Working...
ClinicalTrials.gov
ClinicalTrials.gov Menu
Trial record 19 of 38 for:    MM-398

Phase II of BAX2398/5-FU/Calcium Levofolinate in 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.
ClinicalTrials.gov Identifier: NCT02697058
Recruitment Status : Completed
First Posted : March 3, 2016
Last Update Posted : July 29, 2019
Sponsor:
Information provided by (Responsible Party):
Servier ( Institut de Recherches Internationales Servier )

Brief Summary:

Study Part 1: To assess the safety and tolerability, and to characterize the pharmacokinetics (PK) of BAX2398 in combination with 5-FU/calcium levofolinate in Japanese patients.

Study Part 2: To compare the efficacy of BAX2398 in combination with 5-FU/calcium levofolinate versus 5-FU/calcium levofolinate as assessed by Progression Free Survival (PFS) using Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1).


Condition or disease Intervention/treatment Phase
Metastatic Pancreatic Cancer Biological: BAX2398 + 5-FU/calcium levofolinate Drug: 5-FU/calcium levofolinate Phase 2

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 84 participants
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Phase II Randomized Study of BAX2398 in Combination With 5-Fluorouracil and Calcium Levofolinate in Japanese Patients With Metastatic Pancreatic Cancer, Which Progressed or Recurred After Prior Gemcitabine-Based Therapy
Actual Study Start Date : March 30, 2016
Actual Primary Completion Date : May 4, 2017
Actual Study Completion Date : August 28, 2018


Arm Intervention/treatment
Experimental: Part 1: Safety and PK
BAX2398 in combination with 5-FU/calcium levofolinate
Biological: BAX2398 + 5-FU/calcium levofolinate
BAX2398 (a liposomal formulation of irinotecan) in combination with 5-FU/calcium levofolinate
Other Names:
  • nal-IRI
  • MM-398

Experimental: Part 2: Safety, PK, Efficacy
BAX2398 in combination with 5-FU/calcium levofolinate
Biological: BAX2398 + 5-FU/calcium levofolinate
BAX2398 (a liposomal formulation of irinotecan) in combination with 5-FU/calcium levofolinate
Other Names:
  • nal-IRI
  • MM-398

Active Comparator: Part 2: 5-FU/calcium levofolinate alone
5-FU/calcium levofolinate
Drug: 5-FU/calcium levofolinate
5-FU/calcium levofolinate alone




Primary Outcome Measures :
  1. Progression Free Survival (PFS) in Part 2 of Study [ Time Frame: Part 2 Baseline to the end of the study (up to 22 months) ]
    Progression Free Survival (PFS) was defined as the time from randomization to the first documented disease progression based on the independent central review board's assessment using RECIST 1.1 or death due to any cause, whichever occurred first.


Secondary Outcome Measures :
  1. Progression Free Survival (PFS) in Part 1 of Study [ Time Frame: Part 1 Baseline to the end of the study (up to 22 months) ]
    Progression Free Survival (PFS) was defined as the time from randomization to the first documented disease progression based on the independent central review board's assessment using RECIST 1.1 or death due to any cause, whichever occurred first.

  2. Overall Survival (OS) [ Time Frame: Baseline to the end of the study (up to 22 months) ]
    OS was defined as the time from the date of informed consent (Part 1) or date of randomization (Part 2) to death due to any cause or the date of last known alive.

  3. Time to Treatment Failure (TTF) [ Time Frame: Baseline to the end of the study (up to 22 months) ]
    TTF was defined as the time from randomization to disease progression according to RECIST 1.1, death due to any cause, discontinuation of treatment due to toxicity, or for symptomatic deterioration, or start of another anticancer therapy

  4. Objective Response Rate (ORR) [ Time Frame: Baseline to the end of the study (up to 22 months) ]
    ORR was defined as the proportion of participants with a best overall response of complete response (CR) or partial response (PR)

  5. Disease Control Rate (DCR) [ Time Frame: Baseline to the end of the study (up to 22 months) ]
    DCR was defined as the proportion of participants with a best overall response of complete response (CR); partial response (PR); or stable disease (SD) lasting >=24 weeks

  6. Tumor Marker Response [ Time Frame: Baseline, every 6 weeks and 37 days post last visit (up to 22 months) ]
    Tumor marker response was defined as decrease of 50% of cancer antigen (CA)-19-9 in relation to the baseline level at least once during the treatment period. Tumor marker response evaluable population consist of participants who have elevated CA-19-9 level (greater than [<] 30 international unit [IU] / millilitre [ml]) at baseline and at least one post baseline CA-19-9 assessment.

