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A Feasibility Study of Ketorolac Treatment for Cachexia in Patients With Advanced Pancreatic Ductal Adenocarcinoma (KetoROCX)

Primary Purpose

Pancreas Cancer, Pancreatic Ductal Adenocarcinoma, Pancreatic Cancer

Status
Recruiting
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Ketorolac Tromethamine
Sponsored by
Andrew Hendifar, MD
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Pancreas Cancer focused on measuring ketorolac

Eligibility Criteria

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

Inclusion Criteria:

  1. Diagnosis of advanced and refractory pancreatic ductal adenocarcinoma (PDAC) referred to Cedars-Sinai Medical Center (CSMC).
  2. Cachexia defined as ≥5% weight loss in the presence of chronic illness, within any 6-month period prior to screening or as documented by the medical physician based on standard diagnosis of cachexia.
  3. Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2 or Karnofsky performance status >50%.
  4. Patient must have adequate renal function per below lab values:

    • Creatinine OR measured or calculated creatinine clearance (glomerular filtration rate can also be used in place of creatinine or CrCl) ≤1.5 × upper limit of normal OR ≥30 mL/min for participant with creatinine levels >1.5 × institutional ULN.
  5. Patient must have access to WiFi for the Smart Scale.

Exclusion Criteria:

  1. Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements in the opinion of the investigator.
  2. Pregnancy, breastfeeding, or of childbearing potential and not willing to use adequate methods of contraception during the study.
  3. Has any known allergies or hypersensitivity to the study drug or allergic reactions to surgical steel or elastomer/rubber.
  4. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator.
  5. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.
  6. Concurrent use of any other NSAIDs while on study.
  7. Active peptic ulcer disease, recent gastrointestinal bleeding or perforation, or a history of peptic ulcer disease or gastrointestinal bleeding.
  8. Have suspected or confirmed cerebrovascular bleeding, tendency to bleed or bruise easily, incomplete hemostasis (how you body stops bleeding), and at high risk of bleeding.

Sites / Locations

  • Cedars- Sinai Medical CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Ketorolac (open label)

Arm Description

Pancreatic patients receiving Ketorolac four times a day for up to five days

Outcomes

Primary Outcome Measures

Feasibility determined by the number of patients that take the prescribed dose of ketorolac (4 times daily) for 5 consecutive days.
Defined as 75% or more of patients taking the study medication as prescribed for 5 days in a 6-day period: compliance diary.

Secondary Outcome Measures

To describe the adverse events associated with ketorolac when administered.
-Safety is defined as stable or decreased number of adverse events (AEs) compared to published trials for the same chemotherapy.
Mean change in weight from baseline through the End-of-Study visit
-Body weight stability is defined as weight change < 0.1kg/baseline Body Mass Index-unit from Baseline (start of 1 week lead-in prior to Day 1) to Day 6. Weight will be measured using the Aria Smart Scale. Changes in weight from Day 6 to Day 14 and from Day 1 to Day 14 will also be evaluated long term.
Mean change in body fat from baseline through the End-of-Study visit
-Body fat percentage will be measured using the Aria smart scale and compared from Baseline (start of 1 week lead-in prior to Day 1) to Day 6. Changes in body fat percentage from Day 6 to Day 14 and from Day 1 to Day 14 will also be evaluated long term. An increase in body fat percentage will be regarded as a positive outcome.
Evaluate change in quality of life including pain assessment from baseline through the End-of-Study visit
Mean change in reported pain, sleep disturbance, and mood (anxiety/depression) using the NIH PROMIS-29 profile v2.1. The PROMIS-29 profile v2.1 questionnaire consists of 29 questions that ask the subject to rate : 1) how easy it is to perform routine tasks, 2) how mood impacts daily living, 3) quality of sleep, 4) feelings of fatigue, and 5) pain and how it impacts daily living. Each question is answered on a scale of 1-5, where higher scores indicate the most impact or severity. The questionnaire responses at baseline, end of treatment and end of study will be compared.
Evaluate change in physical function from baseline through the End-of Study visit
Mean change in reported physical function using the National Institute of Health (NIH) PROMIS Health Organization and PROMIS Cooperative Group questionnaire v2.0. The NIH PROMIS Scale consists of 165 questions that ask the subject to rate their physical function. Each question is answered on a scale of 1-5 where higher scores indicate the lowest level of difficulty. The questionnaire responses at baseline, end of treatment and end of study will be compared.
Mean change in daily activity (step taken) from baseline
As measured by continuous daily wearable activity monitor
Mean change in average heart rate from baseline
As measured by continuous daily wearable activity monitor
Mean change in peak heart rate from baseline
As measured by continuous daily wearable activity monitor
Mean change in sleep duration from baseline
As measured by continuous daily wearable activity monitor
Mean change in sleep disturbances from baseline
As measured by continuous daily wearable activity monitor
Mean change in daily active minutes from baseline
As measured by continuous daily wearable activity monitor
Decrease in inflammatory biomarkers (CA-19 and CRP) from baseline
CA-19 and CRP lab results from baseline will be compared to results from Day 6
Mean change in calories consumed from baseline through the End-of-Treatment visit
As measured by Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. The ASA is a system to collect 24-hour food recalls and provide complete nutrient analysis of the foods and beverages consumed during the collection timeframe. The tool is used in this study to calculate total calories consumed.

