The purpose of this study is to learn about the safety and potential benefit of metronomic 5-fluorouracil in combination with nab®1-paclitaxel, bevacizumab, leucovorin, and oxaliplatin in treating patients with metastatic pancreatic adenocarcinoma.
The Phase 1 portion of the study is an open-label study enrolling subjects with metastatic pancreatic adenocarcinoma who have not previously received systemic chemotherapy at any time as treatment for pancreatic cancer (including adjuvant chemotherapy), except low dose chemotherapy administered as a radiosensitizer concomitant with radiotherapy and to determine the recommended Phase 2 dose (RP2D) and dose-limiting toxicities (DLTs) of metronomic 5-FU in combination with nab-paclitaxel, bevacizumab, leucovorin, and oxaliplatin in patients with metastatic pancreatic adenocarcinoma. Subjects will be enrolled in cohorts of 6 subjects. There will be no dose escalation. Dose limiting toxicities will be assessed in cycle 1. If there is an incidence of ≥2 of 6 subjects experiencing a DLT, the dose will be de-escalated to the next lower dose. Based on the totality of the data, the investigators may advise the Sponsor to evaluate additional subjects at any of the dose levels. Upon Sponsor agreement, if additional subjects are enrolled at any dose level, DLT evaluation will occur at that same ratio (if ≥ 4 of 12 subjects, or ≥ 6 of 18 subjects experience a DLT, the dose will be de-escalated). Approximately 12-24 subjects will be enrolled in the Phase 1 portion of the study, dependent on the number of dose levels examined and the number of subjects enrolled at each dose level. Safety will continuously be evaluated by incidence of Treatment Emergent Adverse Events (TEAEs) by the Medical Dictionary for Drug Regulatory Activities (MedDRA) and severity according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 4.03 (v4.03). The Phase 2 part of the study is to determine if the combination of metronomic 5-FU, nab-paclitaxel, bevacizumab, leucovorin, and oxaliplatin at the RP2D defined in Phase 1 achieves a clinically meaningful improvement in 1 year survival rate over the historical control. Approximately 60 subjects are planned to be enrolled in the Phase 2 portion of the study. Subjects may remain on treatment until disease progression, unacceptable toxicity, withdrawal of consent, physician decision, or death. The anticipated duration of the study (including Phase 1, Phase 2 and follow-up) is approximately 4 years. The Phase 1 portion of the study is an open-label study enrolling subjects with metastatic pancreatic adenocarcinoma who have not previously received systemic chemotherapy at any time as treatment for pancreatic cancer (including adjuvant chemotherapy), except low dose chemotherapy administered as a radiosensitizer concomitant with radiotherapy and to determine the recommended Phase 2 dose (RP2D) and dose-limiting toxicities (DLTs) of metronomic 5-FU in combination with nab-paclitaxel, bevacizumab, leucovorin, and oxaliplatin in patients with metastatic pancreatic adenocarcinoma. Subjects will be enrolled in cohorts of 6 subjects. There will be no dose escalation. Dose limiting toxicities will be assessed in cycle 1. If there is an incidence of ≥2 of 6 subjects experiencing a DLT, the dose will be de-escalated to the next lower dose. Based on the totality of the data, the investigators may advise the Sponsor to evaluate additional subjects at any of the dose levels. Upon Sponsor agreement, if additional subjects are enrolled at any dose level, DLT evaluation will occur at that same ratio (if ≥ 4 of 12 subjects, or ≥ 6 of 18 subjects experience a DLT, the dose will be de-escalated). Approximately 12-24 subjects will be enrolled in the Phase 1 portion of the study, dependent on the number of dose levels examined and the number of subjects enrolled at each dose level. Safety will continuously be evaluated by incidence of Treatment Emergent Adverse Events (TEAEs) by the Medical Dictionary for Drug Regulatory Activities (MedDRA) and severity according to National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) Version 4.03 (v4.03). The Phase 2 part of the study is to determine if the combination of metronomic 5-FU, nab-paclitaxel, bevacizumab, leucovorin, and oxaliplatin at the RP2D defined in Phase 1 achieves a clinically meaningful improvement in 1 year survival rate over the historical control. Approximately 60 subjects are planned to be enrolled in the Phase 2 portion of the study. Subjects may remain on treatment until disease progression, unacceptable toxicity, withdrawal of consent, physician decision, or death. The anticipated duration of the study (including Phase 1, Phase 2 and follow-up) is approximately 4 years. Upon completion of the Phase 1 portion of the study, a decision not to proceed with the Phase 2 portion was taken by the Sponsor. The decision to terminate the study after Phase 1 was not based on any safety concerns that posed an unacceptable risk for this patient population and no safety issues have been identified.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
12
5 fluorouracil (5-FU) (180 mg/m\^2/day for 14 days) by CIVI via ambulatory pump
nab-paclitaxel (75 mg/m\^2) as a 30-minute (min) IV infusion on Days 1, 8, and 15
bevacizumab (5 mg/kg) as an IV infusion on Days 1 and 15
