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Gemcitabine, Nab-paclitaxel and KPT-330 in Advanced Pancreatic Cancer

Primary Purpose

Acinar Cell Adenocarcinoma of the Pancreas, Duct Cell Adenocarcinoma of the Pancreas, Stage IV Pancreatic Cancer

Status
Suspended
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
gemcitabine hydrochloride
Selinexor
Pharmacological Study
Laboratory Biomarker Analysis
Nab paclitaxel
Sponsored by
Mohammed Najeeb Al Hallak
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acinar Cell Adenocarcinoma of the Pancreas

Eligibility Criteria

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

Inclusion Criteria:

  • Written informed consent in accordance with federal, local, and institutional guidelines
  • Patients with metastatic pancreatic adenocarcinoma not treated with chemotherapy for metastatic disease
  • Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
  • Absolute neutrophil count (ANC) >= 1500/mm^3
  • Platelet count >= 100,000/mm^3
  • Bilirubin < 2 times the upper limit of normal (ULN) (except patients with Gilbert's syndrome who must have a total bilirubin of < 3 times ULN)
  • Alanine aminotransferase (ALT) < 2.5 times ULN
  • Serum creatinine =< 1.5 mg/dL
  • Serum albumin >= 3.0 g/dL
  • Female patients of child-bearing potential must agree to use dual methods of contraception and have a negative serum pregnancy test at screening, and male patients must use an effective barrier method of contraception if sexually active with a female of child-bearing potential; acceptable methods of contraception are condoms with contraceptive foam, oral, implantable or injectable contraceptives, contraceptive patch, intrauterine device, diaphragm with spermicidal gel, or a sexual partner who is surgically sterilized or post-menopausal; for both male and female patients, effective methods of contraception must be used throughout the study and for three months following the last dose
  • Patients with history of previously treated malignancies who have no evidence of disease for last five years are allowed to participate

Exclusion Criteria:

  • Patients who are pregnant or lactating
  • Radiation, chemotherapy, or immunotherapy or any other anticancer therapy =< 3 weeks prior to cycle 1 day 1; mitomycin C or radio-immunotherapy 6 weeks prior to cycle 1 day 1
  • Major surgery within four weeks before cycle 1 day 1
  • Unstable cardiovascular function:

    • Symptomatic ischemia, or
    • Uncontrolled clinically significant conduction abnormalities (e.g.: ventricular tachycardia on antiarrhythmics are excluded and 1st degree atrioventricular [AV] block or asymptomatic left anterior fascicular block [LAFB]/right bundle branch block [RBBB] will not be excluded), or
    • Congestive heart failure (CHF) of New York Heart Association (NYHA) class >= 3, or
    • Myocardial infarction (MI) within 3 months of cycle 1 day 1 dose
  • Uncontrolled active infection requiring parenteral antibiotics, antivirals, or antifungals within one week prior to first dose
  • Known to be HIV seropositive who are on anti-HIV drugs because of the unknown interactions between these drugs and the study agents
  • Known active hepatitis A, B, or C infection; or known to be positive for hepatitis C virus (HCV) ribonucleic acid (RNA) or HBsAg (hepatitis B virus [HBV] surface antigen)
  • Patients with active central nervous system (CNS) malignancy; asymptomatic small lesions are not considered active; treated lesions may be considered inactive if they are stable for at least 3 months
  • Patients with significantly diseased or obstructed gastrointestinal tract or uncontrolled vomiting or diarrhea
  • Grade >= 2 peripheral neuropathy within 14 days prior to cycle 1 day 1
  • History of seizures, movement disorders or cerebrovascular accident within the past 5 years prior to cycle 1 day 1
  • Patients with muscular degeneration, uncontrolled glaucoma, or markedly decreased visual acuity based on physician's assessment
  • Serious psychiatric or medical conditions that could interfere with treatment
  • Participation in an investigational anti-cancer study within 3 weeks prior to cycle 1 day 1
  • Concurrent therapy with approved or investigational anticancer therapeutic
  • Presence of clinically significant ascites

Sites / Locations

  • Barbara Ann Karmanos Cancer Institute
  • Stony Brook University Cancer Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Group I: Phase Ib (gemcitabine, nab-paclitaxel, selinexor)

Group II: Phase II Group I (gemcitabine, selinexor)

GroupIII: Phase II Group II (gemcitabine, selinexor)

Arm Description

Patients receive gemcitabine hydrochloride IV, nab-paclitaxel IV, and selinexor PO on days 1, 8, and 15. Cycles repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.

