Combined S-1 With DC+CIK As Maintenance Therapy For Advanced Pancreatic Ductal Adenocarcinoma

Advanced Solid Tumor Clinical Trial

Official title:

Phase II Randomized Controlled Trial Of Dendritic Cell + Cytokine-Induced Killer Cell Immunotherapy With S-1 Versus S-1 Alone As Maintenance Therapy For Advanced Pancreatic Ductal Adenocarcinoma Patients

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05955157
• Other study ID #: DECIMATE 3.0
• Status: Recruiting
• Phase: Phase 2/Phase 3
• Start date: January 3, 2023
• Est. completion date: June 2025

Study information

• Verified date: January 2023
• Source: University of Malaya
• Contact: HO GWO FUANG, MBBS
• Phone: 03-79492120
• Email: gwoho[@]um.edu.my
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The goal of this randomized phase 2 controlled clinical trial is to study safety, efficacy of S-1 combined DC+CIK maintenance therapy compared with S-1 alone in improving clinical benefit rate (CBR) among advanced PDAC patients. The main objectives aim to be achieved through this study are : 1. To evaluate the safety of DC+CIK combined immunotherapy when administered with the chemotherapy S-1 as maintenance therapy following first-line chemotherapy regime to advanced pancreatic ductal adenocarcinoma patients. 2. To demonstrate the superiority of of DC+CIK combined immunotherapy in improving clinical benefit rate (CBR) of advanced pancreatic ductal adenocarcinoma patients when administered with the chemotherapy S-1 as maintenance therapy following first-line chemotherapy regime. 3. To investigate the ability of S-1 combined DC+CIK maintenance therapy in reducing pancreatic ductal adenocarcinoma patients' circulating cancer stem cells (CSCs). In this study, subjects who achieve at least stable disease or partial response will be randomized in ratio of 1:1 into treatment group: DC-CIK plus S1 (27 patients) and control group: S-1 alone (27 patients). For treatment group, they will be infused with DC first, followed by CIK immune cells on day 1. DC+CIK immunotherapy will be repeated for another 2 times (day 8 and 15) as one cycle. All patients are left to rest for a week (start from day 21) prior to receive another 3 times of infusion (day 28, 35 and 42) if condition allowed. Additional third cycle can be performed on those who tolerate well with no toxicity or respond very well. Patients from treatment group will be assessed for their eligibility to receive booster dose on following conditions: 1) tumour achieves partial response or stable disease and 2) ECOG-PS performance status of 0-2 and 3) doesn't exhibit grade 1 and 2 toxicities to improve tumour control. Additionally, S-1 will be given twice daily after meals for 2 weeks as first cycle along with DC+CIK. Next second cycle of S-1 will be given after 7-days (1 week) rest. The cycles will be repeated every 21 days until disease progression, unacceptable toxic effects, or withdrawal with consent. Dose of S-1 will be determined according to the body surface area. Meanwhile, patients from control group will receive S-1 alone as maintenance therapy twice daily after meals for 14 days (2 weeks) as one cycle. The next cycle of S-1 will be given after 7-days rest. The cycles will be repeated every 21 days until disease progression, unacceptable toxic effects, or withdrawal with consent.

Description:

