Clinical Trials /

Chemotherapy + Anakinra in Patients With Pancreatic Adenocarcinoma (PDAC)

NCT04926467

Description:

Based on a central role of inflammation in pancreas cancer, the role of IL 1 in acute and chronic inflammation , the inhibitory effect of IL 1 alfa and beta by anakinra and preliminary experience with anakinra in combination with chemotherapy in metastasis (with FOLFIRINOX) and localized disease (with gemcitabine/abraxane/cisplatin), a phase 2 study with anakinra in combination with perioperative chemotherapy for patients with PDAC is being proposed.

Related Conditions:
  • Pancreatic Ductal Adenocarcinoma
Recruiting Status:

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Chemotherapy + Anakinra in Patients With Pancreatic Adenocarcinoma (PDAC)
  • Official Title: An Open Label, Phase II Study of Chemotherapy + Anakinra in Patients With Resectable, Locally Advanced or Potentially Resectable Pancreatic Adenocarcinoma (PDAC)

Clinical Trial IDs

  • ORG STUDY ID: 020-476
  • NCT ID: NCT04926467

Conditions

  • Pancreatic Adenocarcinoma

Interventions

DrugSynonymsArms
AnakinraAnakinra plus Chemotherapy

Purpose

Based on a central role of inflammation in pancreas cancer, the role of IL 1 in acute and chronic inflammation , the inhibitory effect of IL 1 alfa and beta by anakinra and preliminary experience with anakinra in combination with chemotherapy in metastasis (with FOLFIRINOX) and localized disease (with gemcitabine/abraxane/cisplatin), a phase 2 study with anakinra in combination with perioperative chemotherapy for patients with PDAC is being proposed.

Detailed Description

      This is an open-label, single-arm, prospective phase II study conducted by Baylor Scott and
      White Research Institute in Dallas.

      The study will enroll patients with pancreatic adenocarcinoma that are planned to receive
      pre-operative chemotherapy followed by surgical resection and post operative treatment. Local
      surgical/biopsy and pathology reports will constitute adequate documentation of
      histology/cytology for study inclusion.

      Patients will receive pre- and post-operative chemotherapy plus Anakinra. Specifically, the
      pre-operative chemotherapy regimen will be a combination of Nab-paclitaxel, gemcitabine and
      cisplatin, while post-operative chemotherapy will use 5-Fluorouracil, oxaliplatin, and
      irinotecan. Patients will also receive growth factor (Neupogen followed by Neulasta) for
      safety and to ensure that treatment is not delayed due to neutropenic effects of
      chemotherapy.

      Anakinra will be self-administered by the participants through out the treatment period. A
      treatment break of 2 days will be given prior to the surgery day.
    

Trial Arms

NameTypeDescriptionInterventions
Anakinra plus ChemotherapyExperimentalPatients will receive Anakinra during both pre-operative chemotherapy with Nab-paclitaxel, gemcitabine and cisplatin, followed by surgery and post-operative chemotherapy with 5-fluorouracil, oxaliplatin, and irinotecan.
  • Anakinra

Eligibility Criteria

        Inclusion Criteria:

          -  A patient will be eligible for inclusion in this study if he or she meets all of the
             following criteria:

               1. 18 years of age or older

               2. Histologically or Cytologically confirmed pancreatic ductal adenocarcinoma. Mixed
                  subtypes of adenocarcinoma are acceptable as long as majority of cells are ductal
                  adenocarcinoma.

               3. Resectable, locally advanced or potentially resectable pancreatic adenocarcinoma

               4. American Joint Committee on Cancer (AJCC) Stage I-III Pancreatic carcinoma.

               5. Patient has Eastern Cooperative Oncology Group( ECOG ) Performance Status 0 to 1

               6. Serum albumin ≥2.0 g/dL.

               7. Adequate hematologic function as defined by:

                    1. Absolute neutrophil count (ANC) ≥1500/mm3;

                    2. Platelets ≥70,000 x 10^3/µl;

                    3. Hemoglobin ≥9 g/dL (in the absence of red blood transfusion).

               8. Adequate liver function, as defined by:

                    1. Serum total bilirubin ≤2 x ULN mg/dL, prior to initiation of treatment.

                    2. ALT (SGPT) and AST (SGOT) ≤2.5 x upper limit of normal (ULN).

               9. Adequate renal function, as defined by serum creatinine≤ 1.5 x ULN, or creatinine
                  clearance ≥50 mL/min

              10. Women of child bearing potential and men must agree to use contraception
                  throughout the study and for one month after the last anakinra administration.

