Description:
This is a randomized multicentre phase II trial with a large translational component. The
trial will evaluate the two standard chemotherapy regimens: modified folfirinox (mFFX) and
gemcitabine/nab-paclitaxel (GA), in patients with untreated metastatic pancreatic ductal
adenocarcinoma. Integrated into this phase II trial are a number of laboratory components
including molecular profiling, patient derived organoid establishment, and drug testing
sensitivity and other biomarkers.
Title
- Brief Title: Pancreatic Adenocarcinoma Signature Stratification for Treatment
- Official Title: Pancreatic Adenocarcinoma Signature Stratification for Treatment
Clinical Trial IDs
- ORG STUDY ID:
PASS-01
- SECONDARY ID:
CAPCR ID: 20-5105
- NCT ID:
NCT04469556
Conditions
- Pancreatic Cancer Metastatic
- Pancreatic Ductal Adenocarcinoma
- Advanced Pancreatic Cancer
Interventions
Drug | Synonyms | Arms |
---|
Folfirinox | Folinic Acid/Leucovorin, 5-Fluouracil, Irinotecan, Oxaliplatin | Modified Folfirinox |
Gemcitabine/nab-paclitaxel | | Gemcitabine/nab-Paclitaxel |
Purpose
This is a randomized multicentre phase II trial with a large translational component. The
trial will evaluate the two standard chemotherapy regimens: modified folfirinox (mFFX) and
gemcitabine/nab-paclitaxel (GA), in patients with untreated metastatic pancreatic ductal
adenocarcinoma. Integrated into this phase II trial are a number of laboratory components
including molecular profiling, patient derived organoid establishment, and drug testing
sensitivity and other biomarkers.
Detailed Description
The two chemotherapy regimens GA and mFFX remain standard treatment options without
biomarkers to predict response. PASS-01 will for the first time explore progression free
survival differences in the two standard backbone regimens used in the advanced setting.
Biomarker driven strategies in pancreatic ductal adenocarcinoma (PDAC) are lacking, perhaps
accounting for a large number of failed phase II studies. This study will evaluate two
standard of care chemotherapy regimens, but will also explore high content molecular
profiling, chemotherapy sensitivity signatures, GATA6 and other putative biomarkers as
predictors of response to chemotherapy. In addition, the use of patient derived organoid
models for personalized medicine in PDAC will continue to develop within this study.
Approximately 150 patients diagnosed with untreated metastatic pancreatic cancer will be
randomized to either arm.
Trial Arms
Name | Type | Description | Interventions |
---|
Modified Folfirinox | Active Comparator | Modified FOLFIRINOX (Folinic acid/Leucovorin, 5-Fluouracil, Irinotecan, Oxaliplatin) administered intravenously.
Given that both regimens are standard of care, study treatment will be administered as per standard of care at each institution including a maintenance therapy approach which is encouraged in both arms. Dose modifications, anti-emetics, supportive medications, and use of growth factors should follow institutional guidelines. | |
Gemcitabine/nab-Paclitaxel | Active Comparator | Gemcitabine/nab-Paclitaxel administered intravenously.
Given that both regimens are standard of care, study treatment will be administered as per standard of care at each institution including a maintenance therapy approach which is encouraged in both arms. Dose modifications, anti-emetics, supportive medications, and use of growth factors should follow institutional guidelines. | - Gemcitabine/nab-paclitaxel
|
Eligibility Criteria
Inclusion Criteria:
1. Patients must have a histological or radiological diagnosis of untreated metastatic
PDAC at screening with histology subsequently confirmed prior to randomization.
2. Eligible histologic variants include adenocarcinoma or variants to include mucinous
adenocarcinoma or adenosquamous carcinoma.
3. Patients with a history of prior or concurrent second primary malignancy whose natural
history or treatment does not have the potential to interfere with the safety or
primary endpoint efficacy assessment of the pancreas cancer should generally be
eligible for enrollment in clinical trials.
