Efficacy and Safety of BC-819 and Gemcitabine in Patients With Locally Advanced Pancreatic Adenocarcinoma (LAPC-BC-819)
Primary Purpose
Pancreas, Adenocarcinoma
Status
Terminated
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Biological/Vaccine: BC-819
Sponsored by

About this trial
This is an interventional treatment trial for Pancreas, Adenocarcinoma focused on measuring Pancreatic cancer, Gemcitabine, BC-819, Adenocarcinoma, Resectable, H19 gene, DTA-H19, BioCancell, inodiftagene vixteplasmid
Eligibility Criteria
Inclusion Criteria:
- Males or females > 18 years of age
- If female, must not be pregnant or nursing; women of child-bearing potential must practice a medically approved method of contraception
- If male, must practice a medically approved method of contraception if have a partner of childbearing potential
- Histologically or cytologically confirmed adenocarcinoma of the exocrine pancreas
- Locally advanced pancreatic cancer (LAPC) that is clinically unresectable as defined in the NCCN Guidelines
- Karnofsky performance status (KPS) ≥ 70% at baseline
Adequate hematological, renal, and hepatic function
- Platelet count ≥ 100,000/mm3
- Absolute neutrophil count (ANC) ≥ 1500/mm3
- Hemoglobin ≥ 10.0 g/dL (may be achieved by transfusion)
- Creatinine (≤ 1.5 x ULN)
- ALT, AST (≤ 1.5 x ULN)
- Total Bilirubin (≤ 1.5 x ULN)
- Have a target tumor lesion in the pancreas ≤ 6 cm in diameter that is accessible for intratumoral administration by EUS guidance as determined by the physician performing the EUS injection
- Have a biopsy specimen that is positive for H19 expression (grade 2 or greater staining determined by a pathologist). H19 expression can be determined based on a biopsy specimen collected before study participation, if available.
- No prior diagnosis of malignancy within 3 years except for curatively treated non-melanoma skin or in situ malignancies
- Able to comply with the protocol procedures
- Able and willing to provide written (signed) Informed Consent to participate in the study
Exclusion Criteria:
- Have distant metastatic spread (such as liver or lung metastases), peritoneal spread or malignant ascites. Regional lymph node involvement may be considered in accordance with the PI's judgment
- Received any prior therapy for the treatment of pancreatic malignancy (including chemotherapy, immunotherapy, vaccines, monoclonal antibodies, major surgery, or irradiation, whether conventional or investigational, other than up to4 single doses of gemcitabine chemotherapy.Patients who received prior gemcitabine will only be eligible, if they enter the study without evidence of disease progression.
- Known human immunodeficiency virus (HIV) or hepatitis C virus (HCV) or hepatitis B virus (HBV) infection
- Have clinically significant pancreatitis within 12 weeks of treatment
- Have a clinical history of significant coagulopathy
- Have a medical condition contraindicated for endoscopic-guided delivery and/or for IV administration of Gemcitabine or any intercurrent medical illness or other medical condition that would in the judgment of the investigator compromise patient safety or the objectives of the study
- Have participated in any experimental therapeutic research study with an unapproved drug within 4 weeks of the screening visit
- Patients who require ongoing anticoagulation for pre-existing conditions, e.g., thrombophlebitis, pulmonary embolus or atrial fibrillation
Sites / Locations
- Winthrop University Hospital
- Thomas Jefferson University
- Joe Arrington Cancer Research & Treatment Center
- Carmel Medical Center
- Rambam Medical Center
- Hadassah Medical Organization
- Meir Medical Center
- Galil Maaravi
- Tel Aviv Medical Center
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Experimental
Arm Label
8 mg BC-819 and Gemcitabine
12 mg BC-819 and Gemcitabine
Arm Description
gemcitabine dose of 1000mg/m2 + 8 mg of BC-819
gemcitabine dose of 1000mg/m2 + 12 mg of BC-819
Outcomes
Primary Outcome Measures
Progression-free Survival (PFS)
To compare the effect of intratumoral endoscopic ultrasound injection of BC-819 administered with intravenous gemcitabine on progression-free survival. PFS was defined as the time from the date of consent until objective tumor progression or death. Median PFS by Kaplan-Meier analysis was used for evaluation. The target tumor lesion was identified and the longest diameter of the target lesion was measured according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 guidelines. For disease evaluations after treatment, scans conducted at baseline that were used for tumor measurements were repeated.
Secondary Outcome Measures
Overall Survival (OS)
OS was calculated from the date of consent until death due to any cause.
