Description:
This phase I/II trial studies the side effects and best dose of liposomal irinotecan and
rucaparib when given together with fluorouracil and leucovorin calcium and to see how well
they work in treating patients with pancreatic, colorectal, gastroesophageal, or biliary
cancer that has spread to other places in the body (metastatic). Drugs used in chemotherapy,
such as liposomal irinotecan, fluorouracil, and leucovorin calcium, 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. PARPs are proteins that help repair DNA mutations. PARP
inhibitors, such as rucaparib, can keep PARP from working, so tumor cells can't repair
themselves, and they may stop growing. Giving liposomal irinotecan and rucaparib together
with fluorouracil and leucovorin calcium may work better in treating patients with
pancreatic, colorectal, gastroesophageal, or biliary cancer.
Title
- Brief Title: Liposomal Irinotecan, Fluorouracil, Leucovorin Calcium, and Rucaparib in Treating Patients With Metastatic Pancreatic, Colorectal, Gastroesophageal, or Biliary Cancer
- Official Title: Phase I Study of Irinotecan Liposome (Nal-IRI), Fluorouracil, Leucovorin and Rucaparib in the Treatment of Select Gastrointestinal Metastatic Malignancies Followed by a Phase Ib of First and Second Line Treatment of Both Unselected and Selected ( for BRCA 1/2 and PALB2 Mutations) Patients With Metastatic Adenocarcinoma of the Pancreas Then Followed by a Phase II Study of First Line Treatment of Selected Patients With Metastatic Adenocarcinoma of the Pancreas With Genomic Markers (Signature) of Homologous Recombination Deficiency (HRD)
Clinical Trial IDs
- ORG STUDY ID:
ACCRU-GI-1603
- SECONDARY ID:
NCI-2017-01976
- SECONDARY ID:
ACCRU-GI-1603
- SECONDARY ID:
P30CA015083
- NCT ID:
NCT03337087
Conditions
- Metastatic Biliary Tract Carcinoma
- Metastatic Colorectal Carcinoma
- Metastatic Gastroesophageal Junction Adenocarcinoma
- Metastatic Malignant Digestive System Neoplasm
- Metastatic Pancreatic Adenocarcinoma
- Stage IV Colorectal Cancer AJCC v7
- Stage IV Pancreatic Cancer AJCC v6 and v7
- Stage IVA Colorectal Cancer AJCC v7
- Stage IVB Colorectal Cancer AJCC v7
Interventions
Drug | Synonyms | Arms |
---|
Fluorouracil | 5 Fluorouracil, 5 Fluorouracilum, 5 FU, 5-Fluoro-2,4(1H, 3H)-pyrimidinedione, 5-Fluorouracil, 5-Fluracil, 5-Fu, 5FU, AccuSite, Carac, Fluoro Uracil, Fluouracil, Flurablastin, Fluracedyl, Fluracil, Fluril, Fluroblastin, Ribofluor, Ro 2-9757, Ro-2-9757 | Treatment (nal-IRI, leucovorin, fluorouracil, rucaparib) |
Leucovorin Calcium | Adinepar, Calcifolin, Calcium (6S)-Folinate, Calcium Folinate, Calcium Leucovorin, Calfolex, Calinat, Cehafolin, Citofolin, Citrec, Citrovorum Factor, Cromatonbic Folinico, Dalisol, Disintox, Divical, Ecofol, Emovis, Factor, Citrovorum, Flynoken A, Folaren, Folaxin, FOLI-cell, Foliben, Folidan, Folidar, Folinac, Folinate Calcium, folinic acid, Folinic Acid Calcium Salt Pentahydrate, Folinoral, Folinvit, Foliplus, Folix, Imo, Lederfolat, Lederfolin, Leucosar, leucovorin, Rescufolin, Rescuvolin, Tonofolin, Wellcovorin | Treatment (nal-IRI, leucovorin, fluorouracil, rucaparib) |
Liposomal Irinotecan | Irinotecan Liposome, MM-398, nal-IRI, Nanoliposomal Irinotecan, Nanoparticle Liposome Formulation of Irinotecan, Onivyde, PEP02 | Treatment (nal-IRI, leucovorin, fluorouracil, rucaparib) |
Rucaparib | 6H-Pyrrolo(4,3,2-ef)(2)benzazepin-6-one, 8-Fluoro-1,3,4,5-tetrahydro-2-(4-((methylamino)methyl)phenyl)-, 8-Fluoro-2-(4-((methylamino)methyl)phenyl)-1,3,4,5-tetrahydro-6H-azepino(5,4,3-cd)indol-6-one | Treatment (nal-IRI, leucovorin, fluorouracil, rucaparib) |
Purpose
This phase I/II trial studies the side effects and best dose of liposomal irinotecan and
rucaparib when given together with fluorouracil and leucovorin calcium and to see how well
they work in treating patients with pancreatic, colorectal, gastroesophageal, or biliary
cancer that has spread to other places in the body (metastatic). Drugs used in chemotherapy,
such as liposomal irinotecan, fluorouracil, and leucovorin calcium, 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. PARPs are proteins that help repair DNA mutations. PARP
inhibitors, such as rucaparib, can keep PARP from working, so tumor cells can't repair
themselves, and they may stop growing. Giving liposomal irinotecan and rucaparib together
with fluorouracil and leucovorin calcium may work better in treating patients with
pancreatic, colorectal, gastroesophageal, or biliary cancer.
