A Prospective Study of Concurrent Hyperthermia, Chemotherapy and Radiotherapy in Borderline and Locally Advanced Pancreatic Cancer (PANHEAT) (PANHEAT)
A Prospective Study of Concurrent Hyperthermia Plus Standard of Care in Borderline and Locally Advanced Pancreatic Cancer (PANHEAT)
The project proposes a prospective multicenter study to evaluate the incorporation of deep regional hyperthermia into the standard of care neoadjuvant chemotherapy (mFOLFIRINOX/NABPACLITAXEL) followed by radiotherapy in borderline and locally advanced ductal adenocarcinoma pancreatic cancer. Although current treatments, based on induction chemotherapy followed by surgery or radiotherapy in selected patients, have improved survival and resection rates, overall survival remains poor.
Hyperthermia is a therapeutic intensification strategy with a solid biological basis. By controlling tumor heating (39-43°C), it enhances the efficacy of chemotherapy and radiation therapy by improving tumor oxygenation, increasing perfusion, and inhibiting DNA damage repair, without adding significant systemic toxicity. The available clinical evidence, although based mainly on retrospective and small studies, suggests that the combination of HRP with multimodal treatments improves local control, favors conversion to surgery, and may prolong survival while maintaining a favorable safety profile.
The protocol contemplates the initial administration of induction chemotherapy (preferably mFOLFIRINOX or, alternatively, gemcitabine with nab-paclitaxel)plus hyperthermia followed by multidisciplinary reevaluation. Patients who deemed resectable will undergo surgery and adjuvant chemoradiotherapy and hyperthermia. Patients without metastatic progression who remain unresectable will receive SBRT in five fractions along with sessions of deep regional hyperthermia. Subsequently, the possibility of surgery will be assessed again and a standardized follow-up will be carried out with clinical, radiological, biochemical and pathological evaluation when appropriate.
The main objective of the study is to determine the impact of this strategy on overall survival. Secondary objectives will be to evaluate progression-free survival, local control, conversion rate to surgery, proportion of R0 resections, tumor response, safety, tolerability, and feasibility of treatment. With this, the study aims to provide prospective evidence on the role of hyperthermia as a therapeutic intensification strategy in localized pancreatic cancer.
Panoramica dello studio
Stato
Stato
Condizioni
Condizioni
Intervento / Trattamento
Intervento / Trattamento
Tipo di studio
Tipo di studio
Iscrizione (Stimato)
Iscrizione
Fase
Fase
- Non applicabile
Contatti e Sedi
Contatto studio
Contatto studio
- Nome: Pedro C Lara, MD, PhD
- Numero di telefono: +34928012800
- Email: plara@ufpcanarias.es
Luoghi di studio
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Las Palmas
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Las Palmas de Gran Canaria, Las Palmas, Spagna, 35010
- Hospital Universitario de Gran Canaria Dr Negrín
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Contatto:
- Laura Ferrera-Alayón, MD, Phd
- Numero di telefono: +34928450000
- Email: lferala@gobiernodecanarias.org
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Malaga
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Málaga, Malaga, Spagna
- Hospital Universitario Quirón Salud
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Contatto:
- Jorge Contreras, MD, PhD
- Numero di telefono: +34 951 94 00 00
- Email: jorgecontrerasmartinez@gmail.com
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Criteri di partecipazione
Criteri di ammissibilità
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
Patients of borderline or Locally advanced pancreatic cancer
Histopathologically proven ductal adenocarcinoma of the pancreas (biopsy/cytology).
ECOG performance scale 0 and 1.
Age between 18 and 80 years.
Adequate kidney functionality defined as creatinine clearance >50 ml/min.
Adequate liver functionality defined as total bilirubin ≤2 times of the upper limit of normal.
Adequate bone marrow reserves: WBC count ≥2.5 × 109/L, platelet count ≥100 × 109/L, hemoglobin ≥8.0 g/L.
Women of child-bearing age must secure sufficient contraception control (dual protection with condoms and pills) during the clinical trial and 6 months after the clinical trial is completed.
For females of child bearing potential, pregnancy test within 2 week prior to randomization should be negative.
Absence of psychological, familial, sociological or geographical condition that could potentially hamper compliance with the study protocol and follow-up schedule.
Exclusion criteria
Absence of distant metastasis or gross peritoneal carcinomatosis.
Prior or concurrent malignancies.
Patients having metal implants, pacemakers or clustered markers.
Patients with metallic endobiliary stent would need to be replaced with plastic stents.
Any history of myocardial infarction within the past 12 months.
Any connective tissue disorder that contraindicate RT, e.g., scleroderma.
Pre-existing grade 2 peripheral neuropathy.
Any known contraindication or hypersensitivity to the chemotherapeutic agents used in the study as decided by the medical oncologists.
Pregnancy, lactation period or lack of reliable contraception.
Any other disease or therapy, which, according to the investigator, present a risk to the patient or which are not compatible with the aims of the clinical trial.
Indications that the person concerned will possibly not keep to the clinical trial plan because of unwillingness to cooperate or difficulties in keeping the check-up appointments.
