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Sonoporation and Chemotherapy for the Treatment of Pancreatic Cancer

Primary Purpose

Locally Advanced Pancreatic Ductal Adenocarcinoma, Metastatic Pancreatic Ductal Adenocarcinoma, Stage II Pancreatic Cancer AJCC v8

Status
Recruiting
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Gemcitabine Hydrochloride
Nab-paclitaxel
Fluorouracil
Irinotecan Hydrochloride
Leucovorin Calcium
Oxaliplatin
Perflubutane Microbubble
Contrast-Enhanced Ultrasound
Quality-of-Life Assessment
Sponsored by
Thomas Jefferson University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Locally Advanced Pancreatic Ductal Adenocarcinoma

Eligibility Criteria

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

Inclusion Criteria:

  • Patient must be >= 18 years old
  • Patient has a new diagnosis of inoperable PDAC and is scheduled to undergo SoC chemotherapy (inclusion of patients with human immunodeficiency virus [HIV] or chronic hepatitis B and C will be at the discretion of their treating oncologist based on their ability to tolerate SoC chemotherapy)

    • (International Classification of Diseases [ICD]-10 C25.0 Malignant neoplasm: Body of pancreas, C25.2 Malignant neoplasm: Tail of pancreas and C25.3 Malignant neoplasm: Pancreatic duct)
    • Histologically verified, locally advanced (nonresectable stage II/III) or metastatic (stage IV) adenocarcinoma of the pancreas
  • The PDAC must be visible on grayscale ultrasound prior to injection of ultrasound contrast
  • Must be ambulatory with an ECOG performance status between 0 and 2
  • Female patients of child-bearing potential must have a negative urine pregnancy test and use (and agree to continue to use throughout the study) one of the following forms of contraception from the screening Visit until completion of the first study follow-up visit: hormonal (oral, implant or injection) begun > 15 days prior to the screening visit, barrier (e.g., condom, diaphragm with spermicide), intra-uterine device or vasectomized partner (6 months minimum). Male patients must also agree to practice throughout the study an approved method of birth control.

    * (Note: To be considered NOT of child-bearing potential, female patients must be postmenopausal [with amenorrhea for at least 2 years prior to study entry] or surgically sterile [bilateral tubal ligation at least 6 months prior to study entry, or of a hysterectomy and/or bilateral oophorectomy])

  • Hemoglobin > 10 g/dL (prior to enrollment per SoC)
  • Neutrophils (polymorphonuclear leukocytes) > 3.5 x 10^9/L (prior to enrollment per SoC)
  • Platelets (PLT) > 100 x 10^9/L (prior to enrollment per SoC)
  • Bilirubin < 75 umol/L (1.5 x upper limit of normal [ULN]) (prior to enrollment per SoC)
  • Aspartate aminotransferase (AST)/serum glutamic-oxaloacetic transaminase (SGOT) and alanine aminotransferase (ALT)/serum glutamate pyruvate transaminase (SGPT) =< 3 x ULN (prior to enrollment per SoC)
  • Absolute neutrophil count (ANC) of > 1.5 x 10^9/L (1500mm^3) (prior to enrollment per SoC)
  • Signed informed consent and expected cooperation of the patients for the treatment and follow up must be obtained and documented according to International Conference on Harmonization (ICH)/Good Clinical Practice (GCP), and national/local regulations

Exclusion Criteria:

  • Patient participated in an investigational study within 7 days prior to study entry (or, if longer, within five half-lives of the last dose of any investigational drug
  • Patient has severe chronic obstructive pulmonary disease, or pulmonary hypertension or unstable cardiopulmonary conditions
  • Patients with pulmonary vasculitis or a history of pulmonary emboli
  • Patients who are medically unstable. For example:

    • Patients on life support or in a critical care unit
    • Patients with unstable occlusive disease (e.g., crescendo angina)
    • Patients with clinically unstable cardiac arrhythmias, such as recurrent ventricular tachycardia
    • Patients with uncontrolled congestive heart failure (New York Heart Association [NYHA] class IV)
    • Patients with recent cerebral hemorrhage
    • Patients who have undergone surgery within 24 hours prior to the study sonographic examination
  • Patient with a history of any psychiatric disorder or cognitive impairment that would interfere with participation in the study in the opinion of the investigator
  • Patient requires dialysis or has severely impaired renal function, defined as a serum creatinine >= 1.5 x ULN or calculated creatinine clearance < 45 mL/min at the screening visit
  • Patient has severe impairment of liver function, defined as a serum albumin level =< 25 g/L and/or a prothrombin time international normalized ratio (INR) > 2.3 (or activated partial thromboplastin time [APTT] > 6 seconds above the upper limit of normal) at the screening visit
  • Patients with a history of anaphylactic allergy to eggs or egg products, manifested by one or more of the following symptoms: generalized urticaria, difficulty in breathing, swelling of the mouth and throat, hypotension, or shock. (Subjects with non anaphylactic allergies to eggs or egg products may be enrolled in the study, but must be watched carefully for 1 hour following the administration of Sonazoid)
  • Patients that are allergic to any other component of Sonazoid
  • Any reason why, in the opinion of the investigator, the patient should not participate
  • Patients with metastatic adenocarcinoma of the pancreas who have moderate to severe hepatic impairment
  • Patient is pregnant or is breast-feeding

Sites / Locations

  • Sidney Kimmel Cancer Center at Thomas Jefferson UniversityRecruiting
  • Haukeland University HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Arm I (sonazoid, ultrasound, chemotherapy)

Arm II (chemotherapy)

Arm Description

Patients receive standard of care chemotherapy consisting of gemcitabine hydrochloride and nab-paclitaxel IV over 60 minutes on days 1, 8 and 15 OR FOLFIRINOX IV on days 1 and 2. Treatments repeat every 28 days for up to 3 cycles for gemcitabine and nab-paclitaxel, and every 14 days for up to 7 cycles for FOLFIRINOX in the absence of disease progression or unacceptable toxicity. Patients also receive sonazoid IV over 20 minutes and undergo CEUS.

Patients receive standard of care chemotherapy consisting of gemcitabine hydrochloride and nab-paclitaxel IV over 60 minutes on days 1, 8 and 15 OR FOLFIRINOX IV on days 1 and 2. Treatments repeat every 28 days for up to 3 cycles for gemcitabine and nab-paclitaxel, and every 14 days for up to 7 cycles for FOLFIRINOX in the absence of disease progression or unacceptable toxicity.

Outcomes

Primary Outcome Measures

Progression-free survival
Gehan-Breslow-Wilcoxon test and Log-rank (Mantel-Cox) test will be used to compare survival. All clinical variables (e.g., concomitant imaging results, blood tests, etc.) will also be compared between the groups with and without sonoporation. When both types of variables are ordinal or continuous, correlations will be calculated. Continuous data will be analyzed using t-tests, or Mann-Whitney tests.

Secondary Outcome Measures

Full Information

First Posted
March 26, 2021
Last Updated
September 29, 2023
Sponsor
Thomas Jefferson University
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1. Study Identification