Patients receive gemcitabine hydrochloride IV on days 1, 8, and 15. Patients also receive selinexor PO on days 3, 8, and 15 of cycle 1 and on days 1, 8, and 15 for the subsequent cycles. Cycles repeat every 4 weeks in the absence of disease progression or unacceptable toxicity

Patients receive gemcitabine hydrochloride IV and selinexor PO on days 1, 8, and 15. Cycles repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Maximum tolerated dose (MTD) of selinexor, gemcitabine hydrochloride, and paclitaxel albumin-stabilized nanoparticle formulation combination (Phase Ib)
MTD is defined as the lowest dose for which less than a third of patients experience a dose limiting toxicity graded according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.03.
Incidence of toxicity graded according to NCI CTCAE version 4.03 (Phase II)
Point and 90% Wilson's confidence intervals will be estimated to describe toxicity rate.
Overall survival (Phase II)
Estimated on an intention-to-treat basis (using all registered patients), and on a response-evaluable basis (using all patients who completed at least one 4-week treatment cycle) using the Kaplan-Meier method.

Secondary Outcome Measures

Effects the study drug combination has on participants
Pharmacodynamics of selinexor in combination with gemcitabine hydrochloride and paclitaxel albumin-stabilized nanoparticle formulation
Response rate
Point and 90% Wilson's confidence intervals will be estimated to describe response rate.
Progression free survival (Phase II)
Estimated on an intention-to-treat basis (using all registered patients), and on a response-evaluable basis (using all patients who completed at least one 4-week treatment cycle) using the Kaplan-Meier method.

Full Information

First Posted
June 23, 2014
Last Updated
February 2, 2022
Sponsor
Mohammed Najeeb Al Hallak
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT02178436
Brief Title
Gemcitabine, Nab-paclitaxel and KPT-330 in Advanced Pancreatic Cancer
Official Title
Phase Ib Study of the Selective Inhibitor of Nuclear Export (SINE) Selinexor (KPT-330), Gemcitabine and Nab-Paclitaxel and Phase II Study of Gemcitabine and Selinexor in Patients With Metastatic Pancreatic Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
February 2022
Overall Recruitment Status
Suspended
Why Stopped
Contract/budget issues
Study Start Date
October 31, 2014 (Actual)
Primary Completion Date
December 31, 2022 (Anticipated)
Study Completion Date
December 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Mohammed Najeeb Al Hallak
Collaborators
National Cancer Institute (NCI)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This partially randomized phase Ib/II trial studies the side effects and best dose of selinexor when given together with gemcitabine and nab-paclitaxel, and to see how well they work in treating patients with pancreatic cancer that has spread to other parts of the body (metastatic). Drugs used in chemotherapy, such as selinexor, gemcitabine and nab-paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading.
Detailed Description
Primary Objectives: Phase I: To determine the recommended phase 2 dose (RP2D) of gemcitabine, nabpaclitaxel and selinexor for untreated metastatic pancreatic cancer [COMPLETED] Phase I: To determine the safety profile of gemcitabine, nab-paclitaxel and selinexor [COMPLETED] Phase II: To test whether the combination of gemcitabine and selinexor improves the median overall survival of patients with metastatic pancreatic cancer who have failed frontline non-gemcitabine containing regimens beyond 5.6 months (median overall survival of patient receiving gemcitabine only based on historical data. Secondary Objectives: To determine objective response rate to the combination of gemcitabine and selinexor using Response Evaluation Criteria in Solid Tumors (RECIST) criteria. To assess safety of selinexor in combination with gemcitabine in phase II portion of the study To determine progression free survival (PFS) in patients treated with gemcitabine and selinexor To determine the influence of selinexor and gemcitabine on the nuclear expression and localization of tumor suppressor gene proteins.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acinar Cell Adenocarcinoma of the Pancreas, Duct Cell Adenocarcinoma of the Pancreas, Stage IV Pancreatic Cancer

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Phase I is completed, due to Dose Limiting Toxicities (DLT).
Masking
None (Open Label)
Allocation
Randomized
Enrollment
56 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Group I: Phase Ib (gemcitabine, nab-paclitaxel, selinexor)
Arm Type
Experimental
Arm Description
Patients receive gemcitabine hydrochloride IV, nab-paclitaxel IV, and selinexor PO on days 1, 8, and 15. Cycles repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.
Arm Title
Group II: Phase II Group I (gemcitabine, selinexor)
Arm Type
Experimental
Arm Description
Patients receive gemcitabine hydrochloride IV on days 1, 8, and 15. Patients also receive selinexor PO on days 3, 8, and 15 of cycle 1 and on days 1, 8, and 15 for the subsequent cycles. Cycles repeat every 4 weeks in the absence of disease progression or unacceptable toxicity
Arm Title
GroupIII: Phase II Group II (gemcitabine, selinexor)
Arm Type
Experimental
Arm Description
Patients receive gemcitabine hydrochloride IV and selinexor PO on days 1, 8, and 15. Cycles repeat every 4 weeks in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
gemcitabine hydrochloride
Other Intervention Name(s)
dFdC, difluorodeoxycytidine hydrochloride, Gemcitabine HCI, Gemzar
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Selinexor
Other Intervention Name(s)
KPT-330, Xpovio, CRM1 nuclear export inhibitor KPT-330, selective inhibitor of nuclear export KPT-330, SINE KPT-330
Intervention Description
Given IV
Intervention Type
Other
Intervention Name(s)
Pharmacological Study
Intervention Description
Correlative studies
Intervention Type
Other
Intervention Name(s)
Laboratory Biomarker Analysis
Intervention Description
Correlative studies
Intervention Type
Drug
Intervention Name(s)
Nab paclitaxel
Other Intervention Name(s)
ABI 007, Abraxane, Protein-bound Paclitaxel, Nanoparticle Paclitaxel,
Intervention Description
Given IV
Primary Outcome Measure Information:
Title
Maximum tolerated dose (MTD) of selinexor, gemcitabine hydrochloride, and paclitaxel albumin-stabilized nanoparticle formulation combination (Phase Ib)
Description
MTD is defined as the lowest dose for which less than a third of patients experience a dose limiting toxicity graded according to National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.03.
Time Frame
28 days
Title
Incidence of toxicity graded according to NCI CTCAE version 4.03 (Phase II)
Description
Point and 90% Wilson's confidence intervals will be estimated to describe toxicity rate.
Time Frame
Up to 2 years
Title
Overall survival (Phase II)
Description
Estimated on an intention-to-treat basis (using all registered patients), and on a response-evaluable basis (using all patients who completed at least one 4-week treatment cycle) using the Kaplan-Meier method.
Time Frame
Up to 2 years
Secondary Outcome Measure Information:
Title
Effects the study drug combination has on participants
Description
Pharmacodynamics of selinexor in combination with gemcitabine hydrochloride and paclitaxel albumin-stabilized nanoparticle formulation
Time Frame
Day 1 of course 1 (before selinexor administration, 1, 2, 4 and 8 hours after selinexor administration) and days 2, 3 and 8
Title
Response rate
Description
Point and 90% Wilson's confidence intervals will be estimated to describe response rate.
Time Frame
Up to 2 years
Title
Progression free survival (Phase II)
Description
Estimated on an intention-to-treat basis (using all registered patients), and on a response-evaluable basis (using all patients who completed at least one 4-week treatment cycle) using the Kaplan-Meier method.
Time Frame
Up to 2 years
Other Pre-specified Outcome Measures:
Title
Change in gene expression (including forkhead box protein O, I-kappaB, cyclin-dependent kinase inhibitor 1B, Par4 and phosphorylated signal transducer and activator of transcription 3) (Phase II)
Description
Seven patients in each group will yield a two-sided 90% confidence interval with a distance from the mean change to the limits of 0.75 standard deviation units. A two-sided p-value of 0.10 will be used for all analyses.
Time Frame
