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Prostate CancerPhase 2PeP-RALPNCT05679193

Perioperative Propranolol During Prostatectomy to Decrease Cancer Recurrence

A Phase 2 study testing Propranolol in people with Prostate Cancer, run by Oslo University Hospital at 1 site in Norway.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to assess the feasibility of conducting a larger randomized controlled trial to assess the efficacy of perioperative propranolol capsules compared with placebo capsules in decreasing recurrence of prostate cancer (PCa) after robotic assisted laparoscopic prostatectomy (RALP) in… Read more about this study

Who is it for?
Ages 40 to 80 years, men onlyHealthy volunteers can take part
Conditions the study is for
Prostate Cancer
What is being tested?
Propranolol
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
40 participants
Where
1 siteNorway
Study dates
2 Jan 2023to 27 Jan 2024
Phase
Phase 2
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 to 80 years
  • Men only
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • European Association of Urology Intermediate- and High Risk for Biochemical recurrence and planned for curative RALP
  • ECOG Performance Status 0-1

Who cannot join

  • Medical Conditions
  • Sick sinus syndrome
  • Atrioventricular (AV) block grade 2 and 3
  • Recent (3 months) myocardial infarction
  • Known unstable- or vasospastic- angina
  • Heart failure (New York Heart Association [NYHA] > 2)
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  • Symptomatic peripheral vascular disease (e.g. intermittent claudication)
  • Known pulmonary hypertension
  • Known carotid artery stenosis or recent (3 months) stroke
  • Bronchial asthma or other chronic obstructive pulmonary disease (COPD)
  • Kidney failure (estimated Glomerular filtration rate [eGFR]<50)
  • Liver failure (cirrhosis, jaundice, signs of hepatic decompression)
  • Unregulated diabetes mellitus
  • Untreated thyroid disorder
  • Depressive episode within last 6 months (within last 12 months if major depressive episode)
  • Known drug allergy against propranolol or excipients
  • Any medical conditions considered to prohibit Propranolol use as judged by the treating physician (including frailty).
  • Participants with known substance- or alcohol-abuse
  • Prior/Concomitant Therapy
  • Recent (<3 month) use of systemic beta-blockers prior to screening.
  • Patients receiving non-dihydropyridine calcium channel blocking agents (eg diltiazem, verapamil)
  • Patients receiving anti-arrhythmic agents (e.g. amiodarone, sotalol, digoxin, verapamil, flecainide)
  • Patients receiving digoxin, rizatriptan, hydralazine, fluvoksamin, or fluoksetin
  • Patients using daily anxiolytics (e.g. benzodiazepines), alpha-receptor adrenergic agonists (e.g. clonidine)
  • Recommendations in the Summary of Product Characteristics for propranolol regarding concomitant use of other medications will be adhered to.
  • Diagnostic assessments
  • Sinus bradycardia (<60 beats/minute)
  • Resting blood pressure <110/60mmHg OR hypertension BP >160/100
  • AV-block 2 or 3 on ECG

Trial locations and contacts

1 site in 1 country.

Norway1 site
  • Oslo University Hospital The Norwegian Radium Hospital

    Oslo, 4953

Other trials in Norway

About this study

Official title: Perioperative Propranolol in Robotic Assisted Laparoscopic Prostatectomy- A Feasibility Study of Propranolol to Target Perioperative Stress Induced Cancer Progression

The purpose of this study is to assess the feasibility of conducting a larger randomized controlled trial to assess the efficacy of perioperative propranolol capsules compared with placebo capsules in decreasing recurrence of prostate cancer (PCa) after robotic assisted laparoscopic prostatectomy (RALP) in participants with intermediate to high-risk for prostate cancer recurrence.

Read the detailed description

PCa is the most commonly diagnosed cancer in Norway (2020) and RALP is the most frequent curative treatment offered to men with non-metastatic PCa. Biochemical recurrence (BCR) is estimated to occur to 40% of patients with EAU IR and HR PCa. Attempts to combat the high recurrence rates after RALP with neoadjuvant treatment, aiming to reduce the local tumor burden and treat possible micrometastasis, has of yet not proven beneficial.

The prostate is highly innervated and recent evidence has shown the importance of nerves in the development and progression of PCa. The action of particularly adrenergic nerves, in sum lead to a pro-cancerous and metastatic state by influencing key hallmarks of cancer like apoptosis resistance, angiogenesis, immune suppression, invasiveness and metastasis.