Unique Protocol Identification Number
NCT04821284
Brief Title
Sonoporation and Chemotherapy for the Treatment of Pancreatic Cancer
Official Title
Optimizing Ultrasound Enhanced Delivery of Therapeutics
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 6, 2021 (Actual)
Primary Completion Date
June 30, 2024 (Anticipated)
Study Completion Date
December 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Thomas Jefferson University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This phase I/II trial studies the effect of sonoporation in addition to standard of care chemotherapy in treating patients with pancreatic cancer. Sonoporation is a novel method that uses ultrasound and microbubbles to increase therapeutic effect by increasing uptake or enhance sensitization. Sonoporation together with chemotherapy may work better in treating patients with pancreatic cancer compared to chemotherapy alone.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Locally Advanced Pancreatic Ductal Adenocarcinoma, Metastatic Pancreatic Ductal Adenocarcinoma, Stage II Pancreatic Cancer AJCC v8, Stage IIA Pancreatic Cancer AJCC v8, Stage IIB Pancreatic Cancer AJCC v8, Stage III Pancreatic Cancer AJCC v8, Stage IV Pancreatic Cancer AJCC v8, Unresectable Pancreatic Ductal Adenocarcinoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
120 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Arm I (sonazoid, ultrasound, chemotherapy)
Arm Type
Experimental
Arm Description
Patients receive standard of care chemotherapy consisting of gemcitabine hydrochloride and nab-paclitaxel IV over 60 minutes on days 1, 8 and 15 OR FOLFIRINOX IV on days 1 and 2. Treatments repeat every 28 days for up to 3 cycles for gemcitabine and nab-paclitaxel, and every 14 days for up to 7 cycles for FOLFIRINOX in the absence of disease progression or unacceptable toxicity. Patients also receive sonazoid IV over 20 minutes and undergo CEUS.
Arm Title
Arm II (chemotherapy)
Arm Type
Active Comparator
Arm Description
Patients receive standard of care chemotherapy consisting of gemcitabine hydrochloride and nab-paclitaxel IV over 60 minutes on days 1, 8 and 15 OR FOLFIRINOX IV on days 1 and 2. Treatments repeat every 28 days for up to 3 cycles for gemcitabine and nab-paclitaxel, and every 14 days for up to 7 cycles for FOLFIRINOX in the absence of disease progression or unacceptable toxicity.
Intervention Type
Drug
Intervention Name(s)
Gemcitabine Hydrochloride
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Nab-paclitaxel
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Fluorouracil
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Irinotecan Hydrochloride
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Leucovorin Calcium
Intervention Description
Given IV
Intervention Type
Drug
Intervention Name(s)
Oxaliplatin
Intervention Description
Given IV
Intervention Type
Other
Intervention Name(s)
Perflubutane Microbubble
Intervention Description
Oxaliplatin
Intervention Type
Procedure
Intervention Name(s)
Contrast-Enhanced Ultrasound
Intervention Description
Undergo CEUS
Intervention Type
Other
Intervention Name(s)
Quality-of-Life Assessment
Intervention Description
Ancillary studies
Primary Outcome Measure Information:
Title
Progression-free survival
Description
Gehan-Breslow-Wilcoxon test and Log-rank (Mantel-Cox) test will be used to compare survival. All clinical variables (e.g., concomitant imaging results, blood tests, etc.) will also be compared between the groups with and without sonoporation. When both types of variables are ordinal or continuous, correlations will be calculated. Continuous data will be analyzed using t-tests, or Mann-Whitney tests.
Time Frame
Up to 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patient must be >= 18 years old Patient has a new diagnosis of inoperable PDAC and is scheduled to undergo SoC chemotherapy (inclusion of patients with human immunodeficiency virus [HIV] or chronic hepatitis B and C will be at the discretion of their treating oncologist based on their ability to tolerate SoC chemotherapy) (International Classification of Diseases [ICD]-10 C25.0 Malignant neoplasm: Body of pancreas, C25.2 Malignant neoplasm: Tail of pancreas and C25.3 Malignant neoplasm: Pancreatic duct) Histologically verified, locally advanced (nonresectable stage II/III) or metastatic (stage IV) adenocarcinoma of the pancreas The PDAC must be visible on grayscale ultrasound prior to injection of ultrasound contrast Must be ambulatory with an ECOG performance status between 0 and 2 Female patients of child-bearing potential must have a negative urine pregnancy test and use (and agree to continue to use throughout the