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Pancreatic Adenocarcinoma Neoadjuvant Combination Chemotherapy and Stereotactic Body Radiation Therapy Before Surgery (PANCREAS)

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ClinicalTrials.gov Identifier: NCT04452461
Recruitment Status : Not yet recruiting
First Posted : June 30, 2020
Last Update Posted : June 30, 2020
Sponsor:
Information provided by (Responsible Party):
Pablo Serrano, Hamilton Health Sciences Corporation

Brief Summary:
This is a single-arm, single-center feasibility trial of patients with borderline resectable pancreatic adenocarcinoma receiving radiation therapy with Stereotactic body radiation therapy (SBRT) and chemotherapy with mFOLFIRINOX or gemcitabine / nab-paclitaxel followed by pancreatectomy.

Condition or disease Intervention/treatment Phase
Pancreatic Adenocarcinoma Drug: mFOLFIRINOX Drug: Gemcitabine / Nab-paclitaxel Radiation: Stereotactic body radiation therapy Phase 2

Detailed Description:

Borderline resectable pancreatic adenocarcinoma infiltrates into adjacent vascular structures to an extent such that complete macroscopic resection is technically feasible, but an R0 resection poses a challenge when surgery is the primary therapy. Therefore, a different management strategy may be beneficial.

The primary outcome of the PANCREAS trial is defined as the proportion of eligible patients enrolled in the study over an 18-month period and the proportion of patients who complete the protocol (neoadjuvant therapy and pancreatectomy). Certain modifications of the neoadjuvant therapy protocol are expected and allowed, and the primary feasibility outcome will be one of the following: stop, main study non-feasible; continue with protocol modifications; or continue without modification. A safety analysis will be performed after first 15 patients are enrolled and complete neoadjuvant therapy and surgery. Patients enrolled in this trial will undergo interventions in the following order: neoadjuvant chemotherapy, re-staging CT scan, SBRT, re-staging CT scan, pancreatectomy and adjuvant chemotherapy. Postoperative mortality will be recorded up to 90 days after surgery. Patients will be followed every four months with a CT scan of the chest/abdomen for two years after resection or until evidence of disease recurrence. Patients who do not undergo surgical resection will be followed for two years after accrual (duration of study period) or until evidence of disease progression or death.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: mFOLFIRINOX or Gemcitabine / Nab-paclitaxel and Stereotactic Body Radiation Therapy Followed by Pancreatectomy for Patients With Borderline Resectable Pancreatic Adenocarcinoma. A Pilot Feasibility Study.
Estimated Study Start Date : September 1, 2020
Estimated Primary Completion Date : May 1, 2022
Estimated Study Completion Date : May 1, 2026

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Single Arm Intervention
  1. Chemotherapy: 6 cycles (three months) of IV combination chemotherapy with mFOLFIRINOX on day 1 followed by one week of rest (14-day cycle). Alternatively, patients will receive three months of gemcitabine / nab-paclitaxel.
  2. Re-staging CT scan with Carbohydrate Antigen (CA) 19-9 serum test.
  3. Radiation therapy with SBRT for 5 days.
  4. Re-staging CT scan with CA 19-9 serum test one week following the last day of SBRT . Staging laparoscopy to rule out occult metastatic disease is optional based on surgeon's preference.
  5. Pancreatectomy 4 weeks following the last day of SBRT as per standard of care.
  6. Adjuvant chemotherapy: as per standard of care.
  7. Clinical assessment and CT scan with CA 19-9 serum test at 4-month intervals until identification of cancer recurrence.
  8. Follow up of patients after 2 years every six months for up to 5 years following the initiation of treatment will be performed off-protocol as per standard of care.
Drug: mFOLFIRINOX
mFOLFIRINOX, including: Oxaliplatin 85 mg/m2 IV over 2 hours, Leucovorin 400mg/m2 IV over 2 hours, Irinotecan at 150 mg/m2 IV over 90 min, 5-Fluoruracil continuous infusion of 2400 mg/m2 IV over 46h.
Other Names:
  • 5-FU
  • leucovorin
  • oxaliplatin

Drug: Gemcitabine / Nab-paclitaxel
Both drugs are administered once weekly for three weeks (days 1, 8, 15) followed by a week of rest (28-day cycle) for 3 cycles prior to imaging. Gemcitabine: 1000 mg/m2 intravenous infusion over 30 to 40 minutes. Nab-paclitaxel: 125 mg/m2 intravenous infusion over 30 to 40 minutes.
Other Name: gemcitabine / abraxane

Radiation: Stereotactic body radiation therapy
The radiation dose will be limited to 30 Gy maximum for the small bowel. For other organs, we will follow the "as low as reasonably achievable" principle. Radiation quality assurance will be performed for all treatment plans. Volumes of tumour obtained on CT images at 1.25 mm slice thickness will be reconstructed into a three-dimensional image set for SBRT planning. The SBRT will deliver a radiation dose of 36 Gy in three fractions with 12 Gy per fraction to the isodose line best encompassing the planning target volume, including a 2 mm expansion around the gross tumour.
Other Name: SBRT




