Paricalcitol Versus Pirfenidone for Improving Surgical Resectability in Patients With Peritoneal Cancer (RANDY 1A)
A Randomized Phase II Bayesian Pick-the-Winner Clinical Trial Investigating the Efficacy of Fibrosis-Modulating Agents (Paricalcitol and Pirfenidone) in Improving Surgical Resectability in Patients With Peritoneal Carcinomatosis Ineligible for Definitive Cytoreduction (Randy 1A)
The goal of this clinical trial is to learn if paricalcitol or pirfenidone can help make tumors removable by surgery in adults with peritoneal cancer who are currently unable to have their tumor removed.
The study aims to answer are whether paricalcitol or pirfenidone improve tumor response and tissue healing after 12 weeks of treatment, and which of these two drugs is more effective at helping participants become eligible for surgery. Researchers will compare paricalcitol to pirfenidone to see which drug works better and has a manageable safety profile.
Participants will take either paricalcitol or pirfenidone by mouth every day for 12 weeks while continuing their standard chemotherapy, visit the clinic regularly for checkups and lab tests, keep a daily diary to track their study medication, and undergo a surgical re-evaluation after treatment to see if their tumor can be removed.
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
Detailní popis
This is a single-center, randomized Phase II clinical trial designed to investigate the efficacy of repurposing fibrosis-modulating agents to improve surgical resectability in patients with peritoneal carcinomatosis. Peritoneal carcinomatosis is characterized by a challenging tumor microenvironment (TME) featuring extensive fibrosis and a high density of cancer-associated fibroblasts (CAFs). These elements create a dense desmoplastic barrier that impedes drug penetration, limits therapeutic efficacy, and frequently renders patients ineligible for definitive surgical cytoreduction.
To overcome these barriers, the trial evaluates two distinct anti-fibrotic agents: paricalcitol, a synthetic Vitamin D receptor agonist that promotes CAF quiescence and stromal remodeling, and pirfenidone, an oral anti-fibrotic agent that inhibits fibrosis by downregulating the TGF-β signaling pathway and collagen synthesis. Eligible participants are randomized in a 1:1 ratio to receive a 12-week course of either oral paricalcitol (2 mcg daily, titratable) or oral pirfenidone (titrated to 801 mg three times daily with food), administered concurrently with their ongoing standard systemic chemotherapy.
Typ studie
Typ studie
Zápis (Odhadovaný)
Zápis
Fáze
Fáze
- Fáze 2
Kontakty a umístění
Studijní kontakt
Studijní kontakt
- Jméno: Patrick Wagner, MD
- Telefonní číslo: 412-359-3731
- E-mail: patrick.wagner@ahn.org
Studijní záloha kontaktů
- Jméno: AHN Clinical Trial Contact
- Telefonní číslo: 412-359-3731
- E-mail: clinicaltrials@ahn.org
Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
Přijímá zdravé dobrovolníky
Pohlaví způsobilá ke studiu
Popis
Inclusion Criteria:
- Males or females, age 18 to <81 years at the time of consent
- Biopsy-proven peritoneal carcinomatosis
- Documented receipt of at least three months of standard systemic chemotherapy prior to initiation, with persistent disease
- ECOG Performance Status of 0 or 1
- Adequate organ function within 14 days prior to anti-fibrotic initiation
- Negative serum pregnancy test for women of childbearing potential (WOCBP) within 7 days prior to initiation
- Able to understand and provide written informed consent
- Willingness and ability to comply with all study procedures
Exclusion Criteria:
-
Patients deemed eligible for definitive cytoreductive surgery
- Current or recent (within 30 days) use of paricalcitol, pirfenidone, or Vitamin D supplementation above USDA-recommended daily dosage
- Known allergy or medical contraindication to study drugs
- Hypersensitivity to any of the study drugs or to any ingredient in the formulation
- Receipt of any investigational drug within 30 days prior to initiation
- Active pregnancy or lactation
- Active smoking
- Active brain metastases
- Elevated Vitamin D level (>2x upper limit of normal)
- Significant comorbidities including abnormal calcium/phosphate, history of serious drug-induced liver injury, severe cardiac conditions, patients with or predisposed to cardiac arrhythmias, or uncontrolled hypertension
- Concomitant medications that, after review by the study pharmacist(s) and potential dose modification in accordance with prescribing guidelines, still pose an unmanageable drug-drug interaction or unacceptable safety risk with either study drug
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Léčba
- Přidělení: Randomizované
- Intervenční model: Paralelní přiřazení
- Maskování: Žádné (otevřený štítek)
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
|---|---|
|
Experimentální: Paricalcitol Arm
Participants receive oral paricalcitol once daily for 12 weeks concurrently with standard systemic chemotherapy. |
Oral, 2 mcg once daily for 12 weeks |
|
Experimentální: Pirfenidone Arm
Participants receive oral pirfenidone three times daily for 12 weeks (with initial dose titration) concurrently with standard systemic chemotherapy. |
Oral, titrated up to 801 mg three times daily (total daily dose: 2403 mg/day) with food for 12 weeks. |
Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Paricalcitol Efficacy
Časové okno: 12 weeks from treatment initiation
|
Proportion of patients achieving a clinicopathologic response (CPR) |
12 weeks from treatment initiation
|
|
Pirfenidone Efficacy
Časové okno: 12 weeks from treatment initiation
|
Proportion of patients achieving a clinicopathologic response (CPR) |
12 weeks from treatment initiation
|
Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Severity of Treatment-Emergent Adverse Events for Paricalcitol [Safety]
Časové okno: 16 weeks from treatment initiation
|
Maximum severity grade of treatment-emergent adverse events per participant, assessed on a scale from Grade 1 (mild) to Grade 5 (death) according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Higher grades indicate a more severe outcome. |
16 weeks from treatment initiation
|
|
Severity of Treatment-Emergent Adverse Events for Pirfenidone [Safety]
Časové okno: 16 weeks from treatment initiation
|
Maximum severity grade of treatment-emergent adverse events per participant, assessed on a scale from Grade 1 (mild) to Grade 5 (death) according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Higher grades indicate a more severe outcome |
16 weeks from treatment initiation
|
|
Incidence of Treatment-Emergent Adverse Events for Paricalcitol [Safety
Časové okno: 16 weeks from treatment initiation
|
Number of participants experiencing one or more treatment-emergent adverse events, as graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. |
16 weeks from treatment initiation
|
|
Incidence of Treatment-Emergent Adverse Events for Pirfenidone [Safety]
Časové okno: 16 weeks from treatment initiation
|
Number of participants experiencing one or more treatment-emergent adverse events, as graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. |
16 weeks from treatment initiation
|
|
Patient-Reported Quality of Life Outcomes Using the Medical Outcomes Study 20-Item Short-Form Health Survey (SF-20) for Paricalcitol [Tolerability]
Časové okno: 12 weeks
|
Assessment of patient-reported quality of life outcomes using the SF-20 questionnaire. Each subscale ranges from a minimum score of 0 to a maximum score of 100, where higher scores indicate a better health-related quality of life outcome. |
12 weeks
|
|
Patient-Reported Quality of Life Outcomes Using the Medical Outcomes Study 20-Item Short-Form Health Survey (SF-20) for Pirfenidone [Tolerability]
Časové okno: 12 weeks
|
Assessment of patient-reported quality of life outcomes using the SF-20 questionnaire. Each subscale ranges from a minimum score of 0 to a maximum score of 100, where higher scores indicate a better health-related quality of life outcome. |
12 weeks
|
|
Treatment Adherence Evaluated via Study Drug Diaries for Paricalcitol [Feasibility]
Časové okno: 12 weeks
|
Percentage of total prescribed doses taken based on study drug diaries (number of doses taken divided by total expected doses over 12 weeks). |
12 weeks
|
|
Treatment Adherence Evaluated via Study Drug Diaries for Pirfenidone [Feasibility]
Časové okno: 12 weeks
|
Percentage of total prescribed doses taken based on study drug diaries (number of doses taken divided by total expected doses over 12 weeks). |
12 weeks
|
|
Molecular Biomarker Analysis of Treatment Response in Research Blood Samples for Paricalcitol [Efficacy]
Časové okno: 12 weeks
|
Evaluation of molecular correlates of treatment response using research blood samples collected at baseline and post-treatment. |
