Pharmacological ascorbate improves the response to platinum-based chemotherapy in advanced stage non-small cell lung cancer.

Abstract

PURPOSE:

Platinum-based chemotherapy with or without immunotherapy is the mainstay of treatment for advanced stage non-small cell lung cancer (NSCLC) lacking a molecular driver alteration. Pre-clinical studies have reported that pharmacological ascorbate (P-AscH-) enhances NSCLC response to platinum-based therapy. We conducted a phase II clinical trial combining P-AscH- with carboplatin-paclitaxel chemotherapy.

EXPERIMENTAL DESIGN:

Chemotherapy naïve advanced stage NSCLC patients received 75 g ascorbate twice per week intravenously with carboplatin and paclitaxel every three weeks for four cycles. The primary endpoint was to improve tumor response per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 compared to the historical control of 20%. The trial was conducted as an optimal Simon's two-stage design. Blood samples were collected for exploratory analyses.

RESULTS:

The study enrolled 38 patients and met its primary endpoint with an objective response rate of 34.2% (p = 0.03). All were confirmed partial responses (cPR). The disease control rate was 84.2% (stable disease + cPR). Median progression-free and overall survival were 5.7 months and 12.8 months, respectively. Treatment-related adverse events (TRAE) included one grade 5 (neutropenic fever) and five grade 4 events (cytopenias). Cytokine and chemokine data suggest that the combination elicits an immune response. Immunophenotyping of peripheral blood mononuclear cells demonstrated an increase in effector CD8 T-cells in patients with a progression-free survival (PFS) ≥ 6 months.

CONCLUSIONS:

The addition of P-AscH- to platinum-based chemotherapy improved tumor response in advanced stage NSCLC. P-AscH- appears to alter the host immune response and needs further investigation as a potential adjuvant to immunotherapy.

• Authors: Muhammad Furqan, Taher Abu-Hejleh, Laura M Stephens, Stacey M Hartwig, Sarah L Mott, Casey F Pulliam, Michael Petronek, John B Henrich, Melissa A Fath, Jon C Houtman, Steven M Varga, Kellie L Bodeker, Aaron D Bossler, Andrew M Bellizzi, Jun Zhang, Varun Monga, Hariharasudan Mani, Marina Ivanovic, Brian J Smith, Margaret M Byrne, William Zeitler, Brett A Wagner, Garry R Buettner, Joseph J Cullen, John M Buatti, Douglas R Spitz, Bryan G Allen
• Journal: Redox biology (Redox Biol) Vol. 53 Pg. 102318 (07 2022) ISSN: 2213-2317 [Electronic] Netherlands
• PMID: 35525024 (Publication Type: Clinical Trial, Phase II, Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

Chemical References

• Platinum
• Carboplatin
• Paclitaxel

Topics

• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Carboplatin (therapeutic use)
• Carcinoma, Non-Small-Cell Lung (drug therapy, pathology)
• Humans
• Leukocytes, Mononuclear (pathology)
• Lung Neoplasms (drug therapy, pathology)
• Paclitaxel (therapeutic use)
• Platinum (therapeutic use)