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Perioperative Gemcitabine, Cisplatin, and Pembrolizumab in Potentially Resectable Biliary Tract Cancers

Primary Purpose

Pancreatic Cancer

Status
Not yet recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Gemcitabine
Cisplatin
Pembrolizumab
Sponsored by
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pancreatic Cancer focused on measuring Biliary Tract cancer, Pembrolizumab, Gemcitabine, Cisplatin, Immunotherapy, Potentially resectable biliary tract cancer, Anti PD-L1, PD-L1, Carcinoma

Eligibility Criteria

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

Inclusion Criteria: Must have a newly diagnosed, biopsy-proven biliary tract cancer (BTC) including gallbladder, intrahepatic, extrahepatic, and hilar cholangiocarcinoma. Resectable BTC (biliary tract cancer) Measurable disease per RECIST 1.1 as determined by the investigator. Age ≥18 years. ECOG (Eastern Cooperative Oncology Group) performance status ≤1 or Karnofsky ≥80 Patients must have adequate organ and marrow function defined by study-specified laboratory tests. Patients must have adequate liver function defined by study-specified laboratory tests. Patients with chronic or acute HBV or HCV infection must have disease controlled prior to enrollment. Women of childbearing potential (WOCBP) must have a negative urine or serum pregnancy test. For both Women and Men, must use acceptable form of birth control while on study. Ability to understand and willingness to sign a written informed consent document. Exclusion Criteria: Receiving, or previously received, any systemic chemotherapy, or investigational agent for BTC. Has received prior radiotherapy within 2 weeks of start of study intervention. Patients with a history of prior treatment with anti-PD-1 and anti-PD-L1. Have been diagnosed with another cancer or myeloproliferative disorder whose natural history or treatment has the potential to interfere with safety or efficacy assessment of this study's investigational drugs. Has a known history of Human Immunodeficiency Virus (HIV)/AIDS Has active co-infection with HBV and HDV. Has a diagnosis of immunodeficiency. Has active autoimmune disease that has required systemic treatment in the past 2 years. Systemic or topical corticosteroids at immunosuppressive doses. Prior allogeneic stem cell transplantation or organ transplantation. Prior tissue or organ allograft or allogeneic bone marrow transplantation, including corneal transplants. Uncontrolled intercurrent active medical and/or psychiatric illness/social psychosocial problems that that would limit compliance with study requirements. Uncontrolled intercurrent illness including, but not limited to, uncontrolled infection, symptomatic congestive heart failure, unstable angina, cardiac arrhythmia, metastatic cancer, or psychiatric illness/social situations that would limit compliance with study requirements. Evidence of clinical ascites. Has a history of (non-infectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease. Previously identified allergy or hypersensitivity to monoclonal antibodies or any component of the study treatment formulations. Pregnant or breastfeeding. WOCBP and men with female partners (WOCBP) who are not willing to use contraception. Subjects unable to undergo venipuncture and/or tolerate venous access. Patient is at the time of signing informed consent a regular user (including "recreational use") of any illicit drugs or had a recent history (within the last year) of substance abuse (including alcohol).

Sites / Locations

  • SKCCC Johns Hopkins

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Gemcitabine, Cisplatin and Pembrolizumab

Arm Description

Outcomes

Primary Outcome Measures

Average minimum Euclidean distance from CD8+ T cells to immunosuppressive tumor-associated macrophages (TAMs) at the per-cell level in patients with a major pathologic response versus pathologic non-responders.
The evaluable population of this endpoint consist of all patients who receive at least one dose of study drug and have TAMs and CD8 T cell measures at the time of surgery. TAMs being evaluated are the following: immunosuppressive TAMs with high Arginase-1 expression (CD68+CD163+Arg-1hiPDL1-/+), immunosuppressive TAMs with low Arginase-1 expression (CD68+CD163+Arg-1lo PDL1-/+), and less immunosuppressive TAMs (CD68+CD163-HLA-DRhi/CD86hi/PDL1hi)

Secondary Outcome Measures

Number of participants experiencing grade 3 or above drug-related toxicities
When calculating the incidence of AEs, each AE (as defined by NCI CTCAE v5.0) will be counted only once for a given subject.
Number of patients proceeding to surgery without an extended treatment-related delay as a measure of feasibility
Extended treatment delay is defined as a delay of greater than 60 days of the pre-planned surgical evaluation date, or inability to go to surgery due to an adverse event related to study treatment.
Major pathologic response rate
The number of participants with a major pathologic response as defined by ≤ 10% residual viable tumor cells in the resection of the primary tumor and lymph nodes.
R0 resection rate
The number of participants with a R0 resection as defined by a microscopically margin-negative resection, in which no tumor (gross or microscopic) remains in the primary tumor bed.

