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OXIRI [Oxaliplatin (O), Xeloda (X) and Irinotecan (I)] in Pancreatic Adenocarcinoma (OXIRI)

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: NCT02368860
Recruitment Status : Recruiting
First Posted : February 23, 2015
Last Update Posted : May 3, 2019
National Medical Research Council (NMRC), Singapore
Information provided by (Responsible Party):
National Cancer Centre, Singapore

Brief Summary:
This is an exploratory Phase I study is to assess the safety and tolerability of the OXIRI regimen [oxaliplatin (O), xeloda (X) and irinotecan (I)] and to evaluate for preliminary evidence of efficacy, in patients with advanced and/or metastatic pancreatic adenocarcinoma. The investigators hypothesize that 2 of 3 weekly doses of oxaliplatin and genotype directed-dosing of irinotecan in combination with chronomodulated capecitabine (xeloda) administered continuously will be more tolerable than the FOLFIRINOX regimen (folinic acid, fluorouracil, irinotecan and oxaliplatin) while maintaining anti-tumour activity.

Condition or disease Intervention/treatment Phase
Pancreatic Cancer Drug: oxaliplatin, irinotecan, capecitabine Phase 1

Detailed Description:

This study comprises a dose escalation phase using 3+3 design to determine the safety, tolerability and pharmacokinetics of the OXIRI regimen and an expansion phase to further evaluate the MTD and to determine early signs of efficacy.

Eligible patients will receive a novel chemotherapeutic regimen (OXIRI regimen) with xeloda being administered in a chronomodulated fashion and the dose of irinotecan being guided by the UGT1A1*28 and UGT1A1*6 genotype status of the patient.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 90 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase I Trial of OXIRI [Oxaliplatin (O), Xeloda (X) and Irinotecan (I)] Treatment in Patients With Advanced and/or Metastatic Pancreatic Adenocarcinoma
Study Start Date : September 17, 2013
Estimated Primary Completion Date : December 2019
Estimated Study Completion Date : December 2019

Arm Intervention/treatment
Experimental: OXIRI
OXIRI regimen: oxaliplatin, irinotecan, capecitabine
Drug: oxaliplatin, irinotecan, capecitabine
fixed doses of intravenous oxaliplatin 50 mg/m2, and intravenous irinotecan administered on days 1 and 8 in a 21 day-cycle while xeloda will be administered daily at around midnight from day 1 to day 14
Other Name: Eloxatin, Camptosar, CPT-11, Xeloda

Primary Outcome Measures :
  1. Safety and tolerability of the OXIRI regimen as measured by the frequency of significant adverse events incurred by the participants, using CTCAE ver. 4 grading system [ Time Frame: from first dose to 30 days after last dose ]
    The safety and tolerability of the regimen will be assessed when the patient is on treatment and till 30 days after treatment.

Secondary Outcome Measures :
  1. Maximum tolerated dose (MTD) of capecitabine when administered in a continuous chronomodulated fashion with genotype-directed dosing of irinotecan and metronomic dosing of oxaliplatin, using a conventional 3+3 design [ Time Frame: 2 years ]
  2. Recommended Phase II dose (RP2D) of the OXIRI regimen which is the MTD [ Time Frame: 2 years ]
  3. Pharmacokinetics analysis of capecitabine [ Time Frame: cycle 1 day 1 ]
    Plasma level of capecitabine, its intermediary metabolites (5'-deoxy-5-fluorocytidine [DFCR] and 5'- deoxy-5- fluorouridine [DFUR]) and 5FU will be measured at multiple time points on C1D1

  4. Pharmacokinetics analysis of Irinotecan [ Time Frame: cycle 1 day 1 ]
    Plasma level of Irinotecan, SN-38 (active metabolite of irinotecan) and SN-38G will be measured at multiple time points on C1D1

  5. Efficacy of OXIRI as measured by response evaluation criteria in solid tumours (RECIST) version 1.1 [ Time Frame: 3 years ]

Other Outcome Measures:
  1. Circulating tumour cells (CTCs) analysis [ Time Frame: at pre-treatment, Day 1 of each cycle and during response evaluation by imaging ]
    CTC characterization, and the changes of CTCs number and their relationship to changes in serum CA19-9 levels, tumour response on imaging etc. will be analysed.

