PDAC Regression and Intraoperative Surgical Margin With Neoadjuvant TAMP (PRISM-TAMP) (PRISM-TAMP)

PDAC Regression and Intraoperative Surgical Margin With Neoadjuvant TAMP (PRISM-TAMP): A Phase Ib/II Open-Label Trial

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with poor survival outcomes, even when treated with modern chemotherapy and radiation. Patients with borderline resectable PDAC often receive neoadjuvant systemic therapy to improve the likelihood of successful surgical removal of the tumor, but rates of incomplete tumor regression and positive surgical margins remain high.

This Phase Ib/II, single-arm study evaluates the safety and feasibility of adding trans-arterial microperfusion (TAMP) delivery of gemcitabine to standard neoadjuvant therapy for patients with borderline resectable PDAC. In this study, patients receive standard systemic chemotherapy with modified FOLFIRINOX followed by stereotactic body radiation therapy (SBRT). After completion of chemoradiation, gemcitabine is delivered directly to the tumor through the arterial blood supply using the RenovoCath® catheter system. Gemcitabine is an FDA-approved chemotherapy drug for pancreatic cancer, and the study is evaluating a novel method of delivering the drug rather than a new medication.

The primary objective of the study is to assess the safety and tolerability of neoadjuvant TAMP-delivered gemcitabine in this treatment setting. Secondary objectives include evaluation of surgical margin status and pathologic tumor regression following surgical resection. Exploratory analyses will examine relapse-free survival. Results from this study will help determine whether this locoregional chemotherapy approach can be safely integrated into neoadjuvant treatment strategies for patients with borderline resectable PDAC.

Study Overview

• Status: Not yet recruiting
• Conditions: Pancreatic Neoplasms; Borderline Resectable Pancreatic Cancer; Pancreatic Ductal Adenocarcinoma (PDAC)
• Intervention / Treatment: Combination product: Gemcitabine Delivered by Transarterial Microperfusion

Detailed Description

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with low long-term survival rates despite advances in systemic chemotherapy, radiation therapy, and surgical techniques. Surgical resection offers the only potential for cure; however, many patients present with borderline resectable disease, where tumor involvement of adjacent vascular structures increases the risk of incomplete resection and positive surgical margins. Neoadjuvant treatment strategies are commonly used in this population to improve the likelihood of margin-negative (R0) resection, but local disease progression and incomplete tumor response remain significant challenges.

Trans-arterial microperfusion (TAMP) chemotherapy is a locoregional drug delivery platform designed to enhance intratumoral drug concentration while limiting systemic exposure. Using the RenovoCath® catheter system, chemotherapy is delivered directly into the arterial supply of the pancreas under controlled pressure conditions. Prior early-phase clinical studies of TAMP-delivered gemcitabine in patients with locally advanced PDAC have demonstrated feasibility and acceptable safety profiles, as well as evidence of improved local drug delivery compared with standard intravenous administration. However, the use of TAMP chemotherapy in the neoadjuvant setting for borderline resectable PDAC has not been well studied.

The PRISM-TAMP study is a Phase Ib/II, single-arm, open-label clinical trial designed to evaluate the safety and tolerability of incorporating TAMP-delivered gemcitabine into a modern neoadjuvant treatment regimen for patients with borderline resectable PDAC. In this study, patients receive standard systemic chemotherapy with modified FOLFIRINOX, followed by stereotactic body radiation therapy (SBRT), consistent with contemporary neoadjuvant management approaches. After completion of chemoradiation, patients undergo TAMP delivery of gemcitabine using the RenovoCath® catheter system. Gemcitabine is an FDA-approved chemotherapy agent for pancreatic cancer, and its use in this protocol is on-label; the investigational aspect of the study relates to the method of delivery rather than the drug itself.

Radiation therapy is included as a required component of the treatment sequence based on preclinical and early clinical data suggesting that radiation may favorably modify the tumor microenvironment and enhance retention of intra-arterially delivered gemcitabine. The intent of radiation in this study is not solely cytotoxic, but also to serve as a biological modulator that may improve the effectiveness of subsequent TAMP chemotherapy.

Following completion of neoadjuvant therapy, patients who remain appropriate surgical candidates proceed to operative resection per standard surgical practice. Pathologic assessment of the resected specimen is performed to evaluate tumor regression and margin status. Patients are followed postoperatively for safety outcomes and disease status.

The primary objective of the study is to assess the safety and tolerability of neoadjuvant TAMP-delivered gemcitabine when administered following systemic chemotherapy and SBRT in patients with borderline resectable PDAC. Secondary objectives include evaluation of intraoperative surgical margin status and pathologic tumor regression. Exploratory objectives include assessment of relapse-free survival. This study is intended to generate safety and feasibility data to inform future studies evaluating locoregional chemotherapy strategies in pancreatic cancer.

• Study Type: Interventional
• Enrollment (Estimated): 10
• Phase: Phase 2; Phase 1

Contacts and Locations

• Study Contact: Name: Conor O'Neill, MD; Phone Number: 1 (802) 656-2021; Email: conor.oneill@uvm.edu

Study Locations

• United States
  • Vermont
    • Burlington, Vermont, United States, 05401
      • University of Vermont Medical Center
      • Principal Investigator: conor O'Neill, MD
      • Contact: Randall Holcombe, MD, MBA; Phone Number: 1 (802) 656-2021; Email: randall.holcombe@med.uvm.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Histologically confirmed pancreatic ductal adenocarcinoma (PDAC).

• Borderline resectable disease as defined by the ABC classification criteria, incorporating one or more of the following:

  • Anatomy (A): Vascular involvement consistent with borderline resectable or resectable locally advanced-PDAC (e.g., abutment of the superior mesenteric vein or artery, portal vein, or celiac axis) as determined by cross-sectional imaging
  • Biology (B): Concern for extra-pancreatic metastasis or known N1 disease or suspicious but nonconfirmatory liver/lung lesion(s). CA19-9>500 after normalized bilirubin
  • Condition (C): Functional status and comorbidity profile adequate for curative-intent surgery, as assessed by the multidisciplinary team, specifically WHO PS >/=1.
• No prior treatment for PDAC (e.g., chemotherapy, radiation, or surgery).
• Age ≥ 18 years.
• ECOG performance status of 0 or 1.
• Ability to understand and the willingness to sign a written informed consent.

Exclusion Criteria:

• Locally Advanced PDAC or metastatic PDAC
• Histology other than adenocarcinoma
• Non-accessible arterial anatomy
• Gemcitabine hypersensitivity or contraindication to mFOLFIRINOX therapy based on provider assessment

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: Neoadjuvant TAMP Gemcitabine; Participants in this single-arm study receive neoadjuvant systemic chemotherapy with modified FOLFIRINOX followed by stereotactic body radiation therapy (SBRT), consistent with standard-of-care management for borderline resectable pancreatic ductal adenocarcinoma. After completion of chemoradiation, participants undergo trans-arterial microperfusion (TAMP) delivery of gemcitabine using the RenovoCath® catheter system. Following neoadjuvant therapy, participants who remain appropriate surgical candidates proceed to surgical resection per standard clinical practice.

Combination product: Gemcitabine Delivered by Transarterial Microperfusion; Gemcitabine is administered via transarterial microperfusion using an arterial infusion catheter system to deliver chemotherapy directly to the pancreatic tumor bed. Following completion of neoadjuvant systemic chemotherapy with modified FOLFIRINOX and stereotactic body radiation therapy, gemcitabine is infused intra-arterially at a dose of 1000 mg/m² under controlled pressure conditions. The intervention evaluates the safety and feasibility of this locoregional drug delivery approach in the neoadjuvant setting.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Safety and Tolerability of Neoadjuvant Transarterial Gemcitabine Delivery	Safety and tolerability will be assessed by the incidence, severity, and relationship of adverse events associated with transarterial microperfusion delivery of gemcitabine. Adverse events will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 5.0.	3 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Surgical Margin Status	Surgical margin status will be assessed on the resected surgical specimen following completion of neoadjuvant therapy. Margin status will be categorized based on pathologic evaluation as margin-negative (R0) or margin-positive (R1 or R2) according to standard institutional pathology criteria.	At the time of surgical resection
Pathologic Tumor Regression	Pathologic tumor regression will be assessed on the surgical resection specimen following completion of neoadjuvant therapy. Tumor response will be evaluated by a pathologist using a standardized tumor regression grading system to characterize the extent of residual viable tumor relative to treatment-related changes.	At the time of surgical resection
Pancreatic Duct Size	Intraoperative pancreatic duct size.	At the time of surgical resection
Maintenance of Chemotherapy Relative Dose Intensity	The proportion of participants who maintain a relative dose intensity of at least 80% during neoadjuvant modified FOLFIRINOX chemotherapy will be assessed based on delivered doses relative to planned doses over the chemotherapy treatment period.	From start of chemotherapy to surgery resection

Collaborators and Investigators

• Sponsor: University of Vermont

Study record dates

Study Major Dates

• Study Start (Estimated): December 1, 2026
• Primary Completion (Estimated): December 1, 2030
• Study Completion (Estimated): December 1, 2031

Study Registration Dates

• First Submitted: December 19, 2025
• First Submitted That Met QC Criteria: March 12, 2026
• First Posted (Actual): March 17, 2026

Study Record Updates

• Last Update Posted (Actual): March 17, 2026
• Last Update Submitted That Met QC Criteria: March 12, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Gemcitabine; Neoadjuvant Therapy; Intra-arterial Chemotherapy
• Additional Relevant MeSH Terms: Endocrine System Diseases; Neoplasms by Site; Neoplasms; Digestive System Neoplasms; Digestive System Diseases; Endocrine Gland Neoplasms; Pancreatic Diseases; Pancreatic Neoplasms
• Other Study ID Numbers: STUDY00004018/UVMCC2509

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Anonymized patient related data will be incorporated into publications and will be made available to other investigators at reasonable request.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No