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Perioperative Treatment With Zoledronic Acid in Patients With Resectable Pancreas Cancer

Primary Purpose

Adenocarcinoma

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Zoledronic acid
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Adenocarcinoma focused on measuring Neoadjuvant zoledronic acid in resectable pancreas cancer

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient must have a newly diagnosed, histologically or cytologically confirmed diagnosis of pancreatic adenocarcinoma. The histological slides or blocks must be available for review.
  • Patient must have resectable disease and be a candidate for surgical treatment.
  • Recent CT scan demonstrating pancreatic tumor, no evidence of distant disease, and no contraindication to resection.
  • Patients must be ≥ 18 years old.
  • Performance Status: Karnofsky Performance Status (KPS) ≥ 70
  • Life Expectancy > 12 weeks.
  • No previous history of chemotherapy for pancreas cancer prior to the start of protocol treatment.
  • Patients must have recovered from uncontrolled, intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris or cardiac arrhythmia.
  • Patients must have adequate bone marrow function defined as an absolute neutrophil count >1,500/mm3, platelet count >100,000/mm3 and hemoglobin >10 g/dl.
  • Patients must have normal renal function defined as serum creatinine ≤ 1.3 mg/dl or creatinine clearance ≥ 90 ml/min/1.73 m2 with a serum creatinine > 1.3 mg/dl.
  • Patients must have adequate hepatic function with total bilirubin < 5.0 mg/dl and AST ≤ 3x the institutional normal value.
  • Patient must have no prior or current active autoimmune disease requiring management with immunosuppression. This includes inflammatory bowel disease, systemic vasculitis, scleroderma, psoriasis, hemolytic anemia, immune-mediated thrombocytopenia, rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, sarcoidosis or other rheumatologic disease. Asthma and chronic obstructive pulmonary disease that does not require daily systemic corticosteroids is acceptable.
  • The patient with previous history of malignancy is eligible for this study only if the patient meets the following criteria for cancer survivor: (i) patient has undergone potentially curative therapy for all prior malignancies; (ii) the patient has been considered disease free for at least 5 years; (iii) adequately treated non-melanomatous skin cancer.
  • For all sexually active patients, the use of adequate barrier contraception (hormonal or barrier method of birth control) will be required during therapy, prior to study entry and for the duration of study participation. Non-pregnant status will be determined in all women of childbearing potential.
  • After being informed of the treatment involved, patients (or their legally authorized representative) must given written consent.

Exclusion Criteria:

  • Patient is currently receiving other investigational agents.
  • Pregnant and nursing women patients are not eligible.
  • Patients known to be HIV positive are ineligible because of the potential inability to modulate immune responses (patient self-report).
  • Patients treated with any bisphosphonate-based therapeutic for any indication, during the previous year.
  • Patients with recent (within 6 weeks) or planned dental or jaw surgery dental or jaw surgery (e.g. extraction, implants).
  • Current active dental problems including infection of the teeth or jawbone (maxilla or mandibular); dental or fixture trauma, or a current or prior diagnosis of osteonecrosis of the jaw (ONJ), of exposed bone in the mouth, or of slow healing after dental procedures.
  • Patients with a history of aspirin sensitive asthma.

Sites / Locations

  • Washington University School of Medicine

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Neoadjuvant Zoledronic Acid

Arm Description

Zoledronic acid 4 mg IV prior to pancreatic resection (approximately 2 weeks prior to resection) Pancreatic resection Zoledronic acid 4 mg IV monthly for two additional doses

Outcomes

Primary Outcome Measures

Evaluate the safety and feasibility perioperative neoadjuvant zoledronic acid in patients with resectable pancreas cancer.
Rate of grade 3 and 4 toxicities, especially nephrotoxicity, electrolyte imbalance and osteonecrosis of the jaw.
Evaluate whether treatment with perioperative zoledronic acid prolongs overall survival or disease free survival.

