing phosphorylated insulin-receptor substrate protein 1 (phosphor-IRS1)
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Additional biomarker tested: * phosphor-IRS1
Time frame: 4-6 weeks
Effects of metformin on activation pathways downstream of the insulin receptor in endometrial samples by testing phosphorylated-Akt
Additional biomarker tested: * phospho-Akt
Time frame: 4-6 weeks
Effects of metformin on activation pathways downstream of the insulin receptor in endometrial samples by testing phosphorylated mTOR
Additional biomarker tested: * phosphor-mTOR
Time frame: 4-6 weeks
Effects of metformin on activation pathways downstream of the insulin receptor in endometrial samples by testing phosphorylated acetyl-CoA carboxylase (pACC)
Additional biomarker tested: * pACC
Time frame: 4-6 weeks