Gemcitabine+Nab-paclitaxel and FOLFIRINOX and Molecular Profiling for Patients With Advanced Pancreatic Cancer

This study is currently recruiting participants. (see Contacts and Locations)
Verified April 2014 by Pancreatic Cancer Research Team
Sponsor:
Information provided by (Responsible Party):
Pancreatic Cancer Research Team
ClinicalTrials.gov Identifier:
NCT01488552
First received: November 18, 2011
Last updated: April 3, 2014
Last verified: April 2014
  Purpose

The Investigators in the PCRT team have developed a therapeutic regimen which attacks both the tumor compartment and the stromal compartment of pancreatic cancer and induces complete responses in a small percentage of patients with advanced stage IV pancreatic cancer.


Condition Intervention Phase
Stage IV Pancreatic Cancer
Drug: Gemcitabine
Drug: nab-paclitaxel
Drug: FOLFIRINOX
Genetic: Immunohistochemistry (IHC) Analysis
Drug: Metformin
Drug: mFOLFIRI
Phase 1
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Phase II Study of Induction Consolidation and Maintenance Approach for Patients With Advanced Pancreatic Cancer

Resource links provided by NLM:


Further study details as provided by Pancreatic Cancer Research Team:

Primary Outcome Measures:
  • Complete Response Rate [ Time Frame: 1 yr. ] [ Designated as safety issue: No ]

    The primary objectives of this study are to relentlessly pursue treatment for 34 individual patients with Stage IV pancreatic cancer to obtain:

    • The complete response rate (as defined by a complete metabolomic response (CMR) of SUV normalization from baseline, OR a complete response on CT scan using a modified RECIST criteria and CA 19-9 (or CA 125, CEA, or PAM4 if not expressers of CA 19-9) down to normal limits (from at least > 2X ULN).



Secondary Outcome Measures:
  • One-Year Survival Endpoint [ Time Frame: 1 yr. ] [ Designated as safety issue: No ]

    A secondary objective of this study is to:

    Observe the percent of patients who are alive at one year (our goal is to obtain a >70% one year survival.)


  • Efficacy Endpoints using biomarkers [ Time Frame: 1 yr. ] [ Designated as safety issue: No ]

    A secondary objective of this study is to:

    Gather information on other possible efficacy endpoints (e.g. CA 19-9) and other serum/plasma tumor markers


  • Observing toxicity outcomes [ Time Frame: 1 yr. ] [ Designated as safety issue: Yes ]
    A secondary objective of this study is to document the toxicities noted in all patients, particularly with those who receive the FOLFIRINOX regimen. Grade 3-4 neutropenia is expected to be > 40% among those receiving FOLFIRINOX, so to minimize toxicity, all patients will receive prophylactic CGSF. In the first 9 patients receiving FOLFIRINOX, if the hospitalization rate due to toxicity is more than 50% (5 or more patients), then all subjects will have a dose reduction to level -1. The incidence of grade 3 and 4 toxicities and dose delays will also be considered for dose modification.


Estimated Enrollment: 61
Study Start Date: November 2011
Estimated Study Completion Date: August 2014
Estimated Primary Completion Date: May 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Gemcitabine & Abraxane Pancreatic Cancer
Gemcitabine+Nab-paclitaxel, FOLFIRINOX, Immunohistochemistry (IHC) Analysis, Metformin and Folfiri
Drug: Gemcitabine
1000 mg/m2 weekly on days 1,8, and 15 in a 28 day cycle. Part A: nab-paclitaxel/Gem for 6 cycles, followed by FOLFIRINOX for 6 cycles (31 patients); Part B: Alternate nab-paclitaxel/Gem with mFOLFIRI every 2 months for up to 1 year or 6 cycles of each regimen (30 patients).
Other Name: Gemzar
Drug: nab-paclitaxel
125 mg/m2 on days 1,8, and 15 of a 28 day cycle Part A: nab-paclitaxel/Gem for 6 cycles, followed by FOLFIRINOX for 6 cycles (31 patients); Part B: Alternate nab-paclitaxel/Gem with mFOLFIRI every 2 months for up to 1 year or 6 cycles of each regimen (30 patients).
Other Name: Abraxane
Drug: FOLFIRINOX

The combination below will be given on days 1 and 15 of a 28 day cycle; 5-Fluorouracil 2400 mg/m2 with a 46-hour continuous IV infusion; Leucovorin 400 mg/m2 over a 2 hour IV infusion;

Oxaliplatin 85 mg/m2 as a 2 hour IV infusion; Irinotecan 180 mg/m2 over a 90 minute IV infusion Part A: nab-paclitaxel/Gem for 6 cycles, followed by FOLFIRINOX for 6 cycles (31 patients); Part B: Alternate nab-paclitaxel/Gem with mFOLFIRI every 2 months for up to 1 year or 6 cycles of each regimen (30 patients).