Information from the National Library of Medicine

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, Learn About Clinical Studies.

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Ages Eligible for Study:   21 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Patients between 21 to 75 years of age
  2. A histopathologically or cytological confirmed diagnosis of locally advanced and/or metastatic PDAC that is unresectable
  3. Measurable disease as per Response Evaluation Criteria in Solid Tumors (RECIST) ver 1.1 criteria
  4. Life expectancy of at least 12 weeks
  5. Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2
  6. Adequate hematologic function (neutrophils count ≥ 1.5 × 109/L, platelet count ≥ 100 × 109/L)
  7. Adequate hepatic function (total bilirubin ≤ 1.5 x the upper limits of normal (ULN), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3 x ULN
  8. Adequate renal function (calculated creatinine clearance > 50 mL/min)
  9. Able to give informed consent
  10. Toxicity related to previous radiotherapy or chemotherapy resolved to ≤ Grade 1

Exclusion Criteria:

  1. History of prior malignancy except non-melanoma skin cancer within the last 5yrs
  2. Uncontrolled central nervous system (CNS) metastases or carcinomatous meningitis
  3. Uncontrolled concomitant medical illnesses (e.g. hypertension, myocardial infarct, heart failure, ventricular arrhythmia, diabetes, severe infection)
  4. Major surgery within four weeks prior to study treatment
  5. Patients on chronic immunosuppressive therapy
  6. Pregnant or breast-feeding female patients
  7. On anticoagulant therapy with vitamin K antagonists.
  8. Dose-escalation cohort:

    • Patients homozygous for uridine diphosphate glucuronosyltransferase (UGT)1A1*6/*6 or UGT1A1*28/*28
    • Previous oxaliplatin or irinotecan chemotherapy
    • Treatment with any of the following anti-cancer therapies prior to the first dose of OXIRI within the stated timeframes

      • Cyclical chemotherapy within a period of time that is shorter than the cycle length used for that treatment. Exception for weekly chemotherapy regimens, where a minimum of 2 week washout from the last dose is required.
      • Biological therapy (e.g., antibodies) within a period of time that is ≤ 5 t1/2 or ≤ 4 weeks, whichever is shorter, prior to starting study drug
      • Continuous or intermittent small molecule therapeutics within a period of time that is ≤ 5 t1/2 or ≤ 4 weeks (whichever is shorter) prior to starting study drug
      • Any other investigational agents within a period of time that is ≤ 5 t1/2 or less than the cycle length used for that treatment or ≤ 4 weeks (whichever is shortest) prior to starting study drug
      • Wide field radiotherapy ≤ 4 weeks or limited field radiation for palliation ≤ 2 weeks prior to starting study drug
  9. Dose-expansion cohort:

    • Previous chemotherapy or radiotherapy

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): NCT02368860

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Contact: Yvonne Chang 64368447
Contact: Matthew CH Ng, Dr 64368000

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National Cancer Centre Recruiting
Singapore, Singapore, 169610
Contact: Lanying Wang    64368267   
Sponsors and Collaborators
National Cancer Centre, Singapore
National Medical Research Council (NMRC), Singapore
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Principal Investigator: Matthew CH Ng, Dr National Cancer Centre, Singapore

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Responsible Party: National Cancer Centre, Singapore Identifier: NCT02368860    
Other Study ID Numbers: NCC-13-01
First Posted: February 23, 2015    Key Record Dates
Last Update Posted: May 3, 2019
Last Verified: May 2019
Additional relevant MeSH terms:
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Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Topoisomerase I Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors