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Study of Nab-Paclitaxel and Gemcitabine With or Without Tocilizumab in Pancreatic Cancer Patients (PACTO)

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.
 
ClinicalTrials.gov Identifier: NCT02767557
Recruitment Status : Recruiting
First Posted : May 10, 2016
Last Update Posted : April 21, 2020
Sponsor:
Collaborator:
Celgene
Information provided by (Responsible Party):
Inna Chen, MD, Herlev Hospital

Brief Summary:
This is a multicenter center, 2-arms prospective randomized phase II trial which evaluates whether tocilizumab with gemcitabine/nab-paclitaxel is more effective than gemcitabine/nab-paclitaxel.

Condition or disease Intervention/treatment Phase
Unresectable Pancreatic Carcinoma Drug: Tocilizumab Drug: Gemcitabine Drug: nab-Paclitaxel Phase 2

Detailed Description:
The development of new effective treatment strategies remains a major challenge in patients with PC. High levels of IL-6 and presence of a systemic inflammatory response in PC patients have been reported to correlate with worse survival. Preclinical PC models have clearly shown that anti-IL-6-receptor antibody tocilizumab in combination with chemotherapy reduced tumor growth, number of distant metastases and the local recurrence rate. Thus, blockade of IL-6-regulated signaling pathways represents a promising approach in combination with chemotherapy. Elevated C-reactive protein (CRP) alone or in combination with hypoalbuminaemia (Modified Glasgow Prognostic Score - mGPS) are induced by IL-6 and could feasibly represent surrogate markers for IL-6 bioactivity to stratify patients likely to gain benefit through targeting IL-6.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 140 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Multinational, Randomized, Phase II Study of the Combination of Nab-Paclitaxel and Gemcitabine With or Without Tocilizumab, an IL-6R Inhibitor, as First-line Treatment in Patients With Locally Advanced or Metastatic Pancreatic Cancer.
Actual Study Start Date : January 26, 2017
Estimated Primary Completion Date : January 26, 2021
Estimated Study Completion Date : January 26, 2021


Arm Intervention/treatment
Experimental: Tocilizumab & Gemcitabine and nab-Paclitaxel

Tocilizumab:

8 mg/kg given I. V. on day 1 over 60 minutes every 28 day cycle.

Gemcitabine:

1000 mg/m² I. V. on day 1, day 8 and day 15 of every 28 day cycle.

Nab-Paclitaxel:

125 mg/m² I. V. on day 1, day 8 and day 15 of every 28 day cycle.

Drug: Tocilizumab
Intravenous infusion
Other Name: (ACTEMRA®)

Drug: Gemcitabine
Intravenous infusion

Drug: nab-Paclitaxel
Intravenous infusion,
Other Name: ABRAXANE®

Active Comparator: Gemcitabine and nab-Paclitaxel

Gemcitabine:

1000 mg/m² I. V. on day 1, day 8 and day 15 of every 28 day cycle.

Nab-Paclitaxel:

125 mg/m² I. V. on day 1, day 8 and day 15 of every 28 day cycle.

Drug: Gemcitabine
Intravenous infusion

Drug: nab-Paclitaxel
Intravenous infusion,
Other Name: ABRAXANE®




Primary Outcome Measures :
  1. Overall survival at 6 months [ Time Frame: Approximately up to 6 months. ]

Secondary Outcome Measures :
  1. Performance status at 3 and 6 months assessed by investigator [ Time Frame: Approximately up to 6 months. ]
  2. Performance status at 3 and 6 months, assessed by patient [ Time Frame: Approximately up to 6 months. ]
  3. Progression free survival (PFS), defined as the time from the date of randomization until the earliest date of disease progression [ Time Frame: Randomization to disease progression, or death due to any cause if sooner. Approximately up to 6 months. ]
  4. Overall survival (OS), defined as the time from the date of randomization until death due to any cause. [ Time Frame: Randomization until death due to any cause. Approximately up to 12 months. ]
  5. Overall response rate (ORR) (ORR = CR + PR), according to RECIST 1.1.RECIST 1.1 [ Time Frame: Approximately up to 6 months. ]
  6. Disease control rate (DCR), (DCR = CR + PR + SD), according to RECIST 1.1. [ Time Frame: Approximately up to 6 months. ]
  7. Safety (Data on safety parameters) Safety and tolerability of the treatment regimens assessed by a summary of adverse events and clinical laboratory assessments. [ Time Frame: Approximately up to 6 months. ]
  8. Quality of Life (Quality of Life Questionnaire C30 (QLQ-C30) Version 3.0). [ Time Frame: Approximately up to 6 months. ]


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

Inclusion Criteria:

