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Neoadjuvant Folfirinox Followed by Capecitabine and Limited Field Radiation for Localized Pancreatic Head Adenocarcinoma

Primary Purpose

Adenocarcinoma of Head of Pancreas

Status
Terminated
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Neo-adjuvant Chemotherapy
Chemoradiation
Surgical Resection
Sponsored by
Medical University of South Carolina
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Adenocarcinoma of Head of Pancreas focused on measuring NEOADJUVANT FOLFIRINOX CHEMOTHERAPY, LOCALIZED PANCREATIC HEAD ADENOCARCINOMA, RADIATION THERAPY

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patient has histologically or cytologically confirmed borderline resectable adenocarcinoma of the pancreas. Patients with islet cell or other neuroendocrine neoplasms are excluded.
  • Borderline resectable disease as outlined in the protocol
  • ≥ 18 years of age.
  • Male or non-pregnant and non-lactating female. If a female patient is of childbearing potential, she must have a negative serum pregnancy test (β hCG) documented within 72 hours of the first administration of study drug.
  • If sexually active, the patient must agree to use contraception considered adequate and appropriate by the Investigator.
  • Patient must not have received prior chemotherapy or radiation for pancreatic cancer and no exposure to systemic chemotherapy.
  • Patient have acceptable blood counts, chemistries & coagulation at baseline as outlined in the protocol
  • Patient has an ECOG performance status PS 0-1.
  • Patient has been informed about the nature of the study and has agreed to participate in the study and signed the Informed Consent Form prior to participation in any study-related activities.
  • Endoscopic ultrasound (EUS) with FNA for cytology.
  • Patients should not have any evidence of active or uncontrolled infection requiring treatment with antibiotics.

Exclusion Criteria:

  • Patient has localized resectable, locally advanced unresectable or advanced metastatic disease. Patients with adenocarcinoma of the pancreatic body or tail are ineligible.
  • Patient has active, uncontrolled bacterial, viral, or fungal infection(s) requiring systemic therapy.
  • Patient has known infection with HIV.
  • Patient has undergone major surgery, other than diagnostic surgery (i.e.surgery done to obtain a biopsy for diagnosis without removal of an organ), within 4 weeks prior to Day 1 of treatment in this study.
  • Prior chemotherapy, immunotherapy or radiation for pancreatic cancer.
  • Patient has a history of allergy or hypersensitivity to the study drugs.
  • Patient has serious medical risk factors involving any of the major organ systems such that the Investigator considers it unsafe for the patient to receive chemotherapy and/or radiation therapy.
  • Patients must not require chronic use of immunosuppressive agents (e.g. methotrexate, cyclosporine).
  • No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated Stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease-free for five years.
  • Patients must not have clinically significant cardiovascular disease (including myocardial infarction, unstable angina, symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia) < 1 year before randomization.
  • Patients must not have a history of any medical or psychiatric condition or laboratory abnormality that in the opinion of the investigator may increase the risks associated with the study participation or investigational product(s) administration or may interfere with the interpretation of the results.
  • Patient is unwilling or unable to comply with study procedures.
  • Patient is enrolled in any other therapeutic clinical protocol or investigational trial.
  • Patients aged > 70

Sites / Locations

  • Medical University of South Carolina

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Chemotherapy, Chemoradiation, Surgery

Arm Description

Neoadjuvant Chemotherapy- Modified FOLFIRINOX chemotherapy Day 1 and Day 15 of 28 day cycles for 3 cycles with growth factor support Chemoradiation Surgical Resection

Outcomes

Primary Outcome Measures

Estimate the R0/R1 Resection Rate
Estimate the R0/R1 resection rate as the proportion of patients with R0 or R1 resection status based on the ITT population. R0 resection status is macroscopic complete removal of tumor by non-contaminated operation, with neither macroscopic nor microscopic residual tumor. R1 resection status is macroscopic complete removal of tumor by non-contaminated operation, with microscopic residual tumor.