  7. Change From Baseline in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) Scores [ Time Frame: Baseline, Day 1 of Cycle 4, 7, 10, 13, and 16; and 37 days post last visit (up to 22 months) ]
    The EORTC-QLQC30 is a reliable and valid measure of the quality of life of cancer participants in multicultural clinical research settings. It incorporates nine multi-item scales: five functional scales (physical [PFS], role [RFS], cognitive [CFS], emotional [EFS], and social [SFS]); three symptom scales (fatigue [FSS], pain [PSS], and nausea and vomiting [NVSS]); and a global health status (GHS) and quality-of-life scale. Several single-item symptom measures are also included. All scales and single-item measures range=0 to 100. High score for a functional scale=high/healthy level of functioning. High score for global health status/QoL=high QoL. High score for symptom scale/single item=high level of symptomatology/problems.

  8. Change From Baseline in Pain [ Time Frame: Baseline, Days 1 and 8 of Cycles 1, 2, 4, 5, 7, 8, 10, 11, 13, 14, 16, 17, Day 1 of Cycles 3, 6, 9, 12, 15, 18 and 37 days post last visit (up to 22 months) ]
    Participants assessed pain on the VAS. VAS range: 0 (no pain) to 100 worst pain.

  9. Change from Baseline in Analgesic use [ Time Frame: Baseline, Days 1 and 8 of Cycles 1, 2, 4, 5, 7, 8, 10, 11, 13, 14, 16, 17, Day 1 of Cycles 3, 6, 9, 12, 15, 18 and 37 days post last visit (up to 22 months) ]
    Participants recorded their analgesic usage in diaries.

  10. Number of Participants With Karnofsky Performance Score (KPS) [ Time Frame: Baseline, Day 1 of Cycles 1 - 18 and 37 days post last visit (up to 22 months) ]
    The Karnofsky score runs from 100 to 0, where 100 is "perfect" health and 0 is death.

  11. Change From Baseline in Weight [ Time Frame: Baseline, Days 1 and 8 of Cycles 1, 2, 4, 5, 7, 8, 10, 11, 13, 14, 16, 17, Day 1 of Cycles 3, 6, 9, 12, 15, 18 and 37 days post last visit (up to 22 months) ]
    The participant defined to be a clinical benefit responder if the weight change is classified as Positive. (1) Positive: an increase of at least 7% over baseline, maintained for at least 2 cycles (2) Non-positive: any other change in weight.

  12. Number of Participants With Serious Adverse Events [ Time Frame: From start of study treatment up to 22 months ]
    A Serious adverse event (AE) was an AE resulting in any of the following outcomes or deemed significant for any other reason: death; initial or prolonged inpatient hospitalization; life-threatening experience (immediate risk of dying); persistent or significant disability/incapacity; congenital anomaly.

  13. Number of Participants With Non-Serious Adverse Events [ Time Frame: From start of study treatment up to 22 months ]
    An adverse event (AE) is any untoward medical occurrence in a clinical investigation subject administered a pharmaceutical product and that does not necessarily have a causal relationship with this treatment.

  14. Number of Participants With Clinically Significant Findings From the Physical Examination [ Time Frame: From start of study treatment up to 22 months ]
    Physical examination done on the following body systems: general appearance, head and neck, eyes and ears, nose and throat, chest, lungs, heart, abdomen, extremities and joints, lymph nodes, skin, and neurological.

  15. Number of Participants With Clinically Significant Changes in Vital Signs [ Time Frame: From start of study treatment up to 22 months ]
    Number of participants with clinically significant changes in vital signs assessed by measuring height, weight, temperature, respiration rate, pulse rate, systolic and diastolic blood pressure, and body surface area at all the listed time points was reported.

  16. Number of Participants With Clinically Significant Changes in Laboratory Results [ Time Frame: From start of study treatment up to 22 months ]
    Number of participants with clinically significant changes in laboratory results was reported.