Full Information

First Posted
August 8, 2023
Last Updated
August 16, 2023
Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
Merck Sharp & Dohme LLC
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1. Study Identification

Unique Protocol Identification Number
NCT06001658
Brief Title
Perioperative Gemcitabine, Cisplatin, and Pembrolizumab in Potentially Resectable Biliary Tract Cancers
Official Title
Tumor Microenvironment Features of Response to Perioperative Gemcitabine, Cisplatin, and Pembrolizumab in Potentially Resectable Biliary Tract Cancers
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
December 2023 (Anticipated)
Primary Completion Date
December 2027 (Anticipated)
Study Completion Date
December 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
Collaborators
Merck Sharp & Dohme LLC

4. Oversight

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

5. Study Description

Brief Summary
The purpose of this study is to determine the safety of peri-operative gemcitabine, cisplatin, and pembrolizumab in patients with BTC, as well as whether the combination of gemcitabine, cisplatin, and pembrolizumab (gem/cis/pembro) is feasible and lead to pathologic responses.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pancreatic Cancer
Keywords
Biliary Tract cancer, Pembrolizumab, Gemcitabine, Cisplatin, Immunotherapy, Potentially resectable biliary tract cancer, Anti PD-L1, PD-L1, Carcinoma

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Gemcitabine, Cisplatin and Pembrolizumab
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Gemcitabine
Intervention Description
Patients will receive treatment on Day 1 and Day 8 of each cycle. Gemcitabine (1000 mg/m2) will be administered IV on Day 1 and Day 8 of each cycle, Q3 weeks with 2 - 4 cycles prior to surgery and then 4-6 cycles after surgery.
Intervention Type
Drug
Intervention Name(s)
Cisplatin
Intervention Description
Patients will receive treatment on Day 1 and Day 8 of each cycle. Cisplatin (25 mg/m2) will be administered IV on Day 1 and Day 8 of each cycle, Q3 weeks with 2 - 4 cycles prior to surgery and then 4-6 cycles after surgery.
Intervention Type
Drug
Intervention Name(s)
Pembrolizumab
Other Intervention Name(s)
KEYTRUDA; anti-PD-1 mAb
Intervention Description
Patients will receive treatment on Day 1 of each cycle. Pembrolizumab (200 mg) will be administered IV on Day 1 of each cycle, Q3 weeks with 2 - 4 cycles prior to surgery and then 4-6 cycles after surgery. Pembrolizumab (400 mg) will be administered IV Q6 weeks up to 4 cycles as maintenance.
Primary Outcome Measure Information:
Title
Average minimum Euclidean distance from CD8+ T cells to immunosuppressive tumor-associated macrophages (TAMs) at the per-cell level in patients with a major pathologic response versus pathologic non-responders.
Description
The evaluable population of this endpoint consist of all patients who receive at least one dose of study drug and have TAMs and CD8 T cell measures at the time of surgery. TAMs being evaluated are the following: immunosuppressive TAMs with high Arginase-1 expression (CD68+CD163+Arg-1hiPDL1-/+), immunosuppressive TAMs with low Arginase-1 expression (CD68+CD163+Arg-1lo PDL1-/+), and less immunosuppressive TAMs (CD68+CD163-HLA-DRhi/CD86hi/PDL1hi)
Time Frame
4 years
Secondary Outcome Measure Information:
Title
Number of participants experiencing grade 3 or above drug-related toxicities
Description
When calculating the incidence of AEs, each AE (as defined by NCI CTCAE v5.0) will be counted only once for a given subject.
Time Frame
4 years
Title
Number of patients proceeding to surgery without an extended treatment-related delay as a measure of feasibility
Description
Extended treatment delay is defined as a delay of greater than 60 days of the pre-planned surgical evaluation date, or inability to go to surgery due to an adverse event related to study treatment.
Time Frame
144 days
Title
Major pathologic response rate
Description
The number of participants with a major pathologic response as defined by ≤ 10% residual viable tumor cells in the resection of the primary tumor and lymph nodes.
Time Frame
8-12 weeks
Title
R0 resection rate
Description
