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First Line Metastatic Pancreatic Cancer : 5FU/LV+Nal-IRI, Gemcitabine+Nab-paclitaxel or a Sequential Regimen of 2 Months 5FU/LV+Nal-IRI (FUNGEMAX)

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ClinicalTrials.gov Identifier: NCT03693677
Recruitment Status : Recruiting
First Posted : October 3, 2018
Last Update Posted : July 19, 2019
Sponsor:
Information provided by (Responsible Party):
Federation Francophone de Cancerologie Digestive

Brief Summary:

In Europe, pancreatic cancer (PC) is the 7th most common cancer and the 5th leading cause of cancer death in Europe. Each year, the number of deaths due to prostate cancer is almost as high as the number of new cases diagnosed reflecting the poor prognosis associated with this disease. PC is insidious and is often diagnosed late. Despite advances in the management of other more common gastrointestinal cancers, the treatment of PC has had few benefits inherent in recent advances in digestive oncology. Gemcitabine has thus remained the reference treatment for more than 10 years.

Recent studies have shown that gemcitabine/Nab-paclitaxel combination therapy is more effective in PC than gemcitabine-based therapy alone. In addition, multidrug therapy approaches (Irinotecan-5FU/LV) have also emerged to avoid the emergence of resistance to treatments while limiting toxicities. The recently developed Nal-IRI has also shown interesting efficacy in patients with metastatic PC previously treated with gemcitabine, with improved overall survival median and limited toxicity. Based on this information, the NAPOLI trial was conducted in patients with second line PC comparing the efficacy of Nal-IRI/5FU/LV or Nal-IRI and 5FU/LV alone; in this key study, the combination Nal-IRI/5FU/LV treatment was more effective than monotherapies (Nal-IRI or 5FU/LV alone).

Based on all these data, a Phase II trial testing the standard of care gemcitabine/nab-paclitaxel vs Nal-IRI/5FU/LV vs Nal-IRI/5FU/LV 2-months sequential regimen followed by gemcitabine/nab-paclitaxel will be performed. This will allow us to i) know the tolerance and efficacy of Nal-IRI/5FU/LV in the first line of treatment, ii) test a new sequential strategy with Nal-IRI but also iii) compare our results in the experimental arms with one of the two world standard therapeutic regimens: gemcitabine + nab-Paclitaxel. All this in order to improve the management of patients with PC from the first line of treatment.


Condition or disease Intervention/treatment Phase
Metastatic Pancreatic Cancer Drug: Irinotecan Liposomal Injection Drug: 5-FU/LV Drug: Nab-Paclitaxel Drug: Gemcitabine Phase 2

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 288 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Randomized Phase II Study Comparing 5FU/LV+Nal-IRI, Gemcitabine+Nab-paclitaxel or a Sequential Regimen of 2 Months 5FU/LV+Nal-IRI Followed by Two Months of Gemcitabine+Nab-paclitaxel, in Metastatic Pancreatic Cancer
Actual Study Start Date : November 16, 2018
Estimated Primary Completion Date : December 2022
Estimated Study Completion Date : December 2024


Arm Intervention/treatment
Experimental: Nal-IRI/5-FU/LV + Nab-paclitaxel/Gemcitabine alternatively

Nal-IRI plus 5-FU/LV and Nab-Paclitaxel plus Gemcitabine alternately every two months

  • Nal-IRI at 80 mg/m2 IV over 90 minutes followed by folinic acid (leucovorin 400 mg/m2 IV, or Elvorin 200 mg/m2 IV over 30 minutes) then by 5-FU 2400 mg/m2 IV over 46-hours, every 2 weeks.
  • Nab-Paclitaxel + Gemcitabine (6 injections, one injection three weeks out of four; so ≈ 2 months per cycle)

Day 1 (D1): Nab-Paclitaxel plus Gemcitabine at the dose of :

  • Gemcitabine: 1000 mg/m² in 500 ml normal saline infusion at a fixed dose rate of 10 mg/m²/min (i.e. 100 min).
  • Nab-Paclitaxel: 125 mg/m2 This treatment is administered at D1, D8, D15 and at D29, D36, D43.
Drug: Irinotecan Liposomal Injection
Nal-IRI at 80 mg/m2 IV over 90 minutes
Other Name: Nal-IRI

Drug: 5-FU/LV
5-FU 2400 mg/m2 IV over 46-hours, every 2 weeks.

