Patients with advanced pancreas adenocarcinoma will be randomized on a 6:1 basis to receive standard of care chemotherapy followed by adaptive stereotactic body radiotherapy (SBRT) with concurrent and adjuvant FAK inhibitor defactinib (experimental arm) or standard of care chemotherapy followed by SBRT (control arm). Patients enrolled to the experimental arm will be assessed for clinical outcomes such as progression free survival (PFS), local control, distant control, and toxicity. The initial 6 patients randomized to the experimental arm will be considered the safety lead-in and will be assessed for dose-limiting toxicities (DLTs). Following completion of the safety lead-in, additional patients will be accrued in order to reach a total of 36 patients on the experimental arm (inclusive of the safety lead-in cohort) and 6 on the control arm.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
42
* Will be administered using MRIdian and Ethos * 50 Gy in 5 fractions
-Oral drug 400 mg twice a day
-Baseline and 12-14 weeks after end of SBRT (or at time of surgery)
-Baseline, 6-8 weeks after the end of SBRT, and 12-14 weeks after the end of SBRT
Washington University School of Medicine
St Louis, Missouri, United States
Progression-free survival (PFS) (Experimental Arm only)
* PFS is defined as the duration of time from start of standard of care chemotherapy treatment to time of progression or death, whichever occurs first. The alive patients without progression will be censored at the last follow-up. * Progressive disease: 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: After completion of treatment (estimated to be 12 months)
Number of participants with acute adverse events (Experimental Arm only)
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 will be utilized for all toxicity reporting.
Time frame: From start of adaptive SBRT through 90 days
Number of participants with late adverse events (Experimental Arm only)
-The descriptions and grading scales found in the revised NCI Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 will be utilized for all toxicity reporting.
Time frame: From 91 days through 12 months post-SBRT, or through 90 days after the last dose of defactinib, whichever comes first (estimated to be 12 months and 5 days)
Overall survival (Experimental Arm only)
-Overall survival as defined as the time from the date of treatment until death; censored at last follow-up if death is not observed
Time frame: Through completion of follow-up (estimated to be 24 months)
Distant metastasis progression-free survival (DM-PFS) (Experimental Arm only)
-Defined as the days from the date of the treatment to distant metastasis progression or death
Time frame: Through completion of follow-up (estimated to be 24 months)
Objective response rate (Experimental Arm only)
-Objective response rate as determined by RECIST 1.1 criteria, with one change. Patients who undergo resection will be considered to have a CR if there is a pathologic complete response (pCR) on the surgical specimen. After resection, patients will no longer be evaluated for ORR.
Time frame: 12-14 weeks post-adaptive SBRT
Local control (Experimental Arm only)
-Local control as defined by no progression of the primary tumor by RECIST 1.1 criteria
Time frame: Through completion of follow-up (estimated to be 24 months)
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