Sequential Use of AG and mFOLFIRINOX as Neoadjuvant Chemotherapy for Resectable Pancreatic Cancer

Neoadjuvant Chemotherapy Clinical Trial

Official title:

Sequential Use of Nab-paclitaxel Plus Gemcitabine and mFOLFIRINOX as Neoadjuvant Chemotherapy for Resectable Pancreatic Cancer: A Randomized Control Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03750669
• Other study ID #: CISPD-1
• Status: Recruiting
• Phase: Phase 3
• Start date: October 20, 2018
• Est. completion date: October 20, 2026

Study information

• Verified date: January 2024
• Source: Second Affiliated Hospital, School of Medicine, Zhejiang University
• Contact: Tingbo Liang, MD PhD
• Phone: 8613666676128
• Email: liangtingbo[@]zju.edu.cn
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The prognosis of pancreatic cancer is extremely poor. Current guidelines recommend Nab-paclitaxel, Gemcitabine and modified Folfirinox as the first-line chemotherapeutic regimen. Studies have shown that sequential chemotherapeutic regimen can effectively delay the drug resistance and improve the effect of chemotherapy. Here investigators intend to assess the effect of sequential treatment with Nab-paclitaxel plus Gemcitabine and modified Folfirinox as neoadjuvant chemotherapy for resectable pancreatic adenocarcinoma.

Description:

Investigators chose resectable pancreatic adenocarcinoma patients. The planned treatment was given to the participants after randomization. Tumor size, recurrence-free survival, overall survival, drugs related side effects and other endpoints events were recorded and analyzed, to assess the sequential treatment with Nab-paclitaxel plus Gemcitabine and modified Folfirinox could or couldn't benefit the prognosis of resectable pancreatic adenocarcinoma.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 291
• Est. completion date: October 20, 2026
• Est. primary completion date: October 20, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

• Pathologically (histologically or cytologically) confirmed pancreatic ductal adenocarcinoma (PDAC).

• No evidence of distant metastasis (such as liver, peritoneum, lung) evaluated by abdominal contrast-enhanced CT, MRI, and chest CT. PET/CT or other imaging examinations would be used if necessary.

• Initial assessment for definitive resectable tumors (resectability judgment is based on CT enhanced scan or magnetic resonance imaging, NCCN2018 first edition standard).

• ECOG score 0 or 1.

• Serum creatinine level is normal, and serum total bilirubin level is less than 1.5 x ULN.

• ALT and AST are less than 2 x ULN.

• If biliary obstruction is observed, biliary decompression should be performed when the patient is randomly assigned to receive neoadjuvant chemotherapy.

• Leukocyte count (> 3.5 x 10^6 /mL), neutrophil count (> 1.5 x 10^6 /mL), platelet count (> 80 x 10^6 /mL), hemoglobin (> 9 g/dL).

• Signed informed consent.

Exclusion Criteria:

• History of malignance treatment in the past, excluding basal and cutaneous squamous cell carcinoma, cervical carcinoma in situ, papillary thyroid carcinoma

• Tumor is a local recurrent lesion.

• Imaging confirmed severe portal hypertension / cavernous transformation.

• Ascites

• Gastric outlet obstruction

• Respiratory failure requires supplementation of oxygen.

• Immune deficiency syndrome, such as active tuberculosis and HIV infection.

• Hematological precancerous diseases, such as myelodysplastic syndromes.

• Major cardiovascular diseases (including myocardial infarction, unstable angina, congestive heart failure, severe uncontrolled arrhythmia) during the past six months of enrollment.

• Evidence of clinical-related or previous interstitial lung disease, such as noninfectious pneumonia or pulmonary fibrosis, or baseline chest CT scan or chest X-ray findings

• Previous or physical findings of central nervous system disease, except for adequately treated (e.g. primary brain tumors, uncontrolled seizures or strokes with standard medications)

• Preexisting neuropathy > 1 (NCI CTCAE).

• Allograft requires immunosuppressive therapy or other major immunosuppressive therapies.

• Severe serious wounds, ulcers or fractures.

• Confirmed coagulant disease.

• Clinical evaluation is unacceptable.

Related Conditions & MeSH terms

• Adenocarcinoma
• Neoadjuvant Chemotherapy
• Pancreatic Adenocarcinoma Resectable
• Pancreatic Neoplasms

Intervention

Drug:
• AG regimen
Combination of Nab-paclitaxel 125 mg/m^2 and Gemcitabine 1000 mg/m^2
• mFolfirinox
Folic acid 400mg/m^2, 5- fluorouracil 2400mg/m^2 for 46h, irinotecan 135mg/m^2 and oxaliplatin 68mg/m^2

Locations

Country	Name	City	State
China	The second affiliated hospital of Zhejiang University	Hangzhou	Zhejiang

Sponsors (1)

Lead Sponsor	Collaborator
Second Affiliated Hospital, School of Medicine, Zhejiang University

Country where clinical trial is conducted

China, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Disease-free survival	The time of initial response until documented tumor recurrence.	Up to approximately 60 months
Secondary	Overall survival	The time of initial response until documented patient death	Up to approximately 60 months
Secondary	Objective response rate	The proportion of patients with tumor size reduction of a predefined amount and for a minimum time period	Up to approximately 60 months
Secondary	Carbohydrate antigen 19-9	Serum Carbohydrate antigen 19-9 level	Up to approximately 60 months
Secondary	EORTC QLQ - PAN26 score	QLQ score assessed by the European Organization for Research and Treatment of Cancer Quality of Life scale for pancreatic cancer (EORTC QLQ - PAN26. For details: PMID 10533475.)	Up to approximately 60 months
Secondary	Serious adverse events incidence	The proportion of patients with grade 3/4 adverse events	Up to approximately 60 months