Clinical Trials /

Gemcitabine Hydrochloride and Cisplatin With or Without Veliparib or Veliparib Alone in Treating Patients With Locally Advanced or Metastatic Pancreatic Cancer

NCT01585805

Description:

This randomized phase II trial studies how well veliparib together with gemcitabine hydrochloride and cisplatin works compared to gemcitabine hydrochloride and cisplatin alone in treating patients with pancreatic cancer that has spread from where it started to nearby tissue or lymph nodes (locally advanced) or spread from the primary site (place where it started) to other places in the body (metastatic). Veliparib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as gemcitabine hydrochloride and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving veliparib together with gemcitabine hydrochloride and cisplatin is an effective treatment for pancreatic cancer.

Related Conditions:
  • Pancreatic Carcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Gemcitabine Hydrochloride and Cisplatin With or Without Veliparib or Veliparib Alone in Treating Patients With Locally Advanced or Metastatic Pancreatic Cancer
  • Official Title: A Randomized Phase II Study of Gemcitabine, Cisplatin +/- Veliparib in Patients With Pancreas Adenocarcinoma and a Known BRCA/ PALB2 Mutation (Part I) and a Phase II Single Arm Study of Single-Agent Veliparib in Previously Treated Pancreas Adenocarcinoma (Part II)

Clinical Trial IDs

  • ORG STUDY ID: NCI-2012-00864
  • SECONDARY ID: NCI-2012-00864
  • SECONDARY ID: CDR0000732189
  • SECONDARY ID: MSKCC-12-045
  • SECONDARY ID: IRB#12-045
  • SECONDARY ID: 8993
  • SECONDARY ID: 8993
  • SECONDARY ID: N01CM00032
  • SECONDARY ID: N01CM00071
  • SECONDARY ID: P30CA008748
  • SECONDARY ID: U01CA069856
  • SECONDARY ID: UM1CA186705
  • NCT ID: NCT01585805

Conditions

  • Metastatic Pancreatic Adenocarcinoma
  • Recurrent Pancreatic Carcinoma
  • Stage III Pancreatic Cancer AJCC v6 and v7
  • Stage IV Pancreatic Cancer AJCC v6 and v7

Interventions

DrugSynonymsArms
CisplatinAbiplatin, Blastolem, Briplatin, CDDP, Cis-diammine-dichloroplatinum, Cis-diamminedichloridoplatinum, Cis-diamminedichloro Platinum (II), Cis-diamminedichloroplatinum, Cis-dichloroammine Platinum (II), Cis-platinous Diamine Dichloride, Cis-platinum, Cis-platinum II, Cis-platinum II Diamine Dichloride, Cismaplat, Cisplatina, Cisplatinum, Cisplatyl, Citoplatino, Citosin, Cysplatyna, DDP, Lederplatin, Metaplatin, Neoplatin, Peyrone''s Chloride, Peyrone''s Salt, Placis, Plastistil, Platamine, Platiblastin, Platiblastin-S, Platinex, Platinol, Platinol- AQ, Platinol-AQ, Platinol-AQ VHA Plus, Platinoxan, Platinum, Platinum Diamminodichloride, Platiran, Platistin, PlatosinArm A (veliparib, gemcitabine hydrochloride, cisplatin)
GemcitabinedFdC, dFdCyd, DifluorodeoxycytidineArm A (veliparib, gemcitabine hydrochloride, cisplatin)
Gemcitabine HydrochloridedFdCyd, Difluorodeoxycytidine Hydrochloride, FF 10832, FF-10832, FF10832, Gemcitabine HCI, Gemzar, LY-188011, LY188011Arm A (veliparib, gemcitabine hydrochloride, cisplatin)
VeliparibABT-888, PARP-1 inhibitor ABT-888Arm A (veliparib, gemcitabine hydrochloride, cisplatin)

Purpose

This randomized phase II trial studies how well veliparib together with gemcitabine hydrochloride and cisplatin works compared to gemcitabine hydrochloride and cisplatin alone in treating patients with pancreatic cancer that has spread from where it started to nearby tissue or lymph nodes (locally advanced) or spread from the primary site (place where it started) to other places in the body (metastatic). Veliparib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as gemcitabine hydrochloride and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether giving veliparib together with gemcitabine hydrochloride and cisplatin is an effective treatment for pancreatic cancer.

