Altered Tumor Oxygenation by Metformin, a Potential Step in Overcoming Radiotherapy Resistance in LACC

Prior treatment

• Evidence of distant metastasis. Suspicious paraaortic lymph nodes below the renal vessel are allowed if they are covered by the radiation field
• Patients who have received other cancer treatments for their cervical cancer
• Patients who receive other experimental drugs
• Currently taking Metformin or any other antidiabetic drugs (sulfonylureas, thiazolidinediones, insulin)
• Uncontrolled intercurrent somatic illness including, but not limited to, ongoing or active serious infections, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, myocardial infarction within 6 months and cerebrovascular disease with previous stroke
• Already on medication with increased risk of lactic acidosis
• Patients who are pregnant or breastfeeding are excluded due to risk of teratogenic and abortifacient effects of radiotherapy and cisplatin, and the potential risk of adverse effect of nursing infants

Other illness

• Known diabetes mellitus
• History of allergic reaction attributed to compounds of similar chemical or biologic composition to metformin
• Any condition associated with increased risk of metformin- induced lactic acidosis (congestive heart failure defined as New York Heart Association (NYHA) class III or IV functional status, history of acidosis of any kind)

Lab values

• Contraindications such as
  • Hypersensitivity to the active substance or to any of the excipients listed Section 6.1.
  • Severe renal failure (GFR \<30 ml / min).
  • Acute conditions leading to the risk of renal impairment, eg: dehydration, severe infectious conditions, shock.
  • Disease that can cause tissue hypoxia (especially acute illness or exacerbation of chronic illness), such as: acute decompensated heart failure, lung failure, recent heart attack, shock.
  • Liver failure, acute alcohol intoxication, alcoholism.

• Histologically confirmed cervical cancer (squamous cell carcinoma, adenocarcinoma and adenosquamous carcinoma)
  • Planned for radical chemoradiotherapy
  • Over 18 years
  • Speaks and understands Norwegian
  • ECOG 0-1
  • Cervical tumor available for biopsy by gynecological examination
  • Hemoglobin ≥ 9 g/dL (blood transfusions are allowed)
  • Leukocytes ≥ 3,5 x 10\^9/L 18
  • Absolute neutrophil count ≥ 1,5 x 10\^9/L
  • Platelets ≥ 100 x 10\^9/L
  • Total bilirubin ≤ 25 umol/L
  • AST/ALT ≤ 2,5 x institutional upper limit
  • Creatinine ≤ 90 or creatinine clearance ≥ 60 ml/min/1.73m2 Patients with elevated creatinine secondary to hydronephrosis may be eligible if renal function returns to normal after inserting an internal stent or nephrostomy
  • Women of childbearing potential (WOCBP) should have a negative highly sensitive serum pregnancy test within 72 hours prior to receiving the first dose of study medication.