Volatile Anaesthesia and Perioperative Outcomes Related to Cancer (Vapor-C Trial)

Project Details

The VAPOR-C trial is a pragmatic, event-driven, randomised controlled trial on individuals with colorectal or non-small cellular lung cancer (NSCLC), with a single blind for sevoflurane and for propofol with intravenous lidocaine infusion. Anaesthetic agents are implicated in cancer signalling (e.g. cell survival) pathways and in immunomodulation. Specifically, inhalational (volatile) anaesthesia (e.g. sevoflurane) impairs the primary host defence, promotes pro-inflammatory effects on macrophages, and up-regulates anti-apoptotic processes through hypoxia inducible factor-1 alpha (HIF-1α) and PI3K-Akt pathway signalling. In contrast, propofol-based total intravenous anaesthesia (TIVA) enhances host defences (NK cells), inhibits inflammatory effects on macrophages, and down regulates mTOR, p53, p38 MAPK and MMP signalling. Amide local anaesthetics (e.g. lidocaine), increasingly used as an intravenous infusion for analgesia during general anaesthesia, also exhibit immune preserving and anti-inflammatory properties which may reduce cancer recurrence.

The VAPOR-C study will add definitive data to the question of whether anaesthetic technique (propofol vs. sevoflurane) and/or intravenous lidocaine infusion impacts long-term cancer outcomes. Exploratory endpoints will evaluate the incidence of patients able to achieve adjuvant therapy (Return to Intended Oncological Therapy, RIOT), health economic evaluations related to health-related quality of life (HRQoL) to inform on the cost-effectiveness of either anaesthetic technique, and undertake nested cohort mechanistic studies by collecting blood, breath and tissue samples in participating hospitals.

Project Duration

2019-2027

Researchers

• A/Prof An Duy Tran (Project lead)