Detailed Description
PRIMARY OBJECTIVES:
I. To establish the recommended dose level for the phase Ib and phase II trial of liposomal
irinotecan (nal-IRI) and fluorouracil (5-FU) with rucaparib (MFR) in patients with metastatic
disease from pancreatic cancer (up to 2 lines of prior therapy), colorectal cancer (up to 3
lines of prior therapy), gastroesophageal cancer (up to 1 line of prior therapy) and biliary
tract cancer (with 1 line of prior therapy allowed). (Phase I) II. To assess, in a
preliminary fashion, antitumor efficacy, in terms of disease control rate and further
tolerability, of the recommended dose level of combination of nal-IRI and 5-FU with rucaparib
in patients with metastatic disease from pancreatic cancer both unselected and selected for
BRCA 1/2 and PALB2 mutations (=< 1 line of prior therapy in the metastatic setting). (Phase
Ib) III. To estimate the proportion of evaluable patients who reach complete response
(CR)/partial response (PR) =< 32 weeks after registration among patients with metastatic
adenocarcinoma of the pancreas with genomic markers (signature) of homologous recombination
deficiency (HRD), specifically BRCA1, BRCA2, and PALB2 mutation, treated with the combination
of nal-IRI and 5FU/leucovorin calcium (LV) with rucaparib (MFR). (Phase II)
SECONDARY OBJECTIVES:
I. To estimate the progression-free survival (PFS) and overall survival (OS) for patients
with metastatic adenocarcinoma of the pancreas with genomic markers (signature) of homologous
recombination deficiency (HRD), specifically BRCA1, BRCA2, and PALB2 mutation, treated with
the combination of nal-IRI and 5-FU/LV with rucaparib (MFR). (Phase II) II. To assess the
toxicity of the combination of nal-IRI and 5-FU/LV with rucaparib in patients with metastatic
adenocarcinoma of the pancreas with genomic markers (signature) of homologous recombination
deficiency (HRD), specifically BRCA1/2 and PALB2 mutations. (Phase II)
EXPLORATORY OBJECTIVES:
I. To evaluate the role of genomic markers (signature) of HRD, mutation other than BRCA1,
BRCA2, and PALB2 as predictive biomarkers of response to MFR.
II. To evaluate BRCA1, BRCA2, and PALB2 mutations as predictive biomarker of response to MFR.
OUTLINE: This is phase I, dose-escalation study of liposomal irinotecan and rucaparib and
followed by a phase II study.
Patients receive liposomal irinotecan intravenously (IV) over 90 minutes, leucovorin calcium
IV, and fluorouracil IV over 46 hours on days 1 and 15. Patients also receive rucaparib
orally (PO) twice daily (BID) on days 4-13 and 18-27. Cycles repeat every 28 days in the
absence of disease progression or unaccepted toxicity.
After completion of study treatment, patients are followed up every 6 months for 3 years.