The number of participants with a R0 resection as defined by a microscopically margin-negative resection, in which no tumor (gross or microscopic) remains in the primary tumor bed.
Time Frame
60 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Must have a newly diagnosed, biopsy-proven biliary tract cancer (BTC) including gallbladder, intrahepatic, extrahepatic, and hilar cholangiocarcinoma. Resectable BTC (biliary tract cancer) Measurable disease per RECIST 1.1 as determined by the investigator. Age ≥18 years. ECOG (Eastern Cooperative Oncology Group) performance status ≤1 or Karnofsky ≥80 Patients must have adequate organ and marrow function defined by study-specified laboratory tests. Patients must have adequate liver function defined by study-specified laboratory tests. Patients with chronic or acute HBV or HCV infection must have disease controlled prior to enrollment. Women of childbearing potential (WOCBP) must have a negative urine or serum pregnancy test. For both Women and Men, must use acceptable form of birth control while on study. Ability to understand and willingness to sign a written informed consent document. Exclusion Criteria: Receiving, or previously received, any systemic chemotherapy, or investigational agent for BTC. Has received prior radiotherapy within 2 weeks of start of study intervention. Patients with a history of prior treatment with anti-PD-1 and anti-PD-L1. Have been diagnosed with another cancer or myeloproliferative disorder whose natural history or treatment has the potential to interfere with safety or efficacy assessment of this study's investigational drugs. Has a known history of Human Immunodeficiency Virus (HIV)/AIDS Has active co-infection with HBV and HDV. Has a diagnosis of immunodeficiency. Has active autoimmune disease that has required systemic treatment in the past 2 years. Systemic or topical corticosteroids at immunosuppressive doses. Prior allogeneic stem cell transplantation or organ transplantation. Prior tissue or organ allograft or allogeneic bone marrow transplantation, including corneal transplants. Uncontrolled intercurrent active medical and/or psychiatric illness/social psychosocial problems that that would limit compliance with study requirements. Uncontrolled intercurrent illness including, but not limited to, uncontrolled infection, symptomatic congestive heart failure, unstable angina, cardiac arrhythmia, metastatic cancer, or psychiatric illness/social situations that would limit compliance with study requirements. Evidence of clinical ascites. Has a history of (non-infectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease. Previously identified allergy or hypersensitivity to monoclonal antibodies or any component of the study treatment formulations. Pregnant or breastfeeding. WOCBP and men with female partners (WOCBP) who are not willing to use contraception. Subjects unable to undergo venipuncture and/or tolerate venous access. Patient is at the time of signing informed consent a regular user (including "recreational use") of any illicit drugs or had a recent history (within the last year) of substance abuse (including alcohol).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Colleen Apostal, RN
Phone
410-614-3644
Email
GIClinicalTrials@jhmi.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Joann Santmyer, RN
Phone
410-614-3644
Email
GIClinicalTrials@jhmi.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marina Baretti, M.D.
Organizational Affiliation
SKCCC Johns Hopkins Medical Institution
Official's Role
Principal Investigator
Facility Information:
Facility Name
SKCCC Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21231
Country
United States
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Colleen Apostol, RN
Phone
410-614-3644
Email
GIClinicalTrials@jhmi.edu
First Name & Middle Initial & Last Name & Degree
Joann Santmyer, RN
Phone
410-614-3644
Email
GIClinicalTrials@jhmi.edu
First Name & Middle Initial & Last Name & Degree
Marina Baretti, MD

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Perioperative Gemcitabine, Cisplatin, and Pembrolizumab in Potentially Resectable Biliary Tract Cancers

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