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Nivolumab Adding on Gemcitabine/S-1 in Metastatic Pancreatic Cancer

Primary Purpose

Stage IV Pancreatic Cancer

Status
Unknown status
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Nivolumab
Gemcitabine
Tegafur-Gimeracil-Oteracil
Sponsored by
National Taiwan University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Stage IV Pancreatic Cancer focused on measuring pancreatic adenocarcinoma, chemotherapy, nivolumab

Eligibility Criteria

20 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. histologically proven pancreatic adenocarcinoma
  2. newly diagnosed, stage IV pancreatic cancer with limited metastases and tumor burden
  3. no previous radiotherapy, chemotherapy, targeted therapy, curative surgery, local therapy (eg. radiofrequency ablation, irreversible electroporation, etc.), immunotherapy, cell therapy (autologous or allogenic) used for pancreatic cancer
  4. presence of at least one measurable lesion at the pancreas and at least one measurable metastatic lesion
  5. age between 20 and 75 years at registration
  6. ECOG performance status of 0 or 1
  7. adequate major organ functions
  8. baseline CA 19-9 > upper limit of normal
  9. Glasgow prognostic score of 0 (ie. albumin ≥ 3.5 g/dL and CRP ≤ 1 mg/dL)
  10. ability to take study medication (S-1) orally
  11. no clinically significant abnormal ECG findings within 28 days prior to registration
  12. Women of childbearing potential (including women with chemical menopause or no menstruation for other medical reasons) must agree to use contraception from the time of informed consent until 5 months or more after the last dose of investigational products. Also, women must agree not to breastfeed from the time of informed consent until 5 months or more after the last dose of the investigational product.
  13. Men must agree to use contraception from the start of study treatment until 7 months or more after the last dose of the investigational product.
  14. Sign written informed consent

Exclusion Criteria:

  1. interstitial lung disease that is symptomatic or may interfere with the detection or management of suspected treatment-related pulmonary toxicity within 28 days prior to registration
  2. presence of diarrhea ≥ CTCAE v.5.0 grade 2
  3. concomitant systemic infection requiring treatment
  4. clinically significant co-morbid medical conditions, including cardiovascular disease known autoimmune disease
  5. concurrent autoimmune disease or history of chronic or recurrent autoimmune disease
  6. prior organ allograft or allogeneic bone marrow transplantation
  7. received systemic corticosteroids (except for temporary use, e.g., for examination or prophylaxis of allergic reactions) or immunosuppressants within 28 days before registration
  8. HBV (positive HBsAg or HBV DNA) or HCV carrier (positive anti-HCV or HCV RNA)
  9. known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome
  10. moderate or severe ascites, pleural effusion, or pericardial effusion requiring treatment
  11. central nervous system metastasis
  12. prior or concurrent malignancies within the last 3 years, with the exception of carcinoma in situ of the cervix, or basal type skin cancer
  13. concomitant treatment with flucytosine, phenytoin or warfarin
  14. any major surgery within 4 weeks of study treatment. Participants must have recovered from the effects of major surgery or significant traumatic injury at least 14 days before the first dose of study treatment.
  15. transfusion from 72 hours prior to registration to the first dose of study drug administration
  16. pregnant women or nursing mothers, or positive pregnancy tests
  17. severe mental disorder
  18. treatment with botanical preparations (eg, herbal supplements or traditional Chinese medicines) intended for general health support or to treat the disease under study within 2 weeks prior to registration
  19. vaccine therapies for prevention of infectious diseases within 4 weeks of study drug administration except inactivated seasonal influenza vaccine
  20. any condition requiring anti-platelet or anticoagulant therapy within 12 weeks prior to registration
  21. oral or iv antibiotic use within 2 weeks prior to registration
  22. uncontrollable pain caused by a tumor
  23. receiving antineoplastic agents within 28 days before registration
  24. patients judged by the principal investigator or subinvestigators to be inappropriate as subjects of this study

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Nivolumab/GS

    Arm Description

    Part-1: GS Induction Patients will receive GS for 1 cycle. S-1: 60/80/100 mg per day (based on body surface area, BSA); D1-12; 3 weeks per cycle BSA < 1.25 m2: 60 mg/day; 1.25 m2 ≤ BSA < 1.5 m2: 80 mg/day; BSA ≥ 1.5 m2: 100 mg/day Gemcitabine: 850 mg/m2; D1, 8; 3 weeks per cycle After GS, patients fulfilling the pre-defined CA 19-9 criteria will enter the Add-On part. Part-2: Nivolumab Add-On Nivolumab: 3 mg/kg every 2 weeks, 6 weeks per cycle S-1: according to the individualized dose on D8 of cycle 1 in Part-1, 6 weeks per cycle Gemcitabine: according to the individualized dose on D8 of cycle 1 in Part-1, 6 weeks per cycle The treatment will be continued until disease progression, intolerance to study treatment or death.

