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Stereotactic Body Radiotherapy and Focal Adhesion Kinase Inhibitor in Advanced Pancreas Adenocarcinoma

Primary Purpose

Pancreas Cancer, Cancer of the Pancreas, Pancreas Adenocarcinoma

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
MR-guided stereotactic body radiation therapy
Defactinib
Tumor biopsy
Research blood draw
Sponsored by
Washington University School of Medicine
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pancreas Cancer

Eligibility Criteria

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

Inclusion Criteria:

  • Histologically or cytologically confirmed locally advanced pancreas adenocarcinoma that is considered borderline resectable or unresectable per institutional standardized criteria of unresectability or medical inoperability (NCCN guidelines 2.2021 PANC-C 1 of 2).
  • Patients with locoregional adenopathy are eligible as long as all suspicious lymph nodes are deemed to be adjacent to the primary tumor as per radiation oncologist assessment.
  • At least 3 months of systemic chemotherapy for this disease without progression of local or systemic disease. Newly diagnosed patients may be screened for enrollment in this study and can be enrolled once they have completed 3 months of systemic chemotherapy (and still meet all eligibility criteria) prior to the start of study treatment.
  • At least 18 years of age.
  • ECOG performance status ≤ 1
  • Life expectancy > 3 months
  • Normal bone marrow and organ function within 21 days of randomization as defined below:

    • Absolute neutrophil count ≥ 1,500/mcL
    • Platelets ≥ 100,000/mcL
    • Hemoglobin ≥ 9.0 g/dL
    • Total bilirubin ≤ 1.5 x IULN; no prior history of Gilbert's syndrome
    • AST(SGOT)/ALT(SGPT) ≤ 2.5 x IULN or ≤ 5.0 x IULN if due to liver involvement by tumor
    • Creatinine clearance ≤ 1.5 x IULN or glomerular filtration rate of ≥ 60 mL/min
    • INR ≤ 1.5 x IULN unless patient is receiving anticoagulant therapy as long as INR or PTT is within therapeutic range of intended use of anticoagulants
    • aPTT ≤ 1.5 x IULN unless patient is receiving anticoagulant therapy as long as INR or PTT is within therapeutic range of intended use of anticoagulants
    • Albumin ≥ 2.5 mg/dL
  • Corrected QT interval (QTc) < 480 ms (as calculated by the Fridericia correction formula).
  • The effects of defactinib on the developing human fetus are unknown. For this reason and because radiation therapy is known to be teratogenic, women of childbearing potential and men must agree to use highly effective contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of the study, and 120 days after completion of the study
  • Ability to understand and willingness to sign an IRB approved written informed consent document

Exclusion Criteria:

  • A history of other malignancy with the exception of malignancies for which all treatment was completed at least 2 years before registration and the patient has no evidence of disease.
  • Clinical evident ascites or pleural effusion that requires therapeutic paracentesis or thoracentesis.
  • Prior treatment with a drug of the FAK inhibitor class or with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti-cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) antibody (including ipilimumab or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways.
  • Prior anti-human antibody response (AHA or ADA).
  • Currently receiving any other investigational agents or has receive any other investigational agents within 4 weeks or 5 half-lives or planned first dose of study agents.
  • A history of allergic reactions attributed to compounds of similar chemical or biologic composition to defactinib or other agents used in the study.
  • Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy not routinely associated with chemotherapeutic regimen.
  • Requires continued use of warfarin for anticoagulation and cannot stop warfarin or be safely switched to another anticoagulant or direct oral anticoagulant
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, hypertension, immunosuppression, autoimmune conditions, or underlying pulmonary disease.
  • Has an active autoimmune disease requiring systemic treatment within the past 2 years (i.e. with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment.
  • Received a live vaccine within 30 days prior to the first study treatment. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus Calmette-Guérin (BCG), and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g. FluMist) are live attenuated vaccines and are not allowed.
  • Known history of hepatitis B (defined as hepatitis B surface antigen [HBsAg] reactive) or known active hepatitis C virus (defined as HCV RNA [qualitative] is detected).
  • Has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis.
  • Has a known history of active TB (bacillus tuberculosis).
  • Major surgery within 28 days prior to the first study treatment.
  • Pregnant and/or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 14 days of study entry.
  • Patients with HIV are eligible unless their CD4+ T-cell counts are < 350 cells/mcL or they have a history of AIDS-defining opportunistic infection within the 12 months prior to registration. Concurrent treatment with effective ART according to DHHS treatment guidelines is recommended.
  • Known SARS-Cov2 infection ≤28 days prior to first dose of study therapy.
  • Exposure to P-glycoprotein (P-gp) inhibitors or inducers within 14 days prior to the first dose and during the course of therapy.
  • Subjects with the inability to swallow oral medications or impaired gastrointestinal absorption due to gastrectomy or active inflammatory bowel disease.
  • Subjects with a history of hypersensitivity to any of the inactive ingredients (hydroxypropylmethylcellulose, mannitol, magnesium stearate) of the investigational product.