Drug: Nab-Paclitaxel
Nab-Paclitaxel: 125 mg/m2 This treatment is administered at D1, D8, D15 and at D29, D36, D43.

Drug: Gemcitabine
1000 mg/m² in 500 ml normal saline infusion at a fixed dose rate of 10 mg/m²/min (i.e. 100 min). This treatment is administered at D1, D8, D15 and at D29, D36, D43.

Experimental: Nal-IRI/5-FU/LV
Nal-IRI plus 5-FU/LV Nal-IRI at 80 mg/m2 IV over 90 minutes followed by folinic acid (leucovorin 400 mg/m2 IV, or Elvorin 200 mg/m2 IV over 30 minutes) then by 5-FU 2400 mg/m2 IV over 46-hours, every 2 weeks.
Drug: Irinotecan Liposomal Injection
Nal-IRI at 80 mg/m2 IV over 90 minutes
Other Name: Nal-IRI

Drug: 5-FU/LV
5-FU 2400 mg/m2 IV over 46-hours, every 2 weeks.

Active Comparator: Nab-paclitaxel/Gemcitabine

Nab-Paclitaxel plus Gemcitabine Nab-Paclitaxel + Gemcitabine (6 courses, one course three weeks out of four; so ≈ 2 months per cycle)

Day 1 (D1): Nab-Paclitaxel + Gemcitabine at the dose of :

  • Gemcitabine: 1000 mg/m² in 500 ml normal saline infusion at a fixed dose rate of 10 mg/m²/min (i.e. 100 min).
  • Nab-Paclitaxel: 125 mg/m2 This treatment is administered at D1, D8, D15 and at D29, D36, D43.
Drug: Nab-Paclitaxel
Nab-Paclitaxel: 125 mg/m2 This treatment is administered at D1, D8, D15 and at D29, D36, D43.

Drug: Gemcitabine
1000 mg/m² in 500 ml normal saline infusion at a fixed dose rate of 10 mg/m²/min (i.e. 100 min). This treatment is administered at D1, D8, D15 and at D29, D36, D43.




Primary Outcome Measures :
  1. The progression free survival at 6 months according to the RECIST 1.1 criteria [ Time Frame: 6 months ]
    PFS is defined as the time between the date of randomization and the date of the first radiological and/or clinical progression or the date of death (for whatever reason). Patients living without progression will be censured at date of last news. Progression is assessed by investigator and central review according to RECIST v1.1 criteria.


Secondary Outcome Measures :
  1. Progression free survival at 6 months (according to central review) [ Time Frame: 6 months ]
    PFS is defined as the time between the date of randomization and the date of the first radiological and/or clinical progression or the date of death (for whatever reason). Patients living without progression will be censured at date of last news. Progression is assessed by investigator and central review according to RECIST v1.1 criteria.

  2. Best objective response rate [ Time Frame: An average of 1 year ]
    BOR is defined as complete or partial response rate according to scans and RECIST v1.1 criteria over the entire treatment period.

  3. Overall survival [ Time Frame: 2 years ]
    OS is defined as the time between the date of randomization and the date of death (whatever the cause). Alive patients will be censured at date of last news.

  4. Time to treatment failure [ Time Frame: An average of 1 year ]
    Time to treatment failure is defined as the time between the date of randomization and the date of discontinuation of all protocol treatments (regardless of cause) or date last news for patients alive under treatment.

