125 Participants Needed

Adaptive Neoadjuvant Chemotherapy for Pancreatic Cancer

(PANC Trial)

MC
Overseen ByMedical College of Wisconsin Clinical Cancer Center
Age: 18+
Sex: Any
Trial Phase: Phase 2
Sponsor: Medical College of Wisconsin
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Prior Safety DataThis treatment has passed at least one previous human trial
Approved in 3 JurisdictionsThis treatment is already approved in other countries

Trial Summary

Do I need to stop taking my current medications for the trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the drug Gemcitabine with Nab-Paclitaxel for pancreatic cancer?

Research shows that Gemcitabine with Nab-Paclitaxel, when used as a second-line treatment after FOLFIRINOX, can improve survival in patients with advanced pancreatic cancer. Studies have found that these drug combinations are more effective than using Gemcitabine alone.12345

Is adaptive neoadjuvant chemotherapy for pancreatic cancer safe for humans?

The safety of treatments like FOLFIRINOX and gemcitabine plus nab-paclitaxel has been studied in pancreatic cancer patients. FOLFIRINOX can cause more severe side effects like neutropenia (low white blood cell count), febrile neutropenia (fever with low white blood cell count), and diarrhea, while gemcitabine plus nab-paclitaxel may lead to anemia and less severe nausea. Both treatments have different safety profiles, so careful monitoring and patient selection are important.678910

How is the adaptive neoadjuvant chemotherapy for pancreatic cancer unique?

This treatment is unique because it uses a combination of drugs like FOLFIRINOX and gemcitabine with nab-paclitaxel, which are typically used separately, to potentially improve outcomes by adapting to the patient's response, offering a more personalized approach compared to standard treatments.1112131415

What is the purpose of this trial?

This is an open-label, phase II study in patients with resectable and borderline resectable pancreas cancer.

Research Team

KC

Kathleen Christians, MD

Principal Investigator

Professor

Eligibility Criteria

Adults with confirmed pancreatic adenocarcinoma that's resectable or borderline so, who haven't had extensive prior treatments and are in fairly good health (ECOG <2). They must have certain blood and organ function levels, not be pregnant or breastfeeding, use contraception if of childbearing potential, and can't have HIV/HBV/HCV or other serious conditions.

Inclusion Criteria

My cancer diagnosis was confirmed through a biopsy.
My blood and organ tests meet the required levels for treatment.
I am either not able to have children, using birth control, or have a negative pregnancy test.
See 4 more

Exclusion Criteria

I haven't had a CA19-9 test done before starting chemotherapy when my bilirubin was low.
I have had chemotherapy or radiation in the last 3 years.
Pregnant or breastfeeding patients or any patient with childbearing potential not using contraception four weeks prior to treatment.
See 4 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Chemotherapy

Participants receive standard chemotherapy for pancreatic cancer, with treatment response assessed by imaging, biomarkers, and performance status

16 weeks
Regular visits for treatment and assessment

Chemoradiation

Participants receive chemoradiation (50.4 Gy in 28 fractions) if they complete four months of chemotherapy

5-6 weeks

Surgical Resection

Participants are offered surgical resection if there is no local or metastatic disease progression

Follow-up

Participants are monitored for progression-free survival and overall survival

Five years

Treatment Details

Interventions

  • Chemoradiation
  • First-line Chemotherapy
  • Second-line Chemotherapy
Trial Overview This phase II trial is testing how well patients respond to different sequences of chemotherapy and chemoradiation before surgery. It's open-label, meaning everyone knows which treatment they're getting. The goal is to find the best approach for shrinking tumors pre-surgery.
Participant Groups
3Treatment groups
Experimental Treatment
Group I: Restaging: Response to TreatmentExperimental Treatment1 Intervention
After the first restaging evaluation, further treatment will be based on treatment response. Patients who demonstrate a response \[decline in carbohydrate antigen 19-9 (CA19-9) values\] and radiographic response, along with preserved performance status) will be maintained on the first line chemotherapy for an additional two months.
Group II: Restaging: Patients with Stable DiseaseExperimental Treatment1 Intervention
Patients who do not have a significant decline in CA19-9 values will be changed to a second-line therapy for an additional two months.
Group III: Restaging: Local Disease ProgressionExperimental Treatment1 Intervention
After the first restaging evaluation, further treatment will be based on treatment response. If, at the initial restaging, the patient has local disease progression amenable to surgical resection, he or she will receive chemoradiation, rather than continued chemotherapy, so the window of opportunity for surgical resection is not lost.

First-line Chemotherapy is already approved in European Union, United States, Japan for the following indications:

🇪🇺
Approved in European Union as FOLFIRINOX for:
  • Metastatic pancreatic cancer
🇺🇸
Approved in United States as FOLFIRINOX for:
  • Metastatic pancreatic cancer
🇺🇸
Approved in United States as NALIRIFOX for:
  • Metastatic pancreatic cancer
🇺🇸
Approved in United States as Gemcitabine with Nab-Paclitaxel for:
  • Metastatic pancreatic cancer
🇯🇵
Approved in Japan as GEM+NPTX for:
  • Metastatic pancreatic cancer
🇯🇵
Approved in Japan as S-1 for:
  • Metastatic pancreatic cancer

Find a Clinic Near You

Who Is Running the Clinical Trial?