Sites / Locations

  • Washington University School of MedicineRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

MR-guided SBRT + Defactinib

MR-guided SBRT

Arm Description

Participants in this study will receive 5 fractions of magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) and seventeen 21-day cycles of defactinib (beginning on Day 2 of radiation). Participants who are candidates for surgical resection will undergo standard of care surgery at 2 weeks post-end of SBRT (+/- 1 weeks) or 12 weeks post-end of SBRT (+/- 1 week). These participants will discontinue defactinib the day prior to the operation and will resume taking it for the remainder of the 17 cycles 4 to 6 weeks after surgery. Participants who are not candidates for surgical resection will continue to receive defactinib uninterrupted. All participants should receive 17 cycles of defactinib unless they experience disease progression or intolerable toxicity.

-Participants in this study will receive 5 fractions of magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT)

Outcomes

Primary Outcome Measures

Progression-free survival (PFS)
PFS is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first Progressive disease: At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progressions).

Secondary Outcome Measures

Safety and toxicity profile of the regimen as measured by incidence of acute adverse events
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 will be utilized for all toxicity reporting.
Safety and toxicity profile of the regimen as measured by incidence of late adverse events
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 will be utilized for all toxicity reporting.
Overall survival
-Overall survival as defined as the time from the date of treatment until death; censored at last follow-up if death is not observed
Distant metastasis progression-free survival
-Defined as the days from the date of the treatment to distant metastasis progression or death
Objective response rate
-Objective response rate as determined by RECIST 1.1 criteria
Local control
-Local control as defined by no progression of the primary tumor by RECIST 1.1 criteria

