Ultrasound-Guided Photodynamic Therapy With Photofrin & Gemcitabine for Patients With Locally Advanced Pancreatic Cancer

Open-label, Single-center, Non-randomized, Phase I, Dose-ranging Study of Endoscopic Ultrasound (EUS) Guided Photodynamic Therapy (PDT) With Photofrin® in Locally Advanced Pancreatic Cancer

This phase I trial studies the side effects and best dose of ultrasound-guided photodynamic therapy with porfimer sodium when given together with gemcitabine hydrochloride in treating patients with locally advanced pancreatic cancer. Photodynamic therapy uses a drug, porfimer sodium, that becomes active when it is exposed to a certain kind of light. When the drug is active, cancer cells are killed. Drugs used in chemotherapy, such as gemcitabine hydrochloride, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving photodynamic therapy together with gemcitabine hydrochloride may be effect in patients with pancreatic cancer.

Study Overview

• Status: Completed
• Conditions: Acinar Cell Adenocarcinoma of the Pancreas; Duct Cell Adenocarcinoma of the Pancreas; Stage III Pancreatic Cancer
• Intervention / Treatment: Drug: gemcitabine hydrochloride; Drug: porfimer sodium; Procedure: endoscopic ultrasonography; Procedure: photodynamic therapy

Detailed Description

PRIMARY OBJECTIVES:

I. To determine the safety of increasing porfimer sodium (PHO) dose and total energy by endoscopic ultrasound (EUS)-guided photodynamic therapy (PDT) for locally advanced unresectable pancreatic cancer (PC) in humans.

SECONDARY OBJECTIVES:

I. Quantify computed tomography (CT) detected volume of tumor necrosis produced by EUS-PDT.

II. Quantify rates of tumor size stabilization or decrease by EUS PDT and determine objective response rate per Response Evaluation Criteria in Solid Tumors (RECIST) criteria.

III. Determine surgical downstaging off of abdominal vessels and resectability. IV. Determine changes in serum cancer antigen (CA) 19-9 levels with treatment. V. Evaluate progression-free and overall survival.

OUTLINE: This is a dose-escalation study of EUS-PDT with porfimer sodium.

Patients receive porfimer sodium intravenously (IV) on day 1 and undergo EUS-PDT on days 1, 3, 8, and 21. After completion of EUS-PDT, patients receive gemcitabine hydrochloride IV over 30 minutes on days 1, 8, and 15 of courses 1 and 2 and on day 22 of courses 3 and 5. During courses 1-5, treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. After course 5, treatment with gemcitabine hydrochloride repeats every 2 months in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up periodically.

• Study Type: Interventional
• Enrollment (Anticipated): 12
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Indiana
    • Indianapolis, Indiana, United States, 46202
      • Iu Simon Cancer Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Unresectable, locally advanced measurable (at least bidirectional) adenocarcinoma of the pancreas (regardless of site) proven by biopsy or cytology and confirmed by surgical consultation
• Informed consent and authorization for the release of health information signed by the patient
• Karnofsky performance status >= 70%
• Life expectancy >= 3 months
• Females of childbearing potential and males must use an effective method of contraception

Exclusion Criteria:

• Metastatic (stage IV) disease (including involvement of the colon, adrenals, or kidney, or radiographic evidence of peritoneal seeding or pulmonary metastases)
• Previous chemotherapy, radiotherapy of other treatment for PC
• Gastric or duodenal wall invasion by the primary PC as assessed by CT or MRI and EUS staging
• Gastric or duodenal ulcer (at least 10 mm in size) within 10 mm of expected endoscopy puncture site(s) for PDT
• Esophageal or gastric varices
• Cystic component >= 25% the total volume of the tumor
• Ascites detected by CT, ultrasound (US) or MRI; (trace ascites will not be an exclusion)
• Bulky celiac adenopathy (i.e., >= 2.5 cm in diameter)
• Diagnosis of islet cell tumor, lymphoma, metastatic lesion, acinar cell (or other atypical pathologic malignancy)
• History of other malignancy in the past 2 years except carcinoma in situ of the cervix or bladder, non-melanomatous skin cancer or localized/early stage prostate cancer
• Unable to receive or previously intolerant of moderate and/or deep sedation
• Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) >= 3 x upper limit of normal (ULN)
• Total bilirubin >= 3 x ULN
• Alkaline phosphatase >= 3 x ULN
• International normalized ratio (INR) >= 1.5
• Partial thromboplastin time (PTT) ratio >= 1.5
• Serum creatinine >= 2.0 mg/dL
• Hematocrit =< 28% or hemoglobin =< 9 g/dL, but may have red blood cell (RBC) transfusion
• Platelet count =< 100,000/microliter (uL)
• Absolute neutrophil count (ANC) =< 1500/uL
• Clinically significant pancreatitis within 12 weeks of treatment with protocol therapy
• Contraindication to EUS-guided needle puncture into the pancreas
• History of coagulopathy or known thrombophilias
• Use of anticoagulants that cannot be discontinued both 5 days before and 5 days after EUS
• Clinical evidence of active infection of any type, including hepatitis B or C virus
• Pregnant or lactating women
• Experimental medications within the last 4 weeks prior to day 1
• Any surgery (including diagnostic laparoscopy and/or biliary +/- duodenal palliative bypass for inoperable PC) within the 2 weeks prior to day 1 of study protocol
• Chronic systemic corticosteroid use at superphysiologic doses (>= 10 mg prednisone per day or equivalent)
• Inability to avoid exposure of skin or eyes to direct sunlight or bright indoor light for at least 30 days
• Porphyria
• Inability to obtain venous access in the antecubital region to administer PHO or sedation for endoscopy procedures
• Significant concurrent medical or psychiatric illness which, in the opinion of the principal investigator would interfere with trial participation