    Outcomes

    Primary Outcome Measures

    response rate
    overall response rate of gemcitabine/S-1/nivolumab

    Secondary Outcome Measures

    Full Information

    First Posted
    May 4, 2020
    Last Updated
    May 4, 2020
    Sponsor
    National Taiwan University Hospital
    Collaborators
    Ono Pharmaceutical Co. Ltd, ACT Genomics, TTY Biopharm
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04377048
    Brief Title
    Nivolumab Adding on Gemcitabine/S-1 in Metastatic Pancreatic Cancer
    Official Title
    Nivolumab as add-on to Gemcitabine/S-1 in Metastatic Pancreatic Cancer: a Phase II Trial
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    May 2020
    Overall Recruitment Status
    Unknown status
    Study Start Date
    July 1, 2020 (Anticipated)
    Primary Completion Date
    July 1, 2022 (Anticipated)
    Study Completion Date
    December 31, 2022 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    National Taiwan University Hospital
    Collaborators
    Ono Pharmaceutical Co. Ltd, ACT Genomics, TTY Biopharm

    4. Oversight

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

    5. Study Description

    Brief Summary
    This study assumes that to achieve significant therapeutic efficacy in advanced pancreatic cancer with immunotherapy, the immune system must remain relatively intact. Therefore, early use, low tumor load, adequate organ function, and slow growth of the tumor are the key points. Stage IV pancreatic adenocarcinoma patients with limited metastatic lesions and adequate organ function will be enrolled. Gemcitabine plus S-1 (GS) will be administered initially, and then CA 19-9 will be evaluated. Those fulfilling pre-defined criteria of CA 19-9 will receive nivolumab add-on therapy.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Stage IV Pancreatic Cancer
    Keywords
    pancreatic adenocarcinoma, chemotherapy, nivolumab

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Single Group Assignment
    Model Description
    Simon's two-stage design
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    38 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Nivolumab/GS
    Arm Type
    Experimental
    Arm Description
    Part-1: GS Induction Patients will receive GS for 1 cycle. S-1: 60/80/100 mg per day (based on body surface area, BSA); D1-12; 3 weeks per cycle BSA < 1.25 m2: 60 mg/day; 1.25 m2 ≤ BSA < 1.5 m2: 80 mg/day; BSA ≥ 1.5 m2: 100 mg/day Gemcitabine: 850 mg/m2; D1, 8; 3 weeks per cycle After GS, patients fulfilling the pre-defined CA 19-9 criteria will enter the Add-On part. Part-2: Nivolumab Add-On Nivolumab: 3 mg/kg every 2 weeks, 6 weeks per cycle S-1: according to the individualized dose on D8 of cycle 1 in Part-1, 6 weeks per cycle Gemcitabine: according to the individualized dose on D8 of cycle 1 in Part-1, 6 weeks per cycle The treatment will be continued until disease progression, intolerance to study treatment or death.
    Intervention Type
    Drug
    Intervention Name(s)
    Nivolumab
    Intervention Description
    as described in "NGS Arm"
    Intervention Type
    Drug
    Intervention Name(s)
    Gemcitabine
    Intervention Description
    as described in "NGS Arm"
    Intervention Type
    Drug
    Intervention Name(s)
    Tegafur-Gimeracil-Oteracil
    Other Intervention Name(s)
    S-1
    Intervention Description
    as described in "NGS Arm"
    Primary Outcome Measure Information:
    Title
    response rate
    Description
    overall response rate of gemcitabine/S-1/nivolumab
    Time Frame
    6 weeks