  5. Treatment safety [ Time Frame: An average of 1 year ]
    Toxicities are evaluated according to NCI-CTC v4.0.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Histopathologically or cytologically proven pancreatic adenocarcinoma (on primitive or metastatic lesion)
  • Metastatic disease at a distance
  • At least one measurable lesion according RECIST v1.1 criteria
  • 18 ≤ age ≤ 75 years
  • Life expectancy >12 weeks
  • Performance status WHO < 2
  • No prior chemotherapy : adjuvant chemotherapy by gemcitabine +/- capecitabine is allowed if ended at least 12 months before the inclusion and adjuvant or neo-adjuvant FOLRIFINOX chemotherapy is allowed if ended at least 12 months prior the inclusion
  • Pain well controlled before the inclusion of the patient
  • ANC ≥ 1,500 cells/μL (without the use of hematopoietic growth factors); platelet count ≥ 100,000 cells/μL, hemoglobin ≥ 9 g/dL (blood transfusions is permitted for patients with hemoglobin levels below 9 g/dL)
  • Adequate hepatic function as evidenced by: Serum total bilirubin within normal range for the institution (Serum bilirubin ≤ 1,5 UNL) Biliary drainage allowed for biliary obstruction.
  • Albumin levels ≥ 3.0 g/dL
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 x ULN (≤ 5 x ULN acceptable if liver metastases were present)
  • Normal renal function test (creatinine clearance ≥ 50 ml/min)
  • Normal ECG or ECG without any clinically significant findings
  • Patient able to understand and sign an informed consent
  • Females of child-bearing potential are required to test negative for pregnancy at the time of enrollment based on a urine or serum pregnancy test.
  • Both male and female patients of reproductive potential were required to agree to use a reliable method of birth control, during the study and for 3 months following the last dose of study drug.
  • Patient affiliated to social security
  • Regular follow-up possible

Exclusion Criteria:

  • Uncontrolled brain or meningeal metastasis, or bone metastasis (no need of systematic CT scan)
  • Prior radiation therapy (except if there is at least one measurable target outside irradiation area)
  • Clinically significant gastrointestinal disorder including hepatic disorders, bleeding, inflammation, occlusion, or diarrhea > Grade 1
  • History of chronic inflammatory bowel disease
  • Other types of pancreatic tumours, in particular endocrine or acinar cell tumours
  • Ampulloma
  • Gilbert's syndrome
  • Presence of neuropathy > grade 1 according to NCI-CTC
  • History of any second malignancy in the last 5 years; subjects with prior history of in-situ cancer or basal or squamous cell skin cancer are eligible. Subjects with other malignancies are eligible if they had been continuously disease free for at least 5 years.
  • Severe arterial thromboembolic events (myocardial infarction, unstable angina pectoris, stroke) less than 6 months before inclusion.
  • NYHA Class III or IV congestive heart failure, ventricular arrhythmias or uncontrolled blood pressure.
  • Known hypersensitivity to any of the drugs /constituents or non-liposomal irinotecan
  • Any other medical or social condition deemed by the investigator to be likely to interfere with a patient's ability to sign informed consent, cooperate and participate in the study, or interferes with the interpretation of the results.
  • Use of CYP3A4/UGT1A inducers/inhibitors
  • Use of strong CYP2C8 inhibitors or inducers, or presence of any other contraindications for nab-paclitaxel or gemcitabine
  • ILD presence
  • Pregnant or breast feeding

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 ClinicalTrials.gov identifier (NCT number): NCT03693677


Contacts
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Contact: Daniel Gonzalez +33 3.80.39.34.83 daniel.gonzalez@u-bourgogne.fr

