Efficacy & Safety of ODSH (2-0, 3-0 Desulfated Heparin) in Patients With Metastatic Pancreatic Cancer Treated With Gemcitabine & Abraxane (PGPC1)

This study is currently recruiting participants. (see Contacts and Locations)
Verified November 2012 by Cantex Pharmaceticals
Sponsor:
Collaborator:
Translational Drug Development
Information provided by (Responsible Party):
Cantex Pharmaceticals
ClinicalTrials.gov Identifier:
NCT01461915
First received: October 13, 2011
Last updated: November 9, 2012
Last verified: November 2012
  Purpose

The purpose of the study is to determine whether ODSH (2-0,3-0 desulfated heparin), a low anticoagulant heparin derivate with preserved anti-inflammatory and anti-neoplastic characteristics is efficacious in patients with metastatic pancreatic cancer with gemcitabine and nab-paclitaxel ( Abraxane) as first line therapy.


Condition Intervention Phase
Metastatic Pancreatic Cancer
Drug: Abraxane ( Nab-paclitaxel)
Drug: Gemcitabine
Drug: ODSH ( 2-O, 3-O Desulfated Heparin)
Drug: Abraxane ( nab-paclitaxel)
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Randomized Phase II Open Label Study to Assess the Efficacy & Safety of Gemcitabine + Abraxane® With or Without ODSH (2-0, 3-0 Desulfated Heparin) as First Line Treatment of Metastatic Pancreatic Cancer

Resource links provided by NLM:


Further study details as provided by Cantex Pharmaceticals:

Primary Outcome Measures:
  • Progression-Free Survival (PFS) according to RECIST Guidelines. [ Time Frame: From Baseline to disease progression or death (whichever occurs first), assessed up to 9 months. ] [ Designated as safety issue: No ]
    Median Progression-Free Survival according to RECIST Guidelines Version 4.03


Secondary Outcome Measures:
  • Incidence of Adverse Events & Toxicity [CTCAE Version 4.03] [ Time Frame: From Baseline to disease progression, assessed up to 9 months ] [ Designated as safety issue: Yes ]
    Incidence of Adverse Events, laboratory test abnormalities and chemotherapy toxicity.

  • Overall survival (OS). [ Time Frame: From Baseline to Death, assessed up to 9 months. ] [ Designated as safety issue: No ]
    Comparative OS among study arms at the end of the study.

  • Objective Tumor Response [ Time Frame: From Baseline to disease progression or death (whichever occurs first), assessed up to 9 months. ] [ Designated as safety issue: No ]
    Overall Response Rate (Complete / Partial Responses), Duration of Response and Disease Control Rate will be assessed.

  • ODSH Area Under Curve (AUC) [ Time Frame: Time Frame: 0, 15, 30, 45 and 60 minutes after the ODSH IV bolus and at 48 hours (steady state) during the ODSH IV continuous infusion. ] [ Designated as safety issue: Yes ]
    PK assessment of ODSH plasma concentration during ODSH IV bolus (4 time-points) and at the end of the ODSH 48-hour IV continuous infusion in 6 patients


Estimated Enrollment: 60
Study Start Date: November 2011
Estimated Study Completion Date: March 2013
Estimated Primary Completion Date: December 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Run-in
10 Subjects to be enrolled in the study to receive : gemcitabine + nab-paclitaxel + ODSH
Drug: Abraxane ( Nab-paclitaxel)
Nab-paclitaxel 125 mg/m2 administered IV over 30 minutes. Given weekly for 3 weeks followed by one week of rest.
Other Name: Nab-paclitaxel = Abraxane
Drug: Gemcitabine
Gemcitabine at 1000 mg/m2 administered IV over 30 minutes (after the nab-paclitaxel IV administration is complete). Gemcitabine to be administered weekly for 3 weeks followed by one week of rest.
Other Name: Gemcitabine
Drug: ODSH ( 2-O, 3-O Desulfated Heparin)

ODSH IV bolus at 4 mg/kg to be administered in 5 minutes immediately after completion of gemcitabine administration.

ODSH 48-h IV continuous infusion at 0.375 mg/kg/h should be started immediately after the ODSH IV bolus has been administered.