Trial Arms
Name | Type | Description | Interventions |
---|
Treatment (nal-IRI, leucovorin, fluorouracil, rucaparib) | Experimental | Patients receive liposomal irinotecan IV over 90 minutes, leucovorin calcium IV, and fluorouracil IV over 46 hours on days 1 and 15. Patients also receive rucaparib PO BID on days 4-13 and 18-27. Cycles repeat every 28 days in the absence of disease progression or unaccepted toxicity. | - Fluorouracil
- Leucovorin Calcium
- Liposomal Irinotecan
- Rucaparib
|
Eligibility Criteria
Inclusion Criteria:
- Phase I only: Histologic confirmation of pancreatic, colorectal, gastroesophageal or
biliary adenocarcinoma, as follows:
- Patients with metastatic disease from pancreatic cancer who received no more than
2 lines of prior therapy in the metastatic setting
- Patients with metastatic disease from colorectal cancer who received no more than
3 lines of prior therapy in the metastatic setting
- Patients with metastatic disease from gastroesophageal cancer who received no
more than 1 line of prior therapy in the metastatic setting
- Patients with metastatic disease from biliary tract cancer who received no more
than 1 line of prior therapy in the metastatic setting
- NOTE: No prior exposure to irinotecan in the metastatic setting will be allowed
except in the phase I dose escalation portion and in colon cancer patients only;
in pancreas cancer, exposure to irinotecan is only allowed in the neoadjuvant
setting and no progressive disease < 3 months from last dose of irinotecan
- Phase Ib only: Patients with metastatic adenocarcinoma of the pancreas both unselected
and selected for BRCA1 or BRCA2 or PALB2 mutation who have who received no more than 1
line of prior therapy in the metastatic setting
- NOTE: Exposure to irinotecan is only allowed in the neoadjuvant setting and no
progressive disease < 3 months from last dose of irinotecan
- Phase II only: Patients with metastatic adenocarcinoma of the pancreas with genomic
markers (signature) of homologous recombination deficiency (HRD) or BRCA1 or BRCA2 or
PALB2 mutation, or HRD (non-BRCA, non-PALB) who have not received any systemic therapy
in the metastatic setting
- NOTE: Exposure to irinotecan is only allowed in the neoadjuvant setting and no
progressive disease < 3 months from last dose of irinotecan
- Metastatic colorectal, pancreatic, gastroesophageal or biliary tract adenocarcinoma
not amenable to curative resection
- Measurable disease
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1
- Absolute neutrophil count (ANC) >= 1500/mm^3 (obtained =< 21 days prior to
registration)
- Platelet count >= 100,000/mm^3 (obtained =< 21 days prior to registration)
- Hemoglobin > 9.0 g/dL (obtained =< 21 days prior to registration)
- Total bilirubin =< institutional upper limit of normal (ULN) (obtained =< 21 days
prior to registration)
- Aspartate transaminase (AST) =< 3 x ULN, =< 5.0 x ULN for patients with metastatic
disease to the liver (obtained =< 21 days prior to registration)
- Aminotransferase (ALT) =< 3.0 x ULN, =< 5.0 x ULN for patients with metastatic disease
to the liver (obtained =< 21 days prior to registration)
- Creatinine =< 1.0 mg/dL or creatinine clearance >= 45 ml/min using the Cockcroft-Gault
formula (obtained =< 21 days prior to registration)
- Negative serum or urine pregnancy test done =< 7 days prior to registration and
repeated prior to dosing on day 1 of each cycle, for individuals of childbearing
potential only; NOTE: Individuals are considered to be of childbearing potential
unless one of the following applies:
- Is postmenopausal, defined as no menses for at least 12 months without an
alternative medical cause; a high follicle-stimulating hormone (FSH) level
consistently in the postmenopausal range (30 mIU/mL or higher) may be used to
confirm a postmenopausal state in women not using hormonal contraception or
hormonal replacement therapy; however, in the absence of 12 months of amenorrhea,
a single FSH measurement is insufficient to confirm a postmenopausal state: or
- Considered to be permanently sterile; permanent sterilization includes
hysterectomy, bilateral salpingectomy, and/or bilateral oophorectomy
- Provide informed written consent
- Willing to return to enrolling institution for follow-up (during the Active Monitoring
Phase of the study)
- Note: During the active monitoring phase of a study (i.e., active treatment and
observation), participants must be willing to return to the consenting
institution for follow-up
- Willing to provide tissue and blood samples for mandatory correlative research
purposes