  17. Number of Participants With Clinically Significant Changes in Twelve-lead Electrocardiogram (ECG) [ Time Frame: From start of study treatment up to 22 months ]
    Number of participants with clinically significant changes in ECG results was reported.

  18. Maximum Plasma Concentration (Cmax) of Total Irinotecan in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The Cmax of total irinotecan (encapsulated + unencapsulated) in study part 1 was reported.

  19. Maximum Plasma Concentration (Cmax) of Total Primary Metabolite of Irinotecan (SN-38) in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The Cmax of total SN-38 (encapsulated + unencapsulated) in study part 1 was reported.

  20. Maximum Plasma Concentration (Cmax) of SN-38-Glucuronide (SN-38G) in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The Cmax of SN-38G in study part 1 was reported.

  21. Time of Maximum Concentration (tmax) of Total Irinotecan, Total SN-38, and SN-38-Glucuronide (SN-38G) in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The Tmax of total irinotecan (encapsulated + unencapsulated), total SN-38 (encapsulated + unencapsulated), and SN-38G was reported.

  22. Terminal Half-Life (t1/2) of Total Irinotecan, Total SN-38, and SN-38-Glucuronide (SN-38G) in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The t1/2 of Total irinotecan (encapsulated + unencapsulated), total SN-38 (encapsulated + unencapsulated), and SN-38-glucuronide (SN-38G) in study part 1 was reported.

  23. Area Under the Concentration-time Curve in Plasma Over the Time Interval From 0 Extrapolated to Infinity (AUC0-infinity) of Total Irinotecan in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The AUC0-infinity of Total irinotecan (encapsulated + unencapsulated) in study part 1 was reported.

  24. Area Under the Concentration-time Curve in Plasma Over the Time Interval From 0 Extrapolated to Infinity (AUC0-infinity) of Total SN-38 in Study Part 1. [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The AUC0-infinity of total SN-38 (encapsulated + unencapsulated)in study part 1 was reported.

  25. Area Under the Concentration-time Curve in Plasma Over the Time Interval From 0 Extrapolated to Infinity (AUC0-infinity) of SN-38-Glucuronide (SN-38G) IN Study Part 1. [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The AUC0-infinity of SN-38-glucuronide (SN-38G) in study part 1 was reported.

  26. Systemic Clearance (CL) of Total Irinotecan in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The CL of total irinotecan (encapsulated + unencapsulated) in study part 1 was reported.

  27. Systemic Clearance (CL) of Total SN-38 in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The CL of SN-38 (encapsulated + unencapsulated), in study part 1 was reported.

  28. Systemic Clearance (CL) of SN-38-Glucuronide (SN-38G) in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The CL of SN-38-glucuronide (SN-38G) in study part 1 was reported.

  29. Volume of Distribution (V) of Total Irinotecan in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The V of total irinotecan (encapsulated + unencapsulated) in study part 1 was reported.

  30. Volume of Distribution (V) of Total SN-38 in Study Part 1. [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The V of total SN-38 (encapsulated + unencapsulated), in study part 1 was reported.

  31. Volume of Distribution (V) of SN-38-Glucuronide (SN-38G) in Study Part 1. [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The V of SN-38-glucuronide (SN-38G) in study part 1 was reported.

  32. Volume of Distribution at Steady-State (Vss) of Total Irinotecan in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The Vss of total irinotecan (encapsulated + unencapsulated) in study part 1 was reported.

  33. Volume of Distribution at Steady-state (Vss) of Total SN-38 in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The Vss of total irinotecan (encapsulated + unencapsulated), SN-38 (encapsulated + unencapsulated), and SN-38-glucuronide (SN-38G) was reported.

  34. Volume of Distribution at Steady-state (Vss) of SN-38-Glucuronide (SN-38G) in Study Part 1 [ Time Frame: Cycle 1: pre dose, 30, 60, 90 minutes after start of infusion and 1, 3, 9, 24, 36, 48, 72, 120 and 168 hours after the end of the infusion; Cycle 2: pre dose ]
    The Vss of SN-38-glucuronide (SN-38G) in study part 1 was reported.