Baseline to up to 2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Written informed consent in accordance with federal, local, and institutional guidelines Patients with metastatic pancreatic adenocarcinoma not treated with chemotherapy for metastatic disease Eastern Cooperative Oncology Group (ECOG) performance status of 0-1 Absolute neutrophil count (ANC) >= 1500/mm^3 Platelet count >= 100,000/mm^3 Bilirubin < 2 times the upper limit of normal (ULN) (except patients with Gilbert's syndrome who must have a total bilirubin of < 3 times ULN) Alanine aminotransferase (ALT) < 2.5 times ULN Serum creatinine =< 1.5 mg/dL Serum albumin >= 3.0 g/dL Female patients of child-bearing potential must agree to use dual methods of contraception and have a negative serum pregnancy test at screening, and male patients must use an effective barrier method of contraception if sexually active with a female of child-bearing potential; acceptable methods of contraception are condoms with contraceptive foam, oral, implantable or injectable contraceptives, contraceptive patch, intrauterine device, diaphragm with spermicidal gel, or a sexual partner who is surgically sterilized or post-menopausal; for both male and female patients, effective methods of contraception must be used throughout the study and for three months following the last dose Patients with history of previously treated malignancies who have no evidence of disease for last five years are allowed to participate Exclusion Criteria: Patients who are pregnant or lactating Radiation, chemotherapy, or immunotherapy or any other anticancer therapy =< 3 weeks prior to cycle 1 day 1; mitomycin C or radio-immunotherapy 6 weeks prior to cycle 1 day 1 Major surgery within four weeks before cycle 1 day 1 Unstable cardiovascular function: Symptomatic ischemia, or Uncontrolled clinically significant conduction abnormalities (e.g.: ventricular tachycardia on antiarrhythmics are excluded and 1st degree atrioventricular [AV] block or asymptomatic left anterior fascicular block [LAFB]/right bundle branch block [RBBB] will not be excluded), or Congestive heart failure (CHF) of New York Heart Association (NYHA) class >= 3, or Myocardial infarction (MI) within 3 months of cycle 1 day 1 dose Uncontrolled active infection requiring parenteral antibiotics, antivirals, or antifungals within one week prior to first dose Known to be HIV seropositive who are on anti-HIV drugs because of the unknown interactions between these drugs and the study agents Known active hepatitis A, B, or C infection; or known to be positive for hepatitis C virus (HCV) ribonucleic acid (RNA) or HBsAg (hepatitis B virus [HBV] surface antigen) Patients with active central nervous system (CNS) malignancy; asymptomatic small lesions are not considered active; treated lesions may be considered inactive if they are stable for at least 3 months Patients with significantly diseased or obstructed gastrointestinal tract or uncontrolled vomiting or diarrhea Grade >= 2 peripheral neuropathy within 14 days prior to cycle 1 day 1 History of seizures, movement disorders or cerebrovascular accident within the past 5 years prior to cycle 1 day 1 Patients with muscular degeneration, uncontrolled glaucoma, or markedly decreased visual acuity based on physician's assessment Serious psychiatric or medical conditions that could interfere with treatment Participation in an investigational anti-cancer study within 3 weeks prior to cycle 1 day 1 Concurrent therapy with approved or investigational anticancer therapeutic Presence of clinically significant ascites
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Mohammed N Al Hallak, M.D.
Organizational Affiliation
Barbara Ann Karmanos Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Barbara Ann Karmanos Cancer Institute
City
Detroit
State/Province
Michigan
ZIP/Postal Code
48201
Country
United States
Facility Name
Stony Brook University Cancer Center
City
Stony Brook
State/Province
New York
ZIP/Postal Code
11794
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
31831564
Citation
Azmi AS, Khan HY, Muqbil I, Aboukameel A, Neggers JE, Daelemans D, Mahipal A, Dyson G, Kamgar M, Al-Hallak MN, Tesfaye A, Kim S, Shidham V, M Mohammad R, Philip PA. Preclinical Assessment with Clinical Validation of Selinexor with Gemcitabine and Nab-Paclitaxel for the Treatment of Pancreatic Ductal Adenocarcinoma. Clin Cancer Res. 2020 Mar 15;26(6):1338-1348. doi: 10.1158/1078-0432.CCR-19-1728. Epub 2019 Dec 12.
Results Reference
derived

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Gemcitabine, Nab-paclitaxel and KPT-330 in Advanced Pancreatic Cancer

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