This phase I/II study tests how well zimberelimab and quemliclustat work in combination with chemotherapy (mFOLFIRINOX) in treating patients pancreatic adenocarcinoma that may or may not be able to be removed by surgery (borderline resectable) or that has spread to nearby tissue or lymph nodes (locally advanced). Immunotherapy with monoclonal antibodies, such as zimberelimab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Quemliclustat acts as a blocker for adenosine. Adenosine is a chemical produced in the body that can lead to a decrease in the immune system's response towards cancer. Quemliclustat has the potential to decrease the amount of adenosine, allowing the immune system to recognize and act against the cancer. Chemotherapy drugs, such as oxaliplatin, irinotecan, leucovorin, and fluorouracil, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving chemotherapy in combination with zimberelimab and quemliclustat may kill more cancer cells than chemotherapy alone.
PRIMARY OBJECTIVES: I. To evaluate the safety, tolerability and resection rate (for borderline resectable pancreatic cancer \[BRPC\] cohort) or progression free survival (PFS) (for locally advanced pancreatic cancer \[LAPC\] cohort) in patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) treated with modified fluorouracil, irinotecan, leucovorin and oxaliplatin (mFOLFIRINOX), quemliclustat, and zimberelimab. II. To evaluate development of clinically relevant pancreatic fistula (for BRPC cohort) in the post-operative period after neoadjuvant treatment with mFOLFIRINOX, quemliclustat, and zimberelimab. SECONDARY OBJECTIVES: I. To estimate efficacy as measured by decreases in CA 19-9 and objective response rate (ORR) by imaging (unconfirmed complete and partial responses). II. To estimate the pathologic complete response rate (pCR) (for BRPC cohort) and overall survival (OS). EXPLORATORY OBJECTIVES: I. To evaluate the effects of zimberelimab, quemliclustat, and modified FOLFIRINOX (mFFX) on the tumor-stromal cells comparing pre-treatment core biopsies with operative specimens and on the effects on T cell infiltration, PD1 expression and the tumor microenvironment (TME). II. To investigate potential serum and tumor predictive biomarkers to predict response to experimental therapy. OUTLINE: Patients receive zimberelimab intravenously (IV), quemliclustat IV, oxaliplatin IV, leucovorin calcium IV, and inrinotecan IV on study. Patients undergo collection of blood samples and computed tomography (CT) throughout the trial. Patients with borderline-resectable pancreatic cancer undergo collection of tissue samples. Patients with locally advanced pancreatic cancer undergo core biopsy.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
56
Undergo collection of blood and tissue samples
Undergo a CT scan
Undergo core biopsy
Given IV
Given IV
Given IV
Given IV
Given IV
Given intravenously (IV)
Given IV
Yonemoto,Lisa
Los Angeles, California, United States
RECRUITINGIncidence of adverse events (BPRC Cohort)
All safety summaries and analyses will be based upon the Safety Population, as defined in this study protocol, will include all randomized participants who receive at least 1 dose of any study drug. Overall exposure to study drug, the numbers of participants completing each cycle, and the dose intensity will be summarized using descriptive statistics. The number of participants with any dose adjustment will be presented for entire treatment period as well as for each cycle. The number of participants with dose reductions, dose delays, or dose omissions will also be summarized, as will the reasons for dose adjustments. Adverse events (AEs) and serious adverse events (SAEs) will be reported using Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.0 terminology and severity.
Time frame: From baseline measurement to 90 days after the last dose of study treatment.
Resection rate (BPRC Cohort)
Simon's two-stage design will be used to demonstrate the resection rate is greater than 50%.
Time frame: Up to 2 years
Progression free survival (PFS) (LAPC Cohort)
Descriptive statistics with frequency and proportion will be used to summarize R0 resection rate and PFS. Kaplan-Meier methods will be used to analyze PFS and to generate 95% confidence interval (CI).
Time frame: Up to 2 years
Number of participants who develop clinically relevant pancreatic fistula (BPRC Cohort)
Time frame: Up to 2 years
Change in CA 19-9 levels
Time frame: Up to 30 days after last study drug administration
Objective response rate (ORR)
Descriptive statistics with frequency and proportion used to analyze. Assessed by imaging.
Time frame: Up to 2 years
Pathologic complete response rate (pCR) (BPRC Cohort)
Time frame: Up to 2 years
Overall survival (OS)
Descriptive statistics with frequency and proportion will be used to analyze.
Time frame: Up to 2 years
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