Response Rate of Target Lesion
Response rate will be assessed both for the primary target tumor lesion alone and overall, including development of metastases. Target tumor lesions are identified and the longest diameter of the target lesion is measured by the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 guidelines.
Complete response: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm.
Partial Response: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Progressive Disease: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum must also show an increase of at least 5 mm.
Stable Disease: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Resectability of the Target Tumor Lesion
Resectability of the target tumor lesion was determined by CT/MRI as defined in the National Comprehensive Cancer network (NCCN) guidelines. Resectable tumors have no arterial tumor contact (celiac axis [CA], superior mesenteric artery [SMA], or common hepatic artery [CHA]) and no tumor contact with the superior mesenteric vein (SMV) or portal vein (PV) or ≤180° contact without vein contour irregularity. *Not Applicable refers to another clinically significant abnormality that interfered with resectability determination of the target tumor lesion.
Quality of Life (QoL) Assessed by Karnofsky Performance Status (KPS)
Quality of life will be assessed by the The Karnofsky Performance Status (KPS) Index. KPS scores over time will be compared to those at baseline and changes from baseline will be presented.
KPS scores are on a scale (0, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100) of 0 (dead) to 100 (Normal no complaints; no evidence of disease).
Quality of Life Using the Functional Assessment of Cancer Therapy-General (FACT-G) Questionnaire
The FACT-G is a 27-item compilation of general questions divided into 4 primary QoL domains: physical well-being, social/family well-being, emotional well-being and functional well-being. The total FACT-G scores will be summarized by descriptive statistics (e.g., n, mean, median, standard deviation and range). The individual FACT-G score will be presented by frequency and percentage. Scores range from 0-108. High total scores represent better general QoL.
Serological Tumor Marker: CA 19-9
Serum was collected for quantitative measurement of CA 19-9.
Extent of Exposure - Gemcitabine Total Exposure (g)
Measured by the average and median number of exposure of the patients to BC-819 and gemcitabine.
Extent of Exposure - Gemcitabine Total Number of Treatments
Measured by the average and median number of treatments of the patients to BC-819 and gemcitabine.
Extent of Exposure - BC-819 Total Exposure (mg)
Measured by the average and median exposure of the patients to BC-819 and gemcitabine.
Extent of Exposure - BC-819 Total Number of Treatments
Measured by the average and median number of treatments of the patients to BC-819 and gemcitabine.
Full Information
NCT ID
NCT01413087
First Posted
August 8, 2011
Last Updated
October 14, 2019
Sponsor
Anchiano Therapeutics Israel Ltd.
1. Study Identification
Unique Protocol Identification Number
NCT01413087
Brief Title
Efficacy and Safety of BC-819 and Gemcitabine in Patients With Locally Advanced Pancreatic Adenocarcinoma
Acronym
LAPC-BC-819
Official Title
A Multi-Center, Open-Label, Randomized, Phase 2b Study to Evaluate the Efficacy and Safety of BC-819 and Gemcitabine in Patients With Locally Advanced Pancreatic Adenocarcinoma
Study Type
Interventional
2. Study Status
Record Verification Date
October 2019
Overall Recruitment Status
Terminated
Why Stopped
Due to Sponsor's decision, only 12 patients were randomized & completed study.
Study Start Date
September 2011 (Actual)
Primary Completion Date
January 2013 (Actual)
Study Completion Date
May 2014 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Anchiano Therapeutics Israel Ltd.
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
This is a multicenter, open label, randomized, phase 2b study, designed to evaluate the safety and efficacy of patients with locally advanced pancreatic adenocarcinoma following intratumoral administration of BC-819 and intravenously administered gemcitabine. Intratumoral injections of BC-819 will be performed using endoscopic ultrasound (EUS).
Primary Objective: To assess the effect of intratumoral endoscopic ultrasound injection of BC-819 administered with intravenous gemcitabine on progression-free survival.