Other Names:
  • 5-FU
  • Eloxitan
  • Campostar
Genetic: Immunohistochemistry (IHC) Analysis
Immunohistochemistry (IHC) Analysis will be performed on a fresh tissue biopsy of the tumor after chemotherapy has been administered. A targeted-based regimen will be determined from the results of the IHC analysis for the next therapy given to the patient in the maintenance phase of the study.
Drug: Metformin
Metformin 500 mg daily as a 24 hour extended release tablet will also be given as part of the maintenance phase of this study.
Other Name: Glucophage
Drug: mFOLFIRI
5-FU IV infusion, 2400 mg/m2 46h continuous infusion (no bolus 5-FU) treatments per month equaling 1 cycle Leucovorin 400 mg/m2 dl (over a 2 hour IV infusion) Irinotecan 180 mg/m2 dl (over a 90 minute IV infusion) Part A: nab-paclitaxel/Gem for 6 cycles, followed by FOLFIRINOX for 6 cycles (31 patients); Part B: Alternate nab-paclitaxel/Gem with mFOLFIRI every 2 months for up to 1 year or 6 cycles of each regimen (30 patients).
Other Name: mFOLFIRI

Detailed Description:

The investigators in the PCRT team have developed a therapeutic regimen which attacks both the tumor compartment and the stromal compartment of pancreatic cancer and induces complete responses in a small percentage of patients with advanced stage IV pancreatic cancer.

The gemcitabine + nab-paclitaxel regimen had outstanding activity in a 67 patient phase I/II trial with all patients at the recommended phase II doses (n=44) having a decrease in CA19-9, some complete responses and a median survival of 12.2 months. The proposed regimen that is devised for this study is a bold, innovative approach with the specific aim of utilizing a relentless pursuit approach to try to make the complete response rate >70% and have this response be durable (which the PCRT has defined as lasting at least 6 months) and to dramatically enhance the percent of patients who survive one year (try to make the rate >70%).

The induction regimen the investigators propose collapses the stroma (gemcitabine + nab-paclitaxel) and addresses the use of a non-cross resistant active regimen (FOLFIRINOX) as a consolidation regimen. Both should improve the chance of driving tumor markers down dramatically. The investigators think that FOLFIRINOX with the stromal collapse induced by the initial regimen, plus the totally non-cross resistant shot against the disease (consolidation), will maximize the chance of achieving a complete response with an attendant improvement in survival.

After the consolidation, the patient will be maintained on a less toxic targeted therapy selected by molecular profiling plus the use of the antimetabolomic agent metformin which has consistently been associated with better survival in multiple retrospective studies (Jiralerspong et al., 2009).

  Eligibility

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

Inclusion Criteria:

  • Histologically documented Stage IV metastatic adenocarcinoma of the pancreas with measurable disease
  • Performance status ECOG 0 or 1
  • Patients may not have received prior treatment for metastatic pancreatic adenocarcinoma except for receiving gemcitabine or 5FU as a radiosensitizer along with radiation therapy; or have received gemcitabine for adjuvant treatment if they have been off gemcitabine for > 12 months
  • Adult (>18 years of age) male or non-pregnant and non-lactating female
  • A negative serum pregnancy test (Beta-hCG) documented within 72 hours of the first administration of study drug in female patients of child-bearing potential
  • Agreement to use contraception considered adequate and appropriate by the investigator
  • The following blood counts at baseline:

    • ANC >/= 1.5 x 109/L
    • Hgb > 9g/dL
    • Platelets >100 x 109/L
  • The following blood chemistry levels at baseline:

    • AST and ALT </= 2.5 x upper limit of normal range (ULN) or < 5.0 ULN if liver metastasis are present
    • Bilirubin </= ULN
    • Serum creatinine within 1.5 x ULN
  • PT, INR within 1.5 x ULN unless on therapeutic doses of warfarin
  • Must have measurable disease outside the pancreas by RECIST criteria
  • No clinically significant abnormalities in urinalysis results
  • Voluntary agreement to participate in this study after being informed about the nature of the study including potential risks and benefits and having the ability to have questions addressed. The patient must sign and date the IRB approved Informed Consent Form (ICF) prior to participation in any study-related procedures

