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Trial registered on ANZCTR
Registration number
ACTRN12622000706774
Ethics application status
Approved
Date submitted
23/04/2022
Date registered
17/05/2022
Date last updated
23/03/2023
Date data sharing statement initially provided
17/05/2022
Type of registration
Prospectively registered
Titles & IDs
Public title
The impact of perioperative administration of seasonal influenza vaccine and arginine-enriched immunonutrition on perioperative immune status (PaSIVI): A Feasibility and Pilot Study
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Scientific title
The impact of perioperative administration of seasonal influenza vaccine and arginine-enriched immunonutrition on perioperative immune status of patients presenting for cancer surgery (PaSIVI): A Feasibility and Pilot Study
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Secondary ID [1]
306992
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None
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Universal Trial Number (UTN)
None
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Trial acronym
PaSIVI
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Cancer Surgery
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Perioperative immunosuppression
326212
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Condition category
Condition code
Cancer
323427
323427
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0
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Any cancer
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Surgery
323596
323596
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0
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Other surgery
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
This randomised control trial will include participants undergoing abdominopelvic cancer surgery only
Arm 1: Control - no intervention
Arm 2: Influenza vaccine only:
1. Seasonal quadrivalent influenza vaccine, 0.5mL - administered 1 day prior to abdomino-pelvic cancer surgery or on day of surgery, administered by doctor.
Arm 3: Influenza vaccine and arginine immunonutrition:
1. Seasonal quadrivalent influenza vaccine, 0.5mL - administered 1 day prior to abdomino-pelvic cancer surgery or on day of surgery, adminsitered by doctor.
2. Dietary supplementation of oral arginine - 4.5g twice daily (powder to be diluted in 200ml water), prescribed 5 days before and after surgery
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Intervention code [1]
323435
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Treatment: Drugs
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Intervention code [2]
323518
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Treatment: Other
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Comparator / control treatment
Participants in the control arm proceed with surgery without preoperative influenza vaccine, nor receive perioperative arginine supplementation
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Control group
Active
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Outcomes
Primary outcome [1]
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To characterise the effect of influenza vaccine and immunonutrition on perioperative natural killer cell number
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Assessment method [1]
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Timepoint [1]
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Natural kill cell number, in ex-vivo assays from participant blood collected at baseline, pre-induction of anaesthesia, postoperative days 1, 3 and 5.
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Primary outcome [2]
331272
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To characterise the effect of influenza vaccine and immunonutrition on perioperative natural killer cell activity
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Assessment method [2]
331272
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Timepoint [2]
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Natural kill cell activity, in ex-vivo assays from participant blood collected at baseline, pre-induction of anaesthesia, postoperative days 1, 3 and 5.
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Secondary outcome [1]
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To measure the rate of recruitment of eligible patients into the study by audit of screening logs for the study.
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Assessment method [1]
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Timepoint [1]
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Cumulative data will be assessed at the end of the 24month recruitment period
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Secondary outcome [2]
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Feasibility will be assessed as successful delivery of the randomised treatment arm in 90% participants, to be measured by audit of electronic study records in which study treatment of subjects will be recorded
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Assessment method [2]
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Timepoint [2]
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Cumulative data will be assessed at the end of the 24month recruitment period
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Eligibility
Key inclusion criteria
Inclusion Criteria:
• Male or female
• Age >18 years.
• Elective surgery
• Major intra-abdominal cancer surgery, including:
o Colorectal
o Sarcoma
o Upper gastrointestinal
o Hepatobiliary
o Genitourinary
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Minimum age
18
Years
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Maximum age
99
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
• History of allergy or anaphylaxis to previous influenza vaccine
• Contraindication to the influenza vaccine
• Patients on immunotherapy: Including: Immune checkpoint inhibitors; T-cell therapy; Monoclonal antibodies; Treatment vaccines and Immune system modulators (modulating therapy e.g., cytokines such as Interferon, interleukin, haematopoietic growth factors such as erythropoietin, IL-11, G-CSF; BCG, thalidomide, lanalidomide, monoclonal antibodies (mabs, mibs), steroids
• History of allergy or anaphylaxis to arginine or arginine supplemented products
• Participants who have already received a dose of the influenzae vaccine for that calendar year
• Palliative surgery for end-stage disease with no curative intent
• Patients with existing metastatic disease
• Emergency surgery
• Extensive comorbid disease, i.e. ASA > 3
• Age <18 years old
• Refusal or inability to provide valid informed consent
• Currently enrolled in another clinical trial unless agreed by the CPI and PI that co-enrolment can occur.