  35. Terminal Half-life (t1/2) - Total Irinotecan, SN-38, and SN-38-Glucuronide (SN-38G) [ Time Frame: Cycle 1: pre dose, 15-90 minutes after start of infusion; and 0-6, 6-24, 24-48, 72-168, and 216-264 hours after the end of the infusion; Cycle 2: pre dose ]
    The t1/2 of total irinotecan (encapsulated + unencapsulated), SN-38 (encapsulated + unencapsulated), and SN-38-glucuronide (SN-38G) was reported.

  36. Area Under the Curve (AUC) - Total Irinotecan, SN-38, and SN-38-Glucuronide (SN-38G) [ Time Frame: Cycle 1: pre dose, 15-90 minutes after start of infusion; and 0-6, 6-24, 24-48, 72-168, and 216-264 hours after the end of the infusion; Cycle 2: pre dose ]
    The AUC of total irinotecan (encapsulated + unencapsulated), SN-38 (encapsulated + unencapsulated), and SN-38-glucuronide (SN-38G) was reported.

  37. Systemic Clearance (CL) -Total Irinotecan, SN-38, and SN-38-Glucuronide (SN-38G) [ Time Frame: Cycle 1: pre dose, 15-90 minutes after start of infusion; and 0-6, 6-24, 24-48, 72-168, and 216-264 hours after the end of the infusion; Cycle 2: pre dose ]
    The CL of total irinotecan (encapsulated + unencapsulated), SN-38 (encapsulated + unencapsulated), and SN-38-glucuronide (SN-38G) was reported.

  38. Volume of Distribution (V)-Total Irinotecan, SN-38, and SN-38-Glucuronide (SN-38G) [ Time Frame: Cycle 1: pre dose, 15-90 minutes after start of infusion; and 0-6, 6-24, 24-48, 72-168, and 216-264 hours after the end of the infusion; Cycle 2: pre dose ]
    The V of total irinotecan (encapsulated + unencapsulated), SN-38 (encapsulated + unencapsulated), and SN-38-glucuronide (SN-38G) was reported.

  39. Volume of Distribution at Steady-State (Vss)-Total Irinotecan, SN-38, and SN-38-Glucuronide (SN-38G) [ Time Frame: Cycle 1: pre dose, 15-90 minutes after start of infusion; and 0-6, 6-24, 24-48, 72-168, and 216-264 hours after the end of the infusion; Cycle 2: pre dose ]
    The Vss of total irinotecan (encapsulated + unencapsulated), SN-38 (encapsulated + unencapsulated), and SN-38-glucuronide (SN-38G) was reported.



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.


Layout table for eligibility information
Ages Eligible for Study:   20 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Participant is ≥20 years of age at the time of screening.
  2. Histologically or cytologically confirmed adenocarcinoma of exocrine pancreas
  3. Documented metastatic disease
  4. Metastatic disease with at least one measurable lesion as defined by RECIST 1.1 guidelines
  5. Documented disease progression after prior gemcitabine or any gemcitabine containing therapy but excluding irinotecan, for locally advanced or metastatic setting. Prior chemotherapy must be stopped for at least 21 days before the first dose.
  6. Karnofsky Performance Status (KPS) ≥70
  7. Adequate bone marrow reserves
  8. Adequate hepatic function
  9. Adequate renal function
  10. Normal ECG including Fridericia corrected QT interval (QTcF) <440 ms within 7 days prior to first dose of study drug
  11. Recovered from the effects of any prior surgery, radiotherapy or other anti-neoplastic therapy with no residual adverse events (AEs) of Grade ≥2.
  12. Able to understand and sign an informed consent (or have a legal representative who is able to do so)
  13. If female of childbearing potential, participant presents with a negative pregnancy, and agrees to employ adequate birth control measures during the study dosing period and for 3 months following the last dose of study drug.
  14. Participant is willing and able to comply with the requirements of the protocol.

