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Gemcitabine and Oxaliplatin in Treating Patients With Pancreatic Cancer That Can Be Removed By Surgery

Primary Purpose

Pancreatic Cancer

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
gemcitabine hydrochloride
oxaliplatin
protein expression analysis
proteomic profiling
diagnostic laboratory biomarker analysis
adjuvant therapy
neoadjuvant therapy
therapeutic conventional surgery
Sponsored by
Memorial Sloan Kettering Cancer Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Pancreatic Cancer focused on measuring adenocarcinoma of the pancreas, stage IA pancreatic cancer, stage IB pancreatic cancer, stage IIA pancreatic cancer, stage IIB pancreatic cancer, stage III pancreatic cancer

Eligibility Criteria

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

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed pancreatic adenocarcinoma

    • No histology other than adenocarcinoma (e.g., neuroendocrine cancer or acinar cancer)

      • Patients with adenosquamous variants are eligible
  • Radiographically resectable pancreatic cancer, as determined by a surgical oncologist

    • No metastatic or locally unresectable pancreatic adenocarcinoma
  • No evidence of distant metastases by CT scan

    • Negative or pending laparoscopy for distant metastases

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • Absolute neutrophil count ≥ 1,500/mm³
  • Platelet count ≥ 100,000/mm³
  • Bilirubin ≤ 4.0 mg/dL (if > 3.0, stented and known to be declining)
  • Serum creatinine ≤ 1.6 mg/dL
  • INR < 1.5 (therapeutic INR is allowed for patients receiving therapeutic anticoagulation)
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 3 months after completion of study therapy
  • No active infection, except for resolving cholangitis, that would preclude study enrollment

    • Neoadjuvant therapy may only be initiated when acute cholangitis has resolved
  • No other malignancy within the past 3 years except for curatively treated basal cell carcinoma of the skin, cervical intraepithelial neoplasia, or localized prostate cancer with a PSA of < 5.0 ng/mL within ≥ 4 weeks of study entry (other circumstances with a recent concurrent or active malignancy will be adjudicated on a case-by-case basis by the principle investigator [PI] or co-PI)
  • No known hypersensitivity to any of the components of oxaliplatin or gemcitabine
  • No hypersensitivity to CT scan IV contrast dye not suitable for premedication
  • No peripheral neuropathy ≥ grade 2
  • No known HIV or hepatitis B or C infection (active, previously treated, or both)
  • No other medical condition, including mental illness or substance abuse that, deemed by the investigator, would preclude study participation

PRIOR CONCURRENT THERAPY:

  • More than 4 weeks since prior radiotherapy
  • No prior radiotherapy to > 25% of bone marrow
  • More than 30 days since prior and no other concurrent investigational therapy
  • No other prior therapy for pancreatic cancer
  • No other concurrent chemotherapy, immunotherapy, or radiotherapy during neoadjuvant therapy
  • Concurrent low molecular weight heparin or warfarin, where medically indicated, allowed

Sites / Locations

  • Memorial Sloan-Kettering Cancer Center

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Gemcitabine And Oxaliplatin

Arm Description

A Phase II Study of Neoadjuvant Gemcitabine And Oxaliplatin In Patients With Potentially Resectable Previously Untreated Pancreatic Adenocarcinoma

Outcomes

Primary Outcome Measures

Overall Survival at 18 Months
Percentage of participants that were alive or survived at 18 months after randomization

Secondary Outcome Measures

Overall Survival (Follow-Up Time)
Specific Tumor Marker Response (CEA) to Neoadjuvant Therapy
RECIST Radiologic Response to Neoadjuvant Therapy
Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR)=CR +PR
Specific Tumor Marker Response (Ca 19-9) to Neoadjuvant Therapy
Specific Tumor Marker Response (CEA) to Neoadjuvant Therapy
Percentage change in specific tumor marker (Carcinoembryonic antigen, CEA) levels in response to neoadjuvant therapy
Specific Tumor Marker Response (Ca 19-9) to Neoadjuvant Therapy
Percent change in specific tumor marker (Cancer Antigen 19-9, Ca 19-9) levels in response to neoadjuvant therapy

Full Information

First Posted
September 27, 2007
Last Updated
February 7, 2017
Sponsor
Memorial Sloan Kettering Cancer Center
Collaborators
National Cancer Institute (NCI)
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1. Study Identification