  • Signed informed consent
  • Histological or cytological pancreatic adenocarcinoma. Malignant unspecified tumor cells in cytological specimen are allowed after investigator assessment, mixed histology including adenosquamous carcinoma is allowed
  • Male or non-pregnant, non-lactating females who are ≥18 years of age at the time of signing the informed consent form (ICF)
  • Non-curable unresectable locally advanced or metastatic pancreatic carcinoma.
  • A modified Glasgow Prognostic Score (mGPS) criteria of 1 or 2 assessed within 14 days of randomization as defined below:
  • mGPS of 1: CRP > 10 mg/L and albumin ≥ 35 g/L
  • mGPS of 2: CRP > 10 mg/L and albumin < 35 g/L
  • No prior antineoplastic chemotherapy or anti-cancer drugs. Patients who have received neoadjuvant or adjuvant chemotherapy and who are diagnosed with loco regional recurrent or metastatic disease are not eligible
  • ECOG/WHO Performance Status (PS) 0-1
  • ≥ 4 weeks since prior major surgery, ≥ 2 weeks since prior minor surgery and ≥ 1 week since prior radiation therapy
  • Measurable disease using the RECIST1.1 criteria, defined as lesions that can be measured in at least one dimension and which have not been previously irradiated. Longest diameter ≥ 20 mm with conventional techniques or ≥ 10 mm with spiral CT scan or MRI
  • Fertile men and women of childbearing potential (defined as a sexually mature woman who (1) has not undergone hysterectomy [the surgical removal of the uterus] or bilateral oophorectomy [the surgical removal of both ovaries] or (2) has not been naturally postmenopausal for at least 24 consecutive months [ie, has had menses at any time during the preceding 24 consecutive months]) must use secure contraception methods as follows: intrauterine device, double-barrier contraception, as a condom and occlusive cap (diaphragm or cervical/vault caps) with a vaginal spermicidal agent (foam/gel/cream/suppository), vasectomized partner who is sterile prior to the female subject's entry and is the sole sexual partner for that female, or complete abstinence from sexual intercourse from before 2 months entering the study until 6 months after end of chemotherapy
  • Acceptable hematology parameters defined as:
  • Absolute neutrophil count (ANC) ≥ 1.5 x 10⁹/L
  • Platelet count ≥ 100 x 10⁹/L
  • Haemoglobin ≥ 5.6 mmol/L
  • Acceptable liver function defined as:
  • Serum bilirubin < 1.5 x upper limit of normal (ULN)
  • ASAT/ALAT < 2.5 x ULN ( < 5 x ULN with known liver metastasis)
  • Acceptable renal function with a creatinine clearance ≥ 50 mL/min/ (eg, using the Cockroft-Gault formula)
  • Subjects must have signed and dated a BIOPAC IRB/IEC approved written informed consent form in accordance with regulatory and institutional guidelines. This must be obtained before the performance of any protocol related procedures that are not part of normal subject care

Exclusion Criteria:

  • Electrocardiogram (ECG) with significant modifications suggesting a high risk of occurrence of angina pectoris or high risk of arrhythmia.
  • Other malignancies, except adequately treated basal carcinoma or squamous cell carcinoma of the skin or in-situ cervix carcinoma or incidental prostate cancer (T1a, Gleason score ≤ 6, PSA < 0.5 ng/ml), or any other tumor with a disease free survival of ≥ 5 years.
  • History of serious or concurrent illness or uncontrolled medical disorder; any medical condition that might be aggravated by chemotherapy treatment or which could not be controlled; including, but not restricted to:
  • Active infection requiring antibiotics within 2 weeks before the study inclusion
  • Concurrent congestive heart failure NYHA ( class III - IV )
  • Unstable angina pectoris, or myocardial infarction within 6 months and/or prior poorly controlled hypertension
  • Inflammatory bowel disease (colitis, Crohns) or other serious gastrointestinal conditions associated with risk of perforation
  • Peripheral neuropathy grade ≥ 2 according to CTCAE v 4.0
  • Concomitant use of immunosuppressive or myelosuppressive medications that would in the opinion of the investigator, increase the risk of serious neutropenic complications.
  • No known or suspected allergy to the investigational agents or any agents given in association with this trial.
  • Pregnant or lactating women.
  • Any psychological, familial, sociological, or geographical condition which does not permit protocol compliance and medical follow-up.
  • Enrollment in any other clinical protocol or investigational study with an interventional agent or assessments that may interfere with study procedures.

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): NCT02767557


Contacts
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Contact: Inna Chen, MD +45 38682898 Inna.Chen@regionh.dk
Contact: Dorte Nielsen, MD DMSc +45 38682344 Dorte.Nielsen.01@regionh.dk

Locations
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Denmark
Herlev & Gentofte University Hospital, Denmark Recruiting
Herlev, Denmark, 2730
Contact: Inna Chen, MD    +45 38682898    Inna.Chen@regionh.dk   
Contact: Dorte Nielsen, MD DMSc    +45 38682344    Dorte.Nielsen.01@regionh.dk   
Norway
Department of Oncology Recruiting
Oslo, Norway, 0424
Contact: Olav Olav Dajani, MD PhD    +47 23026600    uxolaj@ous-hf.no   
Sponsors and Collaborators
Herlev Hospital
Celgene
Investigators
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Principal Investigator: Inna Chen, MD Herlev & Gentofte Hospital
Principal Investigator: Olav Dajani, MD PhD Oslo University Hospital
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Responsible Party: Inna Chen, MD, Staff Specialist, Herlev Hospital
ClinicalTrials.gov Identifier: NCT02767557    
Other Study ID Numbers: GI1612
First Posted: May 10, 2016    Key Record Dates
Last Update Posted: April 21, 2020
Last Verified: April 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes

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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
Digestive System Diseases
Pancreatic Diseases
Endocrine System Diseases
Gemcitabine
Paclitaxel
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