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Gemcitabine and S-1 for Locally Advanced Unresectable or Metastatic 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. Read our disclaimer for details. Identifier: NCT00429858
Recruitment Status : Terminated (Study accrual rate is very slow, it was mandated by NCI to be terminated.)
First Posted : February 1, 2007
Last Update Posted : February 15, 2019
National Cancer Institute (NCI)
Information provided by (Responsible Party):
University of California, San Francisco

Brief Summary:

RATIONALE: Studying samples of tumor tissue and blood from patients with cancer in the laboratory may help doctors learn more about changes that may occur in DNA and identify biomarkers related to cancer. It may also help doctors predict a patient's response to treatment and help plan the best treatment.

PURPOSE: This phase II trial is studying gene expression in predicting treatment response in patients receiving gemcitabine and S-1 for locally advanced unresectable or metastatic pancreatic cancer.

Condition or disease Intervention/treatment Phase
Pancreatic Cancer Drug: S-1 Drug: gemcitabine hydrochloride Drug: Bevacizumab Phase 2

  Show Detailed Description

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 21 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Individualized Management of Pancreatic Cancer With Targeted Therapeutics (IMPACTT): A Phase II Clinical Trial
Study Start Date : January 2007
Actual Primary Completion Date : October 2010
Actual Study Completion Date : October 2010

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Targeted therapy group
Gemcitabine monotherapy until disease progression, followed by gemcitabine+second-agent (bevacizumab or S-1)
Drug: S-1
S-1 is given as follows: 25 mg/m2 bid on days 1-7 and 15-21 of the cycle (28 days)
Other Names:
  • tegafur-gimeracil-oteracil potassium
  • TS-1
  • TS-ONE

Drug: gemcitabine hydrochloride
Patients will receive gemcitabine at a dose of 1,000 mg/m2 i.v. at a fixed-dose rate (FDR) infusion of 10 mg/m2/minute (100 minutes), once a week for 3 consecutive weeks, followed by one week rest. Each 4 week period is referred to as a treatment cycle
Other Name: Gemzar

Drug: Bevacizumab
Other Name: Avastin

Primary Outcome Measures :
  1. • To correlate intratumoral expression level of ribonucleotide reductase subunit 1 (RRM1) with response to gemcitabine in patients with advanced pancreatic cancer. [ Time Frame: 2 years after the last patient is enrolled ]

Secondary Outcome Measures :
  1. To correlate intratumoral expression levels of other genes, including deoxycytidine kinase (dCK), equilibrative nucleoside transporter 1 (ENT1) and concentrative nucleoside transporters 1 and 3 (CNT1 and CNT3), with response to gemcitabine. [ Time Frame: 2 years after the last patient is enrolled ]
  2. • To correlate intratumoral expression levels of thymidylate synthase (TS), thymidine phosphorylase (TP), dihydropyrimidine dehydrogenase (DPD), orotate phosphoribosyltransferase (ORPT) with response to the combination of gemcitabine/S-1. [ Time Frame: 2 years after the last patient is enrolled ]
  3. • To estimate median survival using the therapeutic strategy outlined herein, entailing sequential addition of agents and decision-making based on early CA19-9 biomarker response. [ Time Frame: 2 years after the last patient is enrolled ]
  4. To determine the safety of this approach. [ Time Frame: 8 weeks after 6th patient is enrolled ]
  5. • To determine the percentage of patients classified as potential biomarker responders (during the initial gemcitabine monotherapy phase). [ Time Frame: 2 years after the last patient is enrolled ]
  6. • To calculate the time to progression on each successive line of treatment. [ Time Frame: 2 years after the last patient is enrolled ]
  7. • To calculate the proportion of patients with at least 25% decline in CA 19-9 biomarker (= "biomarker response") on each successive line of treatment. [ Time Frame: 2 years after the last patient is enrolled ]

Information from the National Library of Medicine

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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

