Phase I Trial of Chemoimmunotherapy and Hypofractionated Radiation Therapy for Borderline Resectable and Locally Advanced Pancreatic Adenocarcinoma.
Overview
- Phase
- Phase 1
- Intervention
- Tadalafil
- Conditions
- Locally Advanced Malignant Neoplasm
- Sponsor
- Providence Health & Services
- Enrollment
- 10
- Locations
- 1
- Primary Endpoint
- Safety
- Status
- Completed
- Last Updated
- 8 years ago
Overview
Brief Summary
The goal of this study is to evaluate the safety of combination treatment that includes chemotherapy, radiation therapy, and immunotherapy in patients with pancreatic cancer.
Detailed Description
This study is for borderline resectable and advanced pancreatic cancer patients. Patients will receive chemotherapy with gemcitabine and immunotherapy with daily tadalafil during the first 21 days of treatment. On study day 22, patients will receive the first of three planned doses of radiation therapy and continue daily tadalafil. Patients are then evaluated to determine if they are candidates for pancreaticoduodenectomy. Patients who are not candidates will continue daily tadalafil and receive gemcitabine chemotherapy. Patients who have surgery will resume daily tadalafil and gemcitabine chemotherapy following recovery from surgery. Patients will receive up to four cycles of gemcitabine.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Pancreatic adenocarcinoma
- •Locally advanced unresectable disease, or borderline resectable disease
- •ECOG (Eastern Cooperative Oncology Group)Performance Status 0 or 1
- •Ability to provide consent and comply with study protocol
- •Women of child-bearing potential must have a negative pregnancy test and avoid pregnancy during the study
Exclusion Criteria
- •Age \< 18
- •History of other malignancy in previous 2 years except carcinoma in situ of the cervix or bladder, or non-melanoma skin cancer
- •Previous chemotherapy or radiation therapy for pancreatic cancer or previous radiation to the target field
- •Clinically active autoimmune disease or active infection
- •History of heart attack within 90 days or stroke within 6 months, hypertension requiring change in blood pressure medications in the last 4 weeks, hypotension, uncontrolled arrhythmias, heart failure (NYHA \>= Class 2 in last 6 months), unstable angina, or angina during sexual activity
- •Use of nitrates or nitroglycerin
- •History of hereditary degenerative retinal disorders including retinitis pigmentosa
- •Chronic systemic corticosteroid use at supra-physiologic doses
- •Use of recreational drugs called 'poppers' like amyl nitrite and butyl nitrite
- •Blood test results (neutrophils \< 1000 /uL (microliter); hemoglobin \< 9 gm /dL; platelet count \< 1000 cells / uL; significant coagulopathy; significant liver or renal dysfunction
Arms & Interventions
Immunochemoradiotherapy
Immunotherapy with oral tadalafil daily; three doses of chemotherapy with IV Gemcitabine in 21-day cycles for up to 4 cycles; three fractions of external beam radiation to the pancreas and and regional lymph nodes; pancreaticoduodenectomy (surgical resection) for eligible patients.
Intervention: Tadalafil
Immunochemoradiotherapy
Immunotherapy with oral tadalafil daily; three doses of chemotherapy with IV Gemcitabine in 21-day cycles for up to 4