Gemcitabine/Nab-Paclitaxel With HIGRT in Resectable Pancreatic Cancer

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT02318095
Recruitment Status : Recruiting
First Posted : December 17, 2014
Last Update Posted : January 9, 2018
Information provided by (Responsible Party):
Duke University

Brief Summary:
This research protocol will evaluate the feasibility of administering neoadjuvant gemcitabine and nab-paclitaxel with hypofractionated, image guided, intensity modulated radiotherapy (HIGRT) in resectable and borderline resectable pancreatic cancer

Condition or disease Intervention/treatment Phase
Resectable Pancreatic Cancers Drug: Gemcitabine/nab-Paclitaxel Radiation: Radiation therapy Other: Sugical resection Drug: Adjuvant chemotheapy Not Applicable

Detailed Description:

Pancreatic cancer is the fourth leading cause of cancer-related death in the United States and accounts for roughly 40,000 deaths each year. Despite the use of neoadjuvant and adjuvant therapies, little progress has been made in the the last three decades, and the search for more efficacious treatment continues.In patients with a good performance status the combination of effective systemic therapy with gemcitabine/nab-paclitaxel and high dose local radiotherapy may improve disease outcomes. This is a prospective, single arm study in patients in newly diagnosed, previously untreated pancreatic cancer who are planned to undergo surgical resection The primary objective of this study is to evaluate the toxicity of a neoadjuvant approach incorporating gemcitabine/nab-paclitaxel and Hypofractionated image guided intensity-modulated radiotherapy (HIGRT) prior to surgical resection. Eligible subjects will recieve standard neoadjuvant gemcitabine and nab-paclitaxel dosing is as follows:Nab-Paclitaxel (125mg/m2) days 1,8,15 every 28 days for 2 cycles Gemcitabine (1000mg/m2) days 1,8,15 every 28 days for 2 cycles followed by HIGRT and surgical resection.

Adjuvant chemotherapy may be given post surgery at the discretion of the treating medical oncologist.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Feasibility Study of Neoadjuvant Gemcitabine/Nab-Paclitaxel and Hypofractionated Image-Guided Intensity Modulated Radiotherapy in Resectable and Borderline Resectable Pancreatic Cancer
Actual Study Start Date : February 17, 2015
Estimated Primary Completion Date : January 2019
Estimated Study Completion Date : January 2020

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
This is a single arm prospective study. All eligible subjects will recieve 2 cycles of neoadjuvant Gemcitabine/nab-Paclitaxel, followed by hypofractionated radiation therapy followed by surgical resection. Subjects may receive adjuvant chemotherapy post surgical resection at the clinical discretion of the medical oncologist.
Drug: Gemcitabine/nab-Paclitaxel
Prospective, single arm study ; eligible subjects will recieve 2 cycles of neoadjuvant Gemcitabine/nab-Paclitaxel. Restaging will be completed post chemotherapy.

Radiation: Radiation therapy
5 fractions of hypofractionated IGRT or IMRT at 5Gy per fraction will be delivered before surgery. Restaging will be completed post radiation therapy.

Other: Sugical resection
Surgical resection of the pancreas post radiation therapy

Drug: Adjuvant chemotheapy
Adjuvant chemotherapy may be given after surgery at the clinical discretion of the medical oncologist

Primary Outcome Measures :
  1. Feasibility of neoadjuvant gemcitabine/nab-paclitaxel and HIGRT in patients with potentially resectable pancreatic cancer. [ Time Frame: 3 years ]
    The neoadjuvant regimen will be considered feasible if (a) the trial can accrue 25 patients in no more than 3 years and (b) if at least 18 of the 25 patients adhere to the neoadjuvant regimen.