- Individuals of reproductive potential and their partners willing to practice total
abstinence or use a highly effective method of contraception (failure rate < 1% per
year) during treatment and for 6 months following the last dose of rucaparib; the
following are allowable only:
- Ongoing use of progesterone-only injectable or implantable contraceptives (eg,
Depo Provera, Implanon, Nexplanon)
- Placement of an intrauterine device or intrauterine system
- Bilateral tubal occlusion
- Sterilization, with appropriate post-vasectomy documentation of absence of sperm
in ejaculate
- True, complete (as opposed to periodic) abstinence
Exclusion Criteria:
- Any of the following because this study involves an investigational agent whose
genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are
unknown:
- Pregnant individuals
- Nursing individuals
- Persons of childbearing potential who are unwilling to employ adequate
contraception
- Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment
of the investigator, would make the patient inappropriate for entry into this study or
interfere significantly with the proper assessment of safety and toxicity of the
prescribed regimens
- Immunocompromised patients and patients known to be human immunodeficiency virus (HIV)
positive and currently receiving antiretroviral therapy
- 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
- Receiving any other investigational agent which would be considered as a treatment for
the primary neoplasm
- Previous or concurrent cancer that is distinct in primary site or histology from
cancer of primary site =< 3 years prior to randomization EXCEPT for curatively treated
cervical cancer in situ, melanoma in situ, non-melanoma skin cancer and superficial
bladder tumors [Ta (non-invasive tumor), Tis (carcinoma in situ) and T1 (tumor invades
lamina propria)]; Note: All cancer treatments for those distinct in a primary site
other than cancer of origin must be completed >= 3 years prior to randomization
- Received any prior poly ADP-ribose polymerase inhibitor (PARPi) treatment
- Corrected QT interval (QTc) prolongation > 480 msec, as calculated by either the
Bazett or Fridericia formula, as per institutional standard
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Number of participants with dose limiting toxicities (Phase I) |
Time Frame: | Up to 28 days from start of treatment |
Safety Issue: | |
Description: | Will be assessed to determine maximum tolerated dose (MTD) of the combination of liposomal irinotecan (nal-IRI) and fluorouracil (5FU) with rucaparib (MFR). MTD is defined as the dose level below the lowest dose that induces dose-limiting toxicity (DLT) in at least one-third of patients (at least 2 of a maximum of 6 new patients). A total of 6 patients treated at the MTD will be sufficient to identify common toxicities at the MTD. |
Secondary Outcome Measures
Measure: | Disease control rate (DCR) |
Time Frame: | Up to 3 years |
Safety Issue: | |
Description: | Will be defined as achieving complete response (CR), partial response (PR), or maintaining stable disease (per RECIST version 1.1) as the tumor assessment result for at least 24 weeks. DCR will be estimated by the number of evaluable patients achieving disease control divided by the total number of evaluable patients. Point estimates will be generated for disease control rates within each cohort along with 95% binomial confidence intervals. |
Measure: | Overall survival (Phase II) |
Time Frame: | Time from registration to death due to any cause, assessed up to 3 years |
Safety Issue: | |
Description: | Will be estimated using the method of Kaplan-Meier. |
Measure: | Progression-free survival (Phase II) |
Time Frame: | Time from registration to the earliest date documentation of disease progression or death due to any cause, assessed up to 3 years |
Safety Issue: | |
Description: | The distribution of progression-free survival will be estimated using the method of Kaplan-Meier. |
Measure: | Incidence of adverse events (Phase II) |
Time Frame: | Up to 3 years |
Safety Issue: | |
Description: | Will be assessed by National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. The maximum grade for each type of toxicity will be recorded for each patient, and frequency tables will be reviewed to determine toxicity patterns within patient groups. The overall adverse event rates for grade 3 or higher adverse events will be compared using Chi-square or Fisher's exact tests between the two treatment groups. |
Details
Phase: | Phase 1/Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Academic and Community Cancer Research United |
Last Updated
August 24, 2021