This is a single-arm open-label phase Ib/II clinical study assessing the efficacy of concurrent high dose ascorbate in combination with radiotherapy in patients with locally advanced, resectable, high grade sarcomas.
Phase Ib: The phase Ib portion of this study is to ensure the safety and tolerability of high dose ascorbate in combination with external beam radiation therapy (EBRT) as assessed by incidence of dose-limiting toxicities (DLT). EBRT will be given at the standard dose for resectable soft tissue sarcomas according to the NCCN sarcoma guidelines.2 Patients will receive 50 Gy over 5 weeks, during which time they will be receiving three times a week IV high dose ascorbate. IV ascorbate infusions will be continued until the end of radiation therapy. Surgery will be performed 4-6 weeks from the end of radiation to allow for adequate tissue healing and resolution of acute toxicities. Phase 2: The phase 2 part of the study will provide an estimate of the relative treatment effect of pharmacological ascorbate in combination with preoperative EBRT in subjects with locally advanced, resectable, extremity, trunk or retroperitoneal high grade sarcomas, as measured by pathological response rates. As above, patients will receive the first dose of pharmacological ascorbate intravenously on day 1 of week 1 provided no reactions are seen to the test dose. This will be followed by 3 times a week dosing at Dose 0 until completion of EBRT. Standard doses of radiation for resectable soft tissue sarcomas according to the NCCN sarcoma guidelines will be administered.2 Patients will receive preoperative radiation at a dose of 50 Gy over 5 weeks starting on week 1 day 1. Subjects will be followed either by clinic visit or phone contact every 12 weeks for approximately 24 months after the end of the treatment phase, at which time the initial survival data and disease recurrence will be assessed.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
25
Phase 1 dose escalation: 75gm IV three times a week Phase II portion: 75gm IV three times a week if no dose limiting toxicities are experienced in the Phase I portion. Otherwise, ascorbate dose will be deescalated to 62.5 gm IV
University of Iowa Hospitals and Clinics
Iowa City, Iowa, United States
Number of Participants That Experienced Dose Limiting Toxicities (DLTs) Using CTCAE, Version 4.0
To examine the toxicity related to the therapy by measuring the number attributed adverse event (definite, probable or possible) according to CTCAE version 4.0.
Time frame: Start of treatment up to 4 weeks after the last ascorbate infusion
Number of Participants With Pathologic Tumor Necrosis ≥ 95% Following Concurrent Radiation Therapy and Ascorbate
To estimate the efficacy of neoadjuvant ascorbate and radiotherapy as assessed by the pathological complete response rates (pCR) in subjects with locally advanced high grade soft tissue sarcomas.
Time frame: Start of treatment up to 6 weeks after the last ascorbate infusion
Disease Progression as Measured by Time to Disease Progression (TTP)
Time to disease progression (TTP) is defined as the time from enrollment until objective tumor progression including local and distant recurrences.
Time frame: Enrollment or start of treatment up to 2 years following end of treatment
Overall Response Rate as Measured by RECIST 1.1
Overall response rate (ORR) preoperative as measured by RECIST 1.1 or a later tool for monitoring disease progression.
Time frame: Enrollment or start of treatment up to 2 years following end of treatment
Overall Survival Estimated Using the Kaplan-Meier Method
Overall survival (OS) rate data gathered through passive chart review, phone call or scheduled follow-up visit and estimated using the Kaplan-Meier Method.
Time frame: Enrollment or start of treatment up to 2 years following end of treatment
Skin Toxicity
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Pathologist to grade radiation related skin toxicity overlying the tumor as compared to historical controls. Binomial exact tests will be utilized to identify differences in wound complication and Grade 3-4 dermatitis rates compared to historical controls.
Time frame: Within two years following end of treatment
Labile Iron
To measure labile iron using T2\* imaging sequence on MRI pre and post ascorbate treatments and compare with serum iron measurements
Time frame: Within two years following end of treatment
Evaluate Diffusion Weighted Imaging Sequences
To evaluate diffusion weighted imaging sequences on MRI in pre and post treatment tumors and correlate it with necrosis and survival
Time frame: Within two years following end of treatment