This trial is designed as randomized phase 2 controlled clinical trial. Subjects who fulfill following inclusion criteria will be admitted to this phase 2 trial and will be excluded if they fulfill any one of the exclusion criteria. All patients must have undergone first-line of chemotherapy (either modified FOLFIRINOX or gemcitabine-based) for at least 3 months and achieved at least stable disease. The inclusion criteria are as follow: 1) histologically and cytologically confirmed advanced pancreatic ductal adenocarcinoma according to AJCC (American Joint Committee on Cancer) TNM system; 2) have undergone first-line of chemotherapy (modified FOLFIRINOX or gemcitabine-based) for at least 3 months and achieved at least stable disease; 3) Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0-2; 4) age above 18 ages and 5) life expectancy more than three months. Meanwhile, the exclusion criteria are 1) pregnant and lactating women; 2) concomitant beta-adrenergic drug blockers medication; 3) active infection; 4) current enrollment in another clinical study with an investigational agent and 5) patients who undergo pancreas or metastatic site radiotherapy need to be recovered from the toxicities. Next, patients who achieve at least stable disease will be checked for peripheral blood mononuclear cells (PBMC) adequacy, hematoprofiling using full blood count (FBC) and their baseline status. This is followed by leukapheresis once all conditions satisfied and met. Apheretic products will be sent to local sponsor-contracted laboratory prior for incubation of patients' immune cells with PDAC antigens under specific medium. All subjects in this trial have been diagnosed with advanced stage of PDAC and being treated with standard chemo: modified FOLFIRINOX or gemcitabine-based regime for at least 3 months. Once the DC+CIK infusion bags are ready to be manufactured, those who achieve at least stable disease or partial response will be randomized in ratio of 1:1 into treatment group: DC-CIK plus S1 (27 patients) and control group: S-1 alone (27 patients). For treatment group, DC+CIK infusion bag will be administrated right after 17 days patients discharged. Patients will be infused with DC first, followed by CIK immune cells on day 1. DC+CIK immunotherapy will be repeated for another 2 times (day 8 and 15) as one cycle. All patients are left to rest for a week (start from day 21) prior to receive another 3 times of infusion (day 28, 35 and 42) if condition allowed. DC+CIK immunotherapy will be offered as two cycles for every patient in treatment group. Additional third cycle can be performed on those who tolerate well with no toxicity or respond very well. Patients from treatment group will be assessed for their eligibility to receive booster dose on following conditions: 1) tumour achieves partial response or stable disease and 2) ECOG-PS performance status of 0-2 and 3) doesn't exhibit grade 1 and 2 toxicities to improve tumour control. Additionally, S-1 will be given twice daily after meals for 2 weeks as first cycle along with DC+CIK. Next second cycle of S-1 will be given after 7-days (1 week) rest. The cycles will be repeated every 21 days until disease progression, unacceptable toxic effects, or withdrawal with consent. Dose of S-1 will be determined according to the body surface area. Meanwhile, patients from control group will receive S-1 alone as maintenance therapy twice daily after meals for 14 days (2 weeks) as one cycle. The next cycle of S-1 will be given after 7-days rest. The cycles will be repeated every 21 days until disease progression, unacceptable toxic effects, or withdrawal with consent. All patients will be followed up for clinical effects of S-1 combined maintenance therapy translated by tumour best overall response towards the treatment, either complete response (CR), partial response (PR), stable disease (SD) outcomes or progression disease (PD) and level of prognostic biomarkers. Besides, all patients will undergo baseline CT/MRI scan within 4 weeks of patient randomization and before immunotherapy being initiated. This is followed by reassessment CT/MRI scan at the end of 8th weeks starting from date of first treatment, and after S-1 combined DC+CIK immunotherapy completed. All patients will be followed-up regularly to monitor disease progression using reassessment CT/MRI scan at eight weeks interval until first PD observed (Timeframe = 12 months). Patients' blood will be taken before maintenance treatment initiated and after maintenance treatment completed to evaluate serum cytokine concentration changes and level of circulating cancer stem cells (CSCs). Furthermore, blood will also be taken after each cycle of DC+CIK immunotherapy completed to evaluate baseline peripheral immune profile. Serum CA19-9 concentrations will be monitored every 4 weeks using blood test after first cycle of DC+CIK treatment completed. Two endoscopic-ultrasound (EUS) guided biopsy pancreatic specimens (optional) will be collected from treatment group patients before maintenance treatment given and after completion of second cycle DC+CIK immunotherapy to quantify tumour-infiltrating lymphocytes (TILs), apoptotic protein expressed on tumour cells and apoptotic cells. Finally, patients will be monitored for side effects, toxicities and response toward treatment weekly starting on day 7th onward after initial DC+CIK administration. All dated events occurring any time after informed consent will be obtained until 7 days (for non-serious AEs) or 30 days (for SAEs) after the last day of study participation.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 52
• Est. completion date: June 2025
• Est. primary completion date: December 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

1. Histologically and cytologically confirmed advanced pancreatic ductal adenocarcinoma according to AJCC (American Joint Committee on Cancer) TNM system;

2. Have undergone first-line of chemotherapy (modified FOLFIRINOX or gemcitabine-based) for at least 3 months and achieved at least stable disease;

3. Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0-2;

4. Age above 18 ages

5. Life expectancy more than three months.

Exclusion Criteria:

1. Pregnant and lactating women

2. Concomitant beta-adrenergic drug blockers medication

3. Active infection

4. Current enrollment in another clinical study with an investigational agent

5. Patients who undergo radiotherapy to pancreas or metastatic site need to be recovered from the toxicities

Related Conditions & MeSH terms

• Adenocarcinoma
• Advanced Solid Tumor
• Pancreatic Ductal Adenocarcinoma

Intervention

Biological:
• Dendritic cell + Cytokine-induced killer cell (DC+CIK) immunotherapy
DC+CIK immunotherapy will be administrated with S-1 chemo drug as maintenance treatment for patients with advanced PDAC

Drug:
• Tegafur Only Product
Tegafur (TS-1) will be administrated alone as maintenance treatment to control group as standard of care

