Skip to main content
Top
Published in: Trials 1/2015

Open Access 01-12-2015 | Study protocol

Combining curcumin (C3-complex, Sabinsa) with standard care FOLFOX chemotherapy in patients with inoperable colorectal cancer (CUFOX): study protocol for a randomised control trial

Authors: Glen RB Irving, Chinenye OO Iwuji, Bruno Morgan, David P Berry, William P Steward, Anne Thomas, Karen Brown, Lynne M Howells

Published in: Trials | Issue 1/2015

Login to get access

Abstract

Background

The need for low toxicity adjuncts to standard care chemotherapy in inoperable colorectal cancer, with potential to improve outcomes and decrease the side-effect burden, is well recognised. Addition of the low toxicity diet-derived agent, curcumin (the active ingredient of turmeric), to standard oxaliplatin-based therapy has shown promise in numerous pre-clinical studies.

Methods/Design

This study is the first to combine daily oral curcumin with standard care FOLFOX-based (5-fluorouracil, folinic acid and oxaliplatin) chemotherapy in colorectal cancer patients with inoperable liver metastases: the CUFOX trial. CUFOX comprises a Phase 1 dose-escalation study (3 + 3 + 3 design) to determine an acceptable target dose of curcumin with which to safely proceed to a Phase IIa open-labelled randomised controlled trial. Thirty three participants with histological or cytological confirmation of inoperable colorectal cancer will then be randomised to oxaliplatin-based chemotherapy with the addition of daily oral curcumin at the target dose determined in Phase I, or to standard care oxaliplatin-based chemotherapy alone (recruiting at a ratio of 2:1).

Discussion

Primary outcome measures will be the determination of a target dose which is both safe and tolerable for long-term administration to individuals in receipt of first-line oxaliplatin-based chemotherapy for inoperable colorectal cancer. Secondary outcome measures will include observation of any changes in neuropathic side-effects of chemotherapy, improvement to progression-free or overall survival and identification of putative efficacy biomarkers in plasma.
The results will be disseminated via presentation at national and international conferences, via publication in appropriate peer-reviewed journals and via the Cancer Research UK/Department of Health Experimental Cancer Medicine Centre Network. This trial has full ethical and institutional approval, and commenced recruitment in February 2012.

Trial registration

ClinicalTrials.gov (NCT01490996, registered 7th December 2011), European Drug Regulating Authorities (EudraCT 2011-002289-19, registered 13th May 2011), UKCRN ID#10672.
Literature
3.
go back to reference Jullumstro E, Lydersen S, Moller B, Dahl O, Edna TH. Duration of symptoms, stage at diagnosis and relative survival in colon and rectal cancer. Eur J Cancer. 2009;45:2383–90.CrossRefPubMed Jullumstro E, Lydersen S, Moller B, Dahl O, Edna TH. Duration of symptoms, stage at diagnosis and relative survival in colon and rectal cancer. Eur J Cancer. 2009;45:2383–90.CrossRefPubMed
4.
go back to reference Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57. discussion 657–648.CrossRefPubMedPubMedCentral Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg. 2004;240:644–57. discussion 657–648.CrossRefPubMedPubMedCentral
5.
go back to reference de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.PubMed de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.PubMed
6.
go back to reference Van Cutsem E, Kohne CH, Lang I, Folprecht G, Nowacki MP, Cascinu S, et al. Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J Clin Oncol. 2011;29:2011–9.CrossRefPubMed Van Cutsem E, Kohne CH, Lang I, Folprecht G, Nowacki MP, Cascinu S, et al. Cetuximab plus irinotecan, fluorouracil, and leucovorin as first-line treatment for metastatic colorectal cancer: updated analysis of overall survival according to tumor KRAS and BRAF mutation status. J Clin Oncol. 2011;29:2011–9.CrossRefPubMed
7.
go back to reference Primrose J, Falk S, Finch-Jones M, Valle J, O’Reilly D, Siriwardena A, et al. Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis: the New EPOC randomised controlled trial. Lancet Oncol. 2014;15:601–11.CrossRefPubMed Primrose J, Falk S, Finch-Jones M, Valle J, O’Reilly D, Siriwardena A, et al. Systemic chemotherapy with or without cetuximab in patients with resectable colorectal liver metastasis: the New EPOC randomised controlled trial. Lancet Oncol. 2014;15:601–11.CrossRefPubMed
10.
go back to reference Meta-Analysis Group Inc, Levy E, Piedbois P, Buyse M, Pignon JP, Rougier P, et al. Toxicity of fluorouracil in patients with advanced colorectal cancer: effect of administration schedule and prognostic factors. J Clin Oncol. 1998;16:3537–41. Meta-Analysis Group Inc, Levy E, Piedbois P, Buyse M, Pignon JP, Rougier P, et al. Toxicity of fluorouracil in patients with advanced colorectal cancer: effect of administration schedule and prognostic factors. J Clin Oncol. 1998;16:3537–41.
11.
go back to reference Argyriou AA, Cavaletti G, Briani C, Velasco R, Bruna J, Campagnolo M, et al. Clinical pattern and associations of oxaliplatin acute neurotoxicity: a prospective study in 170 patients with colorectal cancer. Cancer. 2013;119:438–44.CrossRefPubMed Argyriou AA, Cavaletti G, Briani C, Velasco R, Bruna J, Campagnolo M, et al. Clinical pattern and associations of oxaliplatin acute neurotoxicity: a prospective study in 170 patients with colorectal cancer. Cancer. 2013;119:438–44.CrossRefPubMed
12.
go back to reference Leonard GD, Wright MA, Quinn MG, Fioravanti S, Harold N, Schuler B, et al. Survey of oxaliplatin-associated neurotoxicity using an interview-based questionnaire in patients with metastatic colorectal cancer. BMC Cancer. 2005;5:116.CrossRefPubMedPubMedCentral Leonard GD, Wright MA, Quinn MG, Fioravanti S, Harold N, Schuler B, et al. Survey of oxaliplatin-associated neurotoxicity using an interview-based questionnaire in patients with metastatic colorectal cancer. BMC Cancer. 2005;5:116.CrossRefPubMedPubMedCentral
13.
go back to reference Manson MM, Foreman BE, Howells LM, Moiseeva EP. Determining the efficacy of dietary phytochemicals in cancer prevention. Biochem Soc Trans. 2007;35:1358–63.CrossRefPubMed Manson MM, Foreman BE, Howells LM, Moiseeva EP. Determining the efficacy of dietary phytochemicals in cancer prevention. Biochem Soc Trans. 2007;35:1358–63.CrossRefPubMed