  • Adenocarcinoma of the pancreas that is already or will be histologically or cytologically proven.
  • Patients must have either locally advanced (unresectable) or metastatic disease.
  • Radiographically measurable disease is not required.
  • No prior therapy for advanced pancreatic cancer. Treatment given in the adjuvant setting (radiation and/or chemotherapy, given either concurrently or systemically) does not count as prior therapy as long as progressive disease occurs > 6 months following completion of treatment.
  • Greater than or equal to 18 years of age.
  • ECOG performance status of 0 or 1 (See Appendix D).
  • Laboratory criteria:
  • ANC > 1500/µL
  • Platelet count > 100,000/µL
  • Hemoglobin > 9 g/dL (may be transfused or receive epoetin alfa to maintain or exceed this level)
  • INR < 1.5 (except those subjects who are receiving full-dose warfarin
  • Total bilirubin < 2.0 mg/dL
  • AST or ALT < 5 times upper limit of normal for subjects with documented liver metastases; < 2.5 times the upper limit of normal for subjects without evidence of liver metastases
  • Serum creatinine < 2.0 mg/dL
  • Serum CA19-9 > 2X upper limits of normal.
  • All patients must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines.
  • Women or men of reproductive potential must agree to use an effective contraceptive method during treatment and for 6 months afterwards.

Exclusion criteria

  • Inability to comply with study and/or follow-up procedures
  • Disease determined to be not amenable to biopsy upon review of radiographs by the oncologist and/or interventional radiologist.
  • Clearly resectable disease in a patient who is an appropriate operative candidate.
  • History of other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that might affect the interpretation of the results of the study or render the subject at high risk from treatment complications
  • Prior systemic therapy for advanced pancreatic cancer
  • Pregnant (positive pregnancy test) or lactating
  • Use of anti-neoplastic or anti-tumor agents not part of the study therapy, including chemotherapy, radiation therapy, immunotherapy, and hormonal anticancer therapy, is not permitted while participating in this study.
  • Use of concurrent investigational agents is not permitted.

S-1 Specific Exclusion Criteria

  • Is receiving a concomitant treatment with drugs interacting with S-1. The following drugs are prohibited because there may be an interaction with S-1:
  • Sorivudine, brivudine, uracil, dipyridamole, cimetidine, and folinic acid (may enhance S-1 activity).
  • Allopurinol (may diminish S-1 activity).
  • Phenytoin (S-1 may enhance phenytoin activity).
  • Flucytosine, a fluorinated pyrimidine antifungal agent (may enhance S-1 and flucytosine activity).
  • Pilocarpine (may inhibit cytochrome P-450 enzyme 2A6 activity).

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): NCT00429858

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United States, California
UCSF Helen Diller Family Comprehensive Cancer Center
San Francisco, California, United States, 94115
United States, Maryland
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Baltimore, Maryland, United States, 21231-2410
Sponsors and Collaborators
University of California, San Francisco
National Cancer Institute (NCI)
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Study Chair: Andrew Ko, MD University of California, San Francisco

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Responsible Party: University of California, San Francisco Identifier: NCT00429858     History of Changes
Other Study ID Numbers: 06456
P30CA082103 ( U.S. NIH Grant/Contract )
UCSF-06456 ( Other Identifier: UCSF California - Cancer Center reference number )
UCSF-H12191-29556-01 ( Other Identifier: UCSF California CHR Approval # )
First Posted: February 1, 2007    Key Record Dates
Last Update Posted: February 15, 2019
Last Verified: February 2019

Keywords provided by University of California, San Francisco:
recurrent pancreatic cancer
stage III pancreatic cancer
adenocarcinoma of the pancreas
stage IV pancreatic cancer

Additional relevant MeSH terms:
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Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Endocrine Gland Neoplasms
Digestive System Diseases
Pancreatic Diseases
Endocrine System Diseases
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Antiviral Agents
Anti-Infective Agents
Enzyme Inhibitors
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antineoplastic Agents, Immunological
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors