The Use of Proton Pump Inhibitor on the Prevention of Gastric Cancer Bleeding

NCT ID: NCT02150447

Last Updated: 2018-04-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE3

Total Enrollment

394 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-06-30

Study Completion Date

2017-05-31

Brief Summary

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The aim of this study is the effect of proton pump inhibitor (PPI) with respect to gastric cancer bleeding in inoperable patients.

Detailed Description

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Tumor bleeding frequently occurs in inoperable gastric cancer patients. Inoperable gastric cancer usually has a large ulcer with friable tumor vessels. Acidic environment in stomach prevents adequate function of coagulation cascade and decrease clot stability. Gastric cancer bleeding may cause significant morbidity and often delays scheduled chemotherapy. National Center Center data showed that about 30% of gastric cancer patient undergoing palliative chemotherapy eventually experience significant cancer bleeding during the treatment period. Once bleeding occurs, endoscopic management is more difficult in gastric cancer patients than in patients with benign peptic ulcers, because the malignant ulcer bed has significant fibrosis. Consequently, gastric cancer patient has a high risk of rebleeding.

Proton pump inhibitor (PPI, lansoprazole for example) decrease gastric acid secretion by inhibiting H+,K+-ATPase, and subsequently stabilize blood clot. PPIs are commonly used for benign peptic ulcer or reflux esophagitis, and PPI can decrease recurrent benign ulcer bleeding or other ulcer complications. Moreover, it was reported to prevent bleeding from NSAID or aspirin induced gastric ulcer. Because PPIs are very safe, and they are even available as over-the-counter drugs in some countries. Furthermore, the drug has no interaction with major chemotherapeutic agents commonly used for gastric cancer. Moreover, the drugs are prescribed to the gastric cancer patients when tumor bleeding occurs. Although gastric cancer bleeding is not uncommon and clinically challenging problem, there has been no recommended measure to prevent cancer bleeding. Also there has been no report about the efficacy of PPIs on the gastric cancer bleeding prevention up to now.

Conditions

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Gastric Cancer Bleeding

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Intervention group

Proton pump inhibitor (lansoprazole) therapy for the prevention of gastric cancer bleeding

Group Type ACTIVE_COMPARATOR

Proton pump inhibitor

Intervention Type DRUG

Lansoprazole 30 mg, daily

Placebo group

Placebo for the prevention of gastric cancer bleeding

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

Placebo, daily

Interventions

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Proton pump inhibitor

Lansoprazole 30 mg, daily

Intervention Type DRUG

Placebo

Placebo, daily

Intervention Type DRUG

Other Intervention Names

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Lansoprazole

Eligibility Criteria

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Inclusion Criteria

* Histologically proven primary gastric adenocarcinoma
* Age ≥18 years
* Plan for 1st line or 2nd line palliative chemotherapy
* Cancer staging: metastatic (TxNxM1) or locally advanced unresectable gastric cancer (T4NxMx with unresectable), or T2-3NxMx with inoperable condition
* Performance status (PS) of 0 to 2 on Eastern Cooperative Oncology Group (ECOG) scale
* Adequate organ functions defined as indicated below: (a) WBC \> 3000/mm3, (b) Hb 9.0 g/dL regardless of any transfusion history, (c) Platelet ≥100,000/mm3, (d) AST/ALT ≤ 2.5 x UNL (≤ 5 x UNL if liver metastases are present) (e) Total bilirubin ≤1.5x UNL (f) Cr ≤1.5 x UNL
* Written informed consent

Exclusion Criteria

* Other malignancy within the past 3 years except adequately treated non-melanomatous skin cancer or carcinoma in situ of the cervix
* Patients with significant or uncontrolled gastrointestinal bleeding in the past two weeks without evidence of resolution documented by endoscopy or colonoscopy
* Previous subtotal gastrectomy or total gastrectomy
* Patient with a plan for neo-adjuvant chemotherapy
* Lack of physical integrity of the upper gastrointestinal tract or malabsorption syndrome, or inability to take oral medication
* Allergy history to proton pump inhibitor
* Serious concurrent infection or nonmalignant illness that is uncontrolled or whose control may be jeopardized by complications of study therapy
* Inadequate cardiovascular function: (a) New York Heart Association class III or IV heart disease, (b) Unstable angina or myocardial infarction within the past 6 months, (c) History of significant ventricular arrhythmia requiring medication with antiarrhythmics or significant conduction system abnormality
* Requirement for therapeutic anticoagulant therapy, aspirin or non-steroidal anti-inflammatory agents except COX-2 selective inhibitor
* Need for PPI maintenance treatment for uncontrolled reflux esophagitis or active peptic ulcer
* Psychiatric disorder that would preclude compliance
* Pregnant or breast-feeding women
* Untreated folate or vitamine B12 deficiency anemia
* Bone marrow metastasis, or evidence of microangiopathic hemolytic anemia (MAHA)
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Pusan National University Hospital

OTHER

Sponsor Role collaborator

Kosin University Gospel Hospital

OTHER

Sponsor Role collaborator

Gyeongsang National University Hospital

OTHER

Sponsor Role collaborator

National Cancer Center, Korea

OTHER_GOV

Sponsor Role lead

Responsible Party

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Il Ju Choi

Head of Gastric Cancer Cencer

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Il Ju Choi, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

National Cancer Center, Korea

Gwang Ha Kim, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Pusan National University Hospital

Moo In Park, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Kosin University Gospel Hospital

Won Sup Lee, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Gyeongsang National University Hospital

Locations

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Kosin University Gospel Hospital

Busan, , South Korea

Site Status

Pusan National University Hospital

Busan, , South Korea

Site Status

National Cancer Center

Goyang, , South Korea

Site Status

Gyeong Sang National University Hospital

Jinju, , South Korea

Site Status

Countries

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South Korea

References

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Kim YI, Kim MJ, Park SR, Kim HK, Cho SJ, Lee JY, Kim CG, Kim GH, Park MI, Nam BH, Park YI, Choi IJ. Effect of a Proton Pump Inhibitor on Tumor Bleeding Prevention in Unresectable Gastric Cancer Patients: a Double-Blind, Randomized, Placebo-Controlled Trial. J Gastric Cancer. 2017 Jun;17(2):120-131. doi: 10.5230/jgc.2017.17.e15. Epub 2017 May 31.

Reference Type DERIVED
PMID: 28680717 (View on PubMed)

Other Identifiers

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0910090

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

1210520

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

NCCCTS09420

Identifier Type: -

Identifier Source: org_study_id

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