              11. Subjects must understand and sign the informed consent form

              12. Patients must be accessible for treatment and follow-up.

        Exclusion Criteria:

          -  A patient will be ineligible for inclusion in this study if he or she meets any of the
             following criteria:

               1. <18 years of age

               2. History of organ transplant.

               3. Patients with islet cell neoplasms

               4. Patients with stage IV pancreatic carcinoma

               5. Active, uncontrolled bacterial, viral, or fungal infection(s) requiring systemic
                  therapy

               6. Known active infection with hepatitis B or hepatitis C

               7. Presence of clinically significant cirrhosis as determined by the investigator

               8. Known HIV positive status.

               9. Current, active immunosuppressive therapy such as cyclosporine, tacrolimus, etc.

              10. Major surgery or vascular device placement within 2 weeks prior to Day 1 of
                  treatment in study

              11. Prior chemotherapy or radiation for pancreatic cancer

              12. History of allergy or hypersensitivity to the study drugs

              13. Patient is enrolled in any outside therapeutic clinical protocol or
                  investigational trial with an investigational drug within 5 half-lives prior to
                  Study ID assignment

              14. Previous or current treatment with anakinra, canakinumab or any other IL-1
                  inhibitor

              15. Other malignancy within five years(except cutaneous, non-melanoma malignancies or
                  cervical carcinoma in site), unless the probability of recurrence of the prior
                  malignancy is <5% as determined by the Principal Investigator based on available
                  information.

              16. Significant cardiac disease (uncontrolled congestive heart failure (CHF),
                  myocardial infarction or significant ventricular arrhythmias) within the last six
                  months.

              17. Other severe and/or uncontrolled medical conditions (e.g: prior gastrointestinal
                  (GI) disease or history of prior pelvic or abdominal radiation) or other
                  conditions deemed by investigator as unsuitable for participation/enrollment

              18. Peripheral sensory neuropathy > or equal to grade 2 at baseline

              19. Abnormal liver function tests as follows:

                    1. Total bilirubin of > 2 x ULN

                    2. AST or ALT > 5x ULN

              20. Serum albumin ˂ 2.0 g/dL.

              21. Abnormal hematologic function as follows :

                    1. Absolute neutrophil count (ANC) ˂ 1500/mm3;

                    2. Platelets ˂ 70,000 x 10^3/µl;

                    3. Hemoglobin ˂ 9 g/dL (in the absence of red blood transfusion).

              22. Pregnant or nursing women

              23. No signed Informed consent form
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:To determine the percentage of patients that have a normalization of CA19-9 after pre-op treatment with the combination of nab-paclitaxel (abraxane), gemcitabine, cisplatin and anakinra.
Time Frame:24 months
Safety Issue:
Description:

Secondary Outcome Measures

Measure:To determine the effect of anakinra in combination with perioperative chemotherapy on overall survival (OS) of PDAC patients. A benchmark of 24 months OS will be used to determine how many patients meet or exceed this goal.
Time Frame:24 months
Safety Issue:
Description:
Measure:To determine the effect of anakinra in combination with perioperative chemotherapy on the median disease free survival (DFS). A benchmark of 12 months DFS will be used to determine how many patients meet or exceed this goal.
Time Frame:12 months
Safety Issue:
Description:
Measure:To determine the effect of anakinra in combination with perioperative chemotherapy on response rate
Time Frame:24 months
Safety Issue:
Description:
Measure:To determine the R0 resection rates (complete tumor removal with negative resection margins) obtained with anakinra + pre-operative chemotherapy.
Time Frame:24 months
Safety Issue:
Description:
Measure:To describe the effect of anakinra in combination with perioperative chemotherapy on the prevalence and severity of pain by monitoring patients' pain level using memorial pain assessment card (MPAC).
Time Frame:24 months
Safety Issue:
Description:
Measure:To determine the effect of anakinra in combination with perioperative chemotherapy on patients' health-related quality of life by monitoring patients using EORTC quality of life survey questionnaire (EORTC QLQ-C30).
Time Frame:24 months
Safety Issue:
Description:
Measure:To determine the effect of anakinra in combination with perioperative chemotherapy on the inflammasomes ( IL6, CRP, IL1α and IL1β) in blood and in the resected pathology specimens.
Time Frame:24 months
Safety Issue:
Description:

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Baylor Research Institute

Last Updated

June 15, 2021