Full Information

First Posted
March 30, 2020
Last Updated
January 29, 2023
Sponsor
Washington University School of Medicine
Collaborators
National Cancer Institute (NCI), Verastem, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT04331041
Brief Title
Stereotactic Body Radiotherapy and Focal Adhesion Kinase Inhibitor in Advanced Pancreas Adenocarcinoma
Official Title
Phase II Study of Stereotactic Body Radiotherapy and Focal Adhesion Kinase Inhibitor in Advanced Pancreas Adenocarcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 21, 2021 (Actual)
Primary Completion Date
June 30, 2026 (Anticipated)
Study Completion Date
June 30, 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Washington University School of Medicine
Collaborators
National Cancer Institute (NCI), Verastem, Inc.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Patients with advanced pancreas adenocarcinoma will be randomized on a 6:1 basis to receive standard of care chemotherapy followed by stereotactic body radiotherapy (SBRT) with concurrent and adjuvant FAK inhibitor defactinib (experimental arm) or standard of care chemotherapy followed by SBRT (control arm). Patients enrolled to the experimental arm will be assessed for clinical outcomes such as progression free survival (PFS), local control, distant control, and toxicity. The first 6 patients randomized to the experimental arm will be considered the safety lead-in and will be assessed for dose-limiting toxicities (DLTs). The 6 patients randomized to the control arm will be evaluated for correlatives but will not be included in the analysis for primary and secondary endpoints. Hypothesis: locally advanced pancreas cancer patients treated with SBRT and concurrent plus adjuvant defactinib will have increased PFS compared to historical rates for patients receiving SBRT alone.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pancreas Cancer, Cancer of the Pancreas, Pancreas Adenocarcinoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
42 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
MR-guided SBRT + Defactinib
Arm Type
Experimental
Arm Description
Participants in this study will receive 5 fractions of magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) and seventeen 21-day cycles of defactinib (beginning on Day 2 of radiation). Participants who are candidates for surgical resection will undergo standard of care surgery at 2 weeks post-end of SBRT (+/- 1 weeks) or 12 weeks post-end of SBRT (+/- 1 week). These participants will discontinue defactinib the day prior to the operation and will resume taking it for the remainder of the 17 cycles 4 to 6 weeks after surgery. Participants who are not candidates for surgical resection will continue to receive defactinib uninterrupted. All participants should receive 17 cycles of defactinib unless they experience disease progression or intolerable toxicity.
Arm Title
MR-guided SBRT
Arm Type
Active Comparator
Arm Description
-Participants in this study will receive 5 fractions of magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT)
Intervention Type
Device
Intervention Name(s)
MR-guided stereotactic body radiation therapy
Other Intervention Name(s)
MR-guided SBRT
Intervention Description
Will be administered using MRIdian or MRIdian Linac system 50 Gy in 5 fractions
Intervention Type
Drug
Intervention Name(s)
Defactinib
Other Intervention Name(s)
VS-6063, PF-04554878
Intervention Description
-Oral drug 400 mg twice a day
Intervention Type
Procedure
Intervention Name(s)
Tumor biopsy
Intervention Description
-Baseline and 12-14 weeks after end of SBRT (or at time of surgery)
Intervention Type
Procedure
Intervention Name(s)
Research blood draw
Intervention Description
-Baseline, 6-8 weeks after the end of SBRT, and 12-14 weeks after the end of SBRT
Primary Outcome Measure Information:
Title
Progression-free survival (PFS)
Description
PFS is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first Progressive disease: At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progressions).
Time Frame
Through completion of follow-up (estimated to be 24 months)
Secondary Outcome Measure Information:
Title
Safety and toxicity profile of the regimen as measured by incidence of acute adverse events
Description
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 will be utilized for all toxicity reporting.
Time Frame
From start of SBRT through 90 days
Title
Safety and toxicity profile of the regimen as measured by incidence of late adverse events
Description
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 will be utilized for all toxicity reporting.
Time Frame
From 91 days through completion of follow-up (estimated to be 24 months)
Title
Overall survival
Description
-Overall survival as defined as the time from the date of treatment until death; censored at last follow-up if death is not observed
Time Frame
Through completion of follow-up (estimated to be 24 months)
Title
Distant metastasis progression-free survival
Description
-Defined as the days from the date of the treatment to distant metastasis progression or death
Time Frame
Through completion of follow-up (estimated to be 24 months)
Title
Objective response rate
Description
-Objective response rate as determined by RECIST 1.1 criteria
Time Frame
12-14 weeks post-radiation therapy
Title
Local control
Description
-Local control as defined by no progression of the primary tumor by RECIST 1.1 criteria
Time Frame
Through completion of follow-up (estimated to be 24 months)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically or cytologically confirmed locally advanced pancreas adenocarcinoma that is considered borderline resectable or unresectable per institutional standardized criteria of unresectability or medical inoperability (NCCN guidelines 2.2021 PANC-C 1 of 2). Patients with locoregional adenopathy are eligible as long as all suspicious lymph nodes are deemed to be adjacent to the primary tumor as per radiation oncologist assessment. At least 3 months of systemic chemotherapy for this disease without progression of local or systemic disease. Newly diagnosed patients may be screened for enrollment in this study and can be enrolled once they have completed 3 months of systemic chemotherapy (and still meet all eligibility criteria) prior to the start of study treatment. At least 18 years of age. ECOG performance status ≤ 1 Life expectancy > 3 months Normal bone marrow and organ function within 21 days of randomization as defined below: Absolute neutrophil count ≥ 1,500/mcL Platelets ≥ 100,000/mcL Hemoglobin ≥ 9.0 g/dL Total bilirubin ≤ 1.5 x IULN; no prior history of Gilbert's syndrome AST(SGOT)/ALT(SGPT) ≤ 2.5 x IULN or ≤ 5.0 x IULN if due to liver involvement by tumor Creatinine clearance ≤ 1.5 x IULN or glomerular filtration rate of ≥ 60 mL/min INR ≤ 1.5 x IULN unless patient is receiving anticoagulant therapy as long as INR or PTT is within therapeutic range of intended use of anticoagulants aPTT ≤ 1.5 x IULN unless patient is receiving anticoagulant therapy as long as INR or PTT is