Secondary Outcome Measures

Radiographic Tumor Response
The rate of CR, PR, SD and PD will be estimated as described in Section 14B prior to chemoradiation start and prior to surgery. The analysis population for estimation of radiographic response rate will be the ITT population.
Histopathologic Tumor Response
Estimate the rate of good histopathologic response as the proportion of grade I and II responders. The analysis population for this objective is the ITT population. Any patient for whom a surgical sample is not available will be considered a poor-responder.
Time to Recurrence:
Time to recurrence is defined as the time from surgical resection to disease recurrence or death from any cause. Patients who have not recurred at the end of follow up will have their recurrence time censored at the last date of contact.
Overall Survival:
Overall survival is defined as the time from enrollment to death from any cause. Patients still alive at the end of follow up will have their survival time censored at the last date of contact.

Full Information

First Posted
August 29, 2012
Last Updated
December 11, 2015
Sponsor
Medical University of South Carolina
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1. Study Identification

Unique Protocol Identification Number
NCT01677988
Brief Title
Neoadjuvant Folfirinox Followed by Capecitabine and Limited Field Radiation for Localized Pancreatic Head Adenocarcinoma
Official Title
Phase II Study of Neoadjuvant Folfirinox Chemotherapy Followed by Capecitabine With Concurrent Limited Field Radiation Therapy in Patients With Localized Pancreatic Head Adenocarcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
July 2015
Overall Recruitment Status
Terminated
Why Stopped
Study was terminated due to low accrual.
Study Start Date
July 2012 (undefined)
Primary Completion Date
October 2015 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Medical University of South Carolina

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study is for subjects with adenocarcinoma of the pancreas. The purpose of this research study is to determine the safety and effectiveness of modified Folfirinox and radiation therapy as treatment for adenocarcinoma (cancer) of the pancreas before surgery. Screening tests will be done to determine if subjects are eligible for participation in this study. If subjects are eligible to participate and agree to participate they will begin chemotherapy. After 3 cycles of chemotherapy, subjects will begin chemoradiation. Within 4 to 8 weeks of completing radiation therapy, subjects will have surgery. There will also be post-treatment and follow-up evaluations. Subjects will be followed for every 3 months for 3 years after their initial registration.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adenocarcinoma of Head of Pancreas
Keywords
NEOADJUVANT FOLFIRINOX CHEMOTHERAPY, LOCALIZED PANCREATIC HEAD ADENOCARCINOMA, RADIATION THERAPY

