A Study of PEGylated Recombinant Human Hyaluronidase in Combination With Nab-Paclitaxel Plus Gemcitabine Compared With Placebo Plus Nab-Paclitaxel and Gemcitabine in Participants With Hyaluronan-High Stage IV Previously Untreated Pancreatic Ductal Adenocarcinoma
Pancreatic Ductal Carcinoma
About this trial
This is an interventional treatment trial for Pancreatic Ductal Carcinoma focused on measuring Pancreatic ductal adenocarcinoma (PDA), Pancreatic ductal carcinoma, PEGylated Recombinant Human Hyaluronidase (PEGPH20), Nab-paclitaxel, Gemcitabine, Metastatic, Stage IV
Eligibility Criteria
Inclusion criteria:
Participants must satisfy all the following inclusion criteria to be enrolled in the study:
- Signed, written Institutional Review Board/Ethics Committee-approved Informed Consent Form (ICF).
- Stage IV PDA with histological or cytological confirmation of PDA.
Participants must be determined to be HA-high based on archived or fresh tumor core biopsy or sample obtained after the participant has documented metastatic disease. Biopsies/samples must meet the following requirements:
- Pancreas tumor biopsies/samples obtained on or after the date that metastatic disease is documented or tumor biopsies/samples from a metastatic lesion are acceptable.
- Tumor biopsies or samples must meet the requirements provided in the Study Laboratory Manual with regard to tumor tissue architecture. Note: cytology samples from fine needle aspirates without maintained tissue architecture or brushing biopsies are not acceptable.
- Tumor tissue (formalin-fixed paraffin-embedded [FFPE] block preferred) must include enough tumor to make a minimum of 5-10 unstained, consecutive FFPE slides (10 slides are preferred) of 1 archival block that meet specific tissue sample requirements.
- Radiographic confirmation of Stage IV PDA with at least 1 tumor metastasis measurable on computed tomography (CT) scan or magnetic resonance imaging (MRI) per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 criteria, excluding the primary pancreatic lesion.
- If a participant has had adjuvant/neoadjuvant therapy and/or therapy for locally advanced disease (chemotherapy for non-metastatic pancreatic cancer in combination with or without radiation therapy), tumor recurrence or disease progression must have occurred no sooner than 6 months after completing the last dose of the aforementioned therapies, provided all toxicities have returned to baseline or less than or equal to (≤) Grade 1.
- Eastern Cooperative Oncology Group (ECOG) Performance Status of 0 or 1.
- Life expectancy greater than or equal to (≥) 3 months.
- Age ≥18 years.
- A negative urine or serum pregnancy test within 7 days before Cycle 1, Day 1 (C1D1; first dose of study medication) if female participant is of childbearing potential.
Screening clinical laboratory values as follows:
- Total bilirubin ≤1.5 times upper limit of normal (ULN) (participants with Gilbert syndrome are eligible independent of bilirubin levels).
- Aspartate aminotransferase (serum glutamic oxaloacetic transaminase) and alanine aminotransferase (serum glutamic pyruvate transaminase) ≤2.5 times ULN, (if liver metastases are present, then ≤5 times ULN is allowed).
- Serum creatinine ≤2.0 milligrams/deciliter (mg/dL) or calculated creatinine clearance ≥40 milliliters/minute (mL/min).
- Serum albumin ≥2.5 grams/deciliter (g/dL).
- Prothrombin time or international normalized ratio (INR) within normal limits (±15%), unless participant takes warfarin, in which case prothrombin time or INR result must be within therapeutic range.
- Partial thromboplastin time (PTT) within normal limits (±15%).
- Hemoglobin ≥9 g/dL (transfusion and erythropoietic agents allowed).
- Absolute neutrophil count ≥1,500 cells/cubic millimeter (cells/mm^3).
- Platelet count ≥100,000/mm^3.
- For women of childbearing potential (WOCBP) and for men, agreement to use a highly effective contraceptive method from the time of screening throughout the study until 1 month (WOCBP) or 6 months (men) after administration of the last dose of any study medication. Highly effective contraceptive methods consist of prior sterilization, intrauterine device (IUD), intrauterine hormone-releasing system (IUS), oral or injectable contraceptives, barrier methods, and/or true sexual abstinence.
Exclusion criteria:
Participants are ineligible for enrollment if they meet any of the following exclusion criteria:
Clinical evidence of deep vein thrombosis (DVT), pulmonary embolism (PE) or other known thromboembolic (TE) event present during the screening period.
- Participants with superficial vein thrombosis are eligible.
