Scheduling Nab-paclitaxel With Gemcitabine
- Conditions
- Pancreatic Adenocarcinoma Metastatic
- Interventions
- Registration Number
- NCT03529175
- Lead Sponsor
- CCTU- Cancer Theme
- Brief Summary
Metastatic pancreatic cancer is difficult to treat. Until recently, most patients would be offered treatment with a chemotherapy drug called gemcitabine. However, a large international trial showed that combining gemcitabine with a drug called nab-paclitaxel (or abraxane) was more effective compared with gemcitabine alone. The purpose of this study is to compare two different ways of combining gemcitabine with abraxane. Conventionally, both drugs are given on the same day via a drip into a vein in the arm but research suggests that giving abraxane 24 hours in advance of gemcitabine could possibly be more beneficial.
In this study, blood and tumour samples will be collected and analysed to try to confirm what has been seen in the laboratory studies. In addition, the investigators wish to find out whether certain tumour characteristics (called biomarkers) can be used to predict for response to chemotherapy.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 146
-
Aged ≥ 18 years old
-
Signed informed consent and ability to comply with the protocol
-
Histologically or cytologically confirmed metastatic PDAC
-
Radiologically confirmed stage IV disease and measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1; baseline tumour assessments and measurements must be done within 28 days prior to randomisation
-
Karnofsky performance status ≥70%
-
Life expectancy >12 weeks from the date of screening assessment
-
Adequate bone marrow function
- Absolute neutrophil count (ANC) ≥1.5 x 109 /L
- Haemoglobin (Hb) ≥ 100 g/L
- Platelets ≥100 x 109 /L
- White blood cell count (WBC) ≥ 3 x 109 /L
-
Adequate liver function
- Aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) ≤2.5 x upper limit of normal range (ULN)
- Total bilirubin <1.5 x ULN
-
Adequate renal function defined as a serum creatinine ≤1.5 x ULN or calculated creatinine clearance by Cockcroft-Gault of ≥50 mL/min
-
Received no prior systemic therapy for metastatic disease
-
Prior adjuvant chemotherapy (with GEM or any other drug/s) is allowed if completed at least 6 months previously
-
Prior radiotherapy is allowed as long as there is measurable disease which has not been irradiated
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Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests, completion of QoL and HE questionnaires and other study procedures
-
Confirmation of tumour tissue sample collected within 12 weeks prior to randomisation and blood to be taken prior to randomisation
-
Women of child-bearing potential (WCBP), defined as a sexually mature woman not surgically sterilized or not post-menopausal for at least 24 consecutive months if age ≤55 years or 12 months if age >55 years, must have a negative serum or urine pregnancy test within 14 days prior to randomisation
-
All WCBP and all sexually active male patients must agree to use effective contraception methods throughout the study and for 30 days after the final dose of study drug for WCBP and for up to 6 months after treatment for male patients
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Patients with operable or locally advanced PDAC
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Other invasive malignancies diagnosed within the last 5 years, except non-melanoma skin cancer and localized cured prostate cancer
-
Significant acute or chronic medical or psychiatric condition, disease or laboratory abnormality which in the judgment of the investigator would place the patient at undue risk or interfere with the trial. Examples include, but are not limited to:
- Patients who have had a venous thromboembolic event who are not appropriately anticoagulated or have had a significant bleeding episode in the 3 weeks prior to randomisation
- Patients with symptoms of severe chronic obstructive airways disease or significant shortness of breath at rest AND have an FEV1<1.0 L within the last 6 months