Other Name: ODSH = 2-O, 3-O Desulfated Heparin
Experimental: Arm A
25 patients to be enrolled to receive gemcitabine + nab-paclitaxel + ODSH
Drug: Abraxane ( Nab-paclitaxel)
Nab-paclitaxel 125 mg/m2 administered IV over 30 minutes. Nab-paclitaxel to be given weekly for 3 weeks followed by one week of rest.
Other Name: Abraxane = nab-paclitaxel
Drug: Gemcitabine
Gemcitabine at 1000 mg/m2 over 30 minutes to be administered after the completion of Abraxane administration. Gemcitabine will be given weekly for 3 weeks followed by one week of rest.
Other Name: Gemcitabine
Drug: ODSH ( 2-O, 3-O Desulfated Heparin)

ODSH IV bolus at 4 mg/kg will be administered in 5 minutes immediately after completion of gemcitabine administration.

ODSH 48-h IV continuous infusion at 0.375 mg/kg/h should be started immediately after the ODSH IV bolus has been administered.

Other Name: ODSH = 2-O, 3-O desulfated heparin
Active Comparator: Arm B
25 patients will be enrolled in the study to receive gemcitabine + nab-paclitaxel
Drug: Abraxane ( nab-paclitaxel)
Nab-paclitaxel 125 mg/m2 administered IV over 30 minutes will be given weekly for 3 weeks followed by one week of rest.
Other Name: Abraxane = nab-paclitaxel
Drug: Gemcitabine
Gemcitabine to be administered IV at 1000 mg/m2 over 30 minutes given weekly for 3 weeks followed by one week of rest
Other Name: Gemcitabine

Detailed Description:

ODSH has demonstrated in vitro and in vivo inhibitory activity on mechanisms that are believed to play important roles in pancreatic cancer invasion, metastasis, and resistance to chemotherapy and radiation. Pancreatic cancer appears to have a dependence on autophagy, a regulated catabolic pathway to degrade and recycle cellular organelles and macromolecules. Autophagy appears to be largely driven by the binding of high mobility group box-1 protein (HMGB1) to the receptor for advanced glycation end-products (RAGE), which is strongly inhibited by ODSH. Autophagy appears to not only assist pancreatic cancer cells to survive in a hypoxic, relatively avascular environment, but also appears to play an important role in chemotherapy resistance. Other important biological activities promoting pancreatic cancer invasion and metastasis affected by ODSH include the inhibition of heparanase and the binding of tumor cells to endothelium and platelets mediated by the selectins. It is believed that these biological activities such as the inhibition of RAGE, heparanase, and selectin-mediated metastasis, can be inhibited by ODSH at dose levels that can safely be administered without clinically significant anticoagulation.

The standard of care of pancreatic cancer is evolving. It appears that two combination regimens, the "FOLFIRINOX" regimen (a combination of 5-fluorouracil, leucovorin, irinotecan and oxaliplatin) and the combination of gemcitabine + nab-paclitaxel, could have more activity than the previous standard treatment of gemcitabine alone.

Subjects with advanced metastatic pancreatic cancer that have not received chemotherapy, surgical or radiation treatments and have a good performance status will be eligible to participate in this study. 10 patients will be enrolled in a Run-in Period to receive gemcitabine + nab-paclitaxel +ODSH. PK sampling and safety assessments will be conducted to decide on the continuation to the Controlled Period of the study where 50 patients will be randomized at a 1:1 ratio to either of the two study arms: Arm A will receive gemcitabine + nab-paclitaxel + ODSH and Arm B will receive gemcitabine + nab-paclitaxel.

The primary endpoint of the study is mean progression free survival. The secondary endpoints consist of tumor response by RECIST criteria, overall survival at the end of the study and changes from baseline for CA19-9 marker, weight and plasma albumin.

  Eligibility

Ages Eligible for Study:   18 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Patients must have histologically confirmed adenocarcinoma of the pancreas that is metastatic and for which potential curative measures, such as resection of an isolated metastasis, are not available. Patients with islet cell neoplasms are excluded.
  2. Patient has one or more metastatic tumors measurable by CT scan AND a serum CA19-9 measurement > 2 times the upper limit of normal. Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as >20 mm with conventional techniques or as >10 mm with spiral CT scan.
  3. Male or non-pregnant and non-lactating female and ≥ 18 to ≤ 75 years of age. If a female patient is of child-bearing potential, she must have a negative serum pregnancy test documented within 72 hours prior to the first administration of study drug and on Day 1 of each cycle thereafter. If sexually active, the patient must agree to use contraception prior to study entry and for the duration of study participation.
  4. Patients must have received no prior radiotherapy or chemotherapy for metastatic disease. Patients who have received radiotherapy or chemotherapy as adjuvant o neo-adjuvant therapy for locally advanced disease six months or more prior to enrollment into this study are eligible.
  5. Patient has adequate biological parameters as demonstrated by the following blood counts at Screening (obtained ≤ 14 days prior to randomization) and at Baseline-Day 0: Absolute neutrophil count (ANC) ≥ 1.5 × 109/L; Platelet count ≥ 100,000/mm3 (100 × 109/L); Hemoglobin (Hgb) ≥ 9 g/dL.
  6. Patient has the following blood chemistry levels at Screening (obtained ≤ 14 days prior to randomization) and at Baseline-Day 0:

