A multi-center, open-label phase I/II study to to determine the safety and tolerability of Azacitidine and/or Romidepsin in combination with nab-Paclitaxel/Gemcitabine in patients with advanced pancreatic ductal adenocarcinoma (PDAC) (Part 1), followed by sequential immune targeting with programmed death-ligand (PD-L)1 blockade in combination with low-dose Lenalidomide (Part 2) in patients with controlled disease after 3 cycles (Part 1).
The first part of the study will employ a standard 3 + 3 design to test safety and tolerability of histone deacetylase (HDAC) inhibition with Romidepsin (Arm A), DNA methyltransferase (DNMT) inhibition with Azacitidine (Arm B) or both agents (Arm C), in each arm in combination with nab-Paclitaxel/Gemcitabine (Part 1a). Study treatment is given until intolerable toxicity as defined in the protocol. Treatment will escalate until the recommended dose for RDE is identified. For the expansion part (Part 1b) of the study, one of the treatment arms (Arm C over B over A) will be continued using a Simon Two-stage design to a maximum of 35 patients. All patients from Part 1a and 1b will be treated for a total of three cycles and will then enter the second part of the study in case of disease control with still measurable disease (PR, SD). In the second part (Part 2) of the study (consolidation therapy), all patients from Part 1 (dose escalation and expansion cohorts from experimental arms and standard arm) who have not progressed after three cycles of nab-Paclitaxel/Gemcitabine with or without additional epigenetic treatment (= at least SD by RECIST 1.1 after 3 cycles) receive sequential immune targeting with PD-L1 blockade (standard fixed dose Durvalumab 1500 mg q4w iv) in combination with low-dose Lenalidomide (10 mg d1-21 q4w po) until documented disease progression.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
75
Powder and solvent for solution for infusion; Intravenous use
Powder for suspension for injection; Subcutaneous use
Powder for suspension for injection; Intravenous use
Powder for solution for infusion; Intravenous use
Concentrate for solution for infusion; Intravenous use
Hard capsule for oral use
Uniklinik Köln
Cologne, Germany
Universitätsklinikum Essen
Essen, Germany
Universitätsklinikum Frankfurt
Frankfurt, Germany
Universitätsmedizin Göttingen
Göttingen, Germany
Universitätsklinikum Hamburg-Eppendorf
Hamburg, Germany
Ludwig-Maximilians-Universität München
München, Germany
Klinikum Nürnberg
Nuremberg, Germany
Universitätsklinikum Ulm
Ulm, Germany
Universitätsklinikum Würzburg
Würzburg, Germany
Safety and tolerability of Azacitidine and/or Romidepsin in combination with nab-Paclitaxel/Gemcitabine
Dose limiting toxicities occurring during treatment cycle 1 of a respective dose level and regarded to be related to the studied drug combination. Common terminology criteria for adverse events (CTCAE) 5.0 will be used to assess toxicities.
Time frame: at Days -7, -4, 1, 8, 15, 22 at cycle 1 (each cycle is 28 days)
Immune targeting with Durvalumab in combination with low-dose Lenalidomide
The efficacy and safety of this experimental (immune) consolidation therapy during this clinical trial will be monitored by imaging changes every 8 weeks.
Time frame: up to 13 cycles (each cycle is 28 days)
Immune targeting with Durvalumab in combination with low-dose Lenalidomide
The efficacy and safety of this experimental (immune) consolidation therapy during this clinical trial will be monitored closely by tumor marker changes on Day 1 of each cycle.
Time frame: up to 13 cycles (each cycle is 28 days)
Recommended dose for expansion (RDE)
Identification of the recommended dose for expansion of Azacitidine and/or Romidepsin in combination with nab-Paclitaxel/Gemcitabine.
Time frame: at the end of cycle 3 (each cycle is 28 days)
Overall response rate (ORR)
Part 1: ORR according to RECIST version 1.1 (complete response \[CR\] and partial response \[PR\]) after respective treatment) every 6 weeks Part 2: ORR according to immune related RECIST 1.1 (irRECIST1.1) (CR and PR) after/during treatment with Lenalidomide and Durvalumab every 8 weeks
Time frame: up to 16 months
Carbohydrate Antigen 19-9 (CA19-9) Response
Part 1: CA19-9 Response: CA19 -9 change after treatment compared to baseline level Part 2: 2nd CA19-9 Response: CA19 -9 change after treatment compared to last level determined in Part 1
Time frame: at Day 1 of each treatment cycle (each cycle is 28 days), up to 16 month
Disease-control rate (DCR)
Part 1: DCR at 3-month according to RECIST version 1.1 (CR and PR and stable disease \[SD\] after respective treatment Part 2: 2nd DCR at 3-month and 6-month according to irRECIST1.1 (CR and PR and stable disease \[SD\] after respective treatment)
Time frame: at the end of cycle 3 and 6 (each cycle is 28 days)
Overall survival (OS)
Time from Day 1 of the first cycle of chemotherapy to date of death from any cause. The rate of patients who are still alive after one year will be assessed.
Time frame: at Day 1 of cycle 1 (each cycle is 28 days) until death or up to 4 years
Progression free survival (PFS)
Time from Day 1 of the first cycle of chemotherapy to date of objective disease progression or to death of any cause.
Time frame: D1 of the first cycle (each cycle is 28 days), up to 16 month
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