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7 Day's of Erlotinib Neo-adjuvant, Followed by Adjuvant Erlotinib-gemcitabine in Pancreatic Cancer Patients

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00841035
Recruitment Status : Terminated (Sponsor stopped due to slow enrollment)
First Posted : February 11, 2009
Results First Posted : October 6, 2014
Last Update Posted : May 19, 2017
OSI Pharmaceuticals
Information provided by (Responsible Party):
Marty Heslin, University of Alabama at Birmingham

Brief Summary:

1.1 Primary Objective

To evaluate the effects of short course preoperative erlotinib treatment in a panel of predictive biomarkers from a group of patients who undergo resection of pancreatic adenocarcinoma with curative intent.

1.2 Secondary Objectives

1.2.1 To analyze the effects of short course preoperative erlotinib treatment followed by postoperative erlotinib-gemcitabine therapy in the disease-free survival of patients who undergo curative intent resection of pancreatic adenocarcinoma.

1.2.2 To evaluate secondary endpoints of disease response such as duration of overall survival and patterns of recurrence for patients with resectable pancreatic cancer who undergo this treatment regimen.

1.2.3 To evaluate the plasma pharmacokinetics of erlotinib in pancreatic cancer patients both in the preoperative and postoperative setting, and to explore correlations between plasma and tumor erlotinib concentrations.

1.2.4 To develop a clinically relevant predictive assay of response to erlotinib based on selected biomarkers in endoscopic ultrasound-fine needle aspiration (EUS-FNA) specimens when it can be obtained at the time of pancreatic cancer diagnosis in chemotherapy-naive patients.

Condition or disease Intervention/treatment Phase
Pancreatic Cancer Drug: erlotinib Phase 2

Detailed Description:

Our current clinical trial proposal includes a short course of pre-operative, single agent erlotinib followed by post-operative erlotinib-gemcitabine in a neo-adjuvant/adjuvant approach to the treatment of patients with resectable pancreatic adenocarcinoma. The short course pre-operative erlotinib treatment serves two objectives: 1) erlotinib, through its cytostatic effects, may hinder the ability of tumor cells to metastasize at the time of surgical resection with minimal toxic effects and no delay in surgical treatment; 2) the true effects of erlotinib on potential determinants of response can be best assayed on the pancreatic cancer itself since no other model can better resemble the patients authentic tumor microenvironment. The post-operative treatment component of the protocol attempts to improve the demonstrated effects of gemcitabine by adding erlotinib in the adjuvant setting, a drug combination that, as mentioned, has already been proven to be advantageous for patients with advanced pancreatic cancer.

Traditionally, chemotherapy for cancer has been conducted in an empiric fashion by first selecting a regimen based on clinical trial evidence and clinical parameters, and then by assessing the objective response to that regimen employing clinical and radiographic imaging means. This approach suffers from many disadvantages, most conspicuously the inability to select the better patient candidates prior to the initiation of therapy, thus sparing the risk and expense of ineffective treatment for patients who are unlikely to respond. Since pancreatic cancer expression of EGFR protein by itself is not predictive of therapeutic response, alternative methods of patient selection seem to be essential for the success of EGFR-targeted treatment. The understanding of EGFR molecular signaling has allowed the drug development process to shift from an empiric random screening approach to a more rational and mechanistic, target-directed approach. Among multiple attempts to identify molecular determinants of tumor cell sensitivity to EGFR inhibitors, there are two main paradigms that stand out: 1) activation of downstream pharmacodynamic effectors associated with response to the drug (i.e. phosphorylation of Akt or extracellular signal-regulated kinase (ERK); expression of c-fos), and 2) prediction of sensitivity based on a "static" analyte (detection of epidermal growth factor receptor (EGFR) sensitizing mutations; epithelial-mesenchymal transition profile). However, given the complexity of factors governing pancreatic cancer response to erlotinib, the biologic heterogeneity of malignant phenotype, and overall relatively low response rates, we believe that it is unlikely that analysis of a single biomarker will be useful for patient selection. A comprehensive analysis of a dynamic panel of biomarkers relevant to EGFR signaling and erlotinib mechanism of action seems more useful in that sense. Furthermore, the limited ability of pancreatic cancer tissue sampling often precludes biomarker correlation to assays worked out in xenograft models or in-vitro conditions.

The translational rationale of this proposal is therefore to develop predictive chemotherapy sensitivity-resistance assays (CSRA) for pancreas carcinoma patients treated with erlotinib and gemcitabine. This will represent a major advance, because the CSRA would enable prediction of clinical response prior to initiation of therapy.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 6 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: University of Alabama at Birmingham(UAB 0808), A Phase II Study of Short-course Preoperative Erlotinib Followed by Post-operative Erlotinib-gemcitabine in Patients With Resectable Pancreatic Adenocarcinoma
Study Start Date : February 2009
Actual Primary Completion Date : July 2011
Actual Study Completion Date : July 2011

