Study of Lonsurf in Combination With Gemcitabine and Nab-Paclitaxel in Patients With Advanced (PDAC)

Phase I Study of Lonsurf in Combination With Gemcitabine and Nab-Paclitaxel in Patients With Advanced Pancreatic Ductal Adenocarcinoma (PDAC)

The purpose of this study is to determine the recommended phase 2 dose (RP2D) of the combination of lonsurf, gemcitabine and nab-paclitaxel in Pancreatic ductal adenocarcinoma (PDAC)

Study Overview

• Status: Terminated
• Conditions: Pancreatic Cancer; Pancreatic Ductal Adenocarcinoma
• Intervention / Treatment: Drug: Lonsurf; Drug: Gemcitabine; Drug: Nab-Paclitaxel

Detailed Description

This is a single-institution, prospective, phase I dose escalation trial of lonsurf combined with gemcitabine and nab-paclitaxel using the 3+3 design. This study will enroll 18 patients over 12-15 months.

Primary Objective To determine the recommended phase 2 dose (RP2D) of the combination of lonsurf, gemcitabine and nab-paclitaxel

Secondary Objectives

1. Examine safety and toxicity of the combination
2. Estimate response rate to the combination
3. Estimate median overall survival (mOS) of the treated population
4. Estimate median progression free survival (mPFS) of the treated population
5. Estimate disease control rate (DCR) at 8 weeks
6. Evaluate quality of life while receiving the combination therapy

• Study Type: Interventional
• Enrollment (Actual): 14
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • Indiana
    • Indianapolis, Indiana, United States, 46202
      • Indiana University Melvin & Bren Simon Cancer Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. ≥ 18 years old at the time of informed consent
2. Ability to provide written informed consent and HIPAA authorization
3. Untreated locally advanced Pancreatic Ductal Adenocarcinoma (PDAC) as defined by National Comprehensive Cancer Network (NCCN) guidelines or, untreated metastatic PDAC (prior adjuvant therapy is permitted if it's been greater than 6 months since completion)
4. Histologically or cytologically confirmed PDAC
5. Confirmed PDAC that is measurable or evaluable per RECIST 1.1
6. Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
7. Gastrointestinal symptoms (nausea, vomiting, and diarrhea) of Grade 1 or less

8. Adequate organ function as defined by:

   1. Aspartate transaminase (AST) and alanine transaminase (ALT) levels ≤ 2.5 x upper limits of normal (ULN)
   2. Total bilirubin level ≤ 1.5 x ULN
   3. Creatinine level < 1.0 x ULN or creatinine clearance > 60 mL/min/1.73 m2 for patients with creatinine levels above or below the institutional normal (as determined by Cockcroft-Gault equation). For patients with a Body Mass Index (BMI) > 30 kg/m2, lean body weight should be used to calculate the glomerular filtration rate (GFR).
   4. Hemoglobin (Hgb) ≥ 9 g/dl
   5. Absolute neutrophil count (ANC) ≥ 1.5 x 109/L
   6. Platelets ≥ 100 x 109/L
   7. Acceptable coagulation studies as demonstrated by prothrombin time (PT) within normal limits (+/-15%) unless they are on anticoagulation therapy
9. Life expectancy estimated at ≥ 3 months

10. Women of childbearing potential definition (WOCBP) must have a negative serum or urine pregnancy test performed within 14 days prior to initiation of study treatment.

    Any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) is classified as WOCBP if she meets the following criteria:

    1. Has not undergone a hysterectomy or bilateral oophorectomy; or
    2. Has not been naturally postmenopausal for at least 24 consecutive months (i.e. has had menses at any time in the preceding 12 consecutive months).
11. WOCBP and men must agree to use adequate contraception prior, to study entry, for the duration of study participation, and 8 weeks after the end of treatment.

Exclusion Criteria:

1. Neuropathy > Grade 1 at baseline
2. Prior systemic chemotherapy for any other malignancy (aside from adjuvant therapy for PDAC) in the last 3 years
3. Active malignancy other than PDAC (other than adequately treated cervical or vulvar carcinoma in situ, treated basal cell or squamous carcinoma of the skin, superficial bladder tumors (Ta, Tis & T1), ductal carcinoma in situ (DCIS) of the breast and low grade prostate cancer. Any cancer curatively treated >3 years prior to entry with no clinical evidence of recurrence is permitted)
4. Prior exposure to nab-paclitaxel, paclitaxel, or other taxanes
5. History of bowel obstruction in the preceding 3 months of therapy, including gastric outlet obstruction related to PDAC
6. Large, uncontrolled ascites requiring paracentesis
7. Major surgery, other than diagnostic or laparoscopic surgery, within 4 weeks prior to first dose. (Port placement would not be considered a surgery.)
8. Any known untreated brain metastases including leptomeningeal metastases
9. Pregnant or breastfeeding
10. Significant gastrointestinal disorder(s) that would, in the opinion of the Principal Investigator, prevent absorption of an orally available agent (e.g., Crohn's disease, ulcerative colitis, extensive gastric resection, and small intestinal resection)
11. Uncontrolled chronic diarrhea > Grade 1 at baseline.
12. Uncontrolled intercurrent illness including, but not limited to uncontrolled active infection, clinically significant non-healing or healing wounds, symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac arrhythmia, significant pulmonary disease, uncontrolled infection, or psychiatric illness/social situations that would limit compliance with study requirements.
13. Interstitial pneumonia or extensive and symptomatic interstitial fibrosis of the lung
14. History of posterior reversible encephalopathy syndrome
15. Enrollment on any additional investigational agent study
16. Known hypersensitivity to gemcitabine or taxanes
17. Significant cardiac disease including the following: unstable angina, New York Heart Association class III-IV congestive heart failure, myocardial infarction < 6 months prior to study enrollment
18. History of hemolytic-uremic syndrome
19. Known infection with Human Immunodeficiency Virus (HIV) and/or active infection with hepatitis B or hepatitis C

Study Plan

How is the study designed?

Design Details

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

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Combination of lonsurf + gemcitabine + nab-paclitaxel

Drug: Lonsurf; Lonsurf will be administered orally twice a day on days 2-6 and 16-20 of every 28-day cycle at a dose of 25 mg/m2, 20 mg/m2 or 30 mg/m2 depending on cohort assignment.; Drug: Gemcitabine; Gemcitabine will be intravenously administered on Days 1 and 15 of every 28-day cycle at a dose of 800 mg/m2, 600 mg/m2 or 1000 mg/m2 depending on cohort assignment.; Drug: Nab-Paclitaxel; Nab-Paclitaxel will be intravenously administered on Days 1 and 15 of every 28-day cycle at a dose of 100 mg/m2, 75 mg/m2 or 125 mg/m2 depending on cohort assignment.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of Dose Limiting Toxicities (DLTs)	Number of DLTs observed	28 days (Cycle 1)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of adverse events in the safety evaluable population	safety and toxicity data will be assessed using NCI CTCAE v5.0	from start of treatment until 30 days after treatment discontinuation (i.e up to 2 years)
Response rate to the combination of lonsurf, gemcitabine, and nab-paclitaxel in the efficacy evaluable population	Using RECIST 1.1	from start of treatment until treatment discontinuation (i.e. up to 2 years)
Median Overall Survival (mOS) of the treated population		from start of treatment until death or last known follow up (i.e up to 2 years)
Median Progression-free Survival (mPFS) of the treated population		from start of treatment until disease progression or last follow up (i.e. up to 2 years)
Disease control rate (DCR)	Disease control rate (DCR) as defined by (complete response + partial response + stable disease)	8 weeks
European Organization for Research and Treatment of Cancer quality of life questionnaire	Scale scores were calculated by averaging items within scales and transforming average scores linearly. All of the scales range in score from 0 to 100. A high score for a functional scale represents a high/healthy level of functioning whereas a high score for a symptom scale or item represents a high level of symptomatology or problems.	Day 1 of each cycle(each cycle is 28 days),from start of treatment until disease progression or discontinuation of treatment (i.e. up to 2 years)

Collaborators and Investigators

• Sponsor: Patrick Joseph Loehrer Sr.
• Collaborators: Indiana University; Taiho Oncology, Inc.
• Investigators: Principal Investigator: Patrick J Loehrer, MD, Indiana University

Study record dates

Study Major Dates

• Study Start (Actual): September 11, 2019
• Primary Completion (Actual): May 10, 2021
• Study Completion (Actual): October 4, 2023

Study Registration Dates

• First Submitted: August 1, 2019
• First Submitted That Met QC Criteria: August 2, 2019
• First Posted (Actual): August 6, 2019

Study Record Updates

• Last Update Posted (Actual): January 5, 2024
• Last Update Submitted That Met QC Criteria: January 2, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Keywords: Pancreatic Cancer; Pancreatic Ductal Adenocarcinoma; Locally Advanced Pancreatic Cancer; Metastatic Pancreatic Cancer
• 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; Molecular Mechanisms of Pharmacological Action; Antimetabolites, Antineoplastic; Antimetabolites; Antineoplastic Agents; Tubulin Modulators; Antimitotic Agents; Mitosis Modulators; Antineoplastic Agents, Phytogenic; Paclitaxel; Gemcitabine
• Other Study ID Numbers: IUSCC-0664

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No