Primary Outcome Measures :
  1. Proportion of patients eligible enrolled [ Time Frame: 18 months ]

    Over an 18-month period The proportion of patients who complete the protocol (neoadjuvant therapy and pancreatectomy). As described, there are certain modifications of the neoadjuvant therapy protocol that are expected and allowed. The primary feasibility outcome will be one of the following:

    • Stop, main study non-feasible: 1) estimated proportion of eligible patients enrolled <40% or 2) estimated proportion of enrolled patients who complete the protocol (neoadjuvant therapy and pancreatectomy) <40%.
    • Continue with protocol modifications: 1) estimated proportion of eligible patients enrolled between 40-59% or 2) estimated proportion of enrolled patients who complete the protocol (neoadjuvant therapy and pancreatectomy) 40-59%.
    • Continue without modification: 1) estimated proportion of eligible patients enrolled equal to or greater than 60% or estimated proportion of enrolled patients who complete the protocol (neoadjuv


Secondary Outcome Measures :
  1. Survival [ Time Frame: 24 months ]
    Defined as percentage of patients alive at two years from enrolment.

  2. Time to Progression [ Time Frame: 24 months from the initiation of chemotherapy (the length of the study) ]
    Defined as the duration of time from enrolment to time to radiological evidence of disease progression or recurrence or death, whichever comes first.

  3. Overall Complications from surgery [ Time Frame: From date of surgery (POD=0) up to 90 postoperative days (POD=90) ]
    Occurrence of any postoperative complication (major or minor) from surgery following each patient's hospital stay and up to 90 days from the initial operation.

  4. Pathological response to chemo-radiation treatment [ Time Frame: From the date of the first chemotherapy to the date of surgery (around 4 months) ]
    Pathological response to treatment will be classified as per protocol.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 79 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • 1. Men and women 18 years of age or older who present with biopsy proven borderline resectable pancreatic adenocarcinoma who are medically fit for surgery as per assessment by treating surgeon.

    2. Age ≤ 79 years 3. Eastern Cooperative Oncology Group (ECOG) performance status ≤ 1 4. Normal bone marrow and organ function

    1. Absolute neutrophil count (ANC) = or > 1500, platelets > 100K
    2. Total bilirubin <1.5x upper limit of normal (ULN)
    3. Alanine transaminase (ALT), Aspartate aminotransferase (AST) < 3 x ULN
    4. Creatinine <150umol/L
    5. Normal prothrombin time and international normalized ratio (INR) 5. Able to provide written informed consent

Exclusion Criteria:

  1. Proven metastatic disease (e.g. on imaging modality such as CT scan of the chest, abdomen and pelvis or MRI)
  2. Locally advanced pancreatic cancer (see definition section 3.3)
  3. Prior treatment with radiation therapy to the pancreas or associated field.
  4. Contraindications to receive chemotherapy
  5. History of cardiac disease including congestive heart failure (New York Heart Association class 2), active coronary artery disease or uncontrolled hypertension
  6. Concurrent ongoing systemic infections
  7. Illegal substance abuse, or social conditions that may interfere with patient's participation in the trial
  8. Pre-existing neuropathy
  9. Pregnant patients

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): NCT04452461


Contacts
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Contact: Pablo E Serrano, MD 905-521-2100 ext 43872 serrano@mcmaster.ca
Contact: Leyo Ruo, MD 905-521-2100 ruol@mcmaster.ca

Locations
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Canada, Ontario
Juravinski Hospital
Hamilton, Ontario, Canada, L8V1C3
Contact: Pablo E Serrano, MD    905-521-2100 ext 43872    serrano@mcmaster.ca   
Sub-Investigator: Leyo Ruo, MD         
Sub-Investigator: Brandon Meyers, MD         
Sub-Investigator: Christian van der Pol, MD         
Sub-Investigator: Tariq Aziz, MD         
Sub-Investigator: Sameer Parpia, PhD         
Sub-Investigator: Kimmen Quan, MD         
Sponsors and Collaborators
Hamilton Health Sciences Corporation
Investigators
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Principal Investigator: Pablo E Serrano, MD McMaster University
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Responsible Party: Pablo Serrano, Associate Professor, Hamilton Health Sciences Corporation
ClinicalTrials.gov Identifier: NCT04452461    
Other Study ID Numbers: 5076
First Posted: June 30, 2020    Key Record Dates
Last Update Posted: June 30, 2020
Last Verified: June 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Product Manufactured in and Exported from the U.S.: No
Additional relevant MeSH terms:
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Adenocarcinoma
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Leucovorin
Gemcitabine
Paclitaxel
Oxaliplatin
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
Antidotes
Protective Agents
Vitamin B Complex
Vitamins
Micronutrients
Nutrients
Growth Substances