    • AST (SGOT), ALT (SGPT) ≤ 2.5 × upper limit of normal range (ULN), unless liver metastases are present, then ≤ 5 × ULN is allowed. Total bilirubin ≤ 1.5 × ULN.
    • Serum creatinine (Cr) within normal limits or calculated clearance ≥ 60 mL/min/1.73 m2 for patients with creatinine (Cr) levels above or below the institutional normal value. If using Cr clearance, actual body weight should be used for calculating Cr clearance (e.g., using the Cockcroft-Gault formula).
  7. Patient has acceptable coagulation studies at Screening (obtained ≤14 days prior to randomization) as demonstrated by prothrombin time (PT) and partial thromboplastin time (PTT) within normal limits (± 15%).
  8. Patient has ECOG performance status ≤ 1.

Exclusion Criteria:

  1. Patient has brain metastases.
  2. Patient has only locally advanced disease.
  3. Patient has experienced an increase of ECOG to > 1 between Screening and Randomization.
  4. Patient requires continuous treatment with coumadin or other oral or parenteral anticoagulation (heparin, LMWH, heparinoids) to prevent or treat thromboembolic disease. The use of prophylactic antiplatelet drugs such as clopidogrel and aspirin are allowed before and during the study.
  5. Patient has active, uncontrolled bacterial, viral, or fungal infection(s) requiring systemic therapy.
  6. Patient has undergone major surgery, other than diagnostic surgery (i.e.--surgery done to obtain a biopsy for diagnosis without removal of an organ), within 4 weeks prior to Randomization in this study.
  7. Patient has a history of allergy or hypersensitivity to any of the study drugs, their pharmaceutical class or any of their excipients.
  8. Patient has a concomitant serious medical or psychiatric illness that, in the opinion of the investigator, could compromise the patient's safety or the study data integrity.
  9. Patient is enrolled in any other clinical protocol or investigational trial involving administration of antineoplastic compounds for the treatment of metastatic pancreatic cancer.
  10. Patient is unwilling or unable to comply with study procedures.
  11. Nab-paclitaxel is metabolized by CYP2C8 and CYP3A4. Co-administration of substrates, inhibitors of CYP2C8 and/or CYP3A4 with nab-paclitaxel is not allowed. The following medications and substances are not allowed during the study: ritonavir, saquinavir, indinavir, nelfinavir, rifampicin, carbamazepine, phenytoin, efavirenz, or nevirapine, grapefruit (juice or seeds) or some herbals like St. John's wort.
  12. Subjects with risk factors for or a history of Torsades des Pointes (TdP), or a significant QT prolongation that in the opinion of the investigator may place the study subject at risk.
  Contacts and Locations
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, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01461915

Contacts
Contact: Jocelyn Harmon, BS, CCRC (602) 358 8385 jharmon@tgen.org
Contact: Amy Stoll, MS, CCRP (602) 358-8319 astoll@tgen.org

