A Study Evaluating the Efficacy of 5-FU + NALIRI and 5-FU + NALIRINOX for PDAC (NALPAC) (NALPAC)
Metastatic Pancreatic Ductal Adenocarcinoma
About this trial
This is an interventional treatment trial for Metastatic Pancreatic Ductal Adenocarcinoma
Eligibility Criteria
Inclusion Criteria:
- Histologically proven metastatic adenocarcinoma of the pancreas
- Progression documented after gemcitabine-Abraxane, or gemcitabine monotherapy
- Signed written informed consent
- Age ≥ 18
- ECOG PS 0/1 at study entry
- Measurable disease
- Adequate renal (serum creatinine ≤ 1.5x upper reference range), liver (total bilirubin ≤ 1.5x upper reference range) and hematopoietic functions (PMN ≥ 1,5x109/L, platelets ≥ 100x109/L, hemoglobin ≥ 9g/dl)
- INR/PTT ≤ 1.5x ULN
- Life expectancy of at least 12 weeks
- Effective contraception for both male and female patients if the risk of conception exists during treatment and for one month after the last administration
- Peripheral Neuropathy < grade 2
Exclusion Criteria:
- Uncontrolled concurrent CNS, cardiac, infectious diseases, hypertension
- History of myocardial infarction, deep venous or arterial thrombosis, CVA during the last 6 months
- Known hypersensitivity to any of the components, including excipients, of study treatments
- Previous malignancy in the last past 3 years except basal cell cancer of the skin or preinvasive cancer of the cervix or carcinoma in situ of any type
- Pregnancy or breast feeding
- Medical or psychological conditions that would not permit the patient to complete the study or sign inform consent
- Unstable angina, congestive heart failure ≥NYHA class II
- Uncontrolled hypertension despite optimal management (systolic blood pressure >150 mmHg or diastolic pressure > 90mmHg)
- HIV infection
- Complete DPD deficiency
- Liver failure, cirrhosis Child Pugh B or C
- Active chronic hepatitis B or C with a need for antiviral treatment
- Brain metastasis
- Major surgery, open biopsy or significant traumatic injury within 4 weeks prior to the first dose of treatment
- History of organ allograft
- Ongoing uncontrolled, serious infection
- Renal failure requiring dialysis
- Patients receiving or having received any investigational treatment within 4 weeks prior to study entry, or participating to another clinical study
Sites / Locations
- AZ St-Lucas
- UZ Antwerpen
- AZ ImeldaRecruiting
- ULB Erasme
- Cliniques Universitaires Saint-Luc UCL
- Grand Hopital de Charleroi
- AZ Maria Middelares
- University Hospital Ghent
- CHC MontLégia
- AZ Sint-Maarten
- CHU Ambroise Paré
- CHR Namur
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
Arm A NALIRI
Arm B NALIRINOX
Cycle length: 14 days Day 1: Leucovorin: 400 mg/m² IV - Dilute in 250 mL DSW and administer over two hours Liposomal irinotecan (FBE): 70 mg/m² IV* - Dilute in 500 mL DSW and administer over 90 min 5 FU: 2400 mg/m² IV - Dilute in 500 to 1000 mL 0,9% NS of DSW and administer as a continuous IV infusion over 46 hours. To accommodate an ambulatory pump for outpatient treatment can be administered undiluted (50 mg/mL) or the total dose diluted in 100 to 150 mL NS. Patients who are known to be homozygous for UGT1A1*28 should start treatment with 50 mg/m2 ONIVYDE. If they do not encounter drug related toxicities during the first cycle of therapy (started at a reduced dose of 50 mg/m2), they may have the dose of ONIVYDE increased to a dose of 70 mg/m2 in subsequent cycles based on individual patient tolerance.
Cycle length: 14 days Day 1: Oxaliplatin 60 mg IV - Dilute in 500 mL D5W and administer over two hours (prior to leucovorin). Shorter oxaliplatin administration schedules (eg. 1mg/m2 per minute) appear to be safe. Leucovorin: 400 mg/m² IV - Dilute in 250 mL DSW and administer over two hours (after oxaliplatin) Nanoliposomal irinotecan (FBE): 50 mg/m² IV - Dilute in 500 mL D5W and administer over 90 min 5 FU: 2400 mg/m² IV - Dilute in 500 to 1000 mL 0,9% NS of DSW and administer as a continuous IV infusion over 46 hours. To accommodate an ambulatory pump for outpatient treatment can be administered undiluted (50 mg/mL) or the total dose diluted in 100 to 150 mL NS.