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Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: N / A
- Modello interventistico: Assegnazione di gruppo singolo
- Mascheramento: Nessuno (etichetta aperta)
Numero di armi
Armi e interventi
Gruppo di partecipanti / ArmGruppo di partecipanti / Arm |
Intervento / TrattamentoIntervento / Trattamento |
|---|---|
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Sperimentale: Hyperthermia plus neoadjuvant chemotherapy/radiotherapy
Hyperthermia plus neoadjuvant chemotherapy (mFOLFIRINOX/nab Paclitaxel) followed by a) surgically resectable: Hyperthermia plus adjuvant chenmotherapy+/-radiotherapy b) surgically non-resectable: hyperthermia plus SBRT |
Hyperthermia plus neoadjuvant chemotherapy/radiotherapy Arm Description: Hyperthermia plus neoadjuvant chemotherapy (mFOLFIRINOX/nab Paclitaxel) followed by a) surgically resectable: Hyperthermia plus adjuvant chenmotherapy+/-radiotherapy b) surgically non-resectable: hyperthermia plus SBRT |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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overall survival
Lasso di tempo: one year
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Time from included in the study to death for any cause |
one year
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Misure di risultato secondarie
Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Progression Free Survival
Lasso di tempo: one year
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Time from included in the study to disease progression |
one year
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Objective response rate (ORR)
Lasso di tempo: 6 months
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according to RECIST 1.1. |
6 months
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disease control rate (DCR),
Lasso di tempo: 6 months
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according to RECIST 1.1. |
6 months
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Biochemical response using CEA and CA 19-9.
Lasso di tempo: 6 months
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Modifications CEA and CA19.9 values |
6 months
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Conversion rate to surgery.
Lasso di tempo: 6 months
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Resectabiity after neoadjuvant treatment |
6 months
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R0 resection rate
Lasso di tempo: 7 months
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Rate of complete resection in surgically treated patients |
7 months
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Pathological response, including ypTNM and GRT.
Lasso di tempo: 7 months
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Pathological confirmed response after neoadjuvant treatment |
7 months
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Local progression-free survival as first cause of failure
Lasso di tempo: one year
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Time from included in the study to local progression after treatment as first site of failure |
one year
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Acute and late toxicity chemotherapy and radiotherapy
Lasso di tempo: Acute: one month. Late: 12 months
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Acute and late toxicity of treatment according to CTCAE v5.0. |
Acute: one month. Late: 12 months
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Collaboratori e investigatori
Sponsor
Sponsor
Investigatori
Investigatori
- Investigatore principale: Pedro C Lara, Md, PhD, Universidad Fernando Pessoa Canarias
Pubblicazioni e link utili
Pubblicazioni generali
- Issels RD, Boeck S, Pelzer U, Mansmann U, Ghadjar P, Lindner LH, Albertsmeier M, Angele MK, Schmidt M, Xu Y, Bahra M, Pratschke J, Schoenberg M, Thasler WE, Salat C, Stoetzer OJ, Knoefel WT, Graf D, Wessalowski R, Keitel-Anselmino V, Koenigsrainer A, Bitzer M, Zips D, Bamberg M, Fietkau R, Ott O, Kawecki M, Wyrwicz L, Rutkowski P, Rentsch M, Ababei J, Reichardt P, Rigamonti M, Weber B, Abdel-Rahman S, Tschoep-Lechner K, Jauch KW, Bruns CJ, Oettle H, von Bergwelt-Baildon M, Heinemann V, Werner J; European Society for Hyperthermic Oncology (ESHO) and the German Arbeitsgemeinschaft Internistische Onkologie (AIO) Study Group for Pancreatic Cancer. Regional hyperthermia with cisplatin added to gemcitabine versus gemcitabine in patients with resected pancreatic ductal adenocarcinoma: The HEAT randomised clinical trial. Eur J Cancer. 2023 Mar;181:155-165. doi: 10.1016/j.ejca.2022.12.009. Epub 2022 Dec 30.
- Datta NR, Pestalozzi B, Clavien PA, Siebenhuner A, Puric E, Khan S, Mamot C, Riesterer O, Knuchel J, Reiner CS, Bodis S; members of the HEATPAC Trial Group. "HEATPAC" - a phase II randomized study of concurrent thermochemoradiotherapy versus chemoradiotherapy alone in locally advanced pancreatic cancer. Radiat Oncol. 2017 Nov 21;12(1):183. doi: 10.1186/s13014-017-0923-8.
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Inizio studio (Stimato)
Inizio studio
Completamento primario (Stimato)
Completamento primario
Completamento dello studio (Stimato)
Completamento dello studio
Date di iscrizione allo studio
Primo inviato
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Primo Inserito
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento pubblicato
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
- Malattie del sistema endocrino
- Ferite e lesioni
- Neoplasie per sede
- Neoplasie
- Neoplasie dell'apparato digerente
- Malattie dell'apparato digerente
- Neoplasie delle ghiandole endocrine
- Malattie pancreatiche
- Cambiamenti di temperatura corporea
- Disturbi da stress da calore
- Condizioni patologiche, segni e sintomi
- Segni e sintomi
- Ipertermia
- Neoplasie pancreatiche
- Terapie
- Ipertermia, indotta
- Terapia di modalità combinata
- Terapia neoadiuvante
- Diatermia
Altri numeri di identificazione dello studio
Altri numeri di identificazione dello studio
- UFPC-26-01
Piano per i dati dei singoli partecipanti (IPD)
Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?
Descrizione del piano IPD
Data will be sharing under request due to ethic limitations
Informazioni su farmaci e dispositivi, documenti di studio
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