| Eligibility |
Inclusion Criteria (Phase I):
- Patients must have histologically or cytologically confirmed metastatic or
unresectable locally advanced adenocarcinoma of the pancreas. Prior therapy with a
non-gemcitabine based regimen is permitted.
- Previous neo-adjuvant or adjuvant treatment is allowed provided that it was given >= 6
months prior to registration
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
- Patients must have a life expectancy of >= 12 weeks
- Patients may have had prior radiotherapy for metastatic disease as long as it was > 4
weeks prior to registration and the patient has recovered from adverse events
associated with the radiotherapy
- Patients must be able to swallow capsules whole
- Patients must be able to tolerate computed tomography (CT), magnetic resonance imaging
(MRI) or PET imaging including contrast agents
- Women of child-bearing potential and men must agree to use adequate contraception
(hormonal and barrier method of birth control; two barrier methods of birth control;
abstinence) for the duration of study treatment and for 3 months after the last dose
of study treatment; should a woman become pregnant or suspect she is pregnant while
participating in this study, she should inform her treating physician immediately;
should a man impregnate or suspect that he has impregnated a woman while participating
in this study, he should inform his treating physician immediately
- Leukocytes >= 3,000/mcL
- Absolute neutrophil count >= 1,500/mcL
- Hemoglobin >= 9 g/dL
- Platelets >= 100,000/mcL
- Total bilirubin =< 1.5 institutional upper limit of normal (ULN)
- Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase
[SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT])
=< 3 X institutional upper limit of normal (ULN) or =< 5 X ULN if the patient has
liver metastases
- Creatinine =< 1.5 mg/dL or creatinine clearance (Cockcroft-Gault) >= 60 mL/min for
patients with creatinine levels above institutional upper limit of normal (ULN)
Exclusion Criteria (Phase I):
- Receiving any other investigational agents concurrently
- Have received any other investigational agents =< 4 weeks prior to registration
- Pre-existing > grade 1 motor or sensory neuropathy
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to nab-paclitaxel, gemcitabine or AZD1775
- Major surgical procedures <=28 days of beginning study treatment or minor surgical
procedures <=7 days
- Taking current medications or substances that are inhibitors of CYP3A4, inhibitors or
substrates of P-glycoprotein or inhibitors of breast cancer resistance protein (BCRP)
- Uncontrolled serious medical illness including, but not limited to, ongoing or active
infection, cardiac arrhythmia, or psychiatric illness that would limit compliance with
study requirements
- Patients with known human immunodeficiency virus (HIV) and cluster of differentiation
(CD)4 count is =< 200 cell/mm^3 or receiving antiretroviral therapy due to potential
unfavorable interaction of the agents with the study treatment
- Previous or concurrent malignancy; exceptions are made for patients who meet any of
the following conditions:
- Non-melanoma skin cancer, in situ cervical cancer, breast cancer in situ, or
superficial bladder cancer (noninvasive papillary carcinoma or carcinoma in situ)
- Prior malignancy completely excised or removed and patient has been continuously
disease free for > 5 years
- Pregnant or breast-feeding
- Females of childbearing potential must have a blood test or urine study within 5
days prior to registration to rule out pregnancy; a female of childbearing
potential is any woman, regardless of sexual orientation or whether they have
undergone tubal ligation, who meets the following criteria: 1) has not undergone
a hysterectomy or bilateral oophorectomy; or 2) has not been naturally
postmenopausal for at least 24 consecutive months (i.e., has had menses at any
time in the preceding 24 consecutive months)
- At least18 years of age
Inclusion Criteria (Phase II):
- Histologically or cytologically confirmed metastatic adenocarcinoma of the pancreas
- Patients must have measurable disease outside of the primary tumor (pancreas) by
RECIST 1.1 criteria; baseline measurements and evaluations of all sites of disease
must be obtained =< 4 weeks prior to randomization
- Previous neo-adjuvant or adjuvant treatment is allowed provided that there was no
evidence of recurrent disease for at least 6 months after completion of
neo-adjuvant/adjuvant treatment
- Patients may have had prior radiotherapy for metastatic disease as long as it was > 4
weeks prior to randomization and the patient has recovered from adverse events
associated with the radiotherapy
- ECOG performance status of 0 or 1
- Life expectancy of >= 12 weeks
- Patients must be able to swallow capsules whole
- Patients with biliary stents are allowed
- Patients must be able to tolerate CT, MRI or PET imaging including contrast agents
- Women of child-bearing potential and men must agree to use adequate contraception
(hormonal and barrier method of birth control; two barrier methods of birth control;
abstinence) for the duration of study treatment and for 3 months after the last dose