Secondary Outcome Measures

Determine the pharmacodynamics on selected immune cell subgroups in the peripheral blood and marrow by flow cytometric analysis.
Determine the pharmacodynamics of neoadjuvant zoledronic acid therapy on selected immune cell subgroups in the tumor microenvironment by flow cytometric analysis of pancreatic tumor samples.
Determine the pharmacodynamics of neoadjuvant zoledronic acid therapy on the neoangiogenesis.
Surrogate markers of tumor-associated neoangiogenesis will be analyzed by ELISA. Serum levels of VEGF and MMP9 will be measured compared pre and post treatment.
Determine the pharmacodynamics and surrogate markers neoangiogenesis analyzed by ELISA.
Serum levels of VEGF and MMP9 will be measured compared pre and post treatment and the expression of VEGF and MMP9 in tumor samples will be analyzed.
Measure the presence and change of micrometastatic disease present in the bone marrow at the time of surgery versus baseline using immunohistochemistry.
Evaluate the clinical response and time to disease progression.
Correlate the presence of micrometastatic disease with time to recurrence and outcome.
Measure the change in the amount of micrometastatic disease from baseline.
Determine the pharmacodynamics of neoadjuvant zoledronic acid therapy on selected immune cell subgroups in the hepatic metastatic niche by flow cytometric analysis of pancreatic tumor samples

Full Information

First Posted
May 1, 2009
Last Updated
September 19, 2014
Sponsor
Washington University School of Medicine
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1. Study Identification

