Given the efficacy of nanoliposomal irinotecan as a second-line regimen in pancreatic ductal adenocarcinoma (PDAC), together with the favorable toxicity profile of paricalcitol and its interplay with irinotecan metabolism, the investigators propose a second-line pilot study in advanced PDAC that will enroll patients who have progressed on a gemcitabine-based regimen.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
20
-Standard of care drug
-Standard of care drug
-Standard of care drug
-Investigational drug
-baseline, day 1 of each cycle beginning with cycle 2
* 5 patients in each arm will be required to undergo a mandatory tumor biopsy from the primary pancreatic site or metastatic site, if safe and feasible, prior to cycle 1 * After Cycle 3 of treatment, all patients who had a baseline biopsy will be required to undergo a mandatory biopsy of the same site if safe and feasible.
Washington University School of Medicine
St Louis, Missouri, United States
Tolerability between two different dose levels of paricalcitol added to the combo regimen of liposomal irinotecan plus 5-FU / LV as measured by the occurrence of grade 3 and 4 toxicities
-Toxicity will be graded using CTCAE version 5.0
Time frame: Through 30 days after completion of paricalcitol treatment (estimated to be 28 weeks)
Overall response rate (ORR)
* The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started). * Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm and disappearance of all non-target lesions and normalization of tumor marker level. * Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
Time frame: Through completion of treatment (estimated to be 20 weeks)
Progression-free survival (PFS)
* PFS: PFS is defined as the duration of time from start of treatment to time of progression or death, whichever occurs first. * Progressive Disease (PD): At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progressions).
Time frame: Through completion of follow-up (estimated to be 72 weeks)
Overall survival (OS)
-Overall survival (OS) is defined as the date from treatment to death or last follow-up.
Time frame: Through completion of follow-up (estimated to be 72 weeks)
CA19-9 biochemical response rate
-The biochemical response (BR) is defined as more than 50% of decrease from baseline CA 19-9.
Time frame: Through beginning of cycle 10 (estimated to be 18 weeks)
Duration of overall response
\- The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).
Time frame: Through completion of treatment (estimated to be 20 weeks)
Duration of complete response
* The duration of overall CR is measured from the time measurement criteria are first met for CR until the first date that progressive disease is objectively documented. * Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm and disappearance of all non-target lesions and normalization of tumor marker level.
Time frame: Through completion of treatment (estimated to be 20 weeks)
Duration of stable disease
* Duration of stable disease is measured from the start of the treatment until the criteria for progression are met, taking as reference the smallest measurements recorded since the treatment started, including the baseline measurements. * Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Time frame: Through completion of treatment (estimated to be 20 weeks)
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