Unique Protocol Identification Number
NCT00536874
Brief Title
Gemcitabine and Oxaliplatin in Treating Patients With Pancreatic Cancer That Can Be Removed By Surgery
Official Title
A Phase II Study of Neoadjuvant Gemcitabine and Oxaliplatin in Patients With Potentially Resectable Previously Untreated Pancreatic Adenocarcinoma
Study Type
Interventional

2. Study Status

Record Verification Date
February 2017
Overall Recruitment Status
Completed
Study Start Date
October 2007 (undefined)
Primary Completion Date
September 2012 (Actual)
Study Completion Date
February 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Memorial Sloan Kettering Cancer Center
Collaborators
National Cancer Institute (NCI)

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy, such as gemcitabine and oxaliplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving chemotherapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving chemotherapy after surgery may kill any tumor cells that remain after surgery. PURPOSE: This phase II trial is studying how well giving gemcitabine together with oxaliplatin works in treating patients with pancreatic cancer that can be removed by surgery.
Detailed Description
OBJECTIVES: Primary To determine the overall 18-month survival of patients with radiographically resectable pancreatic adenocarcinoma treated with neoadjuvant gemcitabine and oxaliplatin followed by surgical resection and adjuvant gemcitabine. Secondary To determine the safety, toxicity, and feasibility of this regimen in the neoadjuvant setting. To determine the feasibility of obtaining preoperative core tissue biopsies and the ability to use these biopsies to establish pathologic correlates of response following neoadjuvant therapy and to determine if xenografts can be developed from these core tissues. To determine the specific tumor marker response (CEA and CA19-9) to neoadjuvant therapy. To determine the prognostic accuracy of serum protein profiles in these patients. To determine the overall survival and patterns of tumor recurrence (local vs distant). OUTLINE: Neoadjuvant therapy: Patients receive gemcitabine IV over 100 minutes and oxaliplatin IV over 2 hours on day 1. Treatment repeats every 14 days for 4 courses in the absence of disease progression or unacceptable toxicity. Surgery: Within 2-6 weeks after completion of neoadjuvant therapy, patients undergo a laparoscopy that includes a pancreaticoduodenectomy or distal pancreatectomy with or without splenectomy. Adjuvant therapy: Beginning 4-16 weeks after surgery, patients receive gemcitabine IV over 30 minutes on days 1, 8, and 15. Treatment repeats every 28 days for 5 courses in the absence of disease progression or unacceptable toxicity. Patients undergo tumor tissue and blood sample collection periodically for correlative studies. Samples are analyzed for protein expression and tumor markers (CEA and CA19-9) pre- and post-neoadjuvant therapy via proteomic analysis. Tumor tissue samples are also banked for research purposes. After completion of study treatment, patients are followed every 3 months.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Pancreatic Cancer
Keywords
adenocarcinoma of the pancreas, stage IA pancreatic cancer, stage IB pancreatic cancer, stage IIA pancreatic cancer, stage IIB pancreatic cancer, stage III pancreatic cancer

