This phase I trial tests the safety, tolerability and impact of adding propranolol to standard radiation therapy (RT) before surgery for the treatment of patients with soft tissue sarcoma. Sarcomas are a diverse group of rare tumors arising from connective tissue. Approximately 13,000-16,000 new cases of sarcomas arise in the United States annually. Sarcoma management involves multidisciplinary team decision making and treatment is multimodal utilizing chemotherapy (if needed) and RT prior to surgical intervention. Propranolol is a drug that has been used for many years for high blood pressure by blocking both beta-1 and beta-2 adrenergic receptors. Preclinical data suggests that blocking the beta-2 adrenergic receptors can improve the response to both chemotherapy and radiation. Radiation therapy uses high energy x-rays, particles, or radioactive seeds to kill tumor cells and shrink tumors. RT before surgery makes the tumor smaller and reduces the amount of tissue that needs to be removed during surgery. Surgery is the most common treatment for soft tissue sarcoma. Giving propranolol with standard RT before surgery may be safe, tolerable and impactful in treating patients with soft tissue carcinoma.
PRIMARY OBJECTIVE: I. To establish the safety and tolerability of adding propranolol to standard RT for soft tissue sarcoma. SECONDARY OBJECTIVE: I. To evaluate the response of tumor immune microenvironment to treatments for patients. OUTLINE: Patients receive propranolol orally (PO) twice daily (BID) for 2 weeks prior to standard of care RT (weeks 1 and 2) and then during and after standard of care RT (weeks 3-7). Treatment continues in the absence of disease progression or unacceptable toxicity until the time of standard of care surgery (week 8). Additionally, patients undergo positron emission tomography (PET) scan and/or computed tomography (CT) scan during screening and may undergo blood and tissue biopsy sample collection throughout the trial. After completion of study treatment, patients are followed up at 5 weeks.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Undergo tissue biopsy sample collection
Undergo blood sample collection
Undergo CT scan
Undergo PET scan
Given PO
Undergo RT
Undergo surgery
Roswell Park Cancer Institute
Buffalo, New York, United States
Incidence of adverse events
Will evaluate safety and tolerability of adding propranolol to standard radiation therapy for soft tissue sarcoma. Will determine the occurrence of a grade 3 or higher treatment related adverse events. Will summarize using frequencies and relative frequencies, with the grade 3 or higher toxicity rate estimated using a 90% credible region obtained by Jeffrey's prior method. Will summarize toxicities and adverse events (as per Common Terminology Criteria for Adverse Events version 5.0) by attribution and grade using frequencies and relative frequencies.
Time frame: Up to 5 weeks post-surgery
Ribonucleic acid sequencing
Will evaluate with biopsy specimens. Will summarize using the mean and standard deviation, and graphically using line and mean plots. Will be modeled as a function of time and a random patient effect using linear mixed models. Tests about the appropriate contrast of model estimates will be used to evaluate changes over time. All model assumptions will be verified graphically and transformations applied as appropriate.
Time frame: Up to 12 weeks
Changes in immune markers
Changes in immune markers of CD8+ and CD4+ T cells and polymorphonuclear-myeloid-derived suppressor cells will be determined by flow cytometry in peripheral blood. Will summarize using the mean and standard deviation, and graphically using line and mean plots. Will be modeled as a function of time and a random patient effect using linear mixed models. Tests about the appropriate contrast of model estimates will be used to evaluate changes over time. All model assumptions will be verified graphically and transformations applied as appropriate.
Time frame: Up to 12 weeks
Catecholamines
Will correlate the levels of catecholamines and metabolites in peripheral blood. Will summarize using the mean and standard deviation, and graphically using line and mean plots. Will be modeled as a function of time and a random patient effect using linear mixed models. Tests about the appropriate contrast of model estimates will be used to evaluate changes over time. All model assumptions will be verified graphically and transformations applied as appropriate.
Time frame: Up to 12 weeks
Metabolites
Will correlate the levels of catecholamines and metabolites in peripheral blood. Will summarize using the mean and standard deviation, and graphically using line and mean plots. Will be modeled as a function of time and a random patient effect using linear mixed models. Tests about the appropriate contrast of model estimates will be used to evaluate changes over time. All model assumptions will be verified graphically and transformations applied as appropriate.
Time frame: Up to 12 weeks
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