MAZEPPA is open-label, phase II study to assess the efficacy of a genomic-driven maintenance therapy in terms of PFS in Pancreatic ductal adenocarcinoma (PDAC) patients with disease controlled after 4 months of mFOLFIRINOX chemotherapy as following: Patients with a BRCAness somatic profile: olaparib Arm A. Patients with no BRCAness profile and with KRAS mutation randomization between durvalumab plus selumetinib Arm B, versus FOLFIRI Arm C.
Searching for efficient maintenance therapies in metastatic PDAC patients whose disease has been controlled using an induction chemotherapy is crucial for two main reasons: 1. Patients may stop IV toxic chemotherapy while their tumor remains under control. Although up to 70% of PDAC patients achieve tumor control when treated during induction with mFOLFIRINOX, toxicity of this regimen, particularly neuropathy and fatigue, remains a key concern. 2. Tumor control may be extended, which might improve quality of life (QoL) and survival. Patients are included in MAZEPPA study based on the genetic profile of their tumor. * If a BRCA gene mutation is present in the tumor, treatment with the drug olaparib will be proposed (arm A), regardless of the status of the other genes analyzed. * In the absence of a mutation in the BRCA gene and in the presence of a mutation in the KRAS gene, a treatment combining immunotherapy and targeted therapy (durvalumab and selumetinib - Arm B) or chemotherapy by FOLFIRI (arm C) will be proposed.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
307
300 mg orally twice daily, for a total daily dose of 600mg Study treatment can be dose-reduced to : First step : 250 mg twice daily , for a total daily dose of 500 mg Second step: 200 mg twice daily taken twice daily, for a total daily dose of 400 mg No further dose reduction is allowed, and study treatment should be discontinued.
Durvalumab administered IV at a flat dose of 1500 mg on day 1 of every 28-day cycle, Selumetinib Starting Dose : 75 mg twice daily Study treatment can be dose-reduced to : Dose Level -1 : 75 mg once daily Dose Level -2 : 50 mg twice daily Dose Level -3 : 50 mg once daily
FOLFIRI every two weeks Irinotecan 180 mg/m2 Intravenous (IV) on day 1 Folinic acid 400 mg/m2 IV on day 1, 5-FU 400 mg/m2 IV bolus on day 1 and 2, and 46h IV infusion of 5-FU 2400 mg/m2
Institut Sainte Catherine
Avignon, France
ARM A - Progression free survival (PFS)
PFS rate at 4 months is defined by the number of patients alive at 4 months from inclusion without PD divided by the total number of patients evaluable at 4 months (dead during 4 months or alive at 4 months with a progressive status available).
Time frame: at 4 months
ARM B/ C - PFS
PFS is defined as time from randomization into arm B/C to the date of first documented PD RECIST 1.1 and/or iRECIST for arm B and PD RECIST1.1 for arm C or death.
Time frame: Assessed up to 36 months
Disease control rate (DCR)
DCR is the percentage of patients who achieve CR, PR, or SD to study treatment (according to RECIST 1.1).
Time frame: Measured at 16 weeks of maintenance therapy.
Overall response rate (ORR)
ORR is the number of patients with a best overall response of CR or PR divided by the number of all treated (at least 1 dose of study treatment) patients.
Time frame: Assessed up to 36 months
Overall survival (OS)
OS is the time between the date of inclusion into Arm A or Arms B/C and death
Time frame: Assessed up to 36 months
Number of participants with treatment-related adverse events
All grade and severe toxicities, according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v5.0
Time frame: Assessed up to 36 months
Time to HRQoL score definitive deterioration (TUDD)
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CHRU Jean Minjoz
Besançon, France
Polyclinique Bordeaux Nord Aquitaine
Bordeaux, France
Centre François Baclesse
Caen, France
Hôpital Beaujon
Clichy, France
GHPSO Site de Creil
Creil, France
Centre Georges François Leclerc
Dijon, France
CHU Dijon
Dijon, France
CHU Grenoble Alpes Hôpital Michallon
Grenoble, France
Hôpital Franco-Britannique
Levallois-Perret, France
...and 19 more locations
TUDD is defined as the time interval between inclusion into Arm A and randomization into Arms B/C and the first occurrence of a decrease in QLQ-C30 score for dimension ⩾5 points compared to baseline HRQoL score without any further improvement in QoL score ⩾5 points or any further available QoL data.
Time frame: At baseline, at every 2 months during treatment, and at the end of treatment visit. Assessed up to 36 months