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Gemcitabine With or Without Bevacizumab in Treating Patients With Locally Advanced or Metastatic Pancreatic Cancer
This study has been completed.

First Received on August 4, 2004.   Last Updated on March 1, 2011   History of Changes
Sponsor: Cancer and Leukemia Group B
Collaborator: National Cancer Institute (NCI)
Information provided by: Cancer and Leukemia Group B
ClinicalTrials.gov Identifier: NCT00088894
  Purpose

RATIONALE: Drugs used in chemotherapy, such as gemcitabine, work in different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as bevacizumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Bevacizumab may also stop the growth of tumor cells by stopping blood flow to the tumor. Combining gemcitabine with bevacizumab may kill more tumor cells. It is not yet known whether gemcitabine is more effective with or without bevacizumab in treating pancreatic cancer.

PURPOSE: This randomized phase III trial is studying gemcitabine and bevacizumab to see how well they work compared to gemcitabine alone in treating patients with locally advanced or metastatic pancreatic cancer.


Condition Intervention Phase
Pancreatic Cancer
Biological: bevacizumab
Drug: gemcitabine hydrochloride
Phase III

Study Type: Interventional
Study Design: Allocation: Randomized
Masking: Double-Blind
Primary Purpose: Treatment
Official Title: A Randomized Phase III Trial Of Gemcitabine Plus Bevacizumab (NSC#704865 IND#7621) Versus Gemcitabine Plus Placebo In Patients With Advanced Pancreatic Cancer

Resource links provided by NLM:


Further study details as provided by Cancer and Leukemia Group B:

Primary Outcome Measures:
  • Overall survival [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Response [ Designated as safety issue: No ]
  • Duration of response [ Designated as safety issue: No ]
  • Progression-free survival [ Designated as safety issue: No ]
  • Toxicity [ Designated as safety issue: Yes ]

Enrollment: 602
Study Start Date: June 2004
Study Completion Date: June 2010
Primary Completion Date: June 2006 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • Compare survival of patients with locally advanced or metastatic adenocarcinoma of the pancreas treated with gemcitabine with vs without bevacizumab.

Secondary

  • Compare objective response rate, duration of response, and progression-free survival of patients treated with these regimens.
  • Compare the toxicity of these regimens in these patients.
  • Correlate baseline levels of vascular endothelial growth factor (VEGF) with treatment outcome in patients treated with these regimens.
  • Determine baseline and on-treatment levels of additional growth factors that may be co- or counter-regulated with VEGF and correlate these levels with response in patients treated with these regimens.
  • Determine baseline and on-treatment levels of coagulation and endothelial cell activation markers that may predict thrombotic or bleeding risks in patients treated with these regimens.
  • Compare the effects of these regimens on resource utilization, cost, and utilities.
  • Determine estimates of marginal cost-utility.

OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to ECOG performance status (0-1 vs 2), disease extent (metastatic vs locally advanced), and prior radiotherapy (yes vs no). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive gemcitabine IV over 30 minutes on days 1, 8, and 15 and bevacizumab IV over 30-90 minutes on days 1 and 15.
  • Arm II: Patients receive gemcitabine IV as in arm I and placebo IV over 30-90 minutes on days 1 and 15.

In both arms, courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Patients are followed every 3 months for 1 year and then every 6 months for 3 years.

PROJECTED ACCRUAL: A total of 590 patients (295 per treatment arm) will be accrued for this study within 26.8 months.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed adenocarcinoma of the pancreas

    • Locally advanced or metastatic disease
  • Not amenable to curative resection
  • No invasion of adjacent organs (e.g., duodenum or stomach) by CT scan
  • No evidence of CNS disease, including primary brain tumor or brain metastasis

PATIENT CHARACTERISTICS:

Age

  • 18 and over

Performance status

  • ECOG 0-2

Life expectancy

  • Not specified

Hematopoietic

  • Granulocyte count ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3
  • No other significant bleeding episodes within the past 6 months

Hepatic

  • Bilirubin normal
  • SGOT ≤ 2.5 times upper limit of normal (ULN)
  • PT and INR ≤ 1.5 times ULN (except for patients on full-dose warfarin)
  • No esophageal varices

Renal

  • Creatinine ≤ 1.5 mg/dL OR
  • Creatinine clearance ≥ 60 mL/min
  • No proteinuria

    • Patients with ≥ 1+ proteinuria must demonstrate < 1 g/dL of protein on 24-hour urine collection

Cardiovascular

  • No clinically significant cardiovascular disease
  • No uncontrolled hypertension (i.e., blood pressure > 150/90 mm Hg on medication)
  • No arterial thromboembolic event within the past 6 months, including any of the following:

    • Myocardial infarction
    • Unstable angina pectoris
    • Cerebrovascular accident
    • Transient ischemic attack
  • No New York Heart Association grade II-IV congestive heart failure
  • No serious cardiac arrhythmia requiring medication
  • No peripheral vascular disease ≥ grade 2
  • No clinically significant peripheral artery disease (i.e., claudication on < 1 block)