- Patients with a history of interstitial lung disease, sarcoidosis, silicosis, idiopathic pulmonary fibrosis, pulmonary hypersensitivity pneumonitis, cystic fibrosis or bronchiectasis
- Patients with uncontrolled ischaemic heart or other cardiovascular event (myocardial infarction (MI), new angina, stroke transient ischaemic attack (TIA), or new congestive cardiac failure (CCF)) within the last 6 months
- Patients with stable but significant cardiovascular disease defined by heart failure (New York Heart Association Functional Classification (NYHF) III or IV, see Appendix 3) or frequent angina
- Presence of active infection
- Cirrhotic liver disease, known chronic active or acute hepatitis B, or hepatitis C
- Known allergy or hypersensitivity to GEM or ABX
-
Women who are pregnant, plan to become pregnant or are lactating
-
Routine use of any of the following will exclude patients:
- Oral anti-oxidant supplements: beta-carotene, selenium, lutein, zeaxanthin, lycopene, pycnogenol, fernblock, omega-3S, vitamin C, vitamin E, astaxanthin
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Sequential Abraxane (nab-paclitaxel) Intravenous Abraxane 125 mg/m2 30-minute infusion will be administered on days 1, 8 and 15 of a 4-week cycle. Intravenous Gemcitabine 1000 mg/m2 30-minute infusion will be administered on days 2, 9 and 16 of a 4-week cycle. Gemcitabine must be delivered 24 +/- 2 hours after commencing Abraxane infusion. Concomitant Gemcitabine Intravenous Abraxane125 mg/m2 30-minute infusion followed immediately by intravenous Gemcitabine 1000 mg/m2 30-minute infusion will be administered on days 1, 8 and 15 of a 4-week cycle. Concomitant Abraxane (nab-paclitaxel) Intravenous Abraxane125 mg/m2 30-minute infusion followed immediately by intravenous Gemcitabine 1000 mg/m2 30-minute infusion will be administered on days 1, 8 and 15 of a 4-week cycle. Sequential Gemcitabine Intravenous Abraxane 125 mg/m2 30-minute infusion will be administered on days 1, 8 and 15 of a 4-week cycle. Intravenous Gemcitabine 1000 mg/m2 30-minute infusion will be administered on days 2, 9 and 16 of a 4-week cycle. Gemcitabine must be delivered 24 +/- 2 hours after commencing Abraxane infusion.
- Primary Outcome Measures
Name Time Method Progression free survival From participant randomisation to the point at which disease progression is reported (i.e. 12 months) The primary objective of the trial is to investigate the outcome of sequential administration of nab-paclitaxel combined with gemcitabine (ABX/GEM, 24 hours apart) in patients with metastatic pancreatic ductal adenocarcinoma (PDAC) in terms of progression-free survival.
- Secondary Outcome Measures
Name Time Method Patient Safety 1 year after end of treatment visit Adverse Events (including Serious Adverse Events), abnormal laboratory test results and performance status
Treatment Efficacy 8 weeks response to treatment assessed using radiological RECIST criteria
Trial Locations
- Locations (23)
Colchester Hospital
🇬🇧Colchester, United Kingdom
The Royal Surrey County Hospital
🇬🇧Guildford, United Kingdom
St James' Institute of Oncology
🇬🇧Leeds, United Kingdom
Leicester Royal Infirmary
🇬🇧Leicester, United Kingdom
Edinburgh Cancer Research Centre
🇬🇧Edinburgh, United Kingdom
Cambridge University Hospitals NHS Foundation Trust
🇬🇧Cambridge, Cambridgeshire, United Kingdom
Ysbyty Gwynedd
🇬🇧Bangor, United Kingdom
Belfast City Hospital
🇬🇧Belfast, United Kingdom
Velindre Cancer Centre
🇬🇧Cardiff, United Kingdom
The Beatson Oncology Centre
🇬🇧Glasgow, United Kingdom
University College London Hospital
🇬🇧London, United Kingdom
Peterborough City Hospital
🇬🇧Peterborough, Cambridgeshire, United Kingdom
Queen Elizabeth Hospital
🇬🇧Birmingham, United Kingdom
University Hospitals Coventry & Warwickshire
🇬🇧Coventry, United Kingdom
Clatterbridge Cancer Centre
🇬🇧Liverpool, United Kingdom
Weston Park Hospital
🇬🇧Sheffield, United Kingdom
Royal Cornwall Hospital
🇬🇧Truro, United Kingdom
Churchill Hospital
🇬🇧Oxford, United Kingdom
The Royal Free Hospital
🇬🇧London, United Kingdom
Hammersmith Hospital
🇬🇧London, United Kingdom
Bristol Haematology & Oncology Centre
🇬🇧Bristol, United Kingdom
The Christie Hospital
🇬🇧Manchester, United Kingdom
Barts Health NHS Trust
🇬🇧London, United Kingdom