This randomized phase II trial studies how well metformin hydrochloride and doxycycline work in treating patients with head and neck squamous cell carcinoma that can be removed by surgery. Metformin hydrochloride may reduce the metabolic activity of cancer cells and of surrounding supportive tissue. Doxycycline may minimize toxic side effects of anti-cancer therapy. Giving metformin hydrochloride and doxycycline may work better in treating patients with head and neck squamous cell carcinoma.
PRIMARY OBJECTIVES: I. To determine if treatment with metformin hydrochloride (metformin), doxycycline, or a combination of metformin and doxycycline can increase the percentage of stromal cells that express CAV1 in patients with squamous cell carcinoma of the head and neck. SECONDARY OBJECTIVES: I. To determine the effect of metformin, doxycycline, or metformin and doxycycline treatment on the percentage of tumor cells that are apoptotic as determined by the TdT-Mediated dUTP Nick End Labeling Assay (TUNEL) assay, and express MCT4, MCT1, BGAL, and TOMM20 in squamous carcinoma of head and neck region tumor cells. II. To assess safety and tolerability of metformin, doxycycline, or metformin and doxycycline treatment in subjects with squamous cell carcinoma of the head and neck. TERTIARY OBJECTIVES: I. To assess the effect of metformin, doxycycline, or metformin and doxycycline therapy on the metabolic profile of cancer cells and stroma using mass spectroscopy imaging (MSI) on paired samples, comparing metabolite profiles in the pre-treatment and post-treatment tumor samples. II. To assess the effect of metformin, doxycycline, or metformin and doxycycline therapy on the metabolic state of the patient as characterized serologically by: erythrocyte sedimentation rate, exosome evaluation, metabolomics profile, and micro ribonucleic acid (RNA) expression profiles and physiologically by performing a nutritional assessment via a nutritionist-mediated 3-day dietary recall and comparing a patient's estimated dietary intake against their estimated caloric needs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
7
Sidney Kimmel Cancer Center at Thomas Jefferson University
Philadelphia, Pennsylvania, United States
Change in Percentage of CFS Expressing Caveolin-1 at an Intensity of 1+ or Greater Assessed in Tumor-associated Stroma Cells by Immunohistochemistry
Within-patient change in IHC scores will be analyzed using the Wilcoxon signed-rank test. Comparisons will be made between pretreatment and post-treatment within each of the cohorts. Caveolin-1 (CAV1) immunohistochemistry (IHC) will be performed on pre- and post-treatment tumor specimens. The mean percentage of fibroblasts expressing CAV1 will be compared before and after treatment.
Time frame: Baseline to 30 days after last drug dose
Incidence of Adverse Events as Assessed by National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0
Safety will be provided in descriptive tables as Incidence of adverse events as assessed by National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0.
Time frame: Up to 30 days after last drug dose: approximately1 year
Change in Percent of Tumor Cells Expressing MCT4, That Are TUNEL Positive and That Express BGAL
Immunohistochemistry will be performed for Caveolin-1, TUNEL, BGAL, MCT1, MCT4, and TOMM20 on the pre- and post- treatment specimens and evaluated for staining distribution and intensity by two blinded pathologists.
Time frame: Baseline to 30 days after last drug dose
Change in Percent of Tumor Cells Expressing MCT4, That Are TUNEL Positive and That Express MCT1
Immunohistochemistry will be performed for Caveolin-1, TUNEL, BGAL, MCT1, MCT4, and TOMM20 on the pre- and post- treatment specimens and evaluated for staining distribution and intensity by two blinded pathologists.
Time frame: Baseline to 30 days after last drug dose
Change in Percent of Tumor Cells Expressing MCT4, That Are TUNEL Positive and That Express MCT4
Immunohistochemistry will be performed for Caveolin-1, TUNEL, BGAL, MCT1, MCT4, and TOMM20 on the pre- and post- treatment specimens and evaluated for staining distribution and intensity by two blinded pathologists.
Time frame: Baseline to 30 days after last drug dose
Change in Percent of Tumor Cells Expressing MCT4, That Are TUNEL Positive and That Express TOMM20
Immunohistochemistry will be performed for Caveolin-1, TUNEL, BGAL, MCT1, MCT4, and TOMM20 on the pre- and post- treatment specimens and evaluated for staining distribution and intensity by two blinded pathologists.
Time frame: Baseline to 30 days after last drug dose
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