Pancreatic Adenocarcinoma Resectable Clinical Trial
— NEOPACHI-001Official title:
Evaluation of Tumoral Perfusion Modification by Dynamic Imaging After Neoadjuvant Chemotherapy Combining Gemcitabine and a Hedgehog Inhibitor (Vismodegib) in Patients With Resectable Pancreatic Adenocarcinoma
Pancreatic ductal adenocarcinoma (PDAC) has one of the worst prognoses of all human cancers
and is considered as a sanctuary, resistant to most of the drugs used. Identification of new
molecular targets involved in its pathogenesis is urgently needed and required both proper
and innovative efficacy assessment.
This proof-of-concept trial is studying the "dynamic" tumor response after the
administration of a short course (4 weeks) neoadjuvant combination of gemcitabine and a
Hedgehog inhibitor (Vismodegib) before surgery in patients with operable pancreatic cancer.
Status | Not yet recruiting |
Enrollment | 21 |
Est. completion date | December 2016 |
Est. primary completion date | June 2014 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Histo(cyto)logically proven ductal pancreatic adenocarcinoma - Resectable or potentially resectable tumor; resectability assessed during a multidisciplinary meeting with expert surgeon and radiologist - First line chemotherapy - Age > 18 years - WHO performance status (PS) grade 0 or 1; - Absolute neutrophil count > 1.5 x 10 9 / L, platelets > 100 x 10 9/ L, creatinine clearance (Cockcroft and Gault formula) > 60 ml/min, haemoglobin level > 10 g/dl (transfusions authorized), bilirubin<1.5 g/dl; - Optimal biliary drainage; - Women of child-bearing potential (WCBP), defined as a sexually mature woman who has not undergone a hysterectomy or tubal ligation of who has not been naturally postmenopausal for at least 24 consecutive months, must have a negative serum or urine pregnancy test prior to treatment. All WCBP, all sexually active male patients, and all partners of patients must agree to use adequate methods of birth control throughout the study; - Signed written informed consent. Exclusion Criteria: - Locally advanced non resectable or metastatic pancreatic adenocarcinoma - Previous anticancer therapy for the pancreatic adenocarcinoma - Biliary obstruction without endoscopic biliary drainage - Any contre-indication for surgery - Prior malignancy (except non-melanoma skin cancer, and in situ carcinoma of the uterine cervix treated with a curative intent and any other tumor in complete remission with a disease-free interval > 3 years) - Uncontrolled congestive heart failure or angina pectoris, myocardial infarction within 1 year prior to study entry, uncontrolled hypertension (systolic pressure > 160 mm or diastolic pressure > 100 mm under well conducted antihypertensive treatment), QT prolongation - Major uncontrolled infection - Severe hepatic impairment - Any medical, psychological, or social condition, which, in the opinion of the investigator, could hamper patient's compliance to the study protocol and/or assessment/interpretation of the data - Pregnant or lactating women, or patients of both genders with procreative potential not using adequate contraceptive methods - Patients receiving or having received any investigational treatment within 4 weeks prior to study entry, or participating to another clinical study;Subject previously enrolled into this study. |
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Country | Name | City | State |
---|---|---|---|
Belgium | Erasme University Hospital (ULB) | Brussels | |
Belgium | Antwerp University Hospital (UZA) | Edegem | Antwerpen |
Lead Sponsor | Collaborator |
---|---|
Jean-Luc Van Laethem | Roche Pharma AG |
Belgium,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Tumor response as assessed by Response Evaluation Criteria in Solid Tumors (RECIST) criteria. | 4 weeks (duration of the neoadjuvant chemotherapy). | No | |
Other | Effect of treatment on selected biomarkers in tumor resection specimens. | The objective is to identify within pre-therapeutic samples and surgical specimens several specific biomarkers involved (1) in the Hedgehog signalling pathway (GLI1, Sonic Hedgehog, Patched, Smoothened immunohistochemical patterns protein expression) and predicting response to anti-Hh therapy, (2) in the metabolization of gemcitabine (human equilibrative nucleoside transporter 1, deoxycytidine kinase) and predicting response to gemcitabine therapy, and (3) in the relative contribution of both anti-Hh therapy and gemcitabine therapy. | 4 weeks (duration of the neoadjuvant chemotherapy). | No |
Primary | "Dynamic" tumor response rate as defined by a 20% modification of tumoral perfusion and cellular density parameters. | In order to detect changes in the tumor microenvironment and to monitor treatment efficacy, Dynamic Contrast-Enhanced-Magnetic Resonance Imaging (DCE-MRI) and Diffusion Weighted-Magnetic Resonance Imaging (DW-MRI) constitute tools more and more used. The acquired data can be analyzed using a pharmacokinetic model to obtain quantitative parameters relative to tissue perfusion and vascular permeability (Ktrans, a volume transfer constant of contrast agent between blood plasma and the extravascular extracellular space; Apparent Diffusion Coefficient as a surrogate marker of tissue cellularity). DCE/DW-MRI will be achieved weekly before each neoadjuvant chemotherapy treatment and before surgery. Each patient will be his/her own control by comparing serial imaging results with those of the baseline MRI. | 4 weeks (duration of the neoadjuvant chemotherapy). | No |
Secondary | Number of participants with adverse events as assessed by National Cancer Institute (NCI) Common Toxicity Criteria for Adverse Effects (CTCAE) V4.0. | Number of participants with (serious) adverse events will be considered as a measure of safety of the whole therapeutic sequence (gemcitabine + Hedgehog inhibitor+ surgery). | End of study follow-up (up to 2 years). | Yes |
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