Northwestern University
Chicago, Illinois, United States
Tufts - New England Medical Center
Boston, Massachusetts, United States
University of Michigan
Ann Arbor, Michigan, United States
Karmanos Cancer Center Wayne State University
Detroit, Michigan, United States
Dose limiting toxicities (Phase 1)
• Any toxicity starting during the first 28 days of treatment and requiring 14 days or more of treatment interruption • Grade 3 or 4 neutropenia associated with fever \> 38.5°C • Grade 3 anemia requiring a transfusion • Any Grade 4 hematological toxicity lasting \> 7 days • Grade 4 thrombocytopenia or a Grade 3 or 4 thrombocytopenia associated with clinically significant bleeding • Grade 3 or 4 non-hematological toxicity with the exception of fatigue, due to any of the study drugs and unresponsive to medical treatment within 4 days of onset • Subjects who experience Grade ≥ 3 hyperbilirubinemia as an apparent DLT. If a Phase 1 subject experiences a Grade ≥ 3 hyperbilirubinemia due principally to unconjugated bilirubin, it will not be defined as a DLT. The subject will be removed from the study and the Phase 1 subject will be replaced. • Any non-hematologic toxicity delaying the initiation of cycle 2 by \> 21 days • Grade ≥ 2 pneumonitis or interstitial lung disease
Time frame: Up to Day 1 of Cycle 2
1 year survival rate (Phase II portion)
1 year survival rate is defined as the time interval between the date of first dose of Investigational Product (IP) and the date of death.
Time frame: Up to 1 year
Number of subjects experiencing Adverse Events (AEs) by severity and overall tabulations by cohort and overall including treatment emergent and Serious AEs
An AE is any noxious, unintended, or untoward medical occurrence that may appear or worsen in a subject during the course of a study. It may be a new intercurrent illness, a worsening concomitant illness, an injury, or any concomitant impairment of the subject's health, including laboratory test values, regardless of etiology. All AEs will be recorded by the Investigator from the time the subject signs informed consent until 28 days after the last dose of IP as well as those SAEs made known to the Investigator at any time thereafter that are suspected of being related to Investigational Product.
Time frame: Up to 4 years
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calcium leucovorin (20 mg/m\^2) IV bolus, on Days 1, 8, 15
oxaliplatin (40 mg/m\^2) as a 60-min IV infusion on Days 1, 8, and 15
Cornell University Weill Medical College
New York, New York, United States
Gibbs Cancer Center and Research Institute
Spartanburg, South Carolina, United States
Virginia Mason Cancer Center
Seattle, Washington, United States
Summary for the number of subjects experiencing Adverse Events (AEs) by severity and overall in tabulations by cohort and overall including treatment emergent AEs and Serious AEs
An AE is any noxious, unintended, or untoward medical occurrence that may appear or worsen in a subject during the course of a study. It may be a new intercurrent illness, a worsening concomitant illness, an injury, or any concomitant impairment of the subject's health, including laboratory test values, regardless of etiology. All AEs will be recorded by the Investigator from the time the subject signs informed consent until 28 days after the last dose of IP as well as those SAEs made known to the Investigator at any time thereafter that are suspected of being related to IP
Time frame: Up to 4 years
Objective Response Rate using Response Evaluation Criteria In Solid Tumours (Recist) v1.1 presented by frequency and percentages
Subjects with confirmed complete or partial response (CR and PR) will be presented by 95% Confidence Intervals (CIs) around the proportion of (CR+PR)/N where N is the total number of subjects who are evaluable for response by RECIST criteria.
Time frame: Up to 4 years
Progression free survival (PFS)
The time interval between the date of first dose of IP until disease progression or death, whichever occurs first.
Time frame: Up to 4 years
Overall Survival (OS)
OS is defined as the time interval between the date of first dose of IP and the date of death.
Time frame: Up to 4 years
Percentage of subjects with symptom improvement
The Pancreatic cancer symptom management using: Functional Assessment Solid Tumors Hepatobiliary Symptom Index-8 (FHSI-8) questionaire will evaluate individual symptom improvement from baseline will be analyzed by different levels of improvement separately, ie, by reduction of score 1, 2, 3, and 4. At any given follow-up time point, the subject is classified having symptom improvement if the subject has reduced symptom severity compared to baseline regardless of subsequent symptom score.
Time frame: Up to 4 years
Percentage of subjects with symptom improvement between subjects who experienced at least partial response and those without partial response
The FHSI-8 assessment will measure the correlation of symptom improvement between those who experienced a Partial Response (PR) to those without a PR.
Time frame: Up to 4 years
Percentage of subjects who experienced symptom improvement by a score of ≥ 2
The FHSI-8 assessment will measure the correlation of symptom improvement with Eastern Cooperative Oncology Group (ECOG) performance status (PS) over the course of treatment
Time frame: Up to 4 years