Exclusion Criteria:

  • Has pancreatic islet cell neoplasms
  • Is pregnant or lactating
  • Has active, uncontrolled bacterial, viral, or fungal infection(s) requiring systemic therapy
  • Known infection with HIV, Hepatitis B or Hepatitis C.
  • Patient with a history of interstitial lung disease, history of slowly progressive dyspnea and unproductive cough, sarcoidosis, silicosis, idiopathic pulmonary fibrosis, pulmonary hypersensitivity pneumonitis or multiple allergies (see section 4.4.9)
  • Has a serious medical risk factor(s) involving any of the major organ systems such that the investigator considers it unsafe for the patient to receive an experimental research drug.
  • Is unwilling or unable to comply with study procedures.
  • Is enrolled in any other investigational trial.

Caution of observation for interstitial pneumonitis in patients prior to enrollment:

Before enrollment, evaluate candidate patients fro familial, environmental or occupational exposure to opportunistic pathogens, and do not enroll those with a history of slowly progressive dyspnea and unproductive cough, or of conditions such as sarcoidosis, silicosis. idiopathic pulmonary fibrosis, pulmonary hypersensitivity pneumonitis or multiple allergies.

  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01488552

Contacts
Contact: Amy Stoll-D'Astice, MS, CCRP 602-358-8319 astoll@td2inc.com

Locations
United States, Arizona
TGen Clinical Research Services (TCRS) Recruiting
Scottsdale, Arizona, United States, 85258
Contact: Molly Downhour, RN, BSN, OCN    480-323-1357    mdownhour@shc.org   
Contact: Joyce Schaffer, RN, MSN, OCN    480-323-1339    joschaffer@shc.org   
Principal Investigator: Daniel D Von Hoff, MD         
United States, California
Disney Family Cancer Center Recruiting
Burbank, California, United States, 91505
Contact: Francisco Capilla    818-748-4797    Francisco.Capilla@providence.org   
Contact: Nikko Grubb    818 847 3219    nikko.grubb@providence.org   
Principal Investigator: Peter J. Rosen, M.D.         
Sub-Investigator: Peter Lee, MD         
United States, Minnesota
Virginia Piper Cancer Institute (VPCI) Recruiting
Minneapolis, Minnesota, United States, 55407
Contact: Lisa Albers    612-863-8716    Lisa.Albers@allina.com   
Principal Investigator: John E. Seng, M.D.         
United States, Washington
Virginia Mason Medical Center Recruiting
Seattle, Washington, United States, 98101
Contact: Allison Fortenberry, CCRC    206-342-6922    allison.fortenberry@vmmc.org   
Principal Investigator: Vincent Picozzi, MD         
Evergreen Hematology and Oncology Recruiting
Spokane, Washington, United States, 99218
Contact: Diane Davis, RN    509-464-2873    ddavis@evergreen4cure.com   
Contact: Melanie Matson, RN       mmatson@evergreen4cure.com   
Principal Investigator: Stephen P. Anthony, D.O         
Sponsors and Collaborators
Pancreatic Cancer Research Team
Investigators
Principal Investigator: Ramesh K Ramanathan, MD Translational Genomics Research Institute, Phoenix, Arizona.
  More Information

Additional Information:
Publications:
Responsible Party: Pancreatic Cancer Research Team
ClinicalTrials.gov Identifier: NCT01488552     History of Changes
Other Study ID Numbers: PCRT 11-002
Study First Received: November 18, 2011
Last Updated: April 3, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Pancreatic Cancer Research Team:
pancreatic cancer
pancreatic adenocarcinoma
Stage IV pancreatic cancer
pancreas
pancreatic

Additional relevant MeSH terms:
Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Endocrine Gland Neoplasms
Digestive System Diseases
Pancreatic Diseases
Endocrine System Diseases
Paclitaxel
Gemcitabine
Metformin
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Antimetabolites
Antiviral Agents
Anti-Infective Agents
Enzyme Inhibitors
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Radiation-Sensitizing Agents
Hypoglycemic Agents

ClinicalTrials.gov processed this record on September 30, 2014