Perioperative stress caused by the cancer surgery, in this case RALP, has been found to promote cancer progression and recurrence both by enhancing growth of preexisting residual tumor/micrometastasis and facilitating formation of new metastasis. The surgical stress response cause a catecholamine-induced cancer progression where β2-adrenergic receptor (ADRB2) have a key role.

Our newly published pharma co-epidemiologic study indicate perioperative stress can be targeted by a non-selective ß-blocker (nsBB) like propranolol [1]. RCTs have found perioperative administration of propranolol alone, or in conjunction with COX-2 inhibition, to be safe and to reduce biomarkers associated with poor prognosis compared with the control group receiving placebo medication in patients undergoing radical surgery for breast-, ovarian- and colorectal cancer [2-7}.

The result of our register study, together with existing evidence of an effect of propranolol/nsBBs, provides foundation for PeP-RALP, a pilot study to establish the recruitment- and infrastructure feasibility of a double-blinded, placebo controlled RCT. The results of this pilot study will be used to investigate the feasibility of a formal larger RCT aiming to assess efficacy of perioperative propranolol to reduce PCa recurrence and progression after RALP.

Conditions
Prostate Cancer
Being tested
Propranolol
Medical subject headings
Prostatic Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • PropranololDrug

    Also called Pranolol

    Propranolol capsules 20mg taken orally.

    Day: 1-3:

    20mg twice daily

    Day: 4-19 (25 , In cases of delayed RALP an extension of up to 6 days is allowed.in cases of delayed surgery).

    2x 20mg twice daily

    Day 20-22 20mg twice daily

Study groups in NCT05679193
Study groupRoleWhat they receive
PropranololExperimentalParticipants will receive Propranolol capsule for a period of 22-28 days, low dose (1 capsule/20mg propranolol twice daily) treatment the first- and last- three days of the treatment period. Higher dose (2 capsules/40mg propranolol twice daily) for the rest of the treatment period.
Receives: Drug: Propranolol
PlaceboPlacebo comparatorParticipants will receive Propranolol capsule for a period of 22-28 days, low dose (1 capsule twice daily) treatment the first- and last- three days of the treatment period. Higher dose (2 capsules twice daily) for the rest of the treatment period.
Receives: Drug: Propranolol

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The feasibility of conducting a formal larger RCT to compare the efficacy of propranolol vs placebo to decrease PCa recurrence following RALP.

    Numbers of eligible participants needed to screen to include 40 patients in the study, reported as % of eligible participants that subsequently were included in the study.

    Compliance of study intervention (defined as >80% of doses taken). Reported as % of participants compliant to the study intervention before RALP and % of participants compliant to the study intervention after RALP.

    Measured: The total duration of study participation from screening to end of follow-up is 50-102 days per participant. The primary outcome will be assessed when inclusion is completed, or if inclusion is not completed within 12 months.

Secondary outcomes (7)
  1. Safety and tolerability of PeP-RALP intervention

    Safety:

    Proportion (%) of patients experiencing treatment related clinical significant hypotension and/or bradycardia.

    Adverse events of PeP-RALP medication as assessed by CTCAE v5.0.

    Tolerability:

    Proportion (%) of patients tolerating daily dose of 80mg propranolol.

    Measured: 9 weeks

  2. Determine the effect of RALP on catecholamine levels

    Changes in catecholamine levels in the perioperative period.

    Measured: Up to 5 weeks

  3. Determine the bioavailability of propranolol

    Serum levels of propranolol pre-operatively and at end of PeP-RALP medication.

    Measured: Up to 5 weeks

  4. Determine the effect of preoperative propranolol treatment on the serum level of PSA

    Changes in PSA levels after 7-14 days of PeP-RALP medication.

    Measured: 7-14 days

  5. To determine the effect of propranolol on post-operative biochemical failure

    Proportion of patients with serum PSA levels above 0.1 ng/ml at 6 weeks post-RALP.

    Measured: Up to 9 weeks

  6. Intraoperative anesthesiological and surgical challenges Surgical complications in PeP RALP patients

    Anesthesiological challenges are assed by:

    Proportion of patients (%) in each intervention group requiring vasopressors to maintain an acceptable mean arterial pressure (MAP >60mmhg). Amount of vasopressor needed.

    Surgical challenges are assed by:

    The surgical procedure time (minutes) and estimated intraoperative blood loss (milliliters).

    Measured: 1 day

  7. Surgical complications

    Frequence (n=) and severity of surgical complications as classified by the Clavian-Dindo classification.