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
3 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Chemotherapy, Chemoradiation, Surgery
Arm Type
Experimental
Arm Description
Neoadjuvant Chemotherapy- Modified FOLFIRINOX chemotherapy Day 1 and Day 15 of 28 day cycles for 3 cycles with growth factor support Chemoradiation Surgical Resection
Intervention Type
Drug
Intervention Name(s)
Neo-adjuvant Chemotherapy
Other Intervention Name(s)
FOLFIRINOX chemotherapy
Intervention Description
Modified FOLFIRINOX chemotherapy Day 1 and Day 15 of 28 day cycles, for three (3) cycles with growth factor support. Restaging # 1. (CT or MRI; use same modality as baseline staging unless otherwise indicated by Study Team) Progressive Disease (PD) → Off study. Subsequent treatment per patient's primary MD. Stable Disease (SD) or Tumor Response → Continue to Registration #2 for Chemoradiation.
Intervention Type
Radiation
Intervention Name(s)
Chemoradiation
Intervention Description
Chemoradiation may be administered at selected approved CTN sites. Determination of resectability as reviewed and documented by MUSC-HCC GI Tumor Board. Unresectable → Off study. Subsequent treatment per patient's primary MD. Resectable → Continue to Registration #3 for Surgical Resection
Intervention Type
Procedure
Intervention Name(s)
Surgical Resection
Intervention Description
Meets criteria for resectable* →pancreaticoduodenectomy (POD) At time of resection, snap frozen tumor specimen sent for correlative biomarker studies
Primary Outcome Measure Information:
Title
Estimate the R0/R1 Resection Rate
Description
Estimate the R0/R1 resection rate as the proportion of patients with R0 or R1 resection status based on the ITT population. R0 resection status is macroscopic complete removal of tumor by non-contaminated operation, with neither macroscopic nor microscopic residual tumor. R1 resection status is macroscopic complete removal of tumor by non-contaminated operation, with microscopic residual tumor.
Time Frame
at time of surgery
Secondary Outcome Measure Information:
Title
Radiographic Tumor Response
Description
The rate of CR, PR, SD and PD will be estimated as described in Section 14B prior to chemoradiation start and prior to surgery. The analysis population for estimation of radiographic response rate will be the ITT population.
Time Frame
From enrollment to Surgery
Title
Histopathologic Tumor Response
Description
Estimate the rate of good histopathologic response as the proportion of grade I and II responders. The analysis population for this objective is the ITT population. Any patient for whom a surgical sample is not available will be considered a poor-responder.
Time Frame
at the time of surgery
Title
Time to Recurrence:
Description
Time to recurrence is defined as the time from surgical resection to disease recurrence or death from any cause. Patients who have not recurred at the end of follow up will have their recurrence time censored at the last date of contact.
Time Frame
2 years
Title
Overall Survival:
Description
Overall survival is defined as the time from enrollment to death from any cause. Patients still alive at the end of follow up will have their survival time censored at the last date of contact.
Time Frame
2 years
Other Pre-specified Outcome Measures:
Title
Feasibility Objective
Description
The feasibility of treating patients with localized pancreatic head adenocarcinoma with this neoadjuvant regimen will be evaluated by estimating the proportion of patients completing five of six planned doses. The analysis population will be the ITT population.
Time Frame
From enrollment to end of chemotherapy part of the study
Title
CTC Analysis
Description
To evaluate and describe CTC numbers, CTC phenotype characteristics and effectiveness/rate of CTC culturing techniques from patients with pancreatic adenocarcinoma.
Time Frame
End of study
Title
CTC Expression
Description
To determine and evaluate the correlation between expression or biomarkers in the CTCs and expression of biomarkers in resected tissue specimens within the same cancer patient.
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient has histologically or cytologically confirmed borderline resectable adenocarcinoma of the pancreas. Patients with islet cell or other neuroendocrine neoplasms are excluded. Borderline resectable disease as outlined in the protocol ≥ 18 years of age. Male or non-pregnant and non-lactating female. If a female patient is of childbearing potential, she must have a negative serum pregnancy test (β hCG) documented within 72 hours of the first administration of study drug. If sexually active, the patient must agree to use contraception considered adequate and appropriate by the Investigator. Patient must not have received prior chemotherapy or radiation for pancreatic cancer and no exposure to systemic chemotherapy. Patient have acceptable blood counts, chemistries & coagulation at baseline as outlined in the protocol Patient has an ECOG performance status PS 0-1. Patient has been informed about the nature of the study and has agreed to participate in the study and signed the Informed Consent Form prior to participation in any study-related activities. Endoscopic ultrasound (EUS) with FNA for cytology. Patients should not have any evidence of active or uncontrolled infection requiring treatment with antibiotics. Exclusion Criteria: Patient has localized resectable, locally advanced unresectable or advanced metastatic disease. Patients with adenocarcinoma of the pancreatic body or tail are ineligible. Patient has active, uncontrolled bacterial, viral, or fungal infection(s) requiring systemic therapy. Patient has known infection with HIV. Patient has undergone major surgery, other than diagnostic surgery (i.e.surgery done to obtain a biopsy for diagnosis without removal of an organ), within 4 weeks prior to Day 1 of treatment in this study. Prior chemotherapy, immunotherapy or radiation for pancreatic cancer. Patient has a history of allergy or hypersensitivity to the study drugs. Patient has serious medical risk factors involving any of the major organ systems such that the Investigator considers it unsafe for the patient to receive chemotherapy and/or radiation therapy. Patients must not require chronic use of immunosuppressive agents (e.g. methotrexate, cyclosporine). No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated Stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease-free for five years. Patients must not have clinically significant cardiovascular disease (including myocardial infarction, unstable angina, symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia) < 1 year before randomization. Patients must not have a history of any medical or psychiatric condition or laboratory abnormality that in the opinion of the investigator may increase the risks associated with the study participation or investigational product(s) administration or may interfere with the interpretation of the results. Patient is unwilling or unable to comply with study procedures. Patient is enrolled in any other therapeutic clinical protocol or investigational trial. Patients aged > 70
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Paul E. O'Brien, MD
Organizational Affiliation
Medical University of South Carolina
Official's Role
Principal Investigator
Facility Information:
Facility Name
Medical University of South Carolina
City
Charleston
State/Province
South Carolina
ZIP/Postal Code
29425
Country
United States

12. IPD Sharing Statement

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Neoadjuvant Folfirinox Followed by Capecitabine and Limited Field Radiation for Localized Pancreatic Head Adenocarcinoma

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