Secondary Outcome Measures :
  1. Grade >/=2 acute toxicity [ Time Frame: Baseline to 60 days post surgery ]
    CTCAE version 4 will be used for all toxicity assessments. The acute toxicity rate, defined as any non-hematologic grade 2+ toxicity occurring during treatment through 60 days post-treatment, will be estimated with its exact 80% confidence interval. Likewise, we will determine the rate of grade 2+ hematologic toxicity occurring during treatment through 60 days post treatment and the proportion of patients requiring treatment breaks longer than 5 days.

  2. Resection rate [ Time Frame: Post surgery ]
    Patients who undergo surgical resection will be documented

  3. R0 resection rate [ Time Frame: 14-30 days post surgery ]
    Pathologic review will determine if an R0 resection has been performed.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patient has signed informed consent and is willing to comply with the protocol
  2. Histologically or cytologically proven adenocarcinoma of the pancreas (within the last 90 days)
  3. Either resectable or borderline resectable as determined on staging imaging (as defined by National Comprehensive Cancer Network [NCCN])
  4. Patient is 18 years or older
  5. Karnofsky performance status 70 or greater
  6. The ANC count ≥ 1500, the platelet count ≥ 100,000 and hemoglobin ≥ 9g/dL
  7. Laboratory values meet the following constraints: Bilirubin less than or equal to 2 mg/dL; AST and ALT less than or equal to 3 x ULN (stenting to improve biliary obstruction is permitted)
  8. No evidence of metastatic disease based on imaging of the chest, abdomen and pelvis.

Exclusion Criteria:

  1. Metastatic disease on pretreatment imaging
  2. Prior systemic therapy
  3. Prior abdominal radiation. Any prior radiation must be approved by the Radiation Oncology PI
  4. Previous treatment for pancreatic cancer
  5. Patients with any serious/poorly controlled medical or psychological conditions that would be exacerbated by treatment, would complicate protocol compliance
  6. Pregnant or lactating. Adequate birth control must be used if child bearing potential as outlined in the protocol. Negative pregnancy test in female patients of child-bearing potential per institutional policy . Post-menopausal women must have had amenorrhea for at least 18 months to be considered non-child bearing
  7. Clinically significant peripheral vascular disease
  8. Presence of active or chronic infection
  9. Clinically significant atherosclerotic cardiovascular disease including patients with New York Heart Class II/III/IV CHF, ventricular arrhythmias requiring medication, myocardial infarction, cerebrovascular accident, transient ischemic attack, coronary artery bypass grafting, angioplasty, cardiac or other vascular stenting within the past 6 months
  10. History of abdominal fistula, gastrointestinal perforation, intra-abdominal abscess within six months prior to treatment start
  11. History of collagen vascular disease or inflammatory bowel disease (Crohn's or ulcerative colitis)
  12. Current grade 2 or higher peripheral neuropathy
  13. Anticoagulation with warfarin
  14. History of arterial thromboembolic events or symptomatic pulmonary embolism within the past 6 months
  15. Active bleeding diathesis or history of major bleeding, CNS bleeding, or significant hemoptysis within the past 6 months

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): NCT02318095

Contact: Eileen Duffy, BNS OCN CCRP 919 6683726
Contact: Joan Cahill, BNS OCN CCRP 919 6685211

United States, North Carolina
Duke Cancer Center Recruiting
Durham, North Carolina, United States, 27710
Contact: Eileen Duffy, RN OCN    919-668-3726      
Contact: Joan Cahill, RN OCN    919-668-3726      
Sponsors and Collaborators
Duke University
Principal Investigator: Manisha Palta, MD Duke University Health System

Responsible Party: Duke University Identifier: NCT02318095     History of Changes
Other Study ID Numbers: Pro00058865
First Posted: December 17, 2014    Key Record Dates
Last Update Posted: January 9, 2018
Last Verified: January 2018

Keywords provided by Duke University:
Cancer of the pancreas

Additional relevant MeSH terms:
Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Endocrine Gland Neoplasms
Pancreatic Diseases
Digestive System Diseases
Endocrine System Diseases
Albumin-Bound Paclitaxel
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Antiviral Agents
Anti-Infective Agents
Enzyme Inhibitors
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs