Monoclonal Antibody RAV12 and Gemcitabine in Treating Patients With Metastatic Pancreatic Cancer

A Phase 2 Evaluation of the Monoclonal Antibody, RAV12, in Combination With Standard Gemcitabine in the Treatment of Patients With Metastatic Pancreatic Cancer Who Have Not Been Previously Treated for Metastatic Disease

RATIONALE: Monoclonal antibodies, such as RAV12, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Drugs used in chemotherapy, such as gemcitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving RAV12 together with gemcitabine may kill more tumor cells.

PURPOSE: This phase II trial is studying the side effects and best dose of monoclonal antibody RAV12 when given together with gemcitabine in treating patients with metastatic pancreatic cancer.

Study Overview

• Status: Terminated
• Conditions: Pancreatic Cancer
• Intervention / Treatment: Biological: RAV12; Drug: Gemcitabine

Detailed Description

OBJECTIVES:

• To determine the maximum tolerated dose of monoclonal antibody RAV12 when administered with standard gemcitabine hydrochloride in patients with previously untreated metastatic pancreatic cancer.
• To determine the proportion of these patients surviving at 8 months after initiation of this regimen.
• To provide point estimates for response rate and duration of response in patients treated with this regimen.
• To define the toxicity profile of this drug in these patients when administered with standard gemcitabine hydrochloride.
• To estimate, preliminarily, the progression-free survival and overall survival of these patients after treatment with this regimen.
• To explore the utility of the tumor marker, carbohydrate antigen 19-9 (CA19-9), in the assessment of these patients.

OUTLINE: This is a dose-escalation study of monoclonal antibody RAV12, followed by an efficacy study. The study is conducted in two segments.

• Segment 1 (dose escalation of RAV12): Patients receive gemcitabine hydrochloride IV over 30 minutes on days 1, 8, 15, and 22 of course 1 and on days 1, 8, and 15 of each subsequent course. Patients also receive RAV12 IV once weekly on days 1, 8, and 15 or twice weekly on days 1, 4 or 5, 8, 11 or 12, 15, and 18 or 19 until the maximum tolerated dose (MTD) is reached. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
• Segment 2 (efficacy): Once the MTD has been determined, patients receive RAV12 at the MTD and gemcitabine hydrochloride as in segment 1. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.

Blood samples are obtained for pharmacokinetic sampling during the dose-escalation segment of the study. Samples are analyzed to determine plasma concentrations of RAV12, gemcitabine hydrochloride, and difluorodeoxyuridine. Blood samples are also examined periodically for expression of serum biomarkers (i.e., CA19-9, RAAG12, and HACA) and for DNA analysis of Fc-gamma receptor polymorphisms. Archival paraffin blocks or slides from biopsy of primary or metastatic deposit or fresh/frozen tissue may be obtained at baseline for additional correlative studies. Samples are analyzed by immunohistochemistry (IHC) for expression of RAAG12 and for development of a companion RAAG12 diagnostic assay.

After completion of study therapy, patients are followed every 8 weeks for up to 3 years.

PROJECTED ACCRUAL: This study will accrue a total of 18 patients in the dose-escalation segment and 63 patients in the efficacy segment of the trial.

• Study Type: Interventional
• Enrollment (Actual): 2
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • California
    • South San Francisco, California, United States, 94080
      • MacroGenics, Incorporated
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19111-2497
      • Fox Chase Cancer Center - Philadelphia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed adenocarcinoma of the pancreas

  • Metastatic disease

    • No prior therapy for metastatic disease (except prior adjuvant chemotherapy and/or radiotherapy)
• At least 1 radiographically measurable site of disease ≥ 2 cm in the largest dimension by traditional CT technique or ≥ 1 cm by spiral CT scan (per RECIST)
• No known history of current or prior central nervous system (CNS) metastatic disease

PATIENT CHARACTERISTICS:

• Eastern Cooperative Oncology Group performance status 0-2
• Absolute neutrophil count ≥ 1,500/mm³
• Platelet count ≥ 100,000/mm³
• Hemoglobin ≥ 9.0 g/dL
• alanine aminotransferase and aspartate aminotransferase ≤ 2.5 times upper limit of normal (ULN)
• Alkaline phosphatase and γ-glutamyltransferase ≤ 2.5 times ULN
• Amylase and lipase ≤ 1.5 times ULN
• Total bilirubin ≤ 1.5 times ULN
• Creatinine < 1.5 mg/dL
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• Must be available for study-related treatments and assessments at the treating institution
• No known hypersensitivity to any component of gemcitabine hydrochloride
• No known hypersensitivity to murine or recombinant proteins, polysorbate 80, or any excipient contained in the drug formulation
• No other primary malignancy that has been in remission for ≤ 3 years except treated nonmelanoma skin cancer, biopsy-confirmed carcinoma in situ of the cervix, squamous intraepithelial lesion on Papanicolaou smear, localized prostate cancer with Gleason score < 6, or resected melanoma in situ
• No other primary malignancy that has a generally accepted recurrence risk ≥ 10%
• No active viral, bacterial, or systemic fungal infection requiring parenteral treatment within 4 weeks of enrollment
• No history of chronic or recurrent infections that require continuous use of antiviral, antifungal, or antibacterial agents
• No serious underlying medical condition that would impair the patient's ability to receive or tolerate the planned treatment at the investigational site, including significant pulmonary compromise or heart disease of New York Heart Association class III or IV
• No dementia or altered mental status that would preclude sufficient understanding to provide informed consent

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• More than 4 weeks since prior major surgery
• More than 4 weeks since prior and no other concurrent investigational agents
• More than 1 week since prior oral antiviral, antifungal, or antibacterial therapy
• No concurrent immunosuppressive medications, steroids (except steroid inhaler, ophthalmic solution, nasal spray, or a stable dose of ≤ 10 mg/day of oral prednisone or equivalent), other antineoplastic therapy, or antitumor vaccinations
• Monoclonal antibody treatment for non-cancer indications must be completed at least 3 half lives from study entry
• No concurrent prophylactic hematologic growth factors
• No concurrent megavitamin therapy
• No concurrent bisphosphonates

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: RAV12 plus gemcitabine	Biological: RAV12; RAV12 at 0.375 mg/kg weekly escalated to 0.75 mg/kg weekly, intravenously.; Drug: Gemcitabine; 1000 mg/m2 weekly, intravenously; Other Names: Gemzar

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Number of Patients Alive at 8 Months	8 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Partial Response and Complete Response Rates	Based on Response Evaluation Criteria in Solid Tumors (RECIST) criteria 1.0; partial response = 30% decrease in sum of longest diameter. complete response = 100% decrease in sum of longest diameter. Rate of response = proportion of complete or partial responses based on number of patients evaluated.	8 months
Cmax	RAV12 and gemcitabine cmax	29 days
Number of Patients Alive at 12 Months		12 months
Median Progression-free Survival	Time from the first dose date to the date of first documented progression or death from any cause, whichever occurs first.	up to 11 months
Median Overall Survival	Time from the first dose date to the date of death from any cause	up to 11 months
Participants With Adverse Events	Frequency of adverse events and serious adverse events	Throughout the study, up to 11 months

Collaborators and Investigators

• Sponsor: MacroGenics
• Investigators: Study Chair: Stanford Stewart, MD, MacroGenics, Incorporated

Study record dates

Study Major Dates

• Study Start: April 15, 2008
• Primary Completion (Actual): January 21, 2009
• Study Completion (Actual): March 18, 2009

Study Registration Dates

• First Submitted: February 26, 2008
• First Submitted That Met QC Criteria: February 26, 2008
• First Posted (Estimated): February 28, 2008

Study Record Updates

• Last Update Posted (Estimated): November 3, 2023
• Last Update Submitted That Met QC Criteria: October 11, 2023
• Last Verified: October 1, 2023

More Information

Terms related to this study

• Keywords: recurrent pancreatic cancer; adenocarcinoma of the pancreas; stage IV pancreatic cancer
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Endocrine System Diseases; Digestive System Neoplasms; Endocrine Gland Neoplasms; Pancreatic Diseases; Pancreatic Neoplasms; Molecular Mechanisms of Pharmacological Action; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Gemcitabine
• Other Study ID Numbers: CDR0000587562; RAVENBIO-RV12-2007-003 (Other Identifier: MacroGenics, Inc.)