Exclusion Criteria:

  1. Active and uncontrolled central nervous system (CNS) metastases; for controlled CNS metastases, patient should have been off steroids for at least 28 days prior to starting study therapy.
  2. History of any second malignancy in the last 5 years; participants with prior history of in-situ cancer or basal or squamous cell skin cancers are eligible. Participants with other malignancies are eligible if they have been continuously disease free for at least 5 years.
  3. Severe arterial thromboembolic events (myocardial infarction, unstable angina pectoris, stroke) less than 6 months before inclusion.
  4. Cannot stop medications that are potent CYP3A4 inducers within 2 weeks and inhibitors within 1 week before start of treatment.
  5. Significant cardiac conduction abnormalities, including a history of long QTcF syndrome and/or pacemaker.
  6. New York Heart Association (NYHA) Class III or IV congestive heart failure, ventricular arrhythmias or uncontrolled blood pressure.
  7. Active infection, including active hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV, or an unexplained fever >38.5°C during screening visits or on the first scheduled day of dosing (at the discretion of the investigator, patients with tumor fever may be enrolled), which in the investigator's opinion might compromise the patient's participation in the trial or affect the study outcome.
  8. Known hypersensitivity to any of the components of BAX2398, other liposomal products, fluoropyrimidines, or calcium levofolinate.
  9. 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 interfere with the interpretation of the results.
  10. Participant has been exposed to an investigational product (IP) within 30 days prior to the first dose of the study drug or is scheduled to participate in another clinical study involving an IP or investigational device during the course of this study.
  11. Participant is a family member or employee of the investigator.
  12. Participant is pregnant or lactating at the time of enrollment. Lactating mothers can resume breast feeding 30 days following the last dose of the study treatment.

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): NCT02697058


Locations
Layout table for location information
Japan
Hirosaki University School of Medicine & Hospital
Hirosaki-shi, Aomori-Ken, Japan, 036-8563
Chiba Cancer Center
Chiba-shi, Chiba-Ken, Japan, 260-8717
National Cancer Center Hospital East
Kashiwa-shi, Chiba-Ken, Japan, 277-8577
NHO Shikoku Cancer Center
Matsuyama-shi, Ehime-Ken, Japan, 791-0280
NHO Kyushu Cancer Center
Fukuoka-shi, Fukuoka-Ken, Japan, 811-1395
Kyushu University Hospital
Fukuoka-shi, Fukuoka-Ken, Japan, 812-8582
Hokkaido University Hospital
Sapporo-shi, Hokkaido, Japan, 060-8648
Kanagawa Cancer Center
Yokohama, Kanagawa -ku, Japan, 241-8515
Yokohama City University Medical Center
Yokohama-shi, Kanagawa-Ken, Japan, 232-0024
Kyoto University Hospital
Kyoto-shi, Kyoto-Fu, Japan, 606-8507
NHO Osaka National Hospital
Osaka-shi, Osaka-Fu, Japan, 540-0006
Osaka International Cancer Institute
Osaka-shi, Osaka-Fu, Japan, 541-8567
Saitama Cancer Center
Kitaadachi-gun, Saitama-Ken, Japan, 362-0806
Cancer Institute Hospital of JFCR
Koto-ku, Tokyo-To, Japan, 135-8550
Kyorin University Hospital
Mitaka-shi, Tokyo-To, Japan, 181-8611
National Cancer Center Hospital
Chuo Ku, Tokyo, Japan, 104-0045
Sponsors and Collaborators
Institut de Recherches Internationales Servier

Layout table for additonal information
Responsible Party: Institut de Recherches Internationales Servier
ClinicalTrials.gov Identifier: NCT02697058     History of Changes
Other Study ID Numbers: 331501
First Posted: March 3, 2016    Key Record Dates
Last Update Posted: July 29, 2019
Last Verified: July 2019

Layout table for additional information
Product Manufactured in and Exported from the U.S.: Yes

Additional relevant MeSH terms:
Layout table for MeSH terms
Pancreatic Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Endocrine Gland Neoplasms
Digestive System Diseases
Pancreatic Diseases
Endocrine System Diseases
Calcium, Dietary
Leucovorin
Fluorouracil
Calcium
Levoleucovorin
Calcium-Regulating Hormones and Agents
Physiological Effects of Drugs
Bone Density Conservation Agents
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Antineoplastic Agents
Immunosuppressive Agents
Immunologic Factors
Antidotes
Protective Agents
Vitamin B Complex
Vitamins
Micronutrients
Nutrients
Growth Substances