- Participants with visceral/splanchnic vein thrombosis are still eligible if, in the opinion of the Investigator, the visceral/splanchnic vein thrombosis is primarily associated with the anatomic location of the underlying disease of metastatic pancreatic cancer (there must be primary or metastatic disease in reasonable proximity to the thrombosis, and the Investigator determines that the thrombosis is due to a local tumor event and not a coagulation issue).
Previous radiotherapy, surgery, chemotherapy, or investigational therapy for the treatment of metastatic disease.
a. Palliative radiotherapy for pain control of metastatic bone lesions is allowed.
- Known central nervous system involvement or brain metastases.
- New York Heart Association Class III or IV cardiac disease or myocardial infarction within the past 12 months.
- History of cerebrovascular accident or transient ischemic attack.
- Clinically significant pre-existing carotid artery disease.
- Known infection with human immunodeficiency virus, or active infection with hepatitis B or hepatitis C within the past 12 months.
- Known allergy to hyaluronidase.
- Current use of megestrol acetate or megestrol acetate-containing drugs (use within 10 days of Day 1).
- Contraindication to heparin as per institutional guidelines.
- Women currently pregnant or breastfeeding.
- Intolerance to dexamethasone.
- History of another primary cancer within the last 3 years with the exception of non-melanoma skin cancer, early-stage prostate cancer, or curatively treated cervical carcinoma in-situ.
- Any other disease, active, uncontrolled bacterial, viral or fungal infection requiring systemic therapy, metabolic dysfunction, physical examination finding or clinical laboratory finding that leads to reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug, or that may affect the interpretation of the results, or that may render the participant at high risk for treatment complications.
- Immunization with a live vaccine up to 2 weeks prior to Day 1.
- Hypersensitivity to the active substance or ingredients of PEGPH20, gemcitabine, and nab-paclitaxel.
- Inability to comply with study and follow-up procedures as judged by the Investigator.
Sites / Locations
- University of South Alabama
- Banner MD Anderson Cancer Center
- Highlands Oncology Group
- St. Jude Hospital Yorba DBA Linda St. Joseph Heritage Health
- Scripps Clinical Research Services
- Samuel Oschin Comprehensive Cancer Institute
- David Geffen School of Medicine (DGSOM) at UCLA
- Chao Family Comprehensive Cancer Center
- St. Joseph Hospital
- Desert Hematology Oncology Medical Group, Inc.
- Cancer Care Associates Medical Group, Inc.
- Pacific Hematology Oncology Associates
- UCSF Helen Diller Family Comprehensive Cancer Center
- Pacific Central Coast Health Centers: San Luis Obispo Oncology and Hematology Health Center
- St Joseph Heritage Healthcare
- Innovative Clinical Research Institution
- Kaiser Permanente Franklin Medical Offices - Denver
- US Oncology - Rocky Mountain Cancer Centers - Midtown
- St. Mary's Medical Center
- Yale Cancer Center
- MedStar Georgetown University Hospital
- Memorial Healthcare System - Memorial Cancer Institute
- 21st Century Oncology
- MD Anderson Cancer Center Orlando
- Fort Wayne Medical Oncology/Hematology, INC.
