Phase II Trial Evaluating OS With Therasphere® + 2nd-Line FOLFOX in Pancreatic Liver Mets

• Number of Participants With Progression Free Survival (PFS) [ Time Frame: Average of 9 months ] [ Designated as safety issue: No ]
  PFS defined as the time from study enrollment to progression in the liver by modified Response Evaluation Criteria in Solid Tumors (RECIST) or death, whichever occurs first will be analyzed and summarized with the survival probabilities over time using Kaplan-Meier method. Confidence intervals for the median PFS rates at different time points will be constructed when appropriate.
• Overall Response Rate (ORR) [ Time Frame: Average of 9 months ] [ Designated as safety issue: No ]
  The overall response: ORR = complete response (CR) + partial response (PR). Rate will be summarized using both point estimates and exact confidence intervals based on the binomial distribution by groups.
• Number of Participants With Adverse events [ Time Frame: Average of 9 months ] [ Designated as safety issue: Yes ]
  Common Toxicity Criteria for Adverse Effects (CTCAE) v4 toxicity

• Number of Participants With Progression Free Survival (PFS) [ Time Frame: Average of 9 months ] [ Designated as safety issue: No ]
  PFS defined as the time from study enrollment to progression in the liver by modified RECIST or death, whichever occurs first will be analyzed and summarized with the survival probabilities over time using Kaplan-Meier method. Confidence intervals for the median PFS rates at different time points will be constructed when appropriate.
• Overall Response Rate (ORR) [ Time Frame: Average of 9 months ] [ Designated as safety issue: No ]
  The overall response (ORR = complete response [CR] + partial response [PR]) rate will be summarized using both point estimates and exact confidence intervals based on the binomial distribution by groups.
• Number of Participants With Adverse events [ Time Frame: Average of 9 months ] [ Designated as safety issue: Yes ]
  CTCAE v4 toxicity

The purpose of this study is to evaluate the safety and impact on survival with treatment with 90-Y glass microspheres in conjunction with leucovorin, 5-fluorouracil (5-FU) and oxaliplatin (FOLFOX) as second-line treatment with in patients gemcitabine-refractory metastatic pancreatic cancer with predominantly liver metastases.

• Liver Cancer
• Pancreatic Cancer

• Drug: FOLFOX7 (Folinic acid, 5-Fluorouracil, and Oxaliplatin)
  The usual treatment if gemcitabine chemotherapy has failed is chemotherapy with a drug combination called FOLFOX (folinic acid, 5-FU and oxaliplatin) given through a vein every 2 weeks for 6-10 cycles. Participants will receive this treatment.
  Other Names:

  • Leucovorin
  • LV
  • FOL
  • OX
  • 5-Fluorouracil (5-FU)
  • FOLFOX
  • ELOXATIN
• Device: TheraSpheres
  TheraSpheres are a medical device containing yttrium-90 (Y-90), a radioactive material that has been used previously in the treatment of liver tumors. Y-90 is incorporated into very tiny glass beads called microspheres and is injected into the liver through the blood vessels supplying the liver. TheraSpheres have restricted approval from the United States Food and Drug Administration (FDA) for the treatment of hepatocellular liver cancer; but has not yet been approved for the treatment of pancreatic cancer that has spread to the liver.
  Other Names:

  • radiotherapy
  • radioembolization

Inclusion Criteria:

• Patients must have metastatic pancreatic cancer with predominantly liver metastatic disease (> 50%), as determined by the principal investigator (PI0 and referring medical oncologist that have progressed on gemcitabine-based chemotherapy.
• Patients can have solitary, multifocal unilobar, or bilobar disease.
• Eastern Cooperative Oncology Group (ECOG) performance status of less than or equal to 2
• No prior radiation or embolization of the liver
• Childs-Pugh score ≤ 7
• Lung shunting that predicts lung dose to be ≤ 30 Gy in a single treatment
• The effects of TheraSpheres on the developing human fetus at the recommended therapeutic dose are unknown. For this reason and because radioactive spheres are known to be teratogenic, women of child-bearing potential and men 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. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
• Ability to understand and the willingness to sign a written informed consent document

• Adequate baseline hematopoietic function:

  • total white blood cell count equal to or greater than 3,000/mm^3
  • absolute granulocyte count greater than 1,500/mm^3
  • platelet count equal to or greater than 50,000/mm^3
  • Hemoglobin > 8.0

Exclusion Criteria:

• Patients currently receiving any other investigational agents
• Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Pregnant women are excluded from this study because TheraSpheres are radioactive and radiation is a known agent with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with TheraSpheres, breastfeeding should be discontinued if the mother is treated with TheraSpheres.
• Initiation of second-line chemotherapy not consisting of FOLFOX
• Patients with immune deficiency are at increased risk of lethal infections when treated with marrow-suppressive therapy. In addition, antiretrovirals are known radiation sensitizers and could dramatically increase the risk of fulminant hepatic failure. Therefore, human immunodeficiency virus(HIV)-positive patients are excluded from the study because of possible lethal side effects.
• Bulk disease (tumor volume > 70% of the target liver volume)
• Aspartic transaminase (AST) or alanine transaminase (ALT) > 5 times upper limit of normal (ULN)
• Bilirubin > 2 mg/dL
• Child-Pugh score > 7
• Tumor volume > 50% of liver combined with an albumin < 3 g/dL
• Complete occlusion of main portal vein causing portal hypertension