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    20 Years
    Maximum Age & Unit of Time
    75 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: histologically proven pancreatic adenocarcinoma newly diagnosed, stage IV pancreatic cancer with limited metastases and tumor burden no previous radiotherapy, chemotherapy, targeted therapy, curative surgery, local therapy (eg. radiofrequency ablation, irreversible electroporation, etc.), immunotherapy, cell therapy (autologous or allogenic) used for pancreatic cancer presence of at least one measurable lesion at the pancreas and at least one measurable metastatic lesion age between 20 and 75 years at registration ECOG performance status of 0 or 1 adequate major organ functions baseline CA 19-9 > upper limit of normal Glasgow prognostic score of 0 (ie. albumin ≥ 3.5 g/dL and CRP ≤ 1 mg/dL) ability to take study medication (S-1) orally no clinically significant abnormal ECG findings within 28 days prior to registration Women of childbearing potential (including women with chemical menopause or no menstruation for other medical reasons) must agree to use contraception from the time of informed consent until 5 months or more after the last dose of investigational products. Also, women must agree not to breastfeed from the time of informed consent until 5 months or more after the last dose of the investigational product. Men must agree to use contraception from the start of study treatment until 7 months or more after the last dose of the investigational product. Sign written informed consent Exclusion Criteria: interstitial lung disease that is symptomatic or may interfere with the detection or management of suspected treatment-related pulmonary toxicity within 28 days prior to registration presence of diarrhea ≥ CTCAE v.5.0 grade 2 concomitant systemic infection requiring treatment clinically significant co-morbid medical conditions, including cardiovascular disease known autoimmune disease concurrent autoimmune disease or history of chronic or recurrent autoimmune disease prior organ allograft or allogeneic bone marrow transplantation received systemic corticosteroids (except for temporary use, e.g., for examination or prophylaxis of allergic reactions) or immunosuppressants within 28 days before registration HBV (positive HBsAg or HBV DNA) or HCV carrier (positive anti-HCV or HCV RNA) known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome moderate or severe ascites, pleural effusion, or pericardial effusion requiring treatment central nervous system metastasis prior or concurrent malignancies within the last 3 years, with the exception of carcinoma in situ of the cervix, or basal type skin cancer concomitant treatment with flucytosine, phenytoin or warfarin any major surgery within 4 weeks of study treatment. Participants must have recovered from the effects of major surgery or significant traumatic injury at least 14 days before the first dose of study treatment. transfusion from 72 hours prior to registration to the first dose of study drug administration pregnant women or nursing mothers, or positive pregnancy tests severe mental disorder treatment with botanical preparations (eg, herbal supplements or traditional Chinese medicines) intended for general health support or to treat the disease under study within 2 weeks prior to registration vaccine therapies for prevention of infectious diseases within 4 weeks of study drug administration except inactivated seasonal influenza vaccine any condition requiring anti-platelet or anticoagulant therapy within 12 weeks prior to registration oral or iv antibiotic use within 2 weeks prior to registration uncontrollable pain caused by a tumor receiving antineoplastic agents within 28 days before registration patients judged by the principal investigator or subinvestigators to be inappropriate as subjects of this study
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Shu-Ling Wu
    Phone
    +886-2-23123456
    Ext
    67573
    Email
    shulingwu.ntuh@gmail.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Shih-Hung Yang, M.D., Ph.D.
    Organizational Affiliation
    Department of Oncology, National Taiwan University Hospital
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    Citations:
    PubMed Identifier
    23547081
    Citation
    Ueno H, Ioka T, Ikeda M, Ohkawa S, Yanagimoto H, Boku N, Fukutomi A, Sugimori K, Baba H, Yamao K, Shimamura T, Sho M, Kitano M, Cheng AL, Mizumoto K, Chen JS, Furuse J, Funakoshi A, Hatori T, Yamaguchi T, Egawa S, Sato A, Ohashi Y, Okusaka T, Tanaka M. Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol. 2013 May 1;31(13):1640-8. doi: 10.1200/JCO.2012.43.3680. Epub 2013 Apr 1.
    Results Reference
    result
    PubMed Identifier
    29119276
    Citation
    Weiss GJ, Blaydorn L, Beck J, Bornemann-Kolatzki K, Urnovitz H, Schutz E, Khemka V. Phase Ib/II study of gemcitabine, nab-paclitaxel, and pembrolizumab in metastatic pancreatic adenocarcinoma. Invest New Drugs. 2018 Feb;36(1):96-102. doi: 10.1007/s10637-017-0525-1. Epub 2017 Nov 8. Erratum In: Invest New Drugs. 2019 Aug;37(4):797.
    Results Reference
    result

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    Nivolumab Adding on Gemcitabine/S-1 in Metastatic Pancreatic Cancer

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