Locations
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France
Clinique privée de l'Europe Recruiting
Amiens, France, 80000
Contact: Khadija KALAI    06 34 28 87 82    kalai_khadija@yahoo.fr ; khadija.kalai@cthe-amiens.fr   
Contact    03 60 12 76 78      
Principal Investigator: Khadija KALAI         
CHU Hôtel Dieu Recruiting
Angers, France, 49000
Contact: Carole VITELLIUS    06 30 40 76 99    carole.vitellius@chu-angers.fr   
Contact    02 41 35 62 90      
Principal Investigator: Carole VITELLIUS         
Sub-Investigator: François-Xavier CAROLI-BOSC         
Sub-Investigator: Dominique LUET         
Sub-Investigator: Guillaume ROQUIN         
Sub-Investigator: Nathalie BAIZE         
Hôpital privé Recruiting
Antony, France, 92160
Contact: Anne THIROT BIDAULT    06 81 96 85 57    a.t.bidault@gmail.com   
Contact    01 46 74 41 73      
Principal Investigator: Anne THIROT BIDAULT         
CH Recruiting
Auxerre, France, 89000
Contact: Anne-Laure VILLING    03 86 48 47 65    alvilling@ch-auxerre.fr   
Principal Investigator: Anne-Laure VILLING         
Sub-Investigator: Adina MARTI         
CH de la Côte Basque Recruiting
Bayonne, France, 64100
Contact: Franck AUDEMAR    05 59 44 37 22    faudemar@ch-cotebasque.fr   
Principal Investigator: Franck AUDEMAR         
Sub-Investigator: Tam KHUONG HUU         
Sub-Investigator: Anne GUILNGAR         
Sub-Investigator: Félix GOUTORBE         
CHU Avicenne Recruiting
Bobigny, France, 93022
Contact: Florence MARY    06 61 57 14 04    florence.mary@aphp.fr   
Contact    01 48 95 54 34      
Principal Investigator: Florence MARY         
Sub-Investigator: Pierre ROMPTEAUX         
Sub-Investigator: Nils STEUER         
Sub-Investigator: Jean-Marc SABATE         
CH Duchenne Recruiting
Boulogne-sur-Mer, France, 62200
Contact: Vincent BOURGEOIS    06 84 88 43 37    vincebourgeois@hotmail.com   
Contact    03 21 99 32 41      
Principal Investigator: Vincent BOURGEOIS         
Sub-Investigator: Claire CAPELLE         
Sub-Investigator: Karine BERNOU DRON         
Hôpital Privé Sainte Marie Recruiting
Chalon-sur-Saône, France, 71100
Contact: Adrien MELIS    03 85 48 89 89    melisadrien@yahoo.fr   
Principal Investigator: Adrien MELIS         
CHU Estaing Recruiting
Clermont-Ferrand, France, 63000
Contact: Caroline PETORIN    04 73 75 05 08    cpetorin@chu-clermontferrand.fr   
Principal Investigator: Caroline PETORIN         
Sub-Investigator: Emmanuel BUC         
Sub-Investigator: Denis PEZET         
Sub-Investigator: Agnès VIMAL-BAGUET         
Hopitaux civils de Colmar Recruiting
Colmar, France, 68026
Contact: Gilles BREYSACHER    06 82 04 27 96    gilles.breysacher@ch-colmar.fr   
Contact    03 89 12 51 23      
Principal Investigator: Gilles BREYSACHER         
Sub-Investigator: Amalia TOPOLSCKI         
Sub-Investigator: Marion BOLLIET         
CH Sud Francilien Recruiting
Corbeil-Essonnes, France, 91100
Contact: Samy LOUAFI    06 62 08 48 89    samy.louafi@chsf.fr   
Principal Investigator: Samy LOUAFI         
Centre GF Leclerc Recruiting
Dijon, France, 21000
Contact: Leila BENGRINE LEFEVRE    03 80 73 75 06    lbengrine@cgfl.fr   
Principal Investigator: Leila BENGRINE LEFEVRE         
Sub-Investigator: François GHIRINGHELLI         
Sub-Investigator: Julie VINCENT         
Sub-Investigator: Audrey HENNEQUIN         
CHU Recruiting
Dijon, France, 21000
Contact: Antoine DROUILLARD    03 80 29 37 50    antoine.drouillard@chu-dijon.fr   
Principal Investigator: Antoine DROUILLARD         
Sub-Investigator: Côme LEPAGE, PR         
Sub-Investigator: Sylvain MANFREDI, PR         
Sub-Investigator: Jean-Louis JOUVE         
Sub-Investigator: Alice GAGNAIRE         