- The University Of Kansas Cancer Center
- University of Louisville
- Ochsner Health Center
- Ochsner Clinic CCOP
- The Sidney Kimmel Comprehensive Cancer Center
- Beth Israel Deaconess Medical Center
- UMass Memorial Medical Center
- University of Michigan Medical Center
- Karmanos Cancer Institute
- Virginia Piper Cancer Institute
- University of Minnesota Medical School
- Comprehensive Cancer Centers of Nevada
- Renown Regional Medical Center
- Dartmouth Hitchcock Medical Center
- Saint Joseph's Ambulatory Clinic
- Jersey Shore University Medical Center
- Northwell Health/Monter Cancer Center
- NYU Langone Medical Center - NYU Langone Arena Oncology
- Columbia University Medical Center
- Mount Sinai School of Medicine - The Tisch Cancer Institute
- University of Rochester Medical Center
- Rex Cancer Center
- Gabrail Cancer Center Research
- The University of Oklahoma Health Sciences Center
- Penn State Milton S. Hershey Medical Center
- Allegheny General Hospital
- Univ of Pittsburgh Cancer institute
- Baylor College of Medicine - Baylor Clinic
- Scott and White
- University of Utah - Huntsman Cancer Institute
- Inova Dwight and Martha Schar Cancer Institute
- Fort Belvoir Community Hospital
- Virginia Cancer Institute
- Swedish Cancer Institute/ Swedish Health Services
- University of Washington (UW) - Seattle Cancer Care Alliance
- Northwest Medical Specialties PLLC
- University of Wisconsin Health - UW Carbone Cancer Center
- Columbia St. Marys
- Medical College of Wisconsin
- Bankstown-Lidcombe Hospital
- Chris O'Brien Lifehouse
- St Vincent's Hospital
- Royal North Shore Hospital
- Flinders Medical Centre
- Bendigo Health Care Group
- Monash Health
- Peninsula & South Eastern Haematology and Oncology Group
- Imelda Ziekenhuis
- UZA
- Cliniques Universitaires Saint-Luc
- Hôpital Erasme
- AZ Maria Middelares - Campus Maria Middelares
- UZ Leuven - Campus Gasthuisberg
- Centre Hospitalier Universitaire (CHU) de Liege - Domaine Un
- CENANTRON - Centro Avançado de Tratamento Oncologico
- Hospital da Cidade de Passo Fundo
- Hospital de Clinicas de Porto Alegre - UFRGS
- Hospital São Lucas da PUCRS
- Occ -Oncologia Clínica De Campinas
- Fundação Amaral Cravalho / Hospital Amaral Carvalho
- Fm Abc/ Cepho
- Faculdade de Medicina da Universidade de Sao Paulo
- Fundacao Pio XII Hospital De Câncer de Barretos
- Instituto COI
- Instituto Nacional de Câncer - INCA
- Royal Victoria Regional Health Centre
- Princess Margaret Hospital
- Klinicki bolnicki centar Zagreb
- Klinicki bolnički centar Sestre milosrdnice
- Masarykuv onkologicky ustav
- FN Hradec Kralove
- Fakultni nemocnice Olomouc
- Nemocnice Na Bulovce (Hospital Na Bulovce)
- Fakultni nemocnice v Motole
- Odense Universitetshospital
- East Tallinn Central Hospital Oncology Center
- North Estonian Medical Centre Foundation Clinic of Oncology
- Centre Eugene Marquis
- Hospitalier Jean Minjoz
- ICM Val d'Aurelle Saint Eloi - Departement Oncologie
- ICO - Site Ren Gauducheau
- CHU Estaing
- Hopital Edouard Herriot
- Institut De Cancerologie Gustave Roussy
- Institut de Cancérologie de l'Ouest - Site Paul Papin
- Hôpital Haut-Leveque
- Henri Mondor - Albert Chevenier
- Centre Lyon Berard
- Hopital Privé Jean Mermoz
- Institut Mutualiste Montsouris
- Pitié Salpetriere Hospital
- Hôpital Beaujon
- Universitätsklinikum Ulm
- Klinikum der Universität München - Campus Grosshadern
- Universitätsklinikum Bonn
- Uniklinik Köln-Klinik für Gastroenterologie und Hepatologie am Abdominalzentrum
- Universitätsklinik Carl-Gustav-Carus Dresden
- Universitätsklinikum Leipzig AöR
- Charité - Universitätsmedizin Berlin
- Kliniken Essen-Mitte Evang. Huyssens-Stiftung
- Universitätsklinikum Halle-Universitätsklinik und Poliklinik
- Facharztzentrum Eppendorf
- Universitätskllinikum Heidelberg
- Pécsi Tudományegyetem Klinikai Központ
- Szegedi Tudomanyegyetem Szent-Gyorgyi Albert Klinikai Kozpo
- Petz Aladár Megyei Oktató Kórház
- Debreceni Egyetem Klinikai Központ
- Egyesített Szent István és Szent László Kórház-Rendelőintéze
- Magyar Honvédség Egészségügyi Központ
- Országos Onkológiai Intézet
- Semmelweis Egyetem - Isz. Bel, Onkológiai Részleg
- Semmelweis Egyetem - Onkohaematológiai Osztály
