Immunochemoradiotherapy in Patients With Pancreatic Cancer
|Locally Advanced Pancreatic Adenocarcinoma||Biological: tadalafil and vaccination||Phase 1|
|Study Design:||Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Other
|Official Title:||Exploratory Trial of Immunochemoradiotherapy for Locally Advanced Pancreatic Adenocarcinoma|
- Safety [ Time Frame: 180 Days ]Adverse events will be graded no less than weekly for the first 180 days. Post-treatment long-term follow-up will occur every 12 weeks beyond day 180 for 6 visits and then every 24 weeks thereafter until progressive disease, withdrawal from study or death. For this pilot study, adverse events and efficacy measures will be personally reviewed by the principal investigator. Both hematologic and non-hematologic toxicity will be anticipated. In conjunction with the IRB, stopping the trial will be among possible measures taken if undue toxicity or inadequate outcomes are observed.
- Immune Response [ Time Frame: 18 months ]In patients having surgery: Tumor tissue obtained at the time of surgery will be examined to determine the degree of macrophage and T cell infiltration. In all patients: Multiparameter flow cytometry will determine the frequency of circulating telomerase-specific memory CD8+ T cells in blood samples obtained pre- and post- treatment. Accrual is anticipate to last 10-12 months, so post treatment samples from the last patient enrolled would be available for analysis approximately 18 months after the first patient enrolled.
- Tumor Response [ Time Frame: 180 days ]Response and progression will be evaluated in this study using the international criteria proposed by the Response Evaluation Criteria in Solid Tumors (RECIST) Committee. Changes in only the largest diameter (unidimensional measurement) of the tumor lesions are used in the RECIST criteria. Tumor measurements are made 4 times during the study, the last at 180 days after study enrollment.
|Actual Study Start Date:||January 2011|
|Estimated Study Completion Date:||April 2018|
|Primary Completion Date:||June 2012 (Final data collection date for primary outcome measure)|
Experimental: tadalafil and vaccination
Participants receive a 4-week course of vaccination with telomerase vaccine and GM-CSF by injection, along with a cycle of gemcitabine chemotherapy (IV). This is followed by radiation and gemcitabine given twice weekly then by another dose of vaccine.
Biological: tadalafil and vaccination
Participants receive a 4-week course of vaccination with telomerase vaccine and GM-CSF by injection, along with a cycle of gemcitabine chemotherapy (IV). This is followed by radiation and gemcitabine given twice weekly then by another dose of vaccine. Four weeks after completion of chemotherapy and radiation, participants able to have surgical treatment will have surgery followed by vaccination and chemotherapy. Participants with stable or responsive disease that cannot be treated by surgery will have vaccination and chemotherapy with 2 cycles of telomerase vaccine with GM-CSF along with gemcitabine. Participants with unresectable and progressive disease after administration of vaccine, chemotherapy and radiation treatment may transition to vaccination and chemotherapy treatment.
All study participants receive an initial 4 week course of intra-dermal vaccination with telomerase vaccine (GV1001) and immune adjuvant, granulocyte macrophage colony-stimulating factor (GM-CSF), along with a cycle of gemcitabine chemotherapy. This is followed by concurrent radiation therapy and low-dose intravenous (IV) gemcitabine chemotherapy given twice weekly followed by one additional dose of vaccine.
About 4 weeks (as late as 8 weeks) after chemotherapy and radiation treatment, participants with disease that can be removed by surgery will proceed to surgery. After recovery, immunochemotherapy will resume.
Participants with stable or responsive disease that is not able to be treated with surgery will proceed to immunochemotherapy.
Immunochemotherapy will consist of 2 cycles of telomerase vaccine with GM-CSF along with gemcitabine chemotherapy. Participants with disease that is not able to be treated with surgery, or that has worsened following immunochemoradiotherapy phase of treatment may continue on study with transition to immunochemotherapy phase of treatment. Tadalafil will be administered orally on a daily basis from start of therapy (Day 1) through completion of therapy with doses held only when required in the immediate perioperative period in patients who proceed to surgery.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01342224
|United States, Oregon|
|Providence Health & Services|
|Portland, Oregon, United States, 97213|
|Principal Investigator:||Todd Crocenzi, MD||Providence Health & Services|