of study treatment; should a woman become pregnant or suspect she is pregnant while
participating in this study, she should inform her treating physician immediately;
should a man impregnate or suspect that he has impregnated a woman while participating
in this study, he should inform his treating physician immediately
- Leukocytes >= 3,000/mcL
- Absolute neutrophil count >= 1,500/mcL
- Hemoglobin >= 9 g/dL
- Platelets >= 100,000/mcL
- Total bilirubin =< 1.5 institutional upper limit of normal (ULN)
- AST (SGOT)/ALT (SGPT) =< 3 X institutional upper limit of normal (ULN) or =< 5 X ULN
if the patient has liver metastases
- Creatinine =< 1.5 mg/dL or creatinine clearance (Cockcroft-Gault) >= 60 mL/min for
patients with creatinine levels above institutional upper limit of normal (ULN)
- For participation in the imaging research studies, patients must meet the additional
following criteria:
- The patient is participating in the trial at an institutional which has agreed to
perform the imaging research studies, completed the American College of Radiation
Imaging Network (ACRIN) defined scanner qualification procedures and received
ACRIN approval
- The patient has consented in writing to participate in one of the imaging
research studies
- The patient meets the criteria required for the imaging study in which the site
is participating:
- NOTE: Eligibility for participating in either imaging sub-study will depend
on the availability of the imaging sub-study at a particular institution
- For participation in the FDG-PET sub-study:
- Patients must have an evaluable lesion of > 20 mm in size on standard
practice imaging study as assessed by site (either primary pancreas mass or
metastasis)
- For participation in the FLT-PET sub-study:
- Patients must be able to lie still for a 1.5 hour PET scan.
- Patients must have an evaluable lesion in the pancreas > 20 mm in size on
standard practice imaging study as assessed by site (lesion must be likely
primary adenocarcinoma of the pancreas that is not primarily fibrotic or
mucinous in nature)
Phase II Exclusion Criteria:
- Prior systemic therapy for metastatic disease
- Locally advanced disease
- Major surgical procedures <=28 days of beginning study treatment or minor surgical
procedures <=7 days
- Any of the following cardiac diseases at registration or within the last 6 months as
defined by New York Heart Association (NYHA) = Class 2:
- Unstable angina pectoris
- Congestive heart failure
- Acute myocardial infarction
- Conduction abnormality not controlled with pacemaker or medication
- Significant ventricular or supraventricular arrhythmias (patients with chronic
rate-controlled atrial fibrillation in the absence of other cardiac abnormalities
are eligible.)
- Taking current medications or substances that are inhibitors of CYP3A4, inhibitors or
substrates of P-glycoprotein or inhibitors of breast cancer resistance protein (BCRP)
- Prior Wee1 inhibitors or AZD1775
- Prior gemcitabine or nab-paclitaxel in a metastatic setting
- Corrected QT interval QTc > 470 msec (as calculated per institutional standards) at
study entry or congenital long QT syndrome).
- Receiving any other investigational agents concurrently or have received any other
investigational agents =< 4 weeks prior to randomization
- Pre-existing > grade 1 motor or sensory neuropathy
- History of allergic reactions attributed to compounds of similar chemical or biologic
composition to nab-paclitaxel, gemcitabine or AZD1775
- Uncontrolled serious medical illness including, but not limited to, ongoing or active
infection, cardiac arrhythmia, or psychiatric illness that would limit compliance with
study requirements
- Previous or concurrent malignancy; exceptions are made for patients who meet any of
the following conditions:
- Non-melanoma skin cancer, in situ cervical cancer, breast cancer in situ, or
superficial bladder cancer (noninvasive papillary carcinoma or carcinoma in situ)
- Prior malignancy completely excised or removed and patient has been continuously
disease free for > 5 years
- Pregnant or breast-feeding
- Females of childbearing potential must have a blood test or urine study within 5
days prior to randomization to rule out pregnancy; a female of childbearing
potential is any woman, regardless of sexual orientation or whether they have
undergone tubal ligation, who meets the following criteria: 1) has not undergone
a hysterectomy or bilateral oophorectomy; or 2) has not been naturally
postmenopausal for at least 24 consecutive months (i.e., has had menses at any
time in the preceding 24 consecutive months)
- For participation in the FDG-PET sub-study:
- Poorly controlled diabetes (defined as fasting glucose level >= 200 mg/dL)
despite efforts to improve glucose control by fasting duration and adjustment of
medications
- Weigh more than the maximum weight limit for the PET table
- For participation in the FLT-PET sub-study:
- History of allergic reaction attributable to compounds of similar chemical or
biologic composition to 18F-fluorothymidine
- Weigh more than the maximum weight limit for the PET table
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