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: porfimer sodium, EUS-PDT, gemcitabine; Patients receive porfimer sodium IV over 3-5 minutes on day 1 and undergo endoscopic ultrasonography-photodynamic therapy (EUS-PDT) on days 1, 3, 8, and 21. After completion of EUS-PDT, patients receive gemcitabine hydrochloride IV over 30 minutes on days 1, 8, and 15 of courses 1 and 2 and on day 22 of courses 3 and 5. During courses 1-5, treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. After course 5, treatment with gemcitabine hydrochloride repeats every 2 months in the absence of disease progression or unacceptable toxicity.

Drug: gemcitabine hydrochloride; Given IV; Other Names: Gemzar; gemcitabine; LY-188011; Drug: porfimer sodium; Given IV; Other Names: Photofrin; Photofrin II; Porfimer; Procedure: endoscopic ultrasonography; Undergo EUS-PDT; Other Names: EUS; endoscopic ultrasound; Procedure: photodynamic therapy; Undergo EUS-PDT; Other Names: PDT; therapy, photodynamic; Light Infusion Therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Evaluate the number of subjects with adverse events which occur when up to 3 sites within the pancreas are treated with PDT using a total dose of 50 or 100 J per site	Adverse events will be graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v4.0 which uses a scale of 1 (mild) to 5 (caused death).	Up to 4 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
CT- or MRI-detected volume of tumor necrosis	Will be compared using paired t-tests or Wilcoxon rank sum tests as appropriate and changes will be plotted by maximal total energy of treatment to explore for dose-response effects.	Week 2
Rates of tumor size stabilization or decease by EUS-PDT	Will be compared using paired t-tests or Wilcoxon rank sum tests as appropriate and changes will be plotted by maximal total energy of treatment to explore for dose-response effects.	Up to 4 years
Objective response rate per RECIST		Up to 4 years
Surgical downstaging off of abdominal vessels or change in tumor unresectability		Up to 4 years
Change in CA 19-9 levels	Will be compared using paired t-tests or Wilcoxon rank sum tests as appropriate and changes will be plotted by maximal total energy of treatment to explore for dose-response effects.	Baseline to up to 4 years
Progression-free survival	A Kaplan-Meier plot will be produced.	From the date of initial treatment to the earliest date of disease progression, resection of measurable tumor or death for patients who fail; and to the date of disease evaluation for patients who remain at risk for failure, assessed up to 4 years
Overall survival	A Kaplan-Meier plot will be produced.	From the day of first treatment to the earlier of death (from any cause) and the last date of patient contact, assessed up to 4 years

Collaborators and Investigators

• Sponsor: John DeWitt
• Collaborators: American Society for Gastrointestinal Endoscopy; Pinnacle Biologics Inc.

Publications and helpful links

General Publications

• DeWitt JM, Sandrasegaran K, O'Neil B, House MG, Zyromski NJ, Sehdev A, Perkins SM, Flynn J, McCranor L, Shahda S. Phase 1 study of EUS-guided photodynamic therapy for locally advanced pancreatic cancer. Gastrointest Endosc. 2019 Feb;89(2):390-398. doi: 10.1016/j.gie.2018.09.007. Epub 2018 Sep 14.

Study record dates

Study Major Dates

• Study Start (Actual): April 19, 2013
• Primary Completion (Actual): July 13, 2017
• Study Completion (Actual): October 28, 2018

Study Registration Dates

• First Submitted: January 15, 2013
• First Submitted That Met QC Criteria: January 15, 2013
• First Posted (Estimate): January 17, 2013

Study Record Updates

• Last Update Posted (Actual): December 13, 2018
• Last Update Submitted That Met QC Criteria: December 11, 2018
• Last Verified: December 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms by Histologic Type; Neoplasms; Neoplasms by Site; Carcinoma; Neoplasms, Glandular and Epithelial; Endocrine System Diseases; Digestive System Neoplasms; Endocrine Gland Neoplasms; Pancreatic Diseases; Adenocarcinoma; Pancreatic Neoplasms; Carcinoma, Acinar Cell; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Anti-Infective Agents; Antiviral Agents; Enzyme Inhibitors; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Immunosuppressive Agents; Immunologic Factors; Photosensitizing Agents; Dermatologic Agents; Gemcitabine; Dihematoporphyrin Ether; Trioxsalen; Hematoporphyrin Derivative
• Other Study ID Numbers: IUCRO-0319; 1207009096 (Other Identifier: Indiana University Institutional Review Board)