14.
go back to reference Aggarwal BB, Sundaram C, Malani N, Ichikawa H. Curcumin: the Indian solid gold. Adv Exp Med Biol. 2007;595:1–75.CrossRefPubMed Aggarwal BB, Sundaram C, Malani N, Ichikawa H. Curcumin: the Indian solid gold. Adv Exp Med Biol. 2007;595:1–75.CrossRefPubMed
15.
go back to reference Irving GR, Karmokar A, Berry DP, Brown K, Steward WP. Curcumin: the potential for efficacy in gastrointestinal diseases. Best Pract Res Clin Gastroenterol. 2011;25:519–34.CrossRefPubMed Irving GR, Karmokar A, Berry DP, Brown K, Steward WP. Curcumin: the potential for efficacy in gastrointestinal diseases. Best Pract Res Clin Gastroenterol. 2011;25:519–34.CrossRefPubMed
16.
go back to reference Tharakan ST, Inamoto T, Sung B, Aggarwal BB, Kamat AM. Curcumin potentiates the antitumor effects of gemcitabine in an orthotopic model of human bladder cancer through suppression of proliferative and angiogenic biomarkers. Biochem Pharmacol. 2010;79:218–28.CrossRefPubMed Tharakan ST, Inamoto T, Sung B, Aggarwal BB, Kamat AM. Curcumin potentiates the antitumor effects of gemcitabine in an orthotopic model of human bladder cancer through suppression of proliferative and angiogenic biomarkers. Biochem Pharmacol. 2010;79:218–28.CrossRefPubMed
17.
go back to reference Howells LM, Sale S, Sriramareddy SN, Irving GR, Jones DJ, Ottley CJ, et al. Curcumin ameliorates oxaliplatin-induced chemoresistance in HCT116 colorectal cancer cells in vitro and in vivo. Int J Cancer. 2011;129:476–86.CrossRefPubMed Howells LM, Sale S, Sriramareddy SN, Irving GR, Jones DJ, Ottley CJ, et al. Curcumin ameliorates oxaliplatin-induced chemoresistance in HCT116 colorectal cancer cells in vitro and in vivo. Int J Cancer. 2011;129:476–86.CrossRefPubMed
18.
go back to reference Dhillon N, Aggarwal BB, Newman RA, Wolff RA, Kunnumakkara AB, Abbruzzese JL, et al. Phase II trial of curcumin in patients with advanced pancreatic cancer. Clin Cancer Res. 2008;14:4491–9.CrossRefPubMed Dhillon N, Aggarwal BB, Newman RA, Wolff RA, Kunnumakkara AB, Abbruzzese JL, et al. Phase II trial of curcumin in patients with advanced pancreatic cancer. Clin Cancer Res. 2008;14:4491–9.CrossRefPubMed
19.
go back to reference Kanai M, Yoshimura K, Asada M, Imaizumi A, Suzuki C, Matsumoto S, et al. A phase I/II study of gemcitabine-based chemotherapy plus curcumin for patients with gemcitabine-resistant pancreatic cancer. Cancer Chemother Pharmacol. 2011;68:157–64.CrossRefPubMed Kanai M, Yoshimura K, Asada M, Imaizumi A, Suzuki C, Matsumoto S, et al. A phase I/II study of gemcitabine-based chemotherapy plus curcumin for patients with gemcitabine-resistant pancreatic cancer. Cancer Chemother Pharmacol. 2011;68:157–64.CrossRefPubMed
20.
go back to reference Bayet-Robert M, Kwiatkowski F, Leheurteur M, Gachon F, Planchat E, Abrial C, et al. Phase I dose escalation trial of docetaxel plus curcumin in patients with advanced and metastatic breast cancer. Cancer Biol Ther. 2010;9:8–14.CrossRefPubMed Bayet-Robert M, Kwiatkowski F, Leheurteur M, Gachon F, Planchat E, Abrial C, et al. Phase I dose escalation trial of docetaxel plus curcumin in patients with advanced and metastatic breast cancer. Cancer Biol Ther. 2010;9:8–14.CrossRefPubMed
21.
go back to reference Braumann C, Guenther N, Loeffler LM, Dubiel W. Liver metastases after colonic carcinoma–palliative chemotherapy plus curcumin. Int J Colorectal Dis. 2009;24:859–60.CrossRefPubMed Braumann C, Guenther N, Loeffler LM, Dubiel W. Liver metastases after colonic carcinoma–palliative chemotherapy plus curcumin. Int J Colorectal Dis. 2009;24:859–60.CrossRefPubMed
22.
go back to reference Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRefPubMed Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRefPubMed
23.