Institut de cancérologie de Bourgogne Recruiting
Dijon, France, 21000
Contact: Ariane DARUT-JOUVE    03 80 67 30 10    ariane.jouve@orange.fr   
Principal Investigator: Ariane DARUT-JOUVE         
Sub-Investigator: Geneviève BOILLEAU-JOLIMOY         
Hôpital Emile Roux Recruiting
Le Puy-en-Velay, France, 43000
Contact: Kheir Eddine BENMAMMAR    04 71 04 33 36    kheireddine.benmammar@ch-lepuy.fr   
Principal Investigator: Kheir Eddine BENMAMMAR         
CH Docteur Schaffner Recruiting
Lens, France, 62218
Contact: Fabienne WATELLE    03 21 69 16 74    fwatelle@ch-lens.fr   
Principal Investigator: Fabienne WATELLE         
CHU Dupuytren Recruiting
Limoges, France, 87000
Contact: Frédéric THUILLIER    05 55 05 62 67    frederic.thuillier@chu-limoges.fr   
Contact    05 55 05 63 96      
Principal Investigator: Frédéric THUILLIER         
Sub-Investigator: Sandrine LAVAU DENES         
Sub-Investigator: Valérie LE BRUN         
CH Recruiting
Longjumeau, France, 91160
Contact: Samy LOUAFI    06 62 08 48 89    samy.louafi@chsf.fr   
Principal Investigator: Samy LOUAFI         
Sub-Investigator: Joël EZENFIS         
Clinique privée Jean Mermoz Recruiting
Lyon, France, 69000
Contact: Jérôme DESRAME    06 85 94 97 83    jerome.desrame@orange.fr   
Contact    04 37 53 87 26      
Principal Investigator: Jérôme DESRAME         
Sub-Investigator: Léa CLAVEL         
Sub-Investigator: Pascal ARTRU         
Sub-Investigator: Gérard LLEDO         
Hôpital Européen Recruiting
Marseille, France, 13000
Contact: Yves RINALDI    06 09 51 15 78    y.rinaldi@hopital-europeen.fr ; yrinaldi@wanadoo.fr   
Contact    04 13 42 75 35 (secrétariat)      
Principal Investigator: Yves RINALDI         
Sub-Investigator: Nicolas BARRIERE         
Sub-Investigator: Julie GIGOUT         
Sub-Investigator: Cécile JULIEN         
Institut Paoli Calmettes Recruiting
Marseille, France, 13000
Contact: Marine GILABERT    06 61 95 59 02    gilabertm@ipc.unicancer.fr   
Contact    04 91 22 33 02      
Principal Investigator: Marine GILABERT         
Sub-Investigator: Marjorie FAURE         
CH Recruiting
Meaux, France, 77100
Contact: Christophe LOCHER    01 64 35 38 54    clocher@ghef.fr   
Principal Investigator: Chirstophe LOCHER         
Sub-Investigator: Marc PRIETO         
Sub-Investigator: Laurence THOMAS MARQUES         
CH Recruiting
Niort, France, 79000
Contact: Albert ALEBA    05 49 78 36 79    albert.aleba@ch-niort.fr   
Principal Investigator: Albert ALEBA         
Centre médical Oncogard Recruiting
Nîmes, France, 30000
Contact: Laurent ALCARAZ    04 30 06 10 10    alcaraz.oncogard@orange.fr   
Principal Investigator: Laurent ALCARAZ         
Sub-Investigator: François PICAUD         
Sub-Investigator: Jacques CRETIN         
CH Privé Sainte Marie Recruiting
Osny, France, 95520
Contact: Philippe SOYER    01 30 38 58 05    p.soyer@crom95.com   
Principal Investigator: Philippe SOYER         
Sub-Investigator: Abderrezak LADOUANI         
Sub-Investigator: Antoine BRUNA         
Groupe Hospitalier La Pitié Salpêtrière Recruiting
Paris, France, 75013
Contact: Jean-Baptiste BACHET    06 62 38 46 56    jean-baptiste.bachet@aphp.fr   
Contact    01 42 16 10 41      
Principal Investigator: Jean-Baptiste BACHET         
Hôpital Cochin Recruiting
Paris, France, 75679
Contact: Romain CORIAT    06 60 65 52 79    romain.coriat@aphp.fr   
Contact    01 58 41 19 52      
Hôpital Tenon Recruiting
Paris, France, 75970
Contact: Jeanne NETTER-COTI    06 89 67 91 54    jeanne.netter-coti@aphp.fr   
Contact    01 56 01 64 04      
Principal Investigator: Jeanne NETTER-COTI         
Sub-Investigator: Xavier AMIOT         
Sub-Investigator: David ANCEL         