Locations

Country	Name	City	State
Malaysia	Clinical Oncology Department, Ummc	Petaling Jaya	Kuala Lumpur

Sponsors (1)

Lead Sponsor	Collaborator
University of Malaya

Country where clinical trial is conducted

Malaysia, 

References & Publications (16)

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He W, Huang Z, Zhou S, Huang L, Wang B, Zhu L, Ding Y, Yu YL, Zhang S. The effect of DC+CIK combined therapy on rat liver cancer model and its modulatory effect on immune functions. Eur Rev Med Pharmacol Sci. 2018 Feb;22(3):778-785. doi: 10.26355/eurrev_201802_14312. — View Citation

Miller KD, Fidler-Benaoudia M, Keegan TH, Hipp HS, Jemal A, Siegel RL. Cancer statistics for adolescents and young adults, 2020. CA Cancer J Clin. 2020 Nov;70(6):443-459. doi: 10.3322/caac.21637. Epub 2020 Sep 17. — View Citation

Pan CC, Huang ZL, Li W, Zhao M, Zhou QM, Xia JC, Wu PH. Serum alpha-fetoprotein measurement in predicting clinical outcome related to autologous cytokine-induced killer cells in patients with hepatocellular carcinoma undergone minimally invasive therapy. Chin J Cancer. 2010 Jun;29(6):596-602. doi: 10.5732/cjc.009.10580. — View Citation

Sudo K, Nakamura K, Yamaguchi T. S-1 in the treatment of pancreatic cancer. World J Gastroenterol. 2014 Nov 7;20(41):15110-8. doi: 10.3748/wjg.v20.i41.15110. — View Citation

Ueno H, Ioka T, Ikeda M, Ohkawa S, Yanagimoto H, Boku N, Fukutomi A, Sugimori K, Baba H, Yamao K, Shimamura T, Sho M, Kitano M, Cheng AL, Mizumoto K, Chen JS, Furuse J, Funakoshi A, Hatori T, Yamaguchi T, Egawa S, Sato A, Ohashi Y, Okusaka T, Tanaka M. Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol. 2013 May 1;31(13):1640-8. doi: 10.1200/JCO.2012.43.3680. Epub 2013 Apr 1. — View Citation

Wang Z, Liu Y, Li R, Shang Y, Zhang Y, Zhao L, Li W, Yang Y, Zhang X, Yang T, Nie C, Han F, Liu Y, Luo S, Gao Q, Song Y. Autologous cytokine-induced killer cell transfusion increases overall survival in advanced pancreatic cancer. J Hematol Oncol. 2016 Feb 3;9:6. doi: 10.1186/s13045-016-0237-6. — View Citation

Xie Y, Huang L, Chen L, Lin X, Chen L, Zheng Q. Effect of dendritic cell-cytokine-induced killer cells in patients with advanced colorectal cancer combined with first-line treatment. World J Surg Oncol. 2017 Nov 28;15(1):209. doi: 10.1186/s12957-017-1278-1. — View Citation

Yuan X, Zhang AZ, Ren YL, Wang XL, Jiang CH, Yang L, Liu CX, Liang WH, Pang LJ, Gu WY, Li F, Hu JM. Cytokine-induced killer cells/dendritic cells and cytokine-induced killer cells immunotherapy for the treatment of esophageal cancer: A meta-analysis. Medicine (Baltimore). 2021 Apr 2;100(13):e24519. doi: 10.1097/MD.0000000000024519. — View Citation

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* Note: There are 16 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of participants with treatment-related adverse events	Safety of patients towards treatment will be evaluated based on number of adverse events (AEs) and serious adverse events (SAEs) reported.	3 months
Primary	Incidence of treatment-emergent hematologic side effects	Feasibility of experimental treatment will be evaluated based on result of differential complete blood count.	3 months
Secondary	Clinical benefit rate (CBR) - Change from baseline in tumour burden	Tumour best overall response will be evaluated based on baseline CT/MRI scan, conducted within 4 weeks of patient randomizations and before immunotherapy, followed by reassessment CT/MRI scan at the end of 8th weeks after S-1 combined DC+CIK maintenance therapy completed for both treatment and control group using RECIST Guidelines version 1.1	12 months
Secondary	Efficacy of S-1 combined DC+CIK in controlling tumour	Intratumour analysis of tumour-infiltrating lymphocytes; EUS-biopsy will be consented toward subjects before enroll the trial. Overall, two endoscopic-ultrasound (EUS) guided biopsy pancreatic specimens (optional) will be collected from treatment group patients before maintenance treatment given and after completion of second cycle DC+CIK immunotherapy. The TILs will be stained using immunohistochemistry method before quantified using H-score under bright-field microscope.	3 months