Peposertib + Radiation Therapy for Pancreatic Cancer

Recruiting at 42 trial locations

Age: 18+

Sex: Any

Trial Phase: Phase 1 & 2

Sponsor: National Cancer Institute (NCI)

Must not be taking: CYP inhibitors, CYP inducers, PPIs

Disqualifiers: Metastatic disease, Abdominal radiation, others

Compensation: Varies

Number of Visits: 41

92 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new treatment for pancreatic cancer that has spread to nearby tissue or lymph nodes. It combines a drug called M3814 (Peposertib), which may block enzymes needed for tumor growth, with Hypofractionated Radiation Therapy (HFRT), a type of radiation therapy that delivers higher doses over a shorter period. Researchers aim to determine if this combination is safe and more effective than radiation alone. People with locally advanced pancreatic cancer who have already received some chemotherapy might be suitable for this trial. As a Phase 1 trial, the research focuses on understanding how the treatment works in people, offering participants the opportunity to be among the first to receive this new treatment.

Will I have to stop taking my current medications?

The trial requires that you stop taking certain medications, specifically those that are strong inducers or inhibitors of certain liver enzymes (CYP3A4/5, CYP2C9, and CYP2C19) and some other specific drugs. You should discuss with the study doctor to see if alternative medications can be used. Proton-pump inhibitors must also be stopped at least 5 days before starting the trial.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that combining M3814 (also known as Peposertib) with hypofractionated radiation therapy might be safe and manageable for patients. In earlier studies, patients who received this combination found it well-tolerated, with no serious safety issues reported.

Hypofractionated radiation therapy involves administering higher doses of radiation over a shorter period, potentially leading to fewer side effects than traditional radiation therapy. The aim of using M3814 with this type of radiation is to enhance treatment effectiveness.

Although specific side effects weren't detailed in the sources, ongoing research suggests that this treatment combination could be promising for those with locally advanced pancreatic cancer. Patient safety is closely monitored in any clinical trial to ensure the best outcomes. ^{1 2 3 4 5}

Why are researchers excited about this trial's treatments?

Unlike the standard treatments for pancreatic cancer, which typically involve a combination of surgery, traditional radiation therapy, and chemotherapy, Peposertib offers a novel approach by enhancing the effects of radiation therapy. Researchers are excited about Peposertib because it targets DNA repair mechanisms in cancer cells, potentially making them more vulnerable to radiation. Hypofractionated radiation therapy is also a unique feature of this trial, delivering higher doses of radiation over a shorter period, which might improve patient convenience and reduce side effects. By combining these innovative elements, this treatment approach could improve outcomes for patients with pancreatic cancer.

What evidence suggests that this trial's treatments could be effective for pancreatic cancer?

Research has shown that combining M3814 (Peposertib) with radiation therapy might effectively treat pancreatic cancer. M3814 blocks certain enzymes that cancer cells need to grow, potentially making it harder for tumors to survive. Studies have found that using M3814 with radiation can cause more damage to cancer cells, potentially enhancing the effectiveness of the radiation.

In this trial, some participants will receive M3814 alongside hypofractionated radiation therapy, which involves administering higher doses of radiation over a shorter period. This approach has yielded good results; one study found that this type of radiation led to long-lasting tumor control and improved survival rates. Other participants will receive hypofractionated radiation therapy with a placebo. Together, these treatments could provide a stronger attack on pancreatic cancer cells. ^{6 7 8 9 10}

Who Is on the Research Team?

Sarah L Davis

Principal Investigator

JHU Sidney Kimmel Comprehensive Cancer Center LAO

Are You a Good Fit for This Trial?

Adults with localized pancreatic cancer that's inoperable but hasn't spread, who've completed 4-6 months of specific chemotherapy. They must be generally healthy, HIV or hepatitis B/C positive patients can join if their viral load is undetectable. Women of childbearing age need a negative pregnancy test and agree to use contraception.

Inclusion Criteria

Received 4-6 months of induction chemotherapy with either fluorouracil, irinotecan, leucovorin and oxaliplatin (FOLFIRINOX) or gemcitabine/Abraxane, as per standard of care

Patients must have locally advanced pancreatic cancer according to National Comprehensive Cancer Network (NCCN) Guidelines (version 1.2020) on CT scan performed within 21 days of registration

Measurable disease per response evaluation criteria in solid tumors (RECIST) version (v)1.1

Exclusion Criteria

Patients who cannot discontinue concomitant medications or herbal supplements that are strong inhibitors or strong inducers of cytochrome P450 (CYP) isoenzymes CYP3A4/5, CYP2CP, and CYP2C19. Concomitant use of CYP1A2, CYP2B6, and CYP3A4/5 substrates with a narrow therapeutic index are also excluded. Patients may confer with the study doctor to determine if alternative medications can be used. The following categories of medications and herbal supplements must be discontinued for at least the specified period of time before the patient can be treated:

Patients who have not recovered from adverse events due to prior anti-cancer therapy (i.e., have residual toxicities > grade 1) with the exception of alopecia and neuropathy grade =< 2

History of allergic reactions attributed to compounds of similar chemical or biologic composition to M3814 (peposertib)

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Phase I Treatment

Patients undergo hypofractionated radiation therapy for 5 fractions every other day over 2 weeks and receive M3814 orally once daily for 14 days

2 weeks

5 visits (in-person)

Phase II Treatment

Patients are randomized to receive either hypofractionated radiation therapy with M3814 or placebo for 5 fractions every other day over 2 weeks

2 weeks

5 visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

Up to 2 years

Visits at 30, 60, and 90 days, then every 3 months

What Are the Treatments Tested in This Trial?

Interventions

• Hypofractionated Radiation Therapy
• M3814 (Peposertib)

Trial Overview

The trial tests M3814 (Peposertib) combined with hypofractionated radiation therapy versus radiation alone. The goal is to find the safest dose of M3814 and see if it's more effective when paired with this intense, short-term radiation treatment for pancreatic cancer.

How Is the Trial Designed?

Group I: Phase II Group I (hypofractionated radiation therapy M3814) Experimental Treatment 6 Interventions

Patients in Phase II undergo hypofractionated radiation therapy for 5 fractions QOD over 2 weeks and receive M3814 PO QD for 14 days in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection and tissue biopsy on study. Patients also undergo CT and MRI during screening and on study.

Group II: Phase I (hypofractionated radiation therapy, M3814) Experimental Treatment 6 Interventions

Patients in Phase I undergo hypofractionated radiation therapy for 5 fractions QOD over 2 weeks and receive M3814 PO QD for 14 days in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection and tissue biopsy on study. Patients also undergo CT and MRI during screening and on study.

Group III: Phase II Group II(hypofractionated radiation therapy, placebo) Placebo Group 6 Interventions

Patients in Phase II undergo hypofractionated radiation therapy for 5 fractions QOD over 2 weeks and receive placebo PO QD for 14 days in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection and tissue biopsy on study. Patients also undergo CT and MRI during screening and on study.

Hypofractionated Radiation Therapy is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Hypofractionated Radiotherapy for:

• Soft tissue sarcoma
• Extremity soft tissue sarcoma

Approved in European Union as Hypofractionated Radiotherapy for:

• Soft tissue sarcoma
• Extremity soft tissue sarcoma

Approved in Canada as Hypofractionated Radiotherapy for:

• Soft tissue sarcoma
• Extremity soft tissue sarcoma

Who Is Running the Clinical Trial?

National Cancer Institute (NCI)

Lead Sponsor

Trials

14,080

Recruited

41,180,000+

Published Research Related to This Trial

In a pilot study involving 10 patients with unresectable pancreatic adenocarcinoma, hypofractionated intensity modulated radiotherapy (H-IMRT) demonstrated a high local control rate, with tumor response observed in 9 out of 10 patients.

The treatment was associated with manageable gastrointestinal toxicity, which correlated with the dose received by the duodenum, and resulted in promising 1-year overall and disease-free survival rates of 83.3% and 68.6%, respectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hypofractionated intensity-modulated radiotherapy in locally advanced unresectable pancreatic cancer: A pilot study. De Felice, F., Benevento, I., Bulzonetti, N., et al.[2020]

In a study of 294 patients receiving hypofractionated stereotactic radiotherapy (HFSRT) for brain metastases, the 12-month rate of radiation necrosis (RN) was found to be 8.8%, indicating a relatively low risk overall.

The risk of RN was significantly higher for patients treated with higher dose regimens (27 Gy in 3 fractions and 35 Gy in 5 fractions) compared to a moderate dose regimen (30 Gy in 5 fractions), and also increased in patients who had received immunotherapy within 3 months prior to HFSRT.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Risk of radiation necrosis after hypofractionated stereotactic radiotherapy (HFSRT) for brain metastases: a single center retrospective study. Di Perri, D., Tanguy, R., Malet, C., et al.[2021]

In a study of 61 patients with locally advanced pancreatic adenocarcinoma, hypofractionated radiotherapy resulted in a 33% incidence of acute gastrointestinal grade 2 toxicity, highlighting the need to manage side effects during treatment.

Dosimetric analysis revealed that higher doses to the stomach (V20[%]) and duodenum (V40[%] and V45[%]) were significant predictors of both acute and late anatomical toxicity, suggesting that careful planning of radiation doses can help minimize these risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dosimetric and clinical predictors of toxicity following combined chemotherapy and moderately hypofractionated rotational radiotherapy of locally advanced pancreatic adenocarcinoma. Cattaneo, GM., Passoni, P., Longobardi, B., et al.[2023]

In a study involving 9 patients with locally advanced pancreatic cancer, hypofractionated radiotherapy at 45 Gy in 15 fractions was well-tolerated, with no dose-limiting toxicities observed, allowing for timely initiation of full-dose gemcitabine chemotherapy.

However, the lower dose of 40 Gy in 8 fractions resulted in significant side effects, preventing timely chemotherapy initiation in most patients, indicating that this regimen is not feasible for this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A phase I study of hypofractionated radiotherapy followed by systemic chemotherapy with full-dose gemcitabine in patients with unresectable locally advanced pancreatic cancer. Furuse, J., Ishii, H., Kawashima, M., et al.[2022]

In a study of 75 patients with 108 brain metastases treated with hypofractionated stereotactic radiotherapy (hfSRT), a cumulative biological equivalent dose (EQD2) of ≥35 Gy was found to be the most effective for achieving better local control of tumors, with a median local control time of 14.9 months compared to 3.4 months for doses ≤35 Gy.

While higher doses (EQD2 >35 Gy) were associated with increased rates of mild toxicity (31% vs. 8.3% for ≤35 Gy), the treatment was still considered safe, indicating that hfSRT can effectively manage limited brain metastases with manageable side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hypofractionated stereotactic radiotherapy of limited brain metastases: a single-centre individualized treatment approach. Märtens, B., Janssen, S., Werner, M., et al.[2022]

In a study of 16 patients with locally advanced pancreatic cancer, the combination of a single 25 Gy stereotactic body radiotherapy (SBRT) session with gemcitabine chemotherapy resulted in a median survival of 11.4 months, comparable to conventional treatments.

While the treatment showed good local control, there was a notable incidence of late gastrointestinal toxicity, including duodenal ulcers, highlighting the need for careful monitoring of patients post-treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Schellenberg, D., Goodman, KA., Lee, F., et al.[2022]

The hyperfractionated accelerated radiotherapy (HART) combined with gemcitabine showed a median survival of 12.9 months for patients with unresectable pancreatic cancer, which is slightly better than the 11.3 months observed with standard-fractionated radiotherapy (SFRT).

HART required significantly fewer treatment days (35.5 days) compared to SFRT (41.3 days) while maintaining similar toxicity profiles and response rates, indicating it is a more efficient treatment option without compromising safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of hyper-fractionated accelerated and standard fractionated radiotherapy with concomitant low-dose gemcitabine for unresectable pancreatic cancer. Maemura, K., Shinchi, H., Noma, H., et al.[2022]

In a study of 28 patients with pancreatic cancer who received hypofractionated stereotactic body radiation therapy (SBRT) after prior radiation, 85.7% were free from local progression, indicating that SBRT can effectively control local disease.

The treatment was generally well-tolerated, with only mild to moderate side effects reported, but the overall survival rate remained low, with a median survival of 5.9 months, highlighting the challenges in treating pancreatic cancer.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stereotactic body radiation therapy for reirradiation of localized adenocarcinoma of the pancreas. Lominska, CE., Unger, K., Nasr, NM., et al.[2022]

In a study of 170 patients with unresectable non-metastatic pancreatic cancer, hypofractionated radiotherapy combined with full-dose gemcitabine resulted in significantly better overall survival (52% at 1 year) and distant metastasis-free survival (41% at 1 year) compared to standard fractionation radiotherapy with 5-fluorouracil (36% and 24%, respectively).

Both treatment regimens showed similar rates of gastrointestinal toxicities, indicating that the hypofractionated RT with gemcitabine is not only more effective but also has a comparable safety profile to the standard treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Hypofractionated Conformal Radiotherapy with Concurrent Full-Dose Gemcitabine Versus Standard Fractionation Radiotherapy with Concurrent Fluorouracil for Unresectable Pancreatic Cancer: a Multi-Institution Experience. Rakhra, S., Strauss, JB., Robertson, J., et al.[2023]

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