    Measured: Up to 9 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Jan 2023
  2. Study start2 Jan 2023
  3. Primary completion28 Nov 2023
  4. Study completion27 Jan 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
parallel-group, phase 2, double-blind, 2-arm study
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
40 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05679193
Sponsor's protocol ID
488466
Acronym
PeP-RALP
Status last verified
May 2024
First submitted
12 Dec 2022
Last updated
29 May 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: IPD that underlie the results reported in a published articles based on this study, after deidentification (text, tables, figures, and appendices)

Publications

  • Sivanesan S, Tasken KA, Grytli HH. Association of beta-Blocker Use at Time of Radical Prostatectomy With Rate of Treatment for Prostate Cancer Recurrence. JAMA Netw Open. 2022 Jan 4;5(1):e2145230. doi: 10.1001/jamanetworkopen.2021.45230.

    PubMed 35080602
  • Zhou L, Li Y, Li X, Chen G, Liang H, Wu Y, Tong J, Ouyang W. Propranolol Attenuates Surgical Stress-Induced Elevation of the Regulatory T Cell Response in Patients Undergoing Radical Mastectomy. J Immunol. 2016 Apr 15;196(8):3460-9. doi: 10.4049/jimmunol.1501677. Epub 2016 Mar 11.

    PubMed 26969754
  • Hiller JG, Cole SW, Crone EM, Byrne DJ, Shackleford DM, Pang JB, Henderson MA, Nightingale SS, Ho KM, Myles PS, Fox S, Riedel B, Sloan EK. Preoperative beta-Blockade with Propranolol Reduces Biomarkers of Metastasis in Breast Cancer: A Phase II Randomized Trial. Clin Cancer Res. 2020 Apr 15;26(8):1803-1811. doi: 10.1158/1078-0432.CCR-19-2641. Epub 2019 Nov 21.

    PubMed 31754048
  • Shaashua L, Shabat-Simon M, Haldar R, Matzner P, Zmora O, Shabtai M, Sharon E, Allweis T, Barshack I, Hayman L, Arevalo J, Ma J, Horowitz M, Cole S, Ben-Eliyahu S. Perioperative COX-2 and beta-Adrenergic Blockade Improves Metastatic Biomarkers in Breast Cancer Patients in a Phase-II Randomized Trial. Clin Cancer Res. 2017 Aug 15;23(16):4651-4661. doi: 10.1158/1078-0432.CCR-17-0152. Epub 2017 May 10.

    PubMed 28490464
  • Haldar R, Shaashua L, Lavon H, Lyons YA, Zmora O, Sharon E, Birnbaum Y, Allweis T, Sood AK, Barshack I, Cole S, Ben-Eliyahu S. Perioperative inhibition of beta-adrenergic and COX2 signaling in a clinical trial in breast cancer patients improves tumor Ki-67 expression, serum cytokine levels, and PBMCs transcriptome. Brain Behav Immun. 2018 Oct;73:294-309. doi: 10.1016/j.bbi.2018.05.014. Epub 2018 May 22.

    PubMed 29800703
  • Jang HI, Lim SH, Lee YY, Kim TJ, Choi CH, Lee JW, Kim BG, Bae DS. Perioperative administration of propranolol to women undergoing ovarian cancer surgery: A pilot study. Obstet Gynecol Sci. 2017 Mar;60(2):170-177. doi: 10.5468/ogs.2017.60.2.170. Epub 2017 Mar 16.

    PubMed 28344958
  • Haldar R, Ricon-Becker I, Radin A, Gutman M, Cole SW, Zmora O, Ben-Eliyahu S. Perioperative COX2 and beta-adrenergic blockade improves biomarkers of tumor metastasis, immunity, and inflammation in colorectal cancer: A randomized controlled trial. Cancer. 2020 Sep 1;126(17):3991-4001. doi: 10.1002/cncr.32950. Epub 2020 Jun 13.

    PubMed 32533792

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Propranolol in people with Prostate Cancer, run by Oslo University Hospital at 1 site in Norway.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 29 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 May 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Norway. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The feasibility of conducting a formal larger RCT to compare the efficacy of propranolol vs placebo to decrease PCa recurrence following RALP. (time frame: The total duration of study participation from screening to end of follow-up is 50-102 days per participant. The primary outcome will be assessed when inclusion is completed, or if inclusion is not completed within 12 months.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05679193, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 May 2024.

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