go back to reference Pieck AC, Drescher A, Wiesmann KG, Messerschmidt J, Weber G, Strumberg D, et al. Oxaliplatin-DNA adduct formation in white blood cells of cancer patients. Br J Cancer. 2008;98:1959–65.CrossRefPubMedPubMedCentral Pieck AC, Drescher A, Wiesmann KG, Messerschmidt J, Weber G, Strumberg D, et al. Oxaliplatin-DNA adduct formation in white blood cells of cancer patients. Br J Cancer. 2008;98:1959–65.CrossRefPubMedPubMedCentral
24.
go back to reference Almadrones L, McGuire DB, Walczak JR, Florio CM, Tian C. Psychometric evaluation of two scales assessing functional status and peripheral neuropathy associated with chemotherapy for ovarian cancer: a gynecologic oncology group study. Oncol Nurs Forum. 2004;31:615–23.CrossRefPubMed Almadrones L, McGuire DB, Walczak JR, Florio CM, Tian C. Psychometric evaluation of two scales assessing functional status and peripheral neuropathy associated with chemotherapy for ovarian cancer: a gynecologic oncology group study. Oncol Nurs Forum. 2004;31:615–23.CrossRefPubMed
25.
go back to reference Irving GR, Howells LM, Sale S, Kralj-Hans I, Atkin WS, Clark SK, et al. Prolonged biologically active colonic tissue levels of curcumin achieved after oral administration - a clinical pilot study including assessment of patient acceptability. Cancer Prev Res (Phila). 2013;6:119–28.CrossRef Irving GR, Howells LM, Sale S, Kralj-Hans I, Atkin WS, Clark SK, et al. Prolonged biologically active colonic tissue levels of curcumin achieved after oral administration - a clinical pilot study including assessment of patient acceptability. Cancer Prev Res (Phila). 2013;6:119–28.CrossRef
26.
go back to reference Perkins S, Verschoyle RD, Hill K, Parveen I, Threadgill MD, Sharma RA, et al. Chemopreventive efficacy and pharmacokinetics of curcumin in the min/+ mouse, a model of familial adenomatous polyposis. Cancer Epidemiol Biomarkers Prev. 2002;11:535–40.PubMed Perkins S, Verschoyle RD, Hill K, Parveen I, Threadgill MD, Sharma RA, et al. Chemopreventive efficacy and pharmacokinetics of curcumin in the min/+ mouse, a model of familial adenomatous polyposis. Cancer Epidemiol Biomarkers Prev. 2002;11:535–40.PubMed
27.
go back to reference Cheng AL, Hsu CH, Lin JK, Hsu MM, Ho YF, Shen TS, et al. Phase I clinical trial of curcumin, a chemopreventive agent, in patients with high-risk or pre-malignant lesions. Anticancer Res. 2001;21:2895–900.PubMed Cheng AL, Hsu CH, Lin JK, Hsu MM, Ho YF, Shen TS, et al. Phase I clinical trial of curcumin, a chemopreventive agent, in patients with high-risk or pre-malignant lesions. Anticancer Res. 2001;21:2895–900.PubMed
28.
go back to reference Epelbaum R, Schaffer M, Vizel B, Badmaev V, Bar-Sela G. Curcumin and gemcitabine in patients with advanced pancreatic cancer. Nutr Cancer. 2010;62:1137–41.CrossRefPubMed Epelbaum R, Schaffer M, Vizel B, Badmaev V, Bar-Sela G. Curcumin and gemcitabine in patients with advanced pancreatic cancer. Nutr Cancer. 2010;62:1137–41.CrossRefPubMed
29.
go back to reference Baum L, Cheung SK, Mok VC, Lam LC, Leung VP, Hui E, et al. Curcumin effects on blood lipid profile in a 6-month human study. Pharmacol Res. 2007;56:509–14.CrossRefPubMed Baum L, Cheung SK, Mok VC, Lam LC, Leung VP, Hui E, et al. Curcumin effects on blood lipid profile in a 6-month human study. Pharmacol Res. 2007;56:509–14.CrossRefPubMed
30.
go back to reference Baum L, Lam CW, Cheung SK, Kwok T, Lui V, Tsoh J, et al. Six-month randomized, placebo-controlled, double-blind, pilot clinical trial of curcumin in patients with Alzheimer disease. J Clin Psychopharmacol. 2008;28:110–3.CrossRefPubMed Baum L, Lam CW, Cheung SK, Kwok T, Lui V, Tsoh J, et al. Six-month randomized, placebo-controlled, double-blind, pilot clinical trial of curcumin in patients with Alzheimer disease. J Clin Psychopharmacol. 2008;28:110–3.CrossRefPubMed
31.