Detailed Description

      PRIMARY OBJECTIVES:

      I. To optimize the dose of veliparib combined with fixed doses of gemcitabine hydrochloride
      (gemcitabine) and cisplatin in a (non-randomized, lead-in portion of Part I).

      II. To evaluate the response rate (Response Evaluation Criteria in Solid Tumors [RECIST]
      criteria) of gemcitabine, cisplatin, and veliparib (Arm A) and gemcitabine, cisplatin (Arm B)
      in BRCA and PALB2 mutation carriers with advanced pancreas adenocarcinoma. (Part I) III. To
      evaluate the response rate (RECIST criteria) of single-agent veliparib (Arm C) in BRCA and
      PALB2 carriers with previously treated pancreas adenocarcinoma. (Part II)

      SECONDARY OBJECTIVES:

      I. To evaluate the progression-free survival of patients in study Arm A and Arm B. (Part I)
      II. To describe the safety and tolerability of gemcitabine, cisplatin, and veliparib and
      gemcitabine and cisplatin in BRCA and PALB2 carriers with advanced pancreas adenocarcinoma.
      (Part I) III. To determine the disease control rate (complete response [CR] + partial
      response [PR] + stable disease [SD]) and duration of response in study Arm A and Arm B. (Part
      I) IV. To evaluate overall survival in study Arm A and Arm B. (Part I) V. To evaluate
      progression-free survival for single-agent veliparib in BRCA and PALB2 mutation carriers with
      previously treated pancreas adenocarcinoma (Arm C). (Part II) VI. To describe the safety and
      tolerability of single-agent veliparib in BRCA and PALB2 mutation carriers with previously
      treated pancreas adenocarcinoma. (Part II) VII. To determine the disease control rate (CR +
      PR + SD) and duration of response in Arm C. (Part II) VIII. To evaluate overall survival in
      Arm C. (Part II)

      CORRELATIVE SCIENCE OBJECTIVES:

      I. To determine the genotype of BRCA1, BRCA2 and PALB2-mutated pancreas adenocarcinoma.

      II. To assess pre and post therapy biopsies for novel or persistent genetic alterations in
      genes identified in aim I.

      III. To quantify levels of PAR in peripheral blood mononuclear cells (PBMCs) and tumor
      tissues at sequential time points before and following therapy with veliparib.

      IV. To quantify levels of gammaH2AX and RAD51 foci in PBMCs and tumor tissue (where
      available) at sequential time points to assess for formation of double-stranded
      deoxyribonucleic acid (DNA) breaks, stalled/collapsed replication forks and evaluate
      homologous recombination competence.

      EXPLORATORY OBJECTIVES:

      I. To correlate the results of genotyping with gene expression to provide functional
      information on mutations identified.

      II. An exploratory assessment of differential expression of genes involved in DNA repair
      pathways pre and post treatment to identify candidate genes predictive of response or
      resistance to therapy for further study in preclinical models of disease.

      OUTLINE: This is a dose-escalation study of veliparib followed by a randomized, open-label
      study.

      Patients receive veliparib orally (PO) twice daily (BID) on days 1-12 or 1-21. Patients also
      receive gemcitabine hydrochloride intravenously (IV) over 30 minutes and cisplatin IV over 30
      minutes on days 3 and 10. Cycles repeat every 21 days in the absence of disease progression
      or unacceptable toxicity. (CLOSED AS OF 12/13/13)

      PART I: Once the maximum-tolerated dose of veliparib has been established, patients are
      randomized to 1 of 2 treatment arms.

      ARM A (no prior therapy or >= 6 months since adjuvant therapy): Patients receive veliparib PO
      BID on days 1-12 and gemcitabine hydrochloride IV over 30 minutes and cisplatin IV over 30
      minutes on days 3 and 10. Cycles repeat every 21 days in the absence of disease progression
      or unacceptable toxicity.

      ARM B (no prior therapy or >= 6 months since adjuvant therapy): Patients receive gemcitabine
      hydrochloride IV and cisplatin IV as patients in arm A. Cycles repeat every 21 days in the
      absence of disease progression or unacceptable toxicity.

      PART II: Patients who are eligible receive treatment in Arm C.

      ARM C (prior therapy): Patients receive veliparib PO BID on days 1-28. Cycles repeat every 28
      days in the absence of disease progression or unacceptable toxicity.

      After completion of study treatment, patients are followed up at 30 days and then every 3
      months thereafter.
    

Trial Arms

NameTypeDescriptionInterventions
Arm A (veliparib, gemcitabine hydrochloride, cisplatin)ExperimentalPatients receive veliparib PO BID on days 1-12 or 1-21. Patients also receive gemcitabine hydrochloride IV over 30 minutes and cisplatin IV over 30 minutes on days 3 and 10. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
  • Cisplatin
  • Gemcitabine
  • Gemcitabine Hydrochloride
  • Veliparib
Arm B (gemcitabine hydrochloride, cisplatin)Active ComparatorPatients receive gemcitabine hydrochloride IV and cisplatin IV as patients in arm A. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
  • Cisplatin
  • Gemcitabine
  • Gemcitabine Hydrochloride
Arm C (veliparib)ExperimentalPatients receive veliparib PO BID on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
  • Veliparib

Eligibility Criteria

        Inclusion Criteria:

          -  Patients with cytologically or histologically confirmed locally advanced or metastatic
             pancreas adenocarcinoma with a BRCA1 or 2 or PALB2 mutation confirmed by report from
             Myriad Genetics (United States of America [USA]); reports from other molecular
             diagnostic companies can be used to confirm mutations as well; BRCA 1 or 2 or PALB2
             mutation can be confirmed locally for all international sites

               -  For Part I, non-randomized, lead-in portion, patients with a known BRCA 1 or 2 or
                  PALB2 mutation are eligible along with patients who potentially may have a
                  likelihood of having a BRCA mutation (e.g., personal or family history of breast,
                  pancreas, ovary, endometrial, prostate or other likely related malignancy); for
                  Part I, randomized portion, a known BRCA 1 or 2 or PALB2 mutation is required

          -  For Part I (Arms A, B): Patients can have either locally advanced or metastatic
             pancreas adenocarcinoma for which no prior therapy has been administered for either
             locally advanced or metastatic disease; prior adjuvant therapy is permissible if
             gemcitabine or a fluoropyrimidine was administered with or without radiation and if
             disease recurrence has been documented at least 6 months after completion of adjuvant
             therapy

          -  For Part II (Arm C): Patients can have either locally advanced or metastatic pancreas
             adenocarcinoma; up to two prior treatment regimens are permissible (excluding a prior
             PARP inhibitor) for either localized or metastatic pancreas adenocarcinoma; prior
             combined chemotherapy and radiotherapy is permissible provided the patient has
             measurable disease outside the radiation port; prior therapy must have been completed
             at least 3 weeks prior to starting study therapy

          -  Eastern Cooperative Oncology Group (ECOG) performance status:

               -  For Part I (Arm A, B): 0-1 (Karnofsky > 70%)

               -  For Part II (Arm C): 0-2 (Karnofsky >= 60%)

          -  Life expectancy of greater than 3 months

          -  Absolute neutrophil count >= 1,500/mcL (measured within 14 days prior to
             administration of ABT-888)

          -  Hemoglobin >= 9.0 g/dl (measured within 14 days prior to administration of ABT-888)

          -  Platelets >= 100,000/mcL (measured within 14 days prior to administration of ABT-888)

          -  Total bilirubin =< 2 x institutional upper limit of normal (measured within 14 days
             prior to administration of ABT-888)

          -  Aspartate aminotransferase(AST)/serum glutamic oxaloacetic transaminase (SGOT) and
             alanine aminotransferase(ALT)/serum glutamate pyruvate transaminase (SGPT) =< 2.5 x
             institutional upper limit of normal unless there is evidence of liver metastases in
             which case the AST (SGOT)/ALT (SGPT) must be =< 5 x institutional upper limit of
             normal (measured within 14 days prior to administration of ABT-888)

          -  Creatinine =< 1.5 x upper limit of normal (ULN) (measured within 14 days prior to
             administration of ABT-888)

          -  Measurable disease by RECIST criteria

               -  For the lead-in, non-randomized portion of Part I, either measurable or evaluable
                  disease is acceptable

