Memantine Hydrochloride in Helping Cancer Survivors Stop Smoking

OBJECTIVES:

Primary

• Estimate participation, accrual, adherence, and retention of cancer survivors who smoke and are randomized to receive memantine (memantine hydrochloride) (10 mg twice daily) or a matching placebo for 12 weeks.
• Estimate the self-reported abstinence rates of patients who are randomized to memantine or a matching placebo for 12 weeks and obtain a preliminary estimate of the treatment effect (difference in abstinence rates between the two groups).

Secondary

• Nicotine addiction will be assessed using the Wisconsin Inventory of Smoking Dependent Motives.
• Nicotine withdrawal will be measured by the Wisconsin Smoking Withdrawal Scale.
• Quality of life will be measured by the SF12 questionnaire.
• Toxicities will be assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.

OUTLINE: This is a randomized, placebo-controlled, pilot study. Participants are stratified according to gender (male vs female). Participants are randomized to 1 of 2 treatment arms.

• Arm I: Participants receive memantine hydrochloride orally (PO) twice daily (BID) on days 1-81 in the absence of unacceptable toxicity.
• Arm II: Participants receive placebo PO BID on days 1-81 in the absence of unacceptable toxicity.

Participants complete the Behavioral Risk Factor Surveillance Survey (BRFSS), the Self-reported Tobacco Abstinence, the Wisconsin Inventory of Smoking Dependent Motives, the Wisconsin Smoking Withdrawal Scale, SF-12 quality-of-life questionnaire, and the Fagerstrom Nicotine Tolerance Scale at baseline and every 2 weeks for 12 weeks during study.

Participants also undergo urine sample collection at weeks 4, 8, and 12 for cotinine test using the NicAlert test.

Inclusion criteria

• Survivors of non-metastatic breast, prostate, or colorectal cancer, or stage I/II non-small cell lung cancer
• Age ≥ 18
• Smoked 100 tobacco cigarettes over lifetime at time of first interview, have smoked 10 or more cigarettes per day on most days over the past month
• Eastern Cooperative Oncology Group (ECOG) performance status 0-1 (Karnofsky ≥ 70%)
• Ability to understand and the willingness to sign a written informed consent document
• Agrees to adhere to the study protocol and attend the required clinic visits
• Negative serum pregnancy test within 10 days prior to registration in women with child-bearing potential; women of child-bearing potential must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation
• Women who are currently breast-feeding are not eligible for this study

Exclusion criteria

• Use of chewing tobacco, pipe tobacco, snuff, or any other non-cigarette tobacco product is not allowed
• No patients with clinically significant uncontrolled medical conditions (e.g., unstable angina, myocardial infarction, transient ischemic attack [TIA], or cerebral vascular accident [CVA]) within past 3 months
• Creatinine ≥ 2 times upper limit of normal (ULN) in last six months
• Serum glutamic oxaloacetic transaminase (SGOT)/serum glutamic pyruvate transaminase (SGPT) ≥ 3 times ULN in last six months
• Current uncontrolled hypertension ≥ 160/90 mm Hg
• Excessive alcohol abuse defined as more than 5 drinks per day for men and 4 drinks per day for women
• Major medical or psychiatric illness which, in the opinion of the investigator, would prevent completion of treatment or would interfere with follow-up
• History of allergic reactions attributed to memantine

PRIOR CONCURRENT THERAPY:

• Six months post definitive treatment (except for ongoing hormonal or targeted therapies)
• Patients currently must not be taking Nicotine Replacement Therapy (NRT) and agree to not start NRT for the duration of the study
• Patients currently taking antidepressant or antianxiety medications must have been on a stable dose for 4 weeks prior to registration
• Patients currently receiving the following medications are not eligible: anticonvulsant agents (e.g., phenytoin, carbamazepine, gabapentin, etc.); antiparkinsonian agents (e.g., Levo Dopa, ropinirole); neuroleptic agents (e.g., risperidone, quetiapine); carbonic anhydrase inhibitors (e.g., Diamox® and Sequels®)
• Memantine should not be combined with other N-methyl d-aspartate (NMDA) antagonists (amantadine, ketamine, and dextromethorphan)
• Participants may not be receiving any other investigational agents
• No current use of illegal drugs or use of prescription medications for non-medical reasons