Full Information

First Posted
March 11, 2022
Last Updated
April 14, 2023
Sponsor
Andrew Hendifar, MD
Collaborators
Yinuoke Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT05336266
Brief Title
A Feasibility Study of Ketorolac Treatment for Cachexia in Patients With Advanced Pancreatic Ductal Adenocarcinoma
Acronym
KetoROCX
Official Title
IIT2021-16-Hendifar-KetoROCX: A Feasibility Study of Ketorolac Treatment for Cachexia in Patients With Advanced Pancreatic Ductal Adenocarcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
April 2023
Overall Recruitment Status
Recruiting
Study Start Date
July 1, 2022 (Actual)
Primary Completion Date
December 5, 2024 (Anticipated)
Study Completion Date
December 5, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Andrew Hendifar, MD
Collaborators
Yinuoke Ltd.

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 see if taking ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), is reasonable, safe and can stabilize or increase weight along with quality of life in pancreatic cancer patients.
Detailed Description
The main things that will happen in this study are: patients will be administered ketorolac for 5 days, blood draws, completion of questionnaires, monitoring physical activity and sleep by wearing a study-provided FitBit along with weight using a study-provided smart scale.

6. Conditions and Keywords

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

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Early Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Ketorolac (open label)
Arm Type
Experimental
Arm Description
Pancreatic patients receiving Ketorolac four times a day for up to five days
Intervention Type
Drug
Intervention Name(s)
Ketorolac Tromethamine
Intervention Description
Trial treatment of ketorolac 10mg orally four times a day for 5 consecutive days
Primary Outcome Measure Information:
Title
Feasibility determined by the number of patients that take the prescribed dose of ketorolac (4 times daily) for 5 consecutive days.
Description
Defined as 75% or more of patients taking the study medication as prescribed for 5 days in a 6-day period: compliance diary.
Time Frame
6 days
Secondary Outcome Measure Information:
Title
To describe the adverse events associated with ketorolac when administered.
Description
-Safety is defined as stable or decreased number of adverse events (AEs) compared to published trials for the same chemotherapy.
Time Frame
14 days
Title
Mean change in weight from baseline through the End-of-Study visit
Description
-Body weight stability is defined as weight change < 0.1kg/baseline Body Mass Index-unit from Baseline (start of 1 week lead-in prior to Day 1) to Day 6. Weight will be measured using the Aria Smart Scale. Changes in weight from Day 6 to Day 14 and from Day 1 to Day 14 will also be evaluated long term.
Time Frame
14 days
Title
Mean change in body fat from baseline through the End-of-Study visit
Description
-Body fat percentage will be measured using the Aria smart scale and compared from Baseline (start of 1 week lead-in prior to Day 1) to Day 6. Changes in body fat percentage from Day 6 to Day 14 and from Day 1 to Day 14 will also be evaluated long term. An increase in body fat percentage will be regarded as a positive outcome.
Time Frame
14 days
Title
Evaluate change in quality of life including pain assessment from baseline through the End-of-Study visit
Description
Mean change in reported pain, sleep disturbance, and mood (anxiety/depression) using the NIH PROMIS-29 profile v2.1. The PROMIS-29 profile v2.1 questionnaire consists of 29 questions that ask the subject to rate : 1) how easy it is to perform routine tasks, 2) how mood impacts daily living, 3) quality of sleep, 4) feelings of fatigue, and 5) pain and how it impacts daily living. Each question is answered on a scale of 1-5, where higher scores indicate the most impact or severity. The questionnaire responses at baseline, end of treatment and end of study will be compared.
Time Frame
14 days
Title
Evaluate change in physical function from baseline through the End-of Study visit
Description
Mean change in reported physical function using the National Institute of Health (NIH) PROMIS Health Organization and PROMIS Cooperative Group questionnaire v2.0. The NIH PROMIS Scale consists of 165 questions that ask the subject to rate their physical function. Each question is answered on a scale of 1-5 where higher scores indicate the lowest level of difficulty. The questionnaire responses at baseline, end of treatment and end of study will be compared.