Secondary Objectives: To compare the effects of intratumoral injection of BC-819 administered in combination with intravenous gemcitabine vs. intravenous gemcitabine alone on:
Overall survival, Response rate, Resectability of the target tumor lesion, Quality of life, Safety, Serological Tumor Marker: CA 19-9, Duration of response, Failure-free survival
Detailed Description
BC-819 (also known as DTA-H19) is a double-stranded DNA plasmid, 4,560 base pairs (bp) in length, carrying the gene for the Diphtheria toxin A (DT-A) chain under the regulation of the H19 promoter. This is a Targeted Cancer Therapy; DT-A chain expression is triggered by the presence of H19 transcription factors that are only up-regulated in tumor cells. The selective initiation of toxin expression results in selective tumor cell destruction via inhibition of protein synthesis selectively in the tumor cell, enabling highly targeted cancer treatment.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pancreas, Adenocarcinoma
Keywords
Pancreatic cancer, Gemcitabine, BC-819, Adenocarcinoma, Resectable, H19 gene, DTA-H19, BioCancell, inodiftagene vixteplasmid
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
12 (Actual)
8. Arms, Groups, and Interventions
Arm Title
8 mg BC-819 and Gemcitabine
Arm Type
Experimental
Arm Description
gemcitabine dose of 1000mg/m2 + 8 mg of BC-819
Arm Title
12 mg BC-819 and Gemcitabine
Arm Type
Experimental
Arm Description
gemcitabine dose of 1000mg/m2 + 12 mg of BC-819
Intervention Type
Biological
Intervention Name(s)
Biological/Vaccine: BC-819
Other Intervention Name(s)
DTA-H19, inodiftagene vixteplasmid
Intervention Description
Post screening and prior to randomization, all patients will receive gemcitabine by IV infusion at a dose of 1000mg/m2 once weekly for four weeks. They may also enter the study if they received up to 4 doses of gemcitabine before entering the study. In this case, they will be randomized immediately provided there is no evidence of disease progression.
After randomization patients will receive 6 weekly IV infusions of gemcitabine at a dose of 1000mg/m2 + 7 intratumoral injections of BC-819 (8 mg or 12 mg according to allocations by randomization)
Primary Outcome Measure Information:
Title
Progression-free Survival (PFS)
Description
To compare the effect of intratumoral endoscopic ultrasound injection of BC-819 administered with intravenous gemcitabine on progression-free survival. PFS was defined as the time from the date of consent until objective tumor progression or death. Median PFS by Kaplan-Meier analysis was used for evaluation. The target tumor lesion was identified and the longest diameter of the target lesion was measured according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 guidelines. For disease evaluations after treatment, scans conducted at baseline that were used for tumor measurements were repeated.
Time Frame
24 months
Secondary Outcome Measure Information:
Title
Overall Survival (OS)
Description
OS was calculated from the date of consent until death due to any cause.
Time Frame
24 months
Title
Response Rate of Target Lesion
Description
Response rate will be assessed both for the primary target tumor lesion alone and overall, including development of metastases. Target tumor lesions are identified and the longest diameter of the target lesion is measured by the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 guidelines.
Complete response: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm.
Partial Response: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Progressive Disease: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study. In addition to the relative increase of 20%, the sum must also show an increase of at least 5 mm.
Stable Disease: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Time Frame
8 weeks
Title
Resectability of the Target Tumor Lesion
Description
Resectability of the target tumor lesion was determined by CT/MRI as defined in the National Comprehensive Cancer network (NCCN) guidelines. Resectable tumors have no arterial tumor contact (celiac axis [CA], superior mesenteric artery [SMA], or common hepatic artery [CHA]) and no tumor contact with the superior mesenteric vein (SMV) or portal vein (PV) or ≤180° contact without vein contour irregularity. *Not Applicable refers to another clinically significant abnormality that interfered with resectability determination of the target tumor lesion.
Time Frame
an average of 16 weeks
Title
Quality of Life (QoL) Assessed by Karnofsky Performance Status (KPS)
Description
Quality of life will be assessed by the The Karnofsky Performance Status (KPS) Index. KPS scores over time will be compared to those at baseline and changes from baseline will be presented.
KPS scores are on a scale (0, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100) of 0 (dead) to 100 (Normal no complaints; no evidence of disease).
Time Frame
Screening, Visit 4 (post gemcitabine induction), Visit 9 (5 weeks), Visit 13 (9 weeks)
Title
Quality of Life Using the Functional Assessment of Cancer Therapy-General (FACT-G) Questionnaire
Description
The FACT-G is a 27-item compilation of general questions divided into 4 primary QoL domains: physical well-being, social/family well-being, emotional well-being and functional well-being. The total FACT-G scores will be summarized by descriptive statistics (e.g., n, mean, median, standard deviation and range). The individual FACT-G score will be presented by frequency and percentage. Scores range from 0-108. High total scores represent better general QoL.
Time Frame
Screening, Visit 4 (post gemcitabine induction), Visit 9 (5 weeks), Visit 13 (9 weeks), every 6 months after Visit 13
Title
Serological Tumor Marker: CA 19-9
Description
Serum was collected for quantitative measurement of CA 19-9.