Unique Protocol Identification Number
NCT00892242
Brief Title
Perioperative Treatment With Zoledronic Acid in Patients With Resectable Pancreas Cancer
Official Title
Perioperative Treatment With Zoledronic Acid in Patients With Resectable Pancreas Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
September 2014
Overall Recruitment Status
Terminated
Why Stopped
Principal Investigator decided to close the study early.
Study Start Date
December 2009 (undefined)
Primary Completion Date
April 2013 (Actual)
Study Completion Date
April 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The overall purpose of this research is to evaluate the safety and side effects of zoledronic acid (also known as Zometa) in patients before they have surgery to remove the cancer.
Detailed Description
Cancer of the pancreas carries an ominous prognosis. The five-year overall survival rate of this malignancy is less than 5%. Chemotherapy with gemcitabine carries a response rate of approximately 25%. Resection offers the only potential for cure; however, even with resection, the great majority of patients will die with metastatic disease. Substantial improvements are needed in the treatment of this malignancy. Patients with this disease process have clearly developed a tolerance to their pancreatic tumor. This is evidenced by an increased number and activity immunosuppressive cells including MDSC and Treg in patients with pancreas cancer. An intervention that inhibits this population of MDSC and Treg may be highly useful in the treatment of this disease process. A novel treatment of pancreas cancer, in this setting, would be to deplete circulating and tumor-associated immunosuppressive cells prior to resection. This would facilitate the host to mount a greater immune response against the tumor. The eventual goal would be to combine neoadjuvant zoledronic acid with gemcitabine, another agent which synergizes with zoledronic acid to target MDSC. When combined with current adjuvant chemoradiation, the use of zoledronic acid in the neoadjuvant and adjuvant setting, it is hoped that the patient could mount a greater immune response leading to increased overall survival through the prevention of local disease and distant metastasis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adenocarcinoma
Keywords
Neoadjuvant zoledronic acid in resectable pancreas cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
24 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Neoadjuvant Zoledronic Acid
Arm Type
Experimental
Arm Description
Zoledronic acid 4 mg IV prior to pancreatic resection (approximately 2 weeks prior to resection) Pancreatic resection Zoledronic acid 4 mg IV monthly for two additional doses
Intervention Type
Drug
Intervention Name(s)
Zoledronic acid
Other Intervention Name(s)
Zometa
Primary Outcome Measure Information:
Title
Evaluate the safety and feasibility perioperative neoadjuvant zoledronic acid in patients with resectable pancreas cancer.
Description
Rate of grade 3 and 4 toxicities, especially nephrotoxicity, electrolyte imbalance and osteonecrosis of the jaw.
Time Frame
1 year postoperatively
Title
Evaluate whether treatment with perioperative zoledronic acid prolongs overall survival or disease free survival.
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Determine the pharmacodynamics on selected immune cell subgroups in the peripheral blood and marrow by flow cytometric analysis.
Time Frame
Marrow (prior to first dose of zoledronic acid and week 10), peripheral blood (prior to first dose of zoledronic acid, week 10, and month 6)
Title
Determine the pharmacodynamics of neoadjuvant zoledronic acid therapy on selected immune cell subgroups in the tumor microenvironment by flow cytometric analysis of pancreatic tumor samples.
Time Frame
Approximately week 2 (at time of surgery)
Title
Determine the pharmacodynamics of neoadjuvant zoledronic acid therapy on the neoangiogenesis.
Description
Surrogate markers of tumor-associated neoangiogenesis will be analyzed by ELISA. Serum levels of VEGF and MMP9 will be measured compared pre and post treatment.
Time Frame
Prior to zoledronic acid treatment and then completion of zoledronic acid treatment (approximately 10 weeks)
Title
Determine the pharmacodynamics and surrogate markers neoangiogenesis analyzed by ELISA.
Description
Serum levels of VEGF and MMP9 will be measured compared pre and post treatment and the expression of VEGF and MMP9 in tumor samples will be analyzed.
Time Frame
Prior to zoledronic acid treatment and then completion of zoledronic acid treatment (approximately 10 weeks)
Title
Measure the presence and change of micrometastatic disease present in the bone marrow at the time of surgery versus baseline using immunohistochemistry.
Time Frame
Baseline and week 2 (time of surgery)
Title
Evaluate the clinical response and time to disease progression.
Time Frame
6 months postoperatively
Title
Correlate the presence of micrometastatic disease with time to recurrence and outcome.
Time Frame
6 months postoperatively
Title
Measure the change in the amount of micrometastatic disease from baseline.
Time Frame
6 months postoperatively
Title
Determine the pharmacodynamics of neoadjuvant zoledronic acid therapy on selected immune cell subgroups in the hepatic metastatic niche by flow cytometric analysis of pancreatic tumor samples
Time Frame
Approximately 2 weeks (time of surgery)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient must have a newly diagnosed, histologically or cytologically confirmed diagnosis of pancreatic adenocarcinoma. The histological slides or blocks must be available for review. Patient must have resectable disease and be a candidate for surgical treatment. Recent CT scan demonstrating pancreatic tumor, no evidence of distant disease, and no contraindication to resection. Patients must be ≥ 18 years old. Performance Status: Karnofsky Performance Status (KPS) ≥ 70 Life Expectancy > 12 weeks. No previous history of chemotherapy for pancreas cancer prior to the start of protocol treatment. Patients must have recovered from uncontrolled, intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris or cardiac arrhythmia. Patients must have adequate bone marrow function defined as an absolute neutrophil count >1,500/mm3, platelet count >100,000/mm3 and hemoglobin >10 g/dl. Patients must have normal renal function defined as serum creatinine ≤ 1.3 mg/dl or creatinine clearance ≥ 90 ml/min/1.73 m2 with a serum creatinine > 1.3 mg/dl. Patients must have adequate hepatic function with total bilirubin < 5.0 mg/dl and AST ≤ 3x the institutional normal value. Patient must have no prior or current active autoimmune disease requiring management with immunosuppression. This includes inflammatory bowel disease, systemic vasculitis, scleroderma, psoriasis, hemolytic anemia, immune-mediated thrombocytopenia, rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, sarcoidosis or other rheumatologic disease. Asthma and chronic obstructive pulmonary disease that does not require daily systemic corticosteroids is acceptable. The patient with previous history of malignancy is eligible for this study only if the patient meets the following criteria for cancer survivor: (i) patient has undergone potentially curative therapy for all prior malignancies; (ii) the patient has been considered disease free for at least 5 years; (iii) adequately treated non-melanomatous skin cancer. For all sexually active patients, the use of adequate barrier contraception (hormonal or barrier method of birth control) will be required during therapy, prior to study entry and for the duration of study participation. Non-pregnant status will be determined in all women of childbearing potential. After being informed of the treatment involved, patients (or their legally authorized representative) must given written consent. Exclusion Criteria: Patient is currently receiving other investigational agents. Pregnant and nursing women patients are not eligible. Patients known to be HIV positive are ineligible because of the potential inability to modulate immune responses (patient self-report). Patients treated with any bisphosphonate-based therapeutic for any indication, during the previous year. Patients with recent (within 6 weeks) or planned dental or jaw surgery dental or jaw surgery (e.g. extraction, implants). Current active dental problems including infection of the teeth or jawbone (maxilla or mandibular); dental or fixture trauma, or a current or prior diagnosis of osteonecrosis of the jaw (ONJ), of exposed bone in the mouth, or of slow healing after dental procedures. Patients with a history of aspirin sensitive asthma.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Linehan, M.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
St. Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States

12. IPD Sharing Statement

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Links:
URL
http://www.siteman.wustl.edu
Description
Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

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Perioperative Treatment With Zoledronic Acid in Patients With Resectable Pancreas Cancer

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