Phase 2 Evaluation of Multi-modality Algorithm for Non-metastatic Adenocarcinoma of Pancreas or Ampulla

Essentia Health

Status and phase: Terminated; Phase 2

Conditions: Adenocarcinoma of Ampulla; Ductal Adenocarcinoma of Pancreas

Treatments: Procedure: Definitive resection; Radiation: Preoperative chemoradiation; Drug: 5-fluorouracil and irinotecan; Drug: Gemcitabine and nanoparticle albumin bound paclitaxel

Study type: Interventional

Funder types: Other

Identifiers

NCT02626520

PANC-1

Details and patient eligibility

About

Patients diagnosed with pancreatic cancer without clinically detectable metastatic disease will be treated with standardized systemic chemotherapy, followed by chemoradiation, and then surgical resection for those with resectable or borderline resectable disease. The primary endpoint is disease-free survival at 1 yr from initiation of treatment.

Full description

Patients with ductal adenocarcinoma of the pancreas (or ampulla) that have received no prior therapy and have no clinically detectable metastatic disease will be enrolled. Management will be driven by resectability status as defined by the American College of Surgeons. All patients will be defined at entry as Resectable, Borderline Resectable or Locally Advanced (Unresectable).

All patients will be treated initially with gemcitabine and nanoparticle albumin bound paclitaxel (nab-paclitaxel) every 14 days for 4 cycles. Patients classified as Resectable, who have CA19-9 below 180 and CA-125 below 30 will then proceed to resection. All other patients will get 5-fluorouracil as 46 hr infusion given with leucovorin and irinotecan (FOLFIRI-3) every 14 days x 4 cycles.

All patients without progression will then receive chemoradiation consisting of external beam radiotherapy (40 Gy in 20 fractions given over 4 weeks). During radiation all patients will receive radiosensitizing radiotherapy as: 5-fluorouracil at 225 mg/m2 5 days per week, Mitomycin-C at 3 mg.m2 on d1, 8, 15 & 22; Cisplatin at 10 mg/m2 on d2, 9, 16, 23 and unfractionated heparin at 6,000 units/m2 daily in divided doses from day 1 to day 28.

After approximately 4 weeks to recover from chemoradiation, all patients with Resectable or Borderline Resectable disease will undergo definitive surgery.

Adjuvant therapy with FOLFIR-3 for an additional 6 cycles will be offered to all patients post-operatively.

Patients will then be actively followed every 3 to 6 months in keeping with National Comprehensive Cancer Network (NCCN) guidelines for 2 yrs, and then followed for recurrence, late toxicity and vital status every 6 months through 5 years.

Enrollment: 11 patients

Sex: All

Ages: 18 to 85 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Histologic proof of adenocarcinoma consistent with ductal carcinoma of pancreas or ampulla, with no evidence of metastatic disease by clinical exam or cross-sectional imaging.
• Fitness for chemotherapy in judgement of treating physician
• Bilirubin < 4 (any means of biliary drainage acceptable)

Exclusion criteria

• Medical or mental illness precluding provision of informed consent
• Pregnancy
• Active infection for which neutropenia would pose high risk of mortality

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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11 participants in 2 patient groups

Resectable, Low Risk

Experimental group

Description:

Systemic chemotherapy followed by definitive surgery without pre-operative or post-operative radiotherapy.

Treatment:

Drug: Gemcitabine and nanoparticle albumin bound paclitaxel

Procedure: Definitive resection

Locally Advanced

Experimental group

Description:

Systemic chemotherapy followed by chemoradiation, followed by definitive surgery

Treatment:

Drug: Gemcitabine and nanoparticle albumin bound paclitaxel

Drug: 5-fluorouracil and irinotecan

Procedure: Definitive resection

Radiation: Preoperative chemoradiation