Gemcitabine With or Without Capecitabine and/or Radiation Therapy or Gemcitabine With or Without Erlotinib in Treating Patients With Locally Advanced Pancreatic Cancer That Cannot Be Removed by Surgery
- Conditions
- Pancreatic Cancer
- Interventions
- Drug: capecitabineDrug: erlotinib hydrochlorideDrug: gemcitabine hydrochlorideOther: laboratory biomarker analysisRadiation: radiation therapy
- Registration Number
- NCT00634725
- Lead Sponsor
- GERCOR - Multidisciplinary Oncology Cooperative Group
- Brief Summary
RATIONALE: Drugs used in chemotherapy, such as gemcitabine and capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Erlotinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radiation therapy uses high-energy x-rays to kill tumor cells. It is not yet known which regimen of chemotherapy with or without erlotinib and/or radiation therapy is most effective in treating pancreatic cancer.
PURPOSE: This randomized phase III trial is studying giving gemcitabine together with or without capecitabine and/or radiation therapy to see how well it works compared with giving gemcitabine together with or without erlotinib in treating patients with locally advanced pancreatic cancer that cannot be removed by surgery.
- Detailed Description
OBJECTIVES:
Primary
* To assess whether administrating chemoradiotherapy in patients whose tumor is controlled after 4 months of induction chemotherapy (CT) increases survival compared with continuation of the same CT in patients with unresectable, locally advanced adenocarcinoma of the pancreas.
Secondary
* To assess whether erlotinib hydrochloride combined with gemcitabine hydrochloride and administered as maintenance treatment increases progression-free survival compared with gemcitabine hydrochloride alone and without maintenance treatment.
* To evaluate the response rate in the CT and chemoradiotherapy (CRT) arms.
* To evaluate tolerance to erlotinib hydrochloride as maintenance treatment after the end of CT or CRT.
* To study the predictive molecular factors (i.e., survivin, K-ras, EGFR, PTEN, or AKT) of survival.
OUTLINE: This is a multicenter study. Patients in the first randomization are stratified according to center and ECOG performance status (0-1 vs 2). Patients in the second randomization are stratified according to center and initial treatment arm (I vs II).
* First randomization: Patients are randomized to 1 of 2 treatment arms.
* Arm I: Patients receive gemcitabine hydrochloride IV over 30 minutes on days 1, 8, 15, 22, 29, 36, and 43. Following the first evaluation, patients continue to receive gemcitabine hydrochloride on days 57, 64, 71, 85, 92, and 99 for a total of 4 months.
* Arm II: Patients receive gemcitabine hydrochloride IV over 30 minutes on days 1, 8, 15, 22, 29, 36, and 43. Following the first evaluation, patients continue to receive gemcitabine hydrochloride on days 57, 64, 71, 85, 92, and 99. Patients also receive oral erlotinib hydrochloride once daily for 4 months.
After completion of treatment in the first randomization proceed to the second randomization.
* Second randomization: Patients are randomized to 1 of 4 treatment arms.
* Arm I: Patients continue gemcitabine hydrochloride as in arm I in the first randomization on days 113, 120, and 127 and on days 141, 148, and 155 for 2 months in the absence of disease progression.
* Arm II: Patients continue gemcitabine hydrochloride as in arm II in the first randomization on days 113, 120, and 127 and on days 141, 148, and 155 and oral erlotinib hydrochloride daily for 2 months followed by erlotinib hydrochloride alone as maintenance therapy in the absence of disease progression.
* Arm III: Patients receive oral capecitabine twice daily and undergo radiotherapy beginning on day 127, 5 days a week, for 6 weeks, in the absence of disease progression.
* Arm IV: Patients receive oral capecitabine twice daily and undergo radiotherapy beginning on day 127, 5 days a week, for 6 weeks. Beginning 15 days after completion of CRT, patients receive a reintroduction of oral erlotinib hydrochloride alone once daily in the absence of disease progression or unacceptable toxicity.
Tumor tissue will be analyzed for the relationship between biological markers and resistance to treatment.
