Study of Pancreatic Enzyme Replacement on Completion of Adjuvant Chemotherapy for Resected Pancreatic Adenocarcinoma

Pancreatic Cancer Clinical Trial

Official title:

A Phase II Study of Pancreatic Enzyme Replacement (Zenpep) on Completion Rates of Adjuvant Chemotherapy Among Subjects With Resected Pancreatic Ductal Adenocarcinoma

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT03469258
• Other study ID #: 17-450
• Status: Terminated
• Phase: Phase 2
• Start date: April 13, 2018
• Est. completion date: October 1, 2019

Study information

• Verified date: July 2020
• Source: Dana-Farber Cancer Institute
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This research study is evaluating a study drug to treat pancreatic exocrine insufficiency (PEI) during the first year after the diagnosis of pancreatic cancer while the participant is recovering from surgery and receiving adjuvant treatment.

The study drug involved in this study is:

-Zenpep

Description:

The FDA (the U.S. Food and Drug Administration) has approved Zenpep as a treatment option for PEI. Zenpep is a combination of three enzymes (proteins). These enzymes are normally produced by the pancreas and are important in the digestion of fats, proteins, and sugars. Zenpep is used to replace these enzymes when the body does not have enough of its own as a result of surgery and/or pancreatic cancer.

In this research study, the investigators are studying whether Zenpep will improve the ability of patients to complete adjuvant treatment for their pancreatic cancer after surgery to remove their tumor. The investigators are also studying if Zenpep will have an effect on nutrition status and quality of life for pancreatic cancer patients after they have had surgery to remove their tumor.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 4
• Est. completion date: October 1, 2019
• Est. primary completion date: October 1, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Participants must have histologically or cytologically confirmed pancreatic ductal adenocarcinoma. Variants or mixed histology will be included if the predominant histology is adenocarcinoma.

• Participants must have potentially resectable pancreatic cancer defined as: (1) no detectable metastases (2) signed consent for attempted resection of pancreatic cancer per treating surgeon.

• ECOG performance status =2.

• Age >18 years. Participants <18 years old are excluded from this study because subsequent adjuvant therapy is based on therapy guidelines in the adult population.

• Willingness to consider adjuvant therapy following surgical resection of disease, signed in the consent form attestation.

• Ability to understand and willingness to provide written informed consent.

• Pre-operative laboratory values adequate to undergo resection of pancreatic cancer, as defined below:

• Hemoglobin > 7.0 g/dL;

• Platelets = 40,000/mL;

• Creatinine < 2.5 mg/dL or; Creatinine clearance = 20 mL/min/1.73 m2 for participants with creatinine levels above institutional normal.

Exclusion Criteria:

• Pancreatic resection not performed. Intraoperative findings and unforeseen medical exigent circumstances may preclude pancreatic resection. Such outcomes include undetected metastases or vascular involvement, which preclude resection with intent to cure, as well as perioperative medical events including cardiopulmonary complications.

• Final pathology other than pancreatic ductal adenocarcinoma or primary component other than adenocarcinoma.

• Any prior chemotherapy and/or radiation for pancreatic cancer at the time of study enrollment, including neoadjuvant chemotherapy and/or radiation therapy.

• Second malignancy with active disease.

• History of allergic reactions or hypersensitivity attributed to compounds of similar chemical or biologic composition to pancrelipase

• Pregnant women are excluded from this study because subsequent adjuvant therapy needed for the primary endpoint is teratogenic. Pancrelipase is category C. Animal reproduction studies have not been conducted on pancrelipase and minimal data is available.

• Participants unable to self-administer pancrelipase.

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

• Participants who are receiving any other investigational agents.

• Participant unable to tolerate oral nutrition.

Related Conditions & MeSH terms

• Adenocarcinoma
• Pancreatic Cancer
• Pancreatic Neoplasms

Intervention

Drug:
• Pancrelipase
Zenpep is a combination of three enzymes (proteins). These enzymes are normally produced by the pancreas and are important in the digestion of fats, proteins, and sugars. Zenpep is used to replace these enzymes when the body does not have enough of its own as a result of surgery and/or pancreatic cancer.

Locations

Country	Name	City	State
United States	Beth Israel Deaconess Medical Center	Boston	Massachusetts

Sponsors (2)

Lead Sponsor	Collaborator
Dana-Farber Cancer Institute	Allergan

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Effect of Pancreatic Enzyme Replacement Therapy on the Completion Rate of Adjuvant Chemotherapy and Radiation After Surgery for Early Stage Pancreatic Cancer	Completion, or not, of all doses of chemotherapy and fractions of radiation prescribed by the treating oncologist prior to the start of adjuvant treatment	40 weeks
Secondary	Initiation Rate of Adjuvant Treatment for Resected Pancreatic Cancer	Percentage of subjects with resected pancreatic cancer starting adjuvant treatment by postoperative day 84	84 days after surgery
Secondary	Subject Adherence to Pancreatic Enzyme Replacement Therapy as Determined by Pill Count	Pill count performed by study staff to be compared to subject meal and pill diary to determine percent adherence to prescribed regimen	52 weeks
Secondary	Subject Adherence to Pancreatic Enzyme Replacement Therapy During Surgery and Adjuvant Treatment for Early Stage Pancreatic Cancer	Pill count performed by study staff will be compared to subject meal and pill diary to determine percent adherence to prescribed regimen	52 weeks
Secondary	Measure Serum Albumin Levels Before and After Surgery and Adjuvant Treatment for Early Stage Pancreatic Cancer	Quantify serum albumin (g/dl ) to correlate pancreatic enzyme replacement therapy with nutrition status before and after surgery and adjuvant therapy for early stage pancreatic cancer	52 weeks
Secondary	Measure Body Weight Before and After Surgery and Adjuvant Treatment for Early Stage Pancreatic Cancer	Measure body weight (in kg) at regular intervals throughout study participation to investigate whether pancreatic enzyme replacement therapy improves nutrition status during surgery and adjuvant treatment for early stage pancreatic cancer	52 weeks
Secondary	Evaluate Quality of Life Before and After Surgery and Adjuvant Treatment for Early Stage Pancreatic Cancer Using the EuroQoL 5 Dimensions 5 Levels (EQ-5D-5L) Questionnaire	Subjects to complete EQ-5D-5L at regular intervals throughout study participation. The scale consists of 5 questions, one each to assess mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each question has answers ranging from No Problems (level 1) to Extreme Problems (level 5). Subjects also to rate their overall health on a given day using the EuroQoL Visual Analog Scale (EQ-VAS) as a part of the EQ-5D-5L, which consists of marking on a visual scale from 0-100 (with 100 being best imaginable health and 0 being worst health imaginable).	52 weeks
Secondary	Monitor the Incidence and Severity of Complications After Surgery for Early Stage Pancreatic Cancer	Incidence and severity of postoperative complications graded by Clavien-Dindo classification	84 days after surgery
Secondary	Measure Grip Strength Before and After Surgery and Adjuvant Treatment for Early-stage Pancreatic Cancer	Standard grip strength dynamometer measurements at regular intervals throughout the study	52 weeks