Use of High-dose Radiation Therapy Plus Chemotherapy to Improve the Likelihood of Surgical Treatment in Patients With Locally Advanced Pancreatic Cancer

Phase 2

Active, not recruiting

Interventions: Radiation: Hypofractionated ablative IMRT (HFA-IMRT)
Drug: capecitabine

Brief Summary: This study is being done to test whether receiving a dose of radiation that is higher than the standard dose, in combination with chemotherapy, improves the chance of becoming a candidate for surgery and improves the chance of extending the patient's life.

Recruitment & Eligibility

Inclusion Criteria

Histologically or cytopathologically confirmed adenocarcinoma of the pancreas.
Locally advanced, unresectable pancreatic cancer defined on post-induction chemotherapy CT as having tumor involvement of >180° (> 50%) of the circumference of the superior mesenteric artery (SMA) or celiac axis, unreconstructable superior mesenteric vein (SMV) or PV involvement.
No evidence of distant metastasis either prior to or after induction chemotherapy.
Completion of at least 3 months of standard induction chemotherapy for LAPC, which may include FOLFIRINOX or gemcitabine and nab-paclitaxel, within 6 weeks of enrollment.
For patients currently receiving investigational agents, a washout of at least 2 weeks or 5 half-lives of experimental agent are required prior to the start of RT.
Age ≥18 years.
KPS 70-100.
Patients must have acceptable organ and marrow function as defined below:
- Leukocytes >3,000/µL
- Absolute neutrophil count >1,500/µL
- Platelets >75,000/µL
- Total bilirubin Within 2 x upper limit of normal
- AST (SGOT)/ALT (SGPT) <2.5 x institutional upper limit of normal Creatinine Within 1.5 x upper limit of normal, OR Creatinine clearance >60 mL/min for patients with creatinine levels above institutional normal
Any systemic therapy associated toxicity should be Grade 1 or less
Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria

Patients who have borderline resectable disease using NCCN definition.
Patients who have had prior abdominal radiotherapy.
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or cardiac arrhythmia.
Patients who are not surgical candidates due to medical co-morbidities.
Patients in whom iodine contrast is contraindicated.
Pregnant and breastfeeding women are excluded. Women of child-bearing potential who are unwilling or unable to use an acceptable method of birth control to avoid pregnancy for the entire study period and for up to 4 weeks after the study are excluded. This applies to any woman who has experienced menarche and who has not undergone successful surgical sterilization or is not postmenopausal (defined as amenorrhea for at least 12 consecutive months, or women on hormone replacement therapy with serum FSH levels greater than 35 mIU/mL. A negative serum pregnancy test must be obtained within 14 days prior to the start of study therapy in all women of child-bearing potential. Male subjects must also agree to use effective contraception for the same period as above.

Arm && Interventions

Group	Intervention	Description
HFA-IMRT	Hypofractionated ablative IMRT (HFA-IMRT)	Eligible patients will receive HFA-IMRT to a total dose of 67.5 Gy in 15 fractions or 75Gy in 25 fractions to areas of gross tumor with concurrent capecitabine. Cross-sectional imaging will be repeated 4-6 weeks after the end of CRT to assess for resectability.
HFA-IMRT	capecitabine	Eligible patients will receive HFA-IMRT to a total dose of 67.5 Gy in 15 fractions or 75Gy in 25 fractions to areas of gross tumor with concurrent capecitabine. Cross-sectional imaging will be repeated 4-6 weeks after the end of CRT to assess for resectability.

Primary Outcome Measures

Name	Time	Method
The proportion of patients who undergo definitive surgery	2 years	The proportion of patients who undergo definitive surgery will be used to evaluate efficacy of HFA-IMRT in improving rates of resectability as compared to historical controls.

Secondary Outcome Measures

Name	Time	Method

Locations (8): Memorial Sloan Kettering Bergen
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Montvale, New Jersey, United States
Memorial Sloan Kettering Commack
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Commack, New York, United States
Memorial Sloan Kettering Cancer Center
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New York, New York, United States
Memorial Sloan Kettering Westchester
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Harrison, New York, United States
Memorial Sloan Kettering Rockville Centre
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Rockville Centre, New York, United States
Memorial Sloan Kettering Nassau
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Uniondale, New York, United States
Memorial Sloan Kettering Monmouth
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Middletown, New Jersey, United States
Memorial Sloan Kettering Basking Ridge
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Basking Ridge, New Jersey, United States