Time Frame
24 months
Title
Extent of Exposure - Gemcitabine Total Exposure (g)
Description
Measured by the average and median number of exposure of the patients to BC-819 and gemcitabine.
Time Frame
24 months
Title
Extent of Exposure - Gemcitabine Total Number of Treatments
Description
Measured by the average and median number of treatments of the patients to BC-819 and gemcitabine.
Time Frame
24 months
Title
Extent of Exposure - BC-819 Total Exposure (mg)
Description
Measured by the average and median exposure of the patients to BC-819 and gemcitabine.
Time Frame
24 months
Title
Extent of Exposure - BC-819 Total Number of Treatments
Description
Measured by the average and median number of treatments of the patients to BC-819 and gemcitabine.
Time Frame
24 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Males or females > 18 years of age
If female, must not be pregnant or nursing; women of child-bearing potential must practice a medically approved method of contraception
If male, must practice a medically approved method of contraception if have a partner of childbearing potential
Histologically or cytologically confirmed adenocarcinoma of the exocrine pancreas
Locally advanced pancreatic cancer (LAPC) that is clinically unresectable as defined in the NCCN Guidelines
Karnofsky performance status (KPS) ≥ 70% at baseline
Adequate hematological, renal, and hepatic function
Platelet count ≥ 100,000/mm3
Absolute neutrophil count (ANC) ≥ 1500/mm3
Hemoglobin ≥ 10.0 g/dL (may be achieved by transfusion)
Creatinine (≤ 1.5 x ULN)
ALT, AST (≤ 1.5 x ULN)
Total Bilirubin (≤ 1.5 x ULN)
Have a target tumor lesion in the pancreas ≤ 6 cm in diameter that is accessible for intratumoral administration by EUS guidance as determined by the physician performing the EUS injection
Have a biopsy specimen that is positive for H19 expression (grade 2 or greater staining determined by a pathologist). H19 expression can be determined based on a biopsy specimen collected before study participation, if available.
No prior diagnosis of malignancy within 3 years except for curatively treated non-melanoma skin or in situ malignancies
Able to comply with the protocol procedures
Able and willing to provide written (signed) Informed Consent to participate in the study
Exclusion Criteria:
Have distant metastatic spread (such as liver or lung metastases), peritoneal spread or malignant ascites. Regional lymph node involvement may be considered in accordance with the PI's judgment
Received any prior therapy for the treatment of pancreatic malignancy (including chemotherapy, immunotherapy, vaccines, monoclonal antibodies, major surgery, or irradiation, whether conventional or investigational, other than up to4 single doses of gemcitabine chemotherapy.Patients who received prior gemcitabine will only be eligible, if they enter the study without evidence of disease progression.
Known human immunodeficiency virus (HIV) or hepatitis C virus (HCV) or hepatitis B virus (HBV) infection
Have clinically significant pancreatitis within 12 weeks of treatment
Have a clinical history of significant coagulopathy
Have a medical condition contraindicated for endoscopic-guided delivery and/or for IV administration of Gemcitabine or any intercurrent medical illness or other medical condition that would in the judgment of the investigator compromise patient safety or the objectives of the study
Have participated in any experimental therapeutic research study with an unapproved drug within 4 weeks of the screening visit
Patients who require ongoing anticoagulation for pre-existing conditions, e.g., thrombophlebitis, pulmonary embolus or atrial fibrillation
Facility Information:
Facility Name
Winthrop University Hospital
City
Mineola
State/Province
New York
ZIP/Postal Code
11501
Country
United States
Facility Name
Thomas Jefferson University
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
Facility Name
Joe Arrington Cancer Research & Treatment Center
City
Lubbock
State/Province
Texas
ZIP/Postal Code
79410
Country
United States
Facility Name
Carmel Medical Center
City
Haifa
Country
Israel
Facility Name
Rambam Medical Center
City
Haifa
Country
Israel
Facility Name
Hadassah Medical Organization
City
Jerusalem
Country
Israel
Facility Name
Meir Medical Center
City
Kfar Saba
Country
Israel
Facility Name
Galil Maaravi
City
Nahariya
Country
Israel
Facility Name
Tel Aviv Medical Center
City
Tel Aviv
Country
Israel
12. IPD Sharing Statement
Learn more about this trial
Efficacy and Safety of BC-819 and Gemcitabine in Patients With Locally Advanced Pancreatic Adenocarcinoma
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