- Szent Margit Kórház
- Somogy Megyei Kaposi Mór Oktató Kórház
- Assaf Harofeh Medical Center
- Meir Medical Center
- Rabin Medical Center - Beilinson Hospital
- Tel Aviv Sourasky Medical Center
- Hadassah Medical Organisation
- Ha'Emek Medical Center
- Soroka Medical Center [Oncology]
- Hillel Yaffe Medical Center
- Rambam Health Care Campus
- Shaare Zedek Medical Center
- The Chaim Sheba Medical Center [Oncology]
- U.O. di Oncologia
- Istituto Clinico Humanitas Rozzano, IRCCS
- PO di Cremona, ASST di Cremona
- AO S. Martino, IRCCS, IST-Istituto Nazionale Ricerca Sul Cancro
- IRCCS Ospedale S.Raffaele
- Ieo, Irccs
- Istituto Oncologico Veneto IOV-IRCCS
- Regina Elena, Istituto Nazionale dei Tumori, IFO, IRCCS
- Borgo Roma, Policlinico G.Rossi, AOU Integrata Verona
- Dong-A University Hospital
- Keimyung University Dongsan Medical Center
- Seoul National University Bundang Hospital
- Asan Medical Center
- Korea University Anam Hospital
- Samsung Medical Center
- Severance Hospital, Yonsei University Health System
- The Catholic University of Korea, Seoul St.Mary's Hospital
- Gachon University Gil Medical Center
- Korea University Guro Hospital
- Seoul National University Hospital
- Daugavpils Regional Hospital
- P.Stradins Clinical University
- SIA "Rigas Austrumu Kliniska Universitates Slimnica"
- National Cancer Institute
- Vilniaus Universiteto ligonines Santariskiu Klinikos
- Maastricht University Medical Centre
- Academisch Medisch Centrum Universiteit van Amsterdam
- Spaarne Gasthuis
- Radboud Universiteit Nijmegen
- Szpital Specjalistyczny w Brzozowie Podkarpacki Ośrodek Onko
- Samodzielny Publiczny Szpital Kliniczny nr 1 w Lublinie
- Centrum Onkologii Instytut im. M. Sklodowskiej-Curie
- Institut Català d'Oncologia-Hospital Germans Trias i Pujol
- Institut Catalá d´Oncología (I.C.O.)
- H.U. de Fuenlabrada
- Clínica Universidad de Navarra
- H.del Mar
- H.Sta.Creu i St.Pau
- H.U.Vall d'Hebrón
- H.C. S.Carlos
- H.G.U. G. Marañón
- H.U. F. Jiménez Díaz
- H.U. R. y Cajal
- Hospital Madrid Norte Sanchinarro
- F.I. Valenciano de Oncología
- Hospital Universitari i Politècnic La Fe
- H.U. Miguel Servet
- China Medical University Hospital
- Changhua Christian Hospital
- National Cheng Kung University Hospital
- National Taiwan University Hospital
- Veterans General Hospital- Taipei
- Addenbrooke's Hospital, Cambridge
- Peterborough And Stamford Hospitals
- Beatson West of Scotland Cancer Centre
- Sarah Cannon Research Institute UK (SCRI UK)
- Edinburgh Cancer Centre Western General Hospital
- The Clatterbridge Cancer Centre NHS Foundation Trust
- Queen Elizabeth Hospital Birmingham
- Castle Hill Hospital
- Coventry Hospital
- Hammersmith Hospital
- The Royal Marsden NHS Foundation - Sutton
- The Royal Marsden NHS Foundation Trust - Chelsea
- North Wales Cancer Treatment Centre
- The Clatterbridge Cancer Centre NHS Foundation Trust
- The Christie NHS Foundation Trust
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
PAG: PEGPH20 + nab-Paclitaxel + Gemcitabine
AG: Placebo + nab-Paclitaxel + Gemcitabine
Participants will receive 3.0 micrograms/kilogram (μg/kg) PEGPH20 as an intravenous (IV) infusion, twice weekly for Weeks 1 to 3 of Cycle 1 (each cycle consisting of 4 weeks [Week 4 of every cycle will be a rest week with no treatment]), then once weekly for Weeks 1 to 3 of Cycle 2 and beyond in combination with 125 milligrams/square meter (mg/m^2) nab-paclitaxel as an IV infusion and 1000 mg/m^2 gemcitabine as an IV infusion, once weekly for Weeks 1 to 3 of all treatment cycles. Treatment will continue until disease progression, unacceptable toxicity, death, or withdrawal of consent.
Participants will receive placebo matching to PEGPH20 as an IV infusion, twice weekly for Weeks 1 to 3 of Cycle 1 (each cycle consisting of 4 weeks [Week 4 of every cycle will be a rest week with no treatment]), then once weekly for Weeks 1 to 3 of Cycle 2 and beyond in combination with 125 mg/m^2 nab-paclitaxel as an IV infusion and 1000 mg/m^2 gemcitabine as an IV infusion, once weekly for Weeks 1 to 3 of all treatment cycles. Treatment will continue until disease progression, unacceptable toxicity, death, or withdrawal of consent.