After completion of study treatment, patients are followed every 2 months.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 820
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm 2 (B1) Gemcitabine + Erlotinib gemcitabine hydrochloride B1 Gemcitabine + Erlotinib (100mg/d) 2 months, then erlotinib maintenance (150 mg/d)until progression Arm 2 (B1) Gemcitabine + Erlotinib laboratory biomarker analysis B1 Gemcitabine + Erlotinib (100mg/d) 2 months, then erlotinib maintenance (150 mg/d)until progression Arm 3 (A2) CRT capecitabine A2 CRT then stop until progression Arm 1 (A1) - Gemcitabine laboratory biomarker analysis Gemcitabine 2 months, then stop until progression Arm 1 (A1) - Gemcitabine gemcitabine hydrochloride Gemcitabine 2 months, then stop until progression Arm 2 (B1) Gemcitabine + Erlotinib erlotinib hydrochloride B1 Gemcitabine + Erlotinib (100mg/d) 2 months, then erlotinib maintenance (150 mg/d)until progression Arm 3 (A2) CRT laboratory biomarker analysis A2 CRT then stop until progression Arm 3 (A2) CRT radiation therapy A2 CRT then stop until progression Arm 4 (B2) CRT then erlotinib erlotinib hydrochloride B2 CRT then erlotinib maintenance (150mg/d) until progression Arm 4 (B2) CRT then erlotinib laboratory biomarker analysis B2 CRT then erlotinib maintenance (150mg/d) until progression Arm 4 (B2) CRT then erlotinib radiation therapy B2 CRT then erlotinib maintenance (150mg/d) until progression Arm 4 (B2) CRT then erlotinib capecitabine B2 CRT then erlotinib maintenance (150mg/d) until progression
- Primary Outcome Measures
Name Time Method Overall survival from the date of the first randomization to the date of patient death,due to any cause, or to the last date the patient was known to be alive, assessed up to 8 years after the beginning of the study an interim analysis is planned when 196 deaths will be observed
- Secondary Outcome Measures
Name Time Method Progression-free survival time from the date of the first randomization to the date of progressive disease or death, assessed up to 8 years after the beginning of the study. Relationship between biological markers and survival From baseline to death, assessed up to 8 years after the beginning of the study 1 biopsy/patient of the pancreas before treatment
tolerance to erlotinib from start of treatment until the event has resolved or stabilized or until death To evaluate tolerance to erlotinib as maintenance treatment after the end of CT or CRT.
During each visit, any adverse events will be noted and graded according to version 3 of the NCI-CTCAE. Any adverse events that persist at the end of the CTI will be followed up until they disappear.
Trial Locations
- Locations (72)
Clinique De Valdegour
🇫🇷Nimes, France
Hopital Prive Jean Mermoz
🇫🇷Lyon, France
Institut Sainte Catherine
🇫🇷Avignon, France
Centre Hospitalier de Beauvais
🇫🇷Beauvais, France
CHU Poitiers
🇫🇷Poitiers, France
Hopital Tenon
🇫🇷Paris, France
Centre Radiotherapie Oncologie Moyenne Garonne
🇫🇷Agen, France
Centre Hospitalier de la Cote Basque
🇫🇷Bayonne, France
Hopital Saint Andre