Locations
United States, Arizona
Mayo Clinic Arizona Recruiting
Scottsdale, Arizona, United States, 85259
Contact: Falicia Mallory    480-301-6072    mallory.falicia@mayo.edu   
Principal Investigator: Mitesh Borad, MD         
United States, California
Disney Family Cancer Center Recruiting
Burbank, California, United States, 91505
Contact: Barbara Rolph, RN    818-847-3220    barbara.rolph@providence.org   
Principal Investigator: Peter J Rosen, MD         
Marin Cancer Care Suspended
Greenbrae, California, United States, 94904
Scripps Clinic Torrey Pines ( Green Hospital) Recruiting
La Jolla, California, United States, 92037
Contact: Jennifer Lashenr, RN    858-554-9379    Perez.Alain@scrippshealth.org   
Principal Investigator: Darren Sigal, MD.         
United States, Florida
Cleveland Clinic Florida Recruiting
Weston, Florida, United States, 33331
Contact: Jessica Woodring, MBA, CAPM    954-659-5538    woodrij@ccf.org   
Principal Investigator: Timmy Nguyen, MD         
United States, Illinois
Loyola University Medical Center/Cardinal Bernardin Cancer Center Recruiting
Maywood, Illinois, United States, 60153
Contact: Sandra Zakrewski, RN    708-327-2831    SZAKRZE@lumc.edu   
Principal Investigator: Shelly S Lo, M.D.         
United States, Indiana
Indiana University Health, Goshen Center for Cancer Care Recruiting
Goshen, Indiana, United States, 46526
Contact: Rebecca Eickhoff, RN,BSN,OCN,CCRP    574 364 2649    Reickhoff@iuhealth.org   
Principal Investigator: Alexander Starodub, MD         
United States, Louisiana
Fesit-Weiller Cancer Center Recruiting
Shreveport, Louisiana, United States, 71130
Contact: Stacy Moss, MEd, CCRC    318-813-1422    smoss@lsuhsc.edu   
Principal Investigator: Tannaz Armaghany, MD         
United States, Michigan
Saint Mary's Health Care Recruiting
Grand Rapids, Michigan, United States, 49503
Contact: Rosa M Bossi, BS, CCRP    616-685-5156    bossir@trinity-health.org   
Principal Investigator: Thomas E Gribbin, MD         
United States, Ohio
Summa Health System - Cooper Cancer Center Recruiting
Akron, Ohio, United States, 44304
Contact: Lynn Kaplan, RN    330-375-6121    kaplanlm@summahealth.org   
Principal Investigator: Sameer Mahesh, MD         
United States, Pennsylvania
Fox Chase Cancer Center Recruiting
Philadelphia, Pennsylvania, United States, 19111
Contact: Alexis Dickens    215-214-3916    alexis.dickens@fccc.edu   
Principal Investigator: Stephen Cohen, MD         
Thomas Jefferson University [Kimmel Cancer Center] Recruiting
Philadelphia, Pennsylvania, United States, 19107
Contact: Deborah Kilpatrick, RN    215-955-0017    Deborah.Kilpatrick@jefferson.edu   
Principal Investigator: Susan J Littman, MD         
UPMC Cancer Center Recruiting
Pittsburgh, Pennsylvania, United States, 15232
Contact: Sarah Rankin, BSN,RN,OCN    412-623-2677    rankinsj@upmc.edu   
Principal Investigator: Nathan Bahary, M.D.         
United States, South Carolina
Medical University of South Carolina Hollings Cancer Center Recruiting
Charleston, South Carolina, United States, 29425
Contact: Alan Brisendine, CCRP    843-792-9007    brisend@musc.edu   
Principal Investigator: Steve Chin, MD         
United States, Texas
University of Texas Medical Branch Recruiting
Galveston, Texas, United States, 77555
Contact: Lisa Hernandez Garcia    409-747-2211    lgherman@utmb.edu   
Principal Investigator: Avi B Markowitz, MD.         
South Texas Oncology & Hematology Suspended
San Antonio, Texas, United States, 78229
Sponsors and Collaborators
Cantex Pharmaceticals
Translational Drug Development
Investigators
Principal Investigator: Mitesh J Borad, MD Division of Hematology/Oncology, Department of Internal Medicine, Mayo Clinic , Scottsdale Arizona
Study Director: Stephen Marcus, MD ParinGenix Inc, Weston FL
  More Information

Additional Information:
No publications provided

Responsible Party: Cantex Pharmaceticals
ClinicalTrials.gov Identifier: NCT01461915     History of Changes
Other Study ID Numbers: PGX-ODSH-2011-PC1
Study First Received: October 13, 2011
Last Updated: November 9, 2012
Health Authority: United States: Food and Drug Administration

Keywords provided by Cantex Pharmaceticals:
Pancreatic Cancer

Additional relevant MeSH terms:
Calcium heparin
Heparin
Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Endocrine Gland Neoplasms
Digestive System Diseases
Pancreatic Diseases
Endocrine System Diseases
Gemcitabine
Paclitaxel
Antimetabolites, Antineoplastic
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antineoplastic Agents
Therapeutic Uses
Antiviral Agents
Anti-Infective Agents
Enzyme Inhibitors
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Radiation-Sensitizing Agents
Antineoplastic Agents, Phytogenic
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Anticoagulants

ClinicalTrials.gov processed this record on September 18, 2014