Pulmonary

  • No hemoptysis within the past 6 months

Other

  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for up to 3 months after study participation
  • No upper or lower gastrointestinal bleeding within the past 6 months
  • No serious or non-healing wound, ulcer, or bone fracture
  • No serious active viral, fungal, or bacterial infection
  • No infection requiring parenteral antibiotics
  • No hypersensitivity to Chinese hamster ovary cell products or other recombinant antibodies
  • No significant traumatic injury within the past 28 days
  • No other active malignancy except nonmelanoma skin cancer

PRIOR CONCURRENT THERAPY:

Biologic therapy

  • No prior bevacizumab in the adjuvant or metastatic setting
  • No other prior vascular endothelial growth factor inhibitors
  • No concurrent prophylactic filgrastim (G-CSF) or sargramostim (GM-CSF)
  • No concurrent pegfilgrastim

Chemotherapy

  • See Radiotherapy
  • More than 4 weeks since prior adjuvant chemotherapy and recovered

    • Patients must have evidence of disease progression after adjuvant chemotherapy
  • No prior chemotherapy for metastatic disease
  • No prior gemcitabine in the adjuvant or metastatic setting
  • No other concurrent chemotherapy agents

Endocrine therapy

  • No concurrent hormones except steroids for adrenal failure, hormones for non-disease-related conditions (e.g., insulin for diabetes), or intermittent dexamethasone as an antiemetic

Radiotherapy

  • Prior radiotherapy with or without a radiosensitizing dose of fluoropyrimidines allowed provided there is disease outside radiotherapy port
  • At least 4 weeks since prior radiotherapy and recovered
  • No concurrent palliative radiotherapy

Surgery

  • More than 28 days since prior major surgical procedure or open biopsy
  • More than 7 days since prior fine needle aspirations
  • No concurrent major surgical procedures

Other

  • More than 1 month since prior thrombolytic agent
  • No concurrent thrombolytic agent
  • Concurrent full-dose anticoagulants allowed provided the patient is maintained on a stable dose of warfarin with an in-range INR (between approximately 2-3) OR on a stable dose of low molecular weight heparin
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00088894

  Show 340 Study Locations
Sponsors and Collaborators
Cancer and Leukemia Group B
Investigators
Study Chair: Hedy L. Kindler, MD University of Chicago
  More Information

Additional Information:
Publications:
Kindler HL, Niedzwiecki D, Hollis D, Sutherland S, Schrag D, Hurwitz H, Innocenti F, Mulcahy MF, O'Reilly E, Wozniak TF, Picus J, Bhargava P, Mayer RJ, Schilsky RL, Goldberg RM. Gemcitabine Plus Bevacizumab Compared With Gemcitabine Plus Placebo in Patients With Advanced Pancreatic Cancer: Phase III Trial of the Cancer and Leukemia Group B (CALGB 80303). J Clin Oncol. 2010 Jul 6; [Epub ahead of print]
Innocenti F, Owzar K, Cox N, et al.: Heritable interleukin-17F (IL17F) gene variation and overall survival (OS) in pancreatic cancer patients (pts): results from a genome-wide association study (GWAS) in CALGB 80303. [Abstract] J Clin Oncol 27 (Suppl 15): A-4531, 2009.
Kindler HL, Niedzwiecki D, Hollis D, et al.: A double-blind, placebo-controlled, randomized phase III trial of gemcitabine (G) plus bevacizumab (B) versus gemcitabine plus placebo (P) in patients (pts) with advanced pancreatic cancer (PC): a preliminary analysis of Cancer and Leukemia Group B (CALGB) 80303. [Abstract] American Society of Clinical Oncology 2007 Gastrointestinal Cancers Symposium, 19 -21 January 2007, Orlando, Florida A-108, 2007.
Romanus D, Archer L, Wang X, et al.: Does health-related quality of life (HRQL) improve for patients who respond to chemotherapy? Analysis of patients with advanced pancreas cancer (APC) receiving gemcitabine on Cancer and Leukemia Group B (CALGB) study #80303. [Abstract] J Clin Oncol 25 (Suppl 18): A-9008, 495s, 2007.
Schrag D, Archer L, Wang X, et al.: A patterns-of-care study of post-progression treatment (Rx) among patients (pts) with advanced pancreas cancer (APC) after gemcitabine therapy on Cancer and Leukemia Group B (CALGB) study #80303. [Abstract] J Clin Oncol 25 (Suppl 18): A-4524, 2007.

Responsible Party: Monica M Bertagnolli, MD, Cancer and Leukemia Group B
ClinicalTrials.gov Identifier: NCT00088894     History of Changes
Other Study ID Numbers: CDR0000377542, U10CA031946, CALGB-80303, ECOG-80303
Study First Received: August 4, 2004
Last Updated: March 1, 2011
Health Authority: United States: Food and Drug Administration

Keywords provided by Cancer and Leukemia Group B:
adenocarcinoma of the pancreas
recurrent pancreatic cancer
stage II pancreatic cancer
stage III pancreatic cancer
stage IV pancreatic cancer

Additional relevant MeSH terms:
Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Endocrine Gland Neoplasms
Digestive System Diseases
Pancreatic Diseases
Endocrine System Diseases
Gemcitabine
Bevacizumab
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Antiviral Agents
Anti-Infective Agents
Enzyme Inhibitors
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Radiation-Sensitizing Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors

ClinicalTrials.gov processed this record on February 12, 2012