Time Frame
14 days
Title
Mean change in daily activity (step taken) from baseline
Description
As measured by continuous daily wearable activity monitor
Time Frame
14 days
Title
Mean change in average heart rate from baseline
Description
As measured by continuous daily wearable activity monitor
Time Frame
14 days
Title
Mean change in peak heart rate from baseline
Description
As measured by continuous daily wearable activity monitor
Time Frame
14 days
Title
Mean change in sleep duration from baseline
Description
As measured by continuous daily wearable activity monitor
Time Frame
14 days
Title
Mean change in sleep disturbances from baseline
Description
As measured by continuous daily wearable activity monitor
Time Frame
14 days
Title
Mean change in daily active minutes from baseline
Description
As measured by continuous daily wearable activity monitor
Time Frame
14 days
Title
Decrease in inflammatory biomarkers (CA-19 and CRP) from baseline
Description
CA-19 and CRP lab results from baseline will be compared to results from Day 6
Time Frame
6 days
Title
Mean change in calories consumed from baseline through the End-of-Treatment visit
Description
As measured by Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. The ASA is a system to collect 24-hour food recalls and provide complete nutrient analysis of the foods and beverages consumed during the collection timeframe. The tool is used in this study to calculate total calories consumed.
Time Frame
6 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosis of advanced and refractory pancreatic ductal adenocarcinoma (PDAC) referred to Cedars-Sinai Medical Center (CSMC). Cachexia defined as ≥5% weight loss in the presence of chronic illness, within any 6-month period prior to screening or as documented by the medical physician based on standard diagnosis of cachexia. Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2 or Karnofsky performance status >50%. Patient must have adequate renal function per below lab values: Creatinine OR measured or calculated creatinine clearance (glomerular filtration rate can also be used in place of creatinine or CrCl) ≤1.5 × upper limit of normal OR ≥30 mL/min for participant with creatinine levels >1.5 × institutional ULN. Patient must have access to WiFi for the Smart Scale. Exclusion Criteria: Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements in the opinion of the investigator. Pregnancy, breastfeeding, or of childbearing potential and not willing to use adequate methods of contraception during the study. Has any known allergies or hypersensitivity to the study drug or allergic reactions to surgical steel or elastomer/rubber. Has a history or current evidence of any condition, therapy, or laboratory abnormality that might confound the results of the trial, interfere with the subject's participation for the full duration of the trial, or is not in the best interest of the subject to participate, in the opinion of the treating investigator. Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial. Concurrent use of any other NSAIDs while on study. Active peptic ulcer disease, recent gastrointestinal bleeding or perforation, or a history of peptic ulcer disease or gastrointestinal bleeding. Have suspected or confirmed cerebrovascular bleeding, tendency to bleed or bruise easily, incomplete hemostasis (how you body stops bleeding), and at high risk of bleeding.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Abrahm Levi
Phone
310-248-8084
Email
abrahm.levi@cshs.org
First Name & Middle Initial & Last Name or Official Title & Degree
Andrew Hendifar, MD
Phone
310-423-2217
Email
Andrew.Hendifar@cshs.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Andrew Hendifar, MD
Organizational Affiliation
Cedars-Sinai Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Cedars- Sinai Medical Center
City
Los Angeles
State/Province
California
ZIP/Postal Code
90048
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Abrahm Levi
Phone
310-248-8084
Email
abrahm.levi@cshs.org
First Name & Middle Initial & Last Name & Degree
Jun Gong, MD
First Name & Middle Initial & Last Name & Degree
Arsen Osipov, MD
First Name & Middle Initial & Last Name & Degree
Gillian Gresham, PhD

12. IPD Sharing Statement

Learn more about this trial

A Feasibility Study of Ketorolac Treatment for Cachexia in Patients With Advanced Pancreatic Ductal Adenocarcinoma

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