Arm Intervention/treatment
Experimental: Eroltinib added to standard of care
150 mg of erlotinib for 7 days prior to surgery,then in the adjuvant stage the subject will receive 100mg of erlotinib and gemcitabine 1000mg/2 for 6 cycles
Drug: erlotinib
Preoperative dosing of 150 mg oral erlotinib for 7 days before surgery. followed by erlotinib 100 mg daily 6 month/6 chemotherapy cycles. Gemcitabine 1000 m2 weekly after surgery for 6 cycles.
Other Name: Tarceva

Primary Outcome Measures :
  1. Epidermal Growth Factor Receptor Signaling(EGFR) in the Presence of Pancreatic Tumor Related to the Mechanism to Erlotinib. [ Time Frame: During the trial only ]
    It was our belief that we would need a comprehensive analysis of a dynamic panel of biomarkers relevant to EGFR signaling as well as the erlotinib mechanism of action it seems more useful in that sense. Furthermore,the ability limited of pancreatic cancer tissue sampling precluded biomarker correlation assays.These could not be worked out in either a xenograft model or in in-vitro conditions.

Secondary Outcome Measures :
  1. The Secondary Objectives Include Analysis of Recurrence-free and Overall Survival and the Development of a Predictive Assay for Response to Erlotinib Based on Selected Bio-markers in Endoscopic Ultrasound-Fine-needle Aspiration Specimens. [ Time Frame: End of the study ]
    The measurement was to be the average length of time before recurrence of disease and the overall survival time. As well as time from recurrence to death in subjects.This time will be measure in months till recurrence and them months to death.

Information from the National Library of Medicine

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Ages Eligible for Study:   19 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

.Histologic or cytologic confirmation of pancreatic ductal adenocarcinoma.

  • Pancreatic cancer must be surgically resectable: a) no evidence of distant metastasis; b) clear fat plane around the celiac and superior mesenteric arteries; c) patent portal and superior mesenteric veins
  • No evidence of post-resection distant metastasis
  • Pathologic confirmation of R0/R1 status following surgical resection
  • Age ≥ 19 years
  • Male or female gender (not pregnant or lactating). If the subject is fertile, use of medically acceptable contraception will be required.
  • Patient should be able to understand and offer signed written informed consent prior to study entry.
  • No prior receipt of chemotherapy or radiotherapy
  • Patients must demonstrate a Eastern Cooperative Oncology Group(ECOG) P.S. of 0 or 1
  • End Organ function must be adequate meeting the below criteria at baseline:

White Blood Cell Count (WBC)> 3000/mm3, absolute neutrophil count(ANC)> 1500/mm3, Platelets>100,000mm3 Calculated creatinine clearance >50 ml/min, normal serum creatinine (mg/dL) (if calculated Crcl <50 ml/min, Crcl should measured and be > 50 ml/min) Bilirubin <3.0 mg/dL (patients with obstructive jaundice require preoperative endoscopic biliary stenting if total bilirubin >3.0 mg/dl) prothrombin time(PT) /partial thromboplastin time(PTT) below the upper limit of normal

Exclusion Criteria:

  • Diagnosis of active (treated in past 5 years) concomitant malignancy with exception of non-melanotic skin cancer
  • Transplant patients or patients receiving immunosuppression
  • Presence of an underlying disease state associated with active bleeding or a past medical history of coagulopathy
  • New York Heart Association Class IV congestive heart failure
  • Limited mental capacity or language skills to the extent simple instructions cannot be followed or information regarding adverse events cannot be provided
  • History of non-compliance with prescribed medical care

Post-Operative Phase Inclusion

  • No Evidence of Post-Resection Distant Metastasis
  • Pathological confirmation of R0/R1 status following Surgical resection
  • Patient must demonstrate a post-operative performance status of 0 or 1.
  • End Organ function must be adequate, meeting the below criteria at baseline:

    1. WBC > 3000/mm³,ANC > 1500/mm³, Platelets > 100,000 mm³
    2. Calculated Creatinine Clearance > 50 ml/min,Serum Creatinine < 1.5 mg/dl
    3. Bilirubin < 3.0 mg/dl; aspartate aminotransferase(AST) and alanine aminotransferase (ALT) < 3 x normal value
    4. PT/PTT/international normalized ratio(INR) within normal Limits.


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00841035

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United States, Alabama
University of Alabama at Birmingham,Comprehensive Cancer Center
Birmingham, Alabama, United States, 35294-0016
Sponsors and Collaborators
University of Alabama at Birmingham
OSI Pharmaceuticals
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Principal Investigator: Juan P Arnoletti, M.D. University of Alabama at Birmingham
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Responsible Party: Marty Heslin, Chief of section of Surgical Oncology, University of Alabama at Birmingham Identifier: NCT00841035    
Other Study ID Numbers: F080718006
First Posted: February 11, 2009    Key Record Dates
Results First Posted: October 6, 2014
Last Update Posted: May 19, 2017
Last Verified: April 2017
Keywords provided by Marty Heslin, University of Alabama at Birmingham:
Additional relevant MeSH terms:
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Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Endocrine Gland Neoplasms
Pancreatic Diseases
Digestive System Diseases
Endocrine System Diseases
Erlotinib Hydrochloride
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action