A Phase I Dual Dose Escalation Study of Radiation and Nab-Paclitaxel in Patients With Unresectable and Borderline Resectable Pancreatic Cancer
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | July 2014 |
| Contact: | Edgar Ben-Josef, MD |
| Email: | PennCancerTrials@emergingmed.com |
| Phone: | 855-216-0098 |
The investigators hypothesize that intensification of local therapy will lead to
improvements in local control and survival in patients with unresectable and borderline
resectable pancreatic cancer. The investigators propose to do this by combining
nab-paclitaxel concurrently with dose-escalated radiation therapy. In the first part of this
phase I study (sub-trial 1), the nab-paclitaxel dose will be escalated while the radiation
dose is held constant at a standardly accepted level. The use of this novel
chemoradiotherapy regimen will take advantage of nab-paclitaxels specific anti-tumor and
anti-stromal properties, which may enhance the efficacy of radiation therapy, and thereby
improve local control. After the MTD of nab-paclitaxel had been determined, in the second
part of this study (sub-trial 2), the investigators will administer nab-paclitaxel at the
determined MTD concurrently with escalated doses of radiation. The investigators will
utilize a combination of protons and IMRT to safely deliver high doses of radiation while
maximally sparing surrounding normal tissue. Patients will also preferentially have 2-3
fiducial markers placed in or around the tumor for daily localization and will be treated at
breath hold in order to prevent tumor movement with normal respiration. Such a technique
will help minimize target volumes and thereby avoid critical normal structures. The
investigators will use gemcitabine and nab-paclitaxel before and after chemoradiotherapy
given its promising results in metastatic pancreatic cancer patients. Correlative tissue and
serum biomarkers are an important, but optional, part of this study.
improvements in local control and survival in patients with unresectable and borderline
resectable pancreatic cancer. The investigators propose to do this by combining
nab-paclitaxel concurrently with dose-escalated radiation therapy. In the first part of this
phase I study (sub-trial 1), the nab-paclitaxel dose will be escalated while the radiation
dose is held constant at a standardly accepted level. The use of this novel
chemoradiotherapy regimen will take advantage of nab-paclitaxels specific anti-tumor and
anti-stromal properties, which may enhance the efficacy of radiation therapy, and thereby
improve local control. After the MTD of nab-paclitaxel had been determined, in the second
part of this study (sub-trial 2), the investigators will administer nab-paclitaxel at the
determined MTD concurrently with escalated doses of radiation. The investigators will
utilize a combination of protons and IMRT to safely deliver high doses of radiation while
maximally sparing surrounding normal tissue. Patients will also preferentially have 2-3
fiducial markers placed in or around the tumor for daily localization and will be treated at
breath hold in order to prevent tumor movement with normal respiration. Such a technique
will help minimize target volumes and thereby avoid critical normal structures. The
investigators will use gemcitabine and nab-paclitaxel before and after chemoradiotherapy
given its promising results in metastatic pancreatic cancer patients. Correlative tissue and
serum biomarkers are an important, but optional, part of this study.
Inclusion Criteria:
- Pathologically confirmed adenocarcinoma of the pancreas.
- Unresectable disease or borderline resectable disease assessed by a multidisciplinary
panel of pancreas surgeon, medical and radiation oncologist, and a radiologist.
Criteria defining unresectable and borderline resectable patients will be based on
the NCCN Guidelines (v 1.2014):
Unresectable
- Greater than 180 degrees of SMA encasement
- Any celiac abutment
- Unreconstructible SMV/portal occlusion
- Aortic invasion or encasement
- Nodal metastases beyond the field of resection Borderline resectable
- Venous involvement of the SMV/portal vein demonstrating tumor abutment with
impingement and narrowing of the lumen
- Encasement of the SMV/portal vein but without encasement of the nearby arteries
- Short-segment venous occlusion resulting from either tumor thrombus or encasement
with suitable proximal and distal vessel for reconstruction/grafting.
- Gastroduodenal artery encasement up to the hepatic artery with either short segment
encasement or direct abutment of the hepatic artery, without extension to celiac axis
- Tumor abutment to SMA but not to exceed greater than 180 degrees of circumferential
vessel wall
- Age > 18 years.
- ECOG performance status of < 1.
- Adequate organ function defined as follows: absolute neutrophil count of ≥ 1500/mm3,
platelets ≥ 100,000/mm3, serum creatinine ≤ 2 mg/dl, total bilirubin ≤ 3, (with
relief of biliary obstruction if present (PTC tube or endobiliary stent) and AST < 5
times the upper limit of normal.
- Patients of reproductive potential must agree to use an effective contraceptive
method during participation in this trial and for 6 months after the trial.
- Patients must be able to provide written informed consent.
Exclusion Criteria:
- Distant metastatic disease.
- Prior history of abdominal radiation therapy.
- Prior systemic therapy for pancreatic cancer.
- Prior or simultaneous malignancy within the past 2 years (other than cutaneous
squamous or basal cell carcinoma, melanoma in situ, thyroid carcinoma, or low-risk
prostate cancer). In-situ carcinoma is allowed.
- Serious uncontrolled concomitant systemic disorders or psychiatric condition that
would interfere with the safe delivery of protocol therapy.
- Treatment with an investigational anti-cancer agent within 4 weeks prior to
enrollment into the study.
- Pregnant women, women planning to become pregnant and women that are nursing.
- Patients who are unable to perform the breath hold scan for planning purposes
We found this trial at
1
site
3400 Civic Center Blvd
Philadelphia, Pennsylvania 19104
Philadelphia, Pennsylvania 19104
(215) 662-6065
Principal Investigator: Edgar Ben-Josef, MD
Phone: 215-615-5645
Abramson Cancer Center of the University of Pennsylvania The Abramson Cancer Center of the University...
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