12 weeks
|
|
Molecular Biomarker Analysis of Treatment Response in Research Blood Samples for Pirfenidone [Efficacy]
Časové okno: 12 weeks
|
Evaluation of molecular correlates of treatment response using research blood samples collected at baseline and post-treatment. |
12 weeks
|
|
Molecular Biomarker Analysis of Treatment Response in Research Blood Samples for Paricalcitol [Efficacy]
Časové okno: 12 weeks
|
Evaluation of circulating biomarkers of treatment response using research blood samples collected at baseline and post-treatment. |
12 weeks
|
|
Molecular Biomarker Analysis of Treatment Response in Research Blood Samples for Pirfenidone [Efficacy]
Časové okno: 12 weeks
|
Evaluation of circulating biomarkers of treatment response using research blood samples collected at baseline and post-treatment. |
12 weeks
|
|
Biomarker Analysis of Treatment Response in Tissue Biopsy Samples for Pirfenidone [Efficacy]
Časové okno: 12 weeks
|
Quantitative assessment of treatment response using baseline and post-treatment archival tissue biopsy samples, measuring changes in Ki-67 positive tumor cells |
12 weeks
|
|
Biomarker Analysis of Treatment Response in Tissue Biopsy Samples for Paricalcitol [Efficacy]
Časové okno: 12 weeks
|
Quantitative assessment of treatment response using baseline and post-treatment archival tissue biopsy samples, measuring changes in Ki-67 positive tumor cells |
12 weeks
|
|
Biomarker Analysis of Treatment Response in Tissue Biopsy Samples for Paricalcitol [Efficacy]
Časové okno: 12 weeks from treatment initiation
|
Quantitative assessment of treatment response using baseline and post-treatment archival tissue biopsy samples, measuring changes in density of Fibroblast Activation Protein-positive (FAP+) |
12 weeks from treatment initiation
|
|
Biomarker Analysis of Treatment Response in Tissue Biopsy Samples for Pirfenidone [Efficacy]
Časové okno: 12 weeks from treatment initiation
|
Quantitative assessment of treatment response using baseline and post-treatment archival tissue biopsy samples, measuring changes in density of Fibroblast Activation Protein-positive (FAP+) |
12 weeks from treatment initiation
|
|
Biomarker Analysis of Treatment Response in Tissue Biopsy Samples for Paricalcitol [Efficacy]
Časové okno: 12 weeks from treatment initiation
|
Quantitative assessment of treatment response using baseline and post-treatment archival tissue biopsy samples measuring changes in collagen density (quantified via Sirius Red or Masson's Trichrome staining). |
12 weeks from treatment initiation
|
|
Biomarker Analysis of Treatment Response in Tissue Biopsy Samples for Pirfenidone [Efficacy]
Časové okno: 12 weeks from treatment initiation
|
Quantitative assessment of treatment response using baseline and post-treatment archival tissue biopsy samples measuring changes in collagen density (quantified via Sirius Red or Masson's Trichrome staining). |
12 weeks from treatment initiation
|
Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Vyšetřovatelé
Vyšetřovatelé
- Vrchní vyšetřovatel: Patrick Wagner, AHN Health Network
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Odhadovaný)
Začátek studia
Primární dokončení (Odhadovaný)
Primární dokončení
Dokončení studie (Odhadovaný)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
- Pirfenidon
- Nádorové mikroprostředí
- Cytoreduktivní chirurgie
- Peritoneální karcinomatóza
- Parikalcitol
- Peritoneální rakovina
- Peritoneální metastázy
- Fibroblasty spojené s rakovinou
- Intra-abdominal malignancies
- Advanced abdominal cancer with fibrosis
- Vitamin D analog
- Anti-fibrotic therapy
- Anti-fibrotic agents
- Repurposed drugs in oncology
- Surgical resectability
- Tumor cytoreduction
Další relevantní podmínky MeSH
Další identifikační čísla studie
Další identifikační čísla studie
- 2026-077
Plán pro data jednotlivých účastníků (IPD)
Plánujete sdílet data jednotlivých účastníků (IPD)?
Popis plánu IPD
Sharing of data or bio-specimens is not currently planned and will require a separate IRB application and a Material Transfer Agreement (MTA) or Data Use Agreement (DUA), as applicable, in the event that such plans arise in the future
Informace o lécích a zařízeních, studijní dokumenty
Studuje lékový produkt regulovaný americkým FDA
Studuje produkt zařízení regulovaný americkým úřadem FDA
produkt vyrobený a vyvážený z USA
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