7. Study Design

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

8. Arms, Groups, and Interventions

Arm Title
Gemcitabine And Oxaliplatin
Arm Type
Experimental
Arm Description
A Phase II Study of Neoadjuvant Gemcitabine And Oxaliplatin In Patients With Potentially Resectable Previously Untreated Pancreatic Adenocarcinoma
Intervention Type
Drug
Intervention Name(s)
gemcitabine hydrochloride
Intervention Description
1,000 mg/m2 IV over 100 minutes on day 1 every 14 days for 4 cycles
Intervention Type
Drug
Intervention Name(s)
oxaliplatin
Intervention Description
80 mg/m2 IV over 2 hours on day 1 every 14 days for 4 cycles.
Intervention Type
Genetic
Intervention Name(s)
protein expression analysis
Intervention Type
Genetic
Intervention Name(s)
proteomic profiling
Intervention Type
Other
Intervention Name(s)
diagnostic laboratory biomarker analysis
Intervention Type
Procedure
Intervention Name(s)
adjuvant therapy
Intervention Type
Procedure
Intervention Name(s)
neoadjuvant therapy
Intervention Type
Procedure
Intervention Name(s)
therapeutic conventional surgery
Primary Outcome Measure Information:
Title
Overall Survival at 18 Months
Description
Percentage of participants that were alive or survived at 18 months after randomization
Time Frame
18 months
Secondary Outcome Measure Information:
Title
Overall Survival (Follow-Up Time)
Time Frame
From Baseline until 2 Years and Follow-Up, up to 120 months
Title
Specific Tumor Marker Response (CEA) to Neoadjuvant Therapy
Time Frame
Baseline and 2 years
Title
RECIST Radiologic Response to Neoadjuvant Therapy
Description
Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR)=CR +PR
Time Frame
2 years
Title
Specific Tumor Marker Response (Ca 19-9) to Neoadjuvant Therapy
Time Frame
Baseline and 2 years
Title
Specific Tumor Marker Response (CEA) to Neoadjuvant Therapy
Description
Percentage change in specific tumor marker (Carcinoembryonic antigen, CEA) levels in response to neoadjuvant therapy
Time Frame
Baseline and 2 years
Title
Specific Tumor Marker Response (Ca 19-9) to Neoadjuvant Therapy
Description
Percent change in specific tumor marker (Cancer Antigen 19-9, Ca 19-9) levels in response to neoadjuvant therapy
Time Frame
Baseline and 2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically or cytologically confirmed pancreatic adenocarcinoma No histology other than adenocarcinoma (e.g., neuroendocrine cancer or acinar cancer) Patients with adenosquamous variants are eligible Radiographically resectable pancreatic cancer, as determined by a surgical oncologist No metastatic or locally unresectable pancreatic adenocarcinoma No evidence of distant metastases by CT scan Negative or pending laparoscopy for distant metastases PATIENT CHARACTERISTICS: ECOG performance status 0-2 Absolute neutrophil count ≥ 1,500/mm³ Platelet count ≥ 100,000/mm³ Bilirubin ≤ 4.0 mg/dL (if > 3.0, stented and known to be declining) Serum creatinine ≤ 1.6 mg/dL INR < 1.5 (therapeutic INR is allowed for patients receiving therapeutic anticoagulation) Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 3 months after completion of study therapy No active infection, except for resolving cholangitis, that would preclude study enrollment Neoadjuvant therapy may only be initiated when acute cholangitis has resolved No other malignancy within the past 3 years except for curatively treated basal cell carcinoma of the skin, cervical intraepithelial neoplasia, or localized prostate cancer with a PSA of < 5.0 ng/mL within ≥ 4 weeks of study entry (other circumstances with a recent concurrent or active malignancy will be adjudicated on a case-by-case basis by the principle investigator [PI] or co-PI) No known hypersensitivity to any of the components of oxaliplatin or gemcitabine No hypersensitivity to CT scan IV contrast dye not suitable for premedication No peripheral neuropathy ≥ grade 2 No known HIV or hepatitis B or C infection (active, previously treated, or both) No other medical condition, including mental illness or substance abuse that, deemed by the investigator, would preclude study participation PRIOR CONCURRENT THERAPY: More than 4 weeks since prior radiotherapy No prior radiotherapy to > 25% of bone marrow More than 30 days since prior and no other concurrent investigational therapy No other prior therapy for pancreatic cancer No other concurrent chemotherapy, immunotherapy, or radiotherapy during neoadjuvant therapy Concurrent low molecular weight heparin or warfarin, where medically indicated, allowed
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Eileen O'Reilly, MD
Organizational Affiliation
Memorial Sloan Kettering Cancer Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Peter J. Allen, MD
Organizational Affiliation
Memorial Sloan Kettering Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Memorial Sloan-Kettering Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
10065-0009
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
24901360
Citation
O'Reilly EM, Perelshteyn A, Jarnagin WR, Schattner M, Gerdes H, Capanu M, Tang LH, LaValle J, Winston C, DeMatteo RP, D'Angelica M, Kurtz RC, Abou-Alfa GK, Klimstra DS, Lowery MA, Brennan MF, Coit DG, Reidy DL, Kingham TP, Allen PJ. A single-arm, nonrandomized phase II trial of neoadjuvant gemcitabine and oxaliplatin in patients with resectable pancreas adenocarcinoma. Ann Surg. 2014 Jul;260(1):142-8. doi: 10.1097/SLA.0000000000000251.
Results Reference
derived

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Gemcitabine and Oxaliplatin in Treating Patients With Pancreatic Cancer That Can Be Removed By Surgery

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