Hopital Européen Georges Pompidou Recruiting
Paris, France
Contact: Julien TAIEB, PR    06 60 55 22 35    jtaieb75@gmail.com   
Contact    01 56 09 35 56      
Principal Investigator: Julien TAIEB, PR         
Sub-Investigator: Bruno LANDI         
Sub-Investigator: Aziz ZAANAN         
Sub-Investigator: Céline LEPERE         
Sub-Investigator: Clélia COUTZAC         
Sub-Investigator: Edouard AUCLIN         
Sub-Investigator: Géraldine PERKINS         
Sub-Investigator: Jean-Nicolas VAILLANT         
Sub-Investigator: Alexandra LAPEYRE-PROST         
Sub-Investigator: Claire GALLOIS         
CH Saint Jean Recruiting
Perpignan, France, 66000
Contact: Faiza KHEMISSA AKOUZ    06 14 25 25 44    faiza.khemissa@ch-perpignan.fr   
Contact    04 68 61 61 37      
Principal Investigator: Faiza KHEMISSA AKOUZ         
Centre Cario HPCA Recruiting
Plérin, France, 22190
Contact: Jérôme MARTIN-BABAU    02 96 75 22 16      
Contact: Pierre-Luc ETIENNE    02 96 75 22 16    pl.etienne@cario-sante.fr ; pl.etienne@wanadoo.fr   
Principal Investigator: Jérôme MARTIN-BABAU         
Sub-Investigator: Pierre-Luc ETIENNE         
Sub-Investigator: Anne-Claire HARDY BESSARD         
Sub-Investigator: Dominique BESSON         
CH Jacques Puel Recruiting
Rodez, France, 12000
Contact: Laurent MOSSER, MD    05 65 55 22 10    l.mosser@ch-rodez.fr   
Sub-Investigator: Guillermo REYEZ ORTEGA         
Sub-Investigator: Véronique FABRE         
Principal Investigator: Laurent MOSSER         
CHU Charles Nicolle Recruiting
Rouen, France, 76000
Contact: Frédéric DI FIORE    06 82 23 33 89    frederic.difiore@chu-rouen.fr   
Contact    02 32 88 86 10      
Principal Investigator: Frédéric DI FIORE         
Sub-Investigator: Alice GANGLOFF         
Sub-Investigator: David SEFRIOUI         
Sub-Investigator: Mélanie HASSINE         
Sub-Investigator: Simon CLAVEL         
Sub-Investigator: Pierre MICHEL         
CH Foch Recruiting
Suresnes, France, 92150
Contact: May MABRO    01 46 25 21 68    m.mabro@hopital-foch.org   
Principal Investigator: May MABRO         
Sub-Investigator: Julie GACHET-MASSON         
Sub-Investigator: Rolande NGUEFACK         
CHRU de Nancy Recruiting
Vandœuvre-lès-Nancy, France, 54500
Contact: Anthony LOPEZ    06 78 56 21 57    anthony-lopez@hotmail.fr ; a.lopez@chru-nancy.fr   
Contact    03 83 15 76 92      
Principal Investigator: Anthony LOPEZ         
Sub-Investigator: Chloé MARECHAL         
Sub-Investigator: Bastien DIRRENBERGEN         
Martinique
CHU Clarac Recruiting
Fort de France, Martinique, 97200
Contact: Nathalie GROSSAT BERNADOU    05 96 59 26 01    nathalie.grossat-bernadou@chu-martinique.fr   
Principal Investigator: Nathalie GROSSAT BERNADOU         
Sponsors and Collaborators
Federation Francophone de Cancerologie Digestive
Investigators
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Principal Investigator: Julien Taieb, Pr HEGP - Paris - France

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Responsible Party: Federation Francophone de Cancerologie Digestive
ClinicalTrials.gov Identifier: NCT03693677     History of Changes
Other Study ID Numbers: PRODIGE 61 - FUNGEMAX
FFCD 1702 ( Other Identifier: FFCD Number )
2017-004309-41 ( EudraCT Number )
First Posted: October 3, 2018    Key Record Dates
Last Update Posted: July 19, 2019
Last Verified: July 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Endocrine Gland Neoplasms
Pancreatic Diseases
Digestive System Diseases
Endocrine System Diseases
Gemcitabine
Paclitaxel
Albumin-Bound Paclitaxel
Irinotecan
Fluorouracil
Antineoplastic Agents, Phytogenic
Antineoplastic Agents
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
Topoisomerase I Inhibitors
Topoisomerase Inhibitors