🇫🇷Bordeaux, France
Hopital Europeen Georges Pompidou
🇫🇷Paris, France
Hopital Saint-Louis
🇫🇷Paris, France
Hopital Bichat - Claude Bernard
🇫🇷Paris, France
Hopital Saint Antoine
🇫🇷Paris, France
Centre Catalan d'Oncologie
🇫🇷Perpignan, France
Hopital Haut Leveque
🇫🇷Pessac, France
Hopital Rene Dubos
🇫🇷Pontoise, France
Centre Hospitalier de Tarbes
🇫🇷Tarbes, France
Centre Hospitalier Regional Metz Thionville
🇫🇷Thionville, France
CHRU de Tours - Hopital Trousseau
🇫🇷Tours, France
Nouvelle Clinique Generale
🇫🇷Valence, France
Centre Hospitalier d'Aix en Provence
🇫🇷Aix en Provence, France
Centre Paul Papin
🇫🇷Angers, France
Centre Hospitalier d'Auxerre
🇫🇷Auxerre, France
Polyclinique Sainte Marguerite
🇫🇷Auxerre, France
Hopital Duffaut
🇫🇷Avignon, France
Centre Hospitalier Regional de Besancon - Hopital Jean Minjoz
🇫🇷Besancon, France
Hopital de Beziers
🇫🇷Beziers, France
Institut Bergonie
🇫🇷Bordeaux, France
Polyclinique Bordeaux Nord Aquitaine
🇫🇷Bordeaux, France
Hopital Ambroise Pare
🇫🇷Boulogne-Billancourt, France
Clinique Tivoli
🇫🇷Bordeaux, France
Centre Hospitalier Pierre Oudot
🇫🇷Bourgoin-Jallieu, France
CHU de Caen
🇫🇷Caen, France
Hopital Louis Pasteur
🇫🇷Colmar, France
Hopital Beaujon
🇫🇷Clichy, France
Centre Hospitalier Compiegne
🇫🇷Compiegne, France
Polyclinique Du Parc
🇫🇷Caen, France
Centre Hospitalier de Digne les Bains
🇫🇷Digne Cedex, France
Centre Hospitalier de Dax
🇫🇷Dax, France
Centre Hospitalier Universitaire Henri Mondor
🇫🇷Creteil, France
Hopital Du Bocage
🇫🇷Dijon, France
C.H.U. de Nimes - Groupe Hospitals-Universitaire Caremeau
🇫🇷Nimes, France
Centre Hospitalier Draguignan
🇫🇷Draguignan, France
CHU de Grenoble - Hopital de la Tronche
🇫🇷Grenoble, France
Centre de Lutte Contre le Cancer Georges-Francois Leclerc
🇫🇷Dijon, France
Hopital Louis Pasteur - Le Coudray
🇫🇷Le Coudray, France
Centre Hospitalier de Lagny
🇫🇷Lagny Sur Marne, France
Centre Hospitalier Departemental
🇫🇷La Roche Sur Yon, France
Clinique Victor Hugo
🇫🇷Le Mans, France
Hopital Robert Boulin
🇫🇷Libourne, France
Centre Hospitalier Universitaire de Bicetre
🇫🇷Le Kremlin Bicetre, France
Polyclinique Du Bois
🇫🇷Lille, France
Polyclinique des Quatre Pavillons
🇫🇷Lormont, France
Centre Leon Berard
🇫🇷Lyon, France
Hopital Edouard Herriot - Lyon
🇫🇷Lyon, France
Centre Hospitalier St. Joseph St. Luc
🇫🇷Lyon, France
Centre Gray
🇫🇷Maubeuge, France
Hopital de la Croix Rousse
🇫🇷Lyon, France
Marseille Institute of Cancer - Institut J. Paoli and I. Calmettes
🇫🇷Marseille, France
CHU de la Timone
🇫🇷Marseille, France
Centre Hospitalier Chanaux
🇫🇷Macon, France
Centre Hospitalier
🇫🇷Saint-Omer, France
Centre Hospitalier General de Mont de Marsan
🇫🇷Mont-de-Marsan, France
Centre Hospitalier de Meaux
🇫🇷Meaux, France
Centre Hospitalier de Montelimar
🇫🇷Montelimar, France
CHR D'Orleans - Hopital de la Source
🇫🇷Orleans, France
Hopital Pitie-Salpetriere
🇫🇷Paris, France
Hopital Charles Nicolle
🇫🇷Rouen, France
Centre Hospitalier Lyon Sud
🇫🇷Pierre Benite, France
CHU - Robert Debre
🇫🇷Reims, France
Hopital Saint Joseph
🇫🇷Paris, France
Centre Hospitalier Bretagne Atlantique
🇫🇷Vannes, France