               -  For Part I, randomized portion, measurable disease is required

          -  If a woman is of child-bearing potential a negative blood or urine pregnancy test is
             required; (the effects of veliparib on the developing human fetus are unknown; for
             this reason and because other therapeutic agents or modalities used in this trial are
             known to be teratogenic, women of child-bearing potential and men must agree to use
             adequate contraception [hormonal or barrier method of birth control; abstinence] prior
             to study entry and for the duration of study participation; should a woman become
             pregnant or suspect she is pregnant while participating in this study, she should
             inform her treating physician immediately)

          -  Ability to understand and the willingness to sign a written informed consent document

        Exclusion Criteria:

          -  Patients who have had chemotherapy or radiotherapy within 3 weeks (6 weeks for
             nitrosoureas or mitomycin C) prior to entering the study or those who have not
             recovered from adverse events due to agents administered more than 3 weeks earlier

               -  For Part I, prior adjuvant therapy with gemcitabine or a fluoropyrimidine therapy
                  is permitted if completed > 6 months prior to recurrence; no prior PARP inhibitor
                  therapy is allowed

               -  For Part II, no prior PARP inhibitor therapy is permitted; up to two prior
                  treatment regimens are permitted as follows: 1 adjuvant and 1 metastatic; 1
                  locally advanced and 1 metastatic; or 2 metastatic, or a variation thereof

          -  Patients may not be receiving any other investigational agents

          -  History of allergic reactions attributed to compounds of similar chemical or biologic
             composition to veliparib or other agents used in study

          -  For Part I: patients with known contraindications to platinum agents are excluded

          -  Uncontrolled intercurrent illness including, but not limited to, ongoing or active
             infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
             arrhythmia, or psychiatric illness/social situations that would limit compliance with
             study requirements

          -  Pregnant women are excluded from this study because veliparib is a PARP inhibitor with
             the potential for teratogenic or abortifacient effects; because there is an unknown
             but potential risk for adverse events in nursing infants secondary to treatment of the
             mother with veliparib, breastfeeding should be discontinued if the mother is treated
             with veliparib; these potential risks may also apply to other agents used in this
             study

          -  Patients with a known active infection, e.g., hepatitis B virus or hepatitis C virus;
             human immunodeficiency virus (HIV)-positive patients who are otherwise well and who do
             not have evidence of significant immune compromise are eligible

          -  Patients with active seizure or history of seizure are not eligible

          -  Patients with uncontrolled central nervous system (CNS) metastasis are not eligible;
             patients with CNS metastases are to be stable for > 3 months after treatment and off
             steroid treatment prior to study enrollment

          -  Patients with prior malignancy successfully treated who are currently stable and on no
             active treatment are eligible

          -  Patients who are unable to swallow pills/capsules are ineligible

          -  Patients with treatment-related acute myeloid leukemia (AML) (t-AML)/myelodysplastic
             syndrome (MDS) or with features suggestive of AML/MDS are ineligible

          -  Patients with prior allogeneic bone marrow transplant or double umbilical cord blood
             transplantation are ineligible
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Optimal dose of veliparib with gemcitabine hydrochloride and cisplatin (non-randomized part I)
Time Frame:21 days
Safety Issue:
Description:Will be assessed by Response Evaluation Criteria in Solid Tumors (RECIST). Simon's two-stage minimax design will be employed separately in each arm A and B.

Secondary Outcome Measures

Measure:Progression-free survival
Time Frame:From the date of study enrollment to documentation of clear-cut progression of disease or last follow-up, assessed up to 5 years
Safety Issue:
Description:Kaplan-Meier method will be used.
Measure:Incidence of adverse events
Time Frame:Up to 5 years
Safety Issue:
Description:Will be assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 (version 5.0 will be utilized for adverse event reporting beginning April 1, 2018). Toxicity and tolerability of all three study arms will be assessed and summarized using descriptive statistics.
Measure:Disease control rate (complete response + partial response + stable disease) and duration of response
Time Frame:Up to 5 years
Safety Issue:
Description:
Measure:Overall survival
Time Frame:From the time of study enrollment to the date of death or last follow-up, assessed up to 5 years
Safety Issue:
Description:Kaplan-Meier method will be used.

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:National Cancer Institute (NCI)

Last Updated

June 30, 2021