4. Age ≥18 years.
5. Patient must have a tumor lesion that is amenable to a core needle biopsy.
6. Patients must be suitable for treatment with either mFFX and GA without
contraindications to either regimen.
7. Eastern Cooperative Group (ECOG) performance status 0-1. (Karnofsky ≥70%).
8. Life expectancy of greater than 90 days, as judged by the investigator
9. Women of child-bearing potential (WOCBP) must have a negative serum pregnancy test and
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.
10. Within 14 days of the proposed randomization date, patients must have normal organ and
marrow function
Exclusion Criteria:
1. Patients who have received prior systemic treatment for PDAC, including treatment in
the neoadjuvant or adjuvant setting. Prior surgery or palliative radiation is
permitted.
2. Patients with histology other than pancreatic ductal adenocarcinoma. Those with
adenosquamous are allowed. Acinar tumors and colloid are excluded.
3. Patients with one or more contraindications to tumor biopsy according to local
institution's standard biopsy procedures.
4. Patients with known brain metastases are excluded from participation in this clinical
study.
5. Uncontrolled inter-current illness including, but not limited to, ongoing or active
infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac
arrhythmia, inability to stop anticoagulation medication for a biopsy, or psychiatric
illness/social situations that would limit compliance with study requirements.
6. Any other condition that would, in the Investigator's judgment, contraindicate the
patient's participation in the clinical study due to safety concerns or compliance
with clinical study procedures.
7. Patients with a known germline mutation in BRCA, PALB2 or other homologous
Recombination Repair Deficiency (HRD) genes.
8. Patients who are pregnant or breastfeeding.
9. Use (including 'recreational use') of any illicit drugs or other substance abuse
(including alcohol) that could potentially interfere with adherence to study
procedures or requirements. *Use of any illicit drugs or other substance abuse
(including alcohol) are not screened in Canada using Toxicity testing. -
Maximum Eligible Age: | N/A |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Progression free survival(PFS) in mFFX and GA arms pancreatic ductal adenocarcinoma (PDAC) in a randomized phase II trial. |
Time Frame: | 2-4 years |
Safety Issue: | |
Description: | Time from the date of randomization to progression based on the radiology assessment of response using RECIST v1.1, or death, whichever is earlier |
Secondary Outcome Measures
Measure: | ORR by RECIST 1.1 and duration of response in patients receiving mFFX or GA |
Time Frame: | 2-4 years |
Safety Issue: | |
Description: | percentage of patient's measurable disease who have achieved either complete response (CR) or partial response (PR) |
Measure: | Overall survival (OS) associated with mFFX or GA profiles, signatures and pharmacotyping |
Time Frame: | 2-4 years |
Safety Issue: | |
Description: | |
Measure: | GATA6 as a biomarker of response to mFFX or GA |
Time Frame: | 2-4 years |
Safety Issue: | |
Description: | |
Measure: | • Concordance between organoid transcriptomic profiles (RNAseq) and patient transcriptomic profiles (descriptive statistics) |
Time Frame: | 2-4 years |
Safety Issue: | |
Description: | |
Measure: | • Concordance between chemotherapy sensitivity signature predictions and response to first line treatment (descriptive statistics). |
Time Frame: | 2-4 years |
Safety Issue: | |
Description: | |
Measure: | • Correlation of individual tumour cytokeratins (eg. CK5 and CK17 expression) with chemotherapy response and resistance |
Time Frame: | 2-4 years |
Safety Issue: | |
Description: | |
Measure: | Cell free circulating tumor (ct) DNA analysis (including KRAS mutational status) |
Time Frame: | 2-4 years |
Safety Issue: | |
Description: | |
Measure: | Cluster Tendency analysis using artificial neural networks and radiomic methods combined |
Time Frame: | 2-4 years |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | University Health Network, Toronto |
Last Updated
June 28, 2021