This is a single arm phase II trial assessing the potential activity of combination PEGPH20 plus Gemcitabine with radiotherapy in ten patients with localized, unresectable pancreatic adenocarcinoma.
This is a pilot trial evaluating the safety and potential efficacy of PEGylated Recombinant Human Hyaluronidase (PEGPH20) plus concurrent Gemcitabine and radiotherapy. Recognizing that PEGPH20 has not been previously delivered with radiotherapy but is unlikely to contribute to increased toxicities, this trial will have an abbreviated sequential dose escalation schema for the first three patients. PEGPH20 will be given twice per week for the first 28 days and then weekly for another 2 weeks during radiotherapy. Gemcitabine will be delivered weekly at the first day of radiotherapy and continued weekly, per published literature. Patients will remain on study for three months. The duration of active treatment with PEGPH20 and Gemcitabine plus radiotherapy will continue for 5-6 weeks. Efficacy outcome will occur 6-8 weeks after the completion of radiotherapy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
4
PEGPH20 Dosing (Cohort I, Dose Escalation, First 3 patients): Administered as an IV infusion over 10 minutes (+/- 2 Minutes), approximately 1mL/minute: Dose level 1 - 1 mcg/kg; Dose level 2 - 1.6 mcg/kg; Dose level 3 - 3 mcg/kg. PEGPH20 Dosing (Cohort II, Patients 4-10): Administered at a dose of 3 mcg/kg as an IV infusion over 10 minutes (+/- 2 Minutes), approximately 1mL/minute. Dosing Schedule: Twice per week beginning Day #1 for 8 doses, then weekly until end of radiotherapy.
Gemcitabine Dosing: Administered at a dose of 600 mg/m2 as an IV infusion over 30 - 60 minutes with standard antiemetic pre-medication. If administered on PEGPH20 day, Gemcitabine will be infused 2-4 Hours after PEGPH20 infusion is completed. Dosing Schedule: Weekly, beginning Day #2, per standard regimen.
Scripps Cancer Center
La Jolla, California, United States
Number of Participants with Treatment Related Adverse Events (AEs)
Adverse events will be assessed weekly, from Day1 Treatment through up to 8 weeks after the end of treatment. Safety will be assessed during the study by evaluation of AEs, clinical safety laboratory tests (hematology, blood chemistry (including C-reactive protein \[CRP\]), coagulation, urinalysis, and PEGPH20 immunogenicity), vital signs, 12-lead ECGs, and physical examinations. The severity of AEs will be graded by Investigators using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 4.03
Time frame: Up to 8 Weeks After the End of Treatment
Overall Tumor Response Rate
CT Chest/Abdomen/Pelvis will be completed at End of Study Visit. End of Study visit will be done 6-8 weeks after the last day of radiotherapy. The evaluation of overall lesion response will be a composite of the target lesion response, non-target lesion response and presence of new lesions, per RECIST 1.1 criteria.
Time frame: Change from Baseline through 8 Weeks After End of Radiation Therapy
Conversion to Resectability Rate
Number of enrolled subjects completing at least 2 weeks of PEGPH20 plus concurrent gemcitabine and radiotherapy who meet institutional surgical criteria for surgical resectability, as determined by End of Study CT imaging. End of Study CT imaging will be done up to 8 weeks after the end of radiation therapy.
Time frame: Up to 8 Weeks After End of Radiation Therapy
Carcinoembryonic Antigen (CEA) Response
Change in CEA serum levels from Day 1 through 8 weeks after end of treatment will be assessed.
Time frame: Change from Day 1 through 8 Weeks After End of Treatment
CA 19-9 Response
Change in CA 19-9 serum levels from Day 1 through 8 weeks after end of treatment will be assessed.
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Radiotherapy, beginning Day #2, delivered at 1.8 Gy per fraction, 5 fractions per week (Monday - Friday), until a total dose of 50.4 to 54 Gy for up to 6 Weeks.
Time frame: Change from Day 1 through 8 Weeks After End of Treatment
Determine the Maximum or Peak Plasma PEGPH20 Concentration (cmax) at End of Infusion
Maximum Plasma PEGPH20 concentration (cmax) will be analyzed in all patients, at the following time points: Day 1: Pre-Dose; Day 1 Post-Dose @ 1hr, 2hr, 6hr; Day 2 (24Hr Post Dose); Day 3 (48Hr Post Dose); Day 4 (72Hr Post Dose); Day 8: Pre-Dose; Day 9 (24Hr Post Dose); Day 10 (48Hr Post Dose); Day 11 (72 Hr Post Dose); Day 36: Pre-Dose; Day 37 (24 Hr Post Dose); Day 38 (48Hr Post Dose); Day 39 (72 Hr Post Dose); Pharmacokinetic (PK) data will analyzed by non-compartmental analysis (NCA).
Time frame: At Specific Timepoints from Day 1 through Day 39 During Treatment
Determine Plasma PEGPH20 Area Under the Curve (AUC) After Day 1 PEGPH20 Infusion
Plasma PEGPH20 Area Under the Curve (AUC) will be analyzed in all patients, at the following time points: Day 1: Pre-Dose; Day 1 Post-Dose @ 1hr, 2hr, 6hr; Day 2 (24Hr Post Dose); Day 3 (48Hr Post Dose); Day 4 (72Hr Post Dose); Day 8: Pre-Dose; Day 9 (24Hr Post Dose); Day 10 (48Hr Post Dose); Day 11 (72 Hr Post Dose); Day 36: Pre-Dose; Day 37 (24 Hr Post Dose); Day 38 (48Hr Post Dose); Day 39 (72 Hr Post Dose); Pharmacokinetic (PK) data will analyzed by non-compartmental analysis (NCA).
Time frame: At Specific Timepoints from Day 1 through Day 39 During Treatment
Determine the Maximum or Peak Plasma Hyaluronan Concentration (cmax) After First Dose of PEGPH20
Plasma Hyaluronan (HA) will be analyzed in all patients, at the following time points: Day 1: Pre-Dose; Day 2 (24Hr Post Dose); Day 3 (48Hr Post Dose); Day 4 (72Hr Post Dose); Day 8: Pre-Dose; Day 9 (24Hr Post Dose); Day 10 (48Hr Post Dose); Day 11 (72 Hr Post Dose); Day 36: Pre-Dose; Day 37(24 Hr Post Dose); Day 38(48Hr Post Dose); Day 39 (72 Hr Post Dose); Hyaluronan pharmacodynamic (PD) data will analyzed by non-compartmental analysis (NCA).
Time frame: At Specific Timepoints from Day 1 through Day 39 During Treatment
Determine Plasma Hyaluronan Area Under Effect Curve (AUEC) After First Dose of PEGPH20
Plasma Hyaluronan (HA) will be analyzed in all patients, at the following time points: Day 1: Pre-Dose; Day 2 (24Hr Post Dose); Day 3 (48Hr Post Dose); Day 4 (72Hr Post Dose); Day 8: Pre-Dose; Day 9 (24Hr Post Dose); Day 10 (48Hr Post Dose); Day 11 (72 Hr Post Dose); Day 36: Pre-Dose; Day 37(24 Hr Post Dose); Day 38(48Hr Post Dose); Day 39 (72 Hr Post Dose); Hyaluronan pharmacodynamic (PD) data will analyzed by non-compartmental analysis (NCA).
Time frame: At Specific Timepoints from Day 1 through Day 39 During Treatment