This research study is studying a combination of interventions as a possible treatment for pancreatic tumor. The interventions involved in this study are: * FOLFIRINOX which is made up of 4 different drugs: * 5-Fluorouracil (5-FU) * Oxaliplatin * Irinotecan * Leucovorin * Losartan * Nivolumab * Radiation Therapy * Surgery
This research study is a Phase II clinical trial. Phase II clinical trials test the safety and effectiveness of an investigational intervention to learn whether the intervention works in treating a specific disease. "Investigational" means that the intervention is being studied. The FDA (the U.S. Food and Drug Administration) has approved FOLFIRINOX as a treatment option for this disease. The FDA has not approved losartan or nivolumab for this specific disease but they have been approved for other uses. FOLFIRINOX is a combination of 4 chemotherapy agents that may help shrink your tumor before surgery. Losartan is a drug that is used to lower blood pressure. Nivolumab is an antibody (a cell that attaches to other cells to fight off infection) that may cause programmed cell death of cancer cells. Radiation therapy is believed to increase the likelihood of response of immunotherapy (the prevention/treatment of a disease through an immune response).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
168
FOLFIRINOX is a combination of 4 chemotherapy agents that may help shrink your tumor before surgery * 5-Fluorouracil (5-FU) - 400 mg/m2 on day one, followed by 1200 mg/m2 by continuous infusion for the subsequent 46-48 hours * Oxaliplatin - 85 mg/m2 by intravenous infusion over 120 minutes on day 1 of each 14 day cycle * Irinotecan - administered at a starting dose of 180 mg/m2 by intravenous infusion over 90 minutes on day 1 of each 14 day cycle * Leucovorin - Administered at a starting dose of 400 mg/m2 over 2 hours on day 1 of each 14 day cycle
Losartan is a drug that is used to lower blood pressure
Nivolumab is an antibody that may cause programmed cell death of cancer cells
University of Colorado Cancer Center
Aurora, Colorado, United States
Sibley Memorial Hospital
Washington D.C., District of Columbia, United States
The Johns Hopkins Hospital
Baltimore, Maryland, United States
Proportion of participants with R0 resection
R0 resection is defined as microscopically negative margins determined by histopathologic assessment of the resection specimen. The R0 resection rate will be analyzed among all eligible patients, including those not resected due to early progression, death or off-study.
Time frame: Up to 8 months after baseline
Progression-free survival
Progression-free survival is defined as the time from the date of randomization (or registration on Arm 4) to first objective documentation of progressive disease (distant or local) or death. Disease status is evaluated using RECIST (Response Evaluation Criteria in Solid Tumors). Disease progression is defined as having at least a 20% increase in the sum of the longest diameter (LD) of target lesion, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions.
Time frame: From randomization until the time of progression or death, up to approximately 6 years
Overall survival
Overall Survival (OS) is defined as the time from randomization (or registration on Arm 4) to death due to any cause, or censored at date last known alive.
Time frame: From randomization until the time of death, up to approximately 6 years
Pathologic complete response
The proportion of participants that achieved a pathologic complete response. Pathologic complete response is defined as the disappearance of all target lesions, as confirmed by a pathologist evaluating the tissue samples removed during surgery.
Time frame: Up to 8 months after baseline
Number of participants with treatment related serious adverse events
Adverse events are assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Adverse events are considered to be related to treatment if the Investigator deems them to be either possibly, probably, or definitely related to treatment.
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Radiation therapy is believed to increase the likelihood of response of immunotherapy
definitive surgical resection
Massachusetts General Hospital
Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center
Boston, Massachusetts, United States
Brigham and Women's Hospital
Boston, Massachusetts, United States
Dana Farber Cancer Institute
Boston, Massachusetts, United States
Newton Wellesley Hospital
Newton, Massachusetts, United States
New York University Langone Medical Center
New York, New York, United States
MD Anderson Cancer Center
Houston, Texas, United States
Time frame: From the start of treatment until 30 days after the end of treatment, up to approximately 14 months