Medical College of Wisconsin

Lead Sponsor

Trials
645
Recruited
1,180,000+

Findings from Research

In a study of 28 patients with advanced pancreatic cancer, the combination of gemcitabine plus nab-paclitaxel (G + Nab-P) after FOLFIRINOX showed a median time to treatment failure of 12 weeks and a median overall survival of 23 weeks, indicating modest efficacy.
The treatment was associated with significant hematologic toxicities, with 25% of patients experiencing anemia and thrombocytopenia, highlighting the need for careful monitoring and further research on optimal dosing and sequencing.
Gemcitabine plus nab-paclitaxel for advanced pancreatic cancer after first-line FOLFIRINOX: single institution retrospective review of efficacy and toxicity.Zhang, Y., Hochster, H., Stein, S., et al.[2022]
A study of 5465 patients with advanced pancreatic cancer in Ontario showed that the introduction of new chemotherapy regimens, GEMNAB and FOLFIRINOX, significantly improved overall survival rates over time, with median survival increasing from 5.6 months to 7.6 months between 2008 and 2018.
FOLFIRINOX was found to provide better overall survival compared to GEMNAB, particularly in younger and healthier patients, while GEMNAB still showed improved survival compared to the older standard treatment, gemcitabine.
The Association of Drug-Funding Reimbursement With Survival Outcomes and Use of New Systemic Therapies Among Patients With Advanced Pancreatic Cancer.Raphael, MJ., Raskin, W., Habbous, S., et al.[2023]
Pancreatic ductal adenocarcinoma (PDAC) is primarily treated with conventional chemotherapy, with gemcitabine/nab-paclitaxel (Gem/NabP) and FOLFIRINOX being the gold standards for first-line treatment, based on 67 trials involving 16,446 patients.
Real-world data shows that the median overall survival for patients treated with FOLFIRINOX is 10.7 months and 9.1 months for Gem/NabP, which aligns closely with results from randomized controlled trials, indicating these treatments are effective options for managing advanced PDAC.
Two decades of research toward the treatment of locally advanced and metastatic pancreatic cancer: Remarkable effort and limited gain.Yeh, C., Bates, SE.[2023]

References

Gemcitabine plus nab-paclitaxel for advanced pancreatic cancer after first-line FOLFIRINOX: single institution retrospective review of efficacy and toxicity. [2022]
The Association of Drug-Funding Reimbursement With Survival Outcomes and Use of New Systemic Therapies Among Patients With Advanced Pancreatic Cancer. [2023]
Two decades of research toward the treatment of locally advanced and metastatic pancreatic cancer: Remarkable effort and limited gain. [2023]
Efficacy and safety of neoadjuvant Folfirinox and Gemcitabine plus Nab-Paclitaxel for borderline resectable and locally advanced pancreatic cancer: a systematic review and meta-analysis. [2022]
Survival Outcomes Associated With Clinical and Pathological Response Following Neoadjuvant FOLFIRINOX or Gemcitabine/Nab-Paclitaxel Chemotherapy in Resected Pancreatic Cancer. [2022]
Equivalent Efficacy but Different Safety Profiles of Gemcitabine Plus Nab-Paclitaxel and FOLFIRINOX in Metastatic Pancreatic Cancer. [2022]
Multicenter phase II trial of modified FOLFIRINOX in gemcitabine-refractory pancreatic cancer. [2020]
Clinical outcomes of first line FOLFIRINOX vs. gemcitabine plus nab-paclitaxel in metastatic pancreatic cancer at the Yale Smilow Hospital System. [2023]
Comparative Effectiveness of Gemcitabine plus Nab-Paclitaxel and FOLFIRINOX in the First-Line Setting of Metastatic Pancreatic Cancer: A Systematic Review and Meta-Analysis. [2020]
10.United Statespubmed.ncbi.nlm.nih.gov
A New Direction for Pancreatic Cancer Treatment: FOLFIRINOX in Context. [2020]
Gemcitabine/Nab-Paclitaxel versus FOLFIRINOX in Locally Advanced Pancreatic Cancer: A European Multicenter Study. [2021]
Sequential first-line treatment with nab-paclitaxel/gemcitabine and FOLFIRINOX in metastatic pancreatic adenocarcinoma: GABRINOX phase Ib-II controlled clinical trial. [2022]
13.United Statespubmed.ncbi.nlm.nih.gov
Comparative Effectiveness of nab-Paclitaxel Plus Gemcitabine vs FOLFIRINOX in Metastatic Pancreatic Cancer: A Retrospective Nationwide Chart Review in the United States. [2022]
14.United Statespubmed.ncbi.nlm.nih.gov
Real life triplet FIr/FOx chemotherapy in first-line metastatic pancreatic ductal adenocarcinoma patients: recommended schedule for expected activity and safety and phase II study. [2022]
15.United Statespubmed.ncbi.nlm.nih.gov
Cost-effectiveness of neoadjuvant FOLFIRINOX versus gemcitabine plus nab-paclitaxel in borderline resectable/locally advanced pancreatic cancer patients. [2023]
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