study) one of the following forms of contraception from the screening Visit until completion of the first study follow-up visit: hormonal (oral, implant or injection) begun > 15 days prior to the screening visit, barrier (e.g., condom, diaphragm with spermicide), intra-uterine device or vasectomized partner (6 months minimum). Male patients must also agree to practice throughout the study an approved method of birth control. * (Note: To be considered NOT of child-bearing potential, female patients must be postmenopausal [with amenorrhea for at least 2 years prior to study entry] or surgically sterile [bilateral tubal ligation at least 6 months prior to study entry, or of a hysterectomy and/or bilateral oophorectomy]) Hemoglobin > 10 g/dL (prior to enrollment per SoC) Neutrophils (polymorphonuclear leukocytes) > 3.5 x 10^9/L (prior to enrollment per SoC) Platelets (PLT) > 100 x 10^9/L (prior to enrollment per SoC) Bilirubin < 75 umol/L (1.5 x upper limit of normal [ULN]) (prior to enrollment per SoC) Aspartate aminotransferase (AST)/serum glutamic-oxaloacetic transaminase (SGOT) and alanine aminotransferase (ALT)/serum glutamate pyruvate transaminase (SGPT) =< 3 x ULN (prior to enrollment per SoC) Absolute neutrophil count (ANC) of > 1.5 x 10^9/L (1500mm^3) (prior to enrollment per SoC) Signed informed consent and expected cooperation of the patients for the treatment and follow up must be obtained and documented according to International Conference on Harmonization (ICH)/Good Clinical Practice (GCP), and national/local regulations Exclusion Criteria: Patient participated in an investigational study within 7 days prior to study entry (or, if longer, within five half-lives of the last dose of any investigational drug Patient has severe chronic obstructive pulmonary disease, or pulmonary hypertension or unstable cardiopulmonary conditions Patients with pulmonary vasculitis or a history of pulmonary emboli Patients who are medically unstable. For example: Patients on life support or in a critical care unit Patients with unstable occlusive disease (e.g., crescendo angina) Patients with clinically unstable cardiac arrhythmias, such as recurrent ventricular tachycardia Patients with uncontrolled congestive heart failure (New York Heart Association [NYHA] class IV) Patients with recent cerebral hemorrhage Patients who have undergone surgery within 24 hours prior to the study sonographic examination Patient with a history of any psychiatric disorder or cognitive impairment that would interfere with participation in the study in the opinion of the investigator Patient requires dialysis or has severely impaired renal function, defined as a serum creatinine >= 1.5 x ULN or calculated creatinine clearance < 45 mL/min at the screening visit Patient has severe impairment of liver function, defined as a serum albumin level =< 25 g/L and/or a prothrombin time international normalized ratio (INR) > 2.3 (or activated partial thromboplastin time [APTT] > 6 seconds above the upper limit of normal) at the screening visit Patients with a history of anaphylactic allergy to eggs or egg products, manifested by one or more of the following symptoms: generalized urticaria, difficulty in breathing, swelling of the mouth and throat, hypotension, or shock. (Subjects with non anaphylactic allergies to eggs or egg products may be enrolled in the study, but must be watched carefully for 1 hour following the administration of Sonazoid) Patients that are allergic to any other component of Sonazoid Any reason why, in the opinion of the investigator, the patient should not participate Patients with metastatic adenocarcinoma of the pancreas who have moderate to severe hepatic impairment Patient is pregnant or is breast-feeding
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Flemming Forsberg, PhD
Phone
215-955-4870
Email
flemming.forsberg@jefferson.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Flemming Forsberg, PhD
Organizational Affiliation
Thomas Jefferson University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Sidney Kimmel Cancer Center at Thomas Jefferson University
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19107
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Flemming Forsberg, PhD
Phone
215-955-4870
Email
Flemming.Forsberg@jefferson.edu
Facility Name
Haukeland University Hospital
City
Bergen
ZIP/Postal Code
5021
Country
Norway
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Odd Gilja
Phone
47 55972133
Email
Odd.Gilja@uib.no

12. IPD Sharing Statement

Learn more about this trial

Sonoporation and Chemotherapy for the Treatment of Pancreatic Cancer

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