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
central randomisation by computer
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation in a 1:1:1 ratio using a randomisation table created by computer software (i.e. computerised sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 2
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
A statistical analysis plan will be completed prior to statistician unblinding and commencement of analysis. Descriptive statistics will consist of number and percentage for categorical variables, and mean and standard deviation (SD) or median and interquartile range (IQR) will be reported for continuous variables (parametric and non-parametric, respectively). The asymptotic [Wald] method based on the normal approximation for the two-sided 95% confidence interval for a single proportion will be used to obtain the confidence interval for the proportion of eligible patients who provided informed consent (primary aim 1) and the proportion of randomized patients for whom the anaesthetic procedure was completed successfully, for each procedure separately (primary aim 2).
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
20/05/2022
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Actual
30/09/2022
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Date of last participant enrolment
Anticipated
31/12/2023
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Actual
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Date of last data collection
Anticipated
1/03/2024
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Actual
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Sample size
Target
54
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Accrual to date
1
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
22236
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Peter MacCallum Cancer Centre - Melbourne
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Recruitment postcode(s) [1]
37398
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3000 - Melbourne
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Funding & Sponsors
Funding source category [1]
311304
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Charities/Societies/Foundations
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Name [1]
311304
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Peter MacCallum Foundation Grant
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Address [1]
311304
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Peter MacCallum Cancer Centre
305 Grattan St, Parkville, VIC, 3050
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Country [1]
311304
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Australia
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Primary sponsor type
Hospital
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Name
Peter MacCallum Cancer Centre
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Address
Peter MacCallum Cancer Centre
305 Grattan St, Parkville, VIC, 3050
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
312668
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Country [1]
312668
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
310806
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PETER MACCALLUM CANCER CENTRE HUMAN RESEARCH ETHICS COMMITTEE [EC00235]
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Ethics committee address [1]
310806
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Peter MacCallum Cancer Centre 305 Grattan St, Parkville, VIC, 3050
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Ethics committee country [1]
310806
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Australia
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Date submitted for ethics approval [1]
310806
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06/12/2021
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Approval date [1]
310806
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01/04/2022
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Ethics approval number [1]
310806
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HREC/81869/PMCC
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Summary
Brief summary
Surgery to remove solid tumours is the most commonly prescribed and effective treatment for most cancers of this presentation. However, major cancer surgery represents a stressor to the patient which results in a relative immunosuppression that can be seen in a reduction in the number and immune activity of natural killer cells. This study aims to assess the feasibility of boosting cancer patients' immunity prior to surgery through a combination of a pre-surgery flu vaccination and dietary supplements. Who is it for? You may be eligible for this study if you are an adult aged 18 or older, you have been diagnosed with an abdominal cancer requiring surgery, colorectal cancer, sarcoma, upper gastrointestinal cancer, liver or gallbladder cancer or genitourinary cancer (e.g. bladder/penile/cervical/uterine/ovarian cancers). Study details Participants who choose to enrol in this study will be allocated by computer randomisation to one of two treatment groups. The first group will be given a flu vaccine the day before on on the day of their scheduled surgery, and will be asked to take a dietary supplement (arginine) each day for the 5 days before and 5 days after their surgery. The second group will not receive a flu vaccine or the dietary supplement and will undergo their scheduled surgery only. The third group will have no intervention (control group). Participants in all groups will be asked to provide up to 5 blood samples for testing. It is hoped this research will determine whether it is practical to administer flu vaccines and dietary supplements to patients prior to a major abdominal cancer surgery. The preliminary results collected from this small study will also be used to determine whether it is worthwhile pursuing a larger clinical trial to investigate the effect of these strategies on immune activity in a larger population of cancer patients.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Dr Julia Dubowitz
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Address
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Department of Anaesthesia, Perioperative and Pain Medicine
Peter MacCallum Cancer Centre
305 Grattan St, Parkville, VIC, 3050
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Country
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Australia
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Phone
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+613 8559 7681
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
118939
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Julia Dubowitz
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Address
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Department of Anaesthesia, Perioperative and Pain Medicine
Peter MacCallum Cancer Centre
305 Grattan St, Parkville, VIC, 3050
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Country
118939
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Australia
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Phone
118939
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+613 8559 7681
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Fax
118939
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Email
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[email protected]
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Contact person for scientific queries
Name
118940
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Julia Dubowitz
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Address
118940
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Department of Anaesthesia, Perioperative and Pain Medicine
Peter MacCallum Cancer Centre
305 Grattan St, Parkville, VIC, 3050
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Country
118940
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Australia
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Phone
118940
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+613 8559 7681
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Fax
118940
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Email
118940
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
Data from the feasibility trial will not be made publicly available due to the limited power of the study. The PI will reconsider IPD status if a large (main) study is run
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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