within therapeutic range of intended use of anticoagulants Albumin ≥ 2.5 mg/dL Corrected QT interval (QTc) < 480 ms (as calculated by the Fridericia correction formula). The effects of defactinib on the developing human fetus are unknown. For this reason and because radiation therapy is known to be teratogenic, women of childbearing potential and men must agree to use highly effective contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of the study, and 120 days after completion of the study Ability to understand and willingness to sign an IRB approved written informed consent document Exclusion Criteria: A history of other malignancy with the exception of malignancies for which all treatment was completed at least 2 years before registration and the patient has no evidence of disease. Clinical evident ascites or pleural effusion that requires therapeutic paracentesis or thoracentesis. Prior treatment with a drug of the FAK inhibitor class or with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CD137, or anti-cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) antibody (including ipilimumab or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways. Prior anti-human antibody response (AHA or ADA). Currently receiving any other investigational agents or has receive any other investigational agents within 4 weeks or 5 half-lives or planned first dose of study agents. A history of allergic reactions attributed to compounds of similar chemical or biologic composition to defactinib or other agents used in the study. Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy not routinely associated with chemotherapeutic regimen. Requires continued use of warfarin for anticoagulation and cannot stop warfarin or be safely switched to another anticoagulant or direct oral anticoagulant Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, hypertension, immunosuppression, autoimmune conditions, or underlying pulmonary disease. Has an active autoimmune disease requiring systemic treatment within the past 2 years (i.e. with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment. Received a live vaccine within 30 days prior to the first study treatment. Examples of live vaccines include, but are not limited to, the following: measles, mumps, rubella, varicella/zoster (chicken pox), yellow fever, rabies, Bacillus Calmette-Guérin (BCG), and typhoid vaccine. Seasonal influenza vaccines for injection are generally killed virus vaccines and are allowed; however, intranasal influenza vaccines (e.g. FluMist) are live attenuated vaccines and are not allowed. Known history of hepatitis B (defined as hepatitis B surface antigen [HBsAg] reactive) or known active hepatitis C virus (defined as HCV RNA [qualitative] is detected). Has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis. Has a known history of active TB (bacillus tuberculosis). Major surgery within 28 days prior to the first study treatment. Pregnant and/or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 14 days of study entry. Patients with HIV are eligible unless their CD4+ T-cell counts are < 350 cells/mcL or they have a history of AIDS-defining opportunistic infection within the 12 months prior to registration. Concurrent treatment with effective ART according to DHHS treatment guidelines is recommended. Known SARS-Cov2 infection ≤28 days prior to first dose of study therapy. Exposure to P-glycoprotein (P-gp) inhibitors or inducers within 14 days prior to the first dose and during the course of therapy. Subjects with the inability to swallow oral medications or impaired gastrointestinal absorption due to gastrectomy or active inflammatory bowel disease. Subjects with a history of hypersensitivity to any of the inactive ingredients (hydroxypropylmethylcellulose, mannitol, magnesium stearate) of the investigational product.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Hyun Kim, M.D.
Phone
314-362-8502
Email
kim.hyun@wustl.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hyun Kim, M.D.
Organizational Affiliation
Washington University School of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Washington University School of Medicine
City
Saint Louis
State/Province
Missouri
ZIP/Postal Code
63110
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Hyun Kim, M.D.
Phone
314-362-8502
Email
kim.hyun@wustl.edu
First Name & Middle Initial & Last Name & Degree
Hyun Kim, M.D.
First Name & Middle Initial & Last Name & Degree
Julie Schwarz, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
David DeNardo, Ph.D.
First Name & Middle Initial & Last Name & Degree
Shahed Badiyan, M.D.
First Name & Middle Initial & Last Name & Degree
Pamela Samson, M.D.
First Name & Middle Initial & Last Name & Degree
Carl DeSelm, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
William Hawkins, M.D.
First Name & Middle Initial & Last Name & Degree
Ryan Fields, M.D.
First Name & Middle Initial & Last Name & Degree
Chet Hammill, M.D.
First Name & Middle Initial & Last Name & Degree
Steven Strasberg, M.D.
First Name & Middle Initial & Last Name & Degree
Majella Doyle, M.D.
First Name & Middle Initial & Last Name & Degree
Adeel Khan, M.D.
First Name & Middle Initial & Last Name & Degree
William Chapman, M.D.
First Name & Middle Initial & Last Name & Degree
Dominic Sanford, M.D.
First Name & Middle Initial & Last Name & Degree
Kian-Huat Lim, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Katrina Pedersen, M.D.
First Name & Middle Initial & Last Name & Degree
Benjamin Tan, M.D.
First Name & Middle Initial & Last Name & Degree
Rama Suresh, M.D.
First Name & Middle Initial & Last Name & Degree
Patrick Grierson, M.D.
First Name & Middle Initial & Last Name & Degree
Nikolaos Trikalinos, M.D.
First Name & Middle Initial & Last Name & Degree
Vladimir Kushnir, M.D.
First Name & Middle Initial & Last Name & Degree
Gabriel Lang, M.D.
First Name & Middle Initial & Last Name & Degree
Dan Mullady, M.D.
First Name & Middle Initial & Last Name & Degree
Natalie Cosgrove, M.D.
First Name & Middle Initial & Last Name & Degree
Koushik Das, M.D.
First Name & Middle Initial & Last Name & Degree
Eugene Koay, M.D., Ph.D.
First Name & Middle Initial & Last Name & Degree
Esther Lu, Ph.D.
First Name & Middle Initial & Last Name & Degree
Olivia Aranha, M.D.

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Sharing of individual participant data that underlie the results reported in the article after deidentification (text, tables, figures, and appendices) for individual participant data meta-analysis.
IPD Sharing Time Frame
Beginning 9 months and ending 36 months following article publication.
IPD Sharing Access Criteria
Investigators who proposed use of the data has been approved by an independent review committee ("learned intermediary") identified for this purpose.
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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Stereotactic Body Radiotherapy and Focal Adhesion Kinase Inhibitor in Advanced Pancreas Adenocarcinoma

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