Chemotherapy and Radiation Therapy Before Surgery Followed by Gemcitabine in Treating Patients With Pancreatic Cancer
Acinar Cell Adenocarcinoma of the Pancreas, Duct Cell Adenocarcinoma of the Pancreas, Recurrent Pancreatic Cancer
About this trial
This is an interventional treatment trial for Acinar Cell Adenocarcinoma of the Pancreas
Eligibility Criteria
Pre-Registration Eligibility Criteria
Documentation of Disease and Radiographic Staging
- Cytologic or histologic proof of adenocarcinoma of the pancreatic head or uncinate process
- Objective radiographic staging with a) contrast-enhanced, helical thin-cut computed tomography (CT)/magnetic resonance imaging (MRI) scan of the abdomen and b) CT scan/MRI of the chest
- Note: echoendoscopic staging will be permitted as an adjunctive modality, but all stage definitions below will be determined using CT/MRI as outlined below. In the event echoendoscopic stage and CT/MRI stage are discordant, the CT/MRI stage will be used. Significant discordance should be discussed with the study principal investigator (PI) prior to enrollment
Borderline resectable primary tumor, defined by the presence of any one or more of the following on CT/MRI, and confirmed by central radiographic review:
- An interface between the primary tumor and the superior mesenteric vein or portal vein (SMV-PV) measuring ≥ 180 degrees of the circumference of the vessel wall
- Short-segment occlusion of the SMV-PV with normal vein above and below the level of obstruction that is amenable to resection and venous reconstruction
- Short segment interface (of any degree) between tumor and hepatic artery with normal artery proximal and distal to the interface that is amenable to resection and reconstruction
- An interface between the tumor and superior mesenteric artery (SMA) measuring < 180 degrees of the circumference of the vessel wall
No potentially resectable disease defined as primary tumors with all of the following:
- An interface between the primary tumor and the superior mesenteric vein or portal vein (SMV-PV) measuring < 180 degrees of the circumference of the vessel wall
- No radiographic interface between the tumor and the (superior mesenteric artery) SMA, hepatic artery or celiac axis
- No radiographic evidence of metastatic disease
No metastatic disease defined as any one or more of the following:
- Suspicious lymphadenopathy outside the standard surgical field (i.e., aortocaval nodes, distant abdominal nodes)
- Radiographic evidence for metastatic disease in distant organs, such as masses in distant organs or ascites
No locally advanced and/or unresectable disease clearly defined by any one or more of the following by CT/MRI:
- An interface between the tumor and the SMA measuring ≥ 180 degrees of the circumference of the vessel wall
- No interface between the tumor and the aorta
- Occlusion of the SMV or portal vein without a sufficient cuff of normal vein above and below the level of obstruction with which to perform venous reconstruction
- Long-segment interface (of any degree) between the tumor and the common hepatic artery or its major tributaries with insufficient artery proximal and distal to the interface to perform reconstruction
- No prior chemotherapy or chemoradiation for pancreatic cancer
- No patients with a "currently active" second malignancy other than non-melanoma skin cancers. Patients are not considered to have a "currently active" malignancy if they have completed therapy and are free of disease for ≥ 3 years
- Baseline peripheral sensory neuropathy must be grade < 2
- No patients with known Gilbert's Syndrome or homozygosity for UGT1A1*28 polymorphism
- No history of pulmonary embolism in the past 6 months
- Age ≥ 18 years of age
- Eastern Cooperative Oncology Group (ECOG)/Zubrod performance status 0-1
- Pregnancy/Nursing Status: Non-pregnant and non-breast-feeding. Female participants of child-bearing potential must have a negative urine or serum pregnancy test prior to registration. Perimenopausal participants must be amenorrheic > 12 months to be considered not of childbearing potential.
Required Pre-Registration Laboratory Values:
- Granulocytes ≥ 2,000/ul
- Hemoglobin > 9 g/dL
- Platelets ≥ 100,000/ul
- Albumin > 3.0 g/dL
- Creatinine ≤1.5 x upper limit of normal (ULN)
Registration Eligibility Criteria
- Confirmation of pre-registration eligibility criteria as described under "Documentation of Disease and Radiographic Staging" by the Alliance Central Radiographic Review
Required Registration Laboratory Values:
- Bilirubin ≤2 mg/dl
- AST (SGOT) & ALT (SGPT) ≤ 2.5 x ULN
Sites / Locations
- UC San Diego Moores Cancer Center
- University of Chicago Comprehensive Cancer Center
- NorthShore University HealthSystem-Evanston Hospital
- The James Graham Brown Cancer Center at University of Louisville
- Ochsner Medical Center Jefferson
- Johns Hopkins University/Sidney Kimmel Cancer Center
- Mayo Clinic
- Wake Forest University Health Sciences
- University of Cincinnati
- Ohio State University Comprehensive Cancer Center
- University Pointe
- Fox Chase Cancer Center
- M D Anderson Cancer Center
- University of Wisconsin Hospital and Clinics
Arms of the Study
Arm 1
Other
mFOLFIRINOX, chemoradiation, surgery and gemcitabine
Each patient will receive mFOLFIRINOX therapy administered every other week for a total of 4 cycles. Each treatment cycle is a total of 14 days. This treatment program consists of four drugs (oxaliplatin 85 mg/m^2 IV over 2 hours on day 1 followed by irinotecan 180 mg/m^2 IV over 90 minutes on day 1 followed by, leucovorin 400 mg/m^2 IV over 2 hours on day 1 followed by 5-FU 2400 mg/m^2 IV over 46-48 hours). Two to six weeks following treatment with the mFOLFIRINOX, if the tumor has not spread to other parts of the body then the patient will receive capecitabine 825 mg/m^2, twice daily for 28 days along with radiation therapy. Patients will have surgery within 4-10 weeks of the last dose of chemoradiation if the tumor has gotten smaller or stayed the same. Within 6-8 weeks following surgery, patients will receive gemcitabine for 2 cycles (1 cycle is 28 days). Gemcitabine will be given IV on days 1, 8 and 15 of every 28 day cycle.