go back to reference He ZY, Shi CB, Wen H, Li FL, Wang BL, Wang J. Upregulation of p53 expression in patients with colorectal cancer by administration of curcumin. Cancer Invest. 2011;29:208–13.CrossRefPubMed He ZY, Shi CB, Wen H, Li FL, Wang BL, Wang J. Upregulation of p53 expression in patients with colorectal cancer by administration of curcumin. Cancer Invest. 2011;29:208–13.CrossRefPubMed
32.
go back to reference Ide H, Tokiwa S, Sakamaki K, Nishio K, Isotani S, Muto S, et al. Combined inhibitory effects of soy isoflavones and curcumin on the production of prostate-specific antigen. Prostate. 2010;70:1127–33.CrossRefPubMed Ide H, Tokiwa S, Sakamaki K, Nishio K, Isotani S, Muto S, et al. Combined inhibitory effects of soy isoflavones and curcumin on the production of prostate-specific antigen. Prostate. 2010;70:1127–33.CrossRefPubMed
33.
go back to reference Lao CD, Ruffin MT, Normolle D, Heath DD, Murray SI, Bailey JM, et al. Dose escalation of a curcuminoid formulation. BMC Complement Altern Med. 2006;6:10.CrossRefPubMedPubMedCentral Lao CD, Ruffin MT, Normolle D, Heath DD, Murray SI, Bailey JM, et al. Dose escalation of a curcuminoid formulation. BMC Complement Altern Med. 2006;6:10.CrossRefPubMedPubMedCentral
34.
go back to reference Sharma RA, McLelland HR, Hill KA, Ireson CR, Euden SA, Manson MM, et al. Pharmacodynamic and pharmacokinetic study of oral Curcuma extract in patients with colorectal cancer. Clin Cancer Res. 2001;7:1894–900.PubMed Sharma RA, McLelland HR, Hill KA, Ireson CR, Euden SA, Manson MM, et al. Pharmacodynamic and pharmacokinetic study of oral Curcuma extract in patients with colorectal cancer. Clin Cancer Res. 2001;7:1894–900.PubMed
35.
go back to reference Vareed SK, Kakarala M, Ruffin MT, Crowell JA, Normolle DP, Djuric Z, et al. Pharmacokinetics of curcumin conjugate metabolites in healthy human subjects. Cancer Epidemiol Biomarkers Prev. 2008;17:1411–7.CrossRefPubMedPubMedCentral Vareed SK, Kakarala M, Ruffin MT, Crowell JA, Normolle DP, Djuric Z, et al. Pharmacokinetics of curcumin conjugate metabolites in healthy human subjects. Cancer Epidemiol Biomarkers Prev. 2008;17:1411–7.CrossRefPubMedPubMedCentral
36.
go back to reference Babu A, Prasanth KG, Balaji B. Effect of curcumin in mice model of vincristine-induced neuropathy. Pharm Biol. 2014;28:1–11. Babu A, Prasanth KG, Balaji B. Effect of curcumin in mice model of vincristine-induced neuropathy. Pharm Biol. 2014;28:1–11.
37.
go back to reference Joshi RP, Negi G, Kumar A, Pawar YB, Munjal B, Bansal AK, et al. SNEDDS curcumin formulation leads to enhanced protection from pain and functional deficits associated with diabetic neuropathy: an insight into its mechanism for neuroprotection. Nanomedicine. 2013;9:776–85.PubMed Joshi RP, Negi G, Kumar A, Pawar YB, Munjal B, Bansal AK, et al. SNEDDS curcumin formulation leads to enhanced protection from pain and functional deficits associated with diabetic neuropathy: an insight into its mechanism for neuroprotection. Nanomedicine. 2013;9:776–85.PubMed
38.
go back to reference Zhao WC, Zhang B, Liao MJ, Zhang WX, He WY, Wang HB, et al. Curcumin ameliorated diabetic neuropathy partially by inhibition of NADPH oxidase mediating oxidative stress in the spinal cord. Neurosci Lett. 2014;560:81–5.CrossRefPubMed Zhao WC, Zhang B, Liao MJ, Zhang WX, He WY, Wang HB, et al. Curcumin ameliorated diabetic neuropathy partially by inhibition of NADPH oxidase mediating oxidative stress in the spinal cord. Neurosci Lett. 2014;560:81–5.CrossRefPubMed
Metadata
Title
Combining curcumin (C3-complex, Sabinsa) with standard care FOLFOX chemotherapy in patients with inoperable colorectal cancer (CUFOX): study protocol for a randomised control trial
Authors
Glen RB Irving
Chinenye OO Iwuji
Bruno Morgan
David P Berry
William P Steward
Anne Thomas
Karen Brown
Lynne M Howells
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Trials / Issue 1/2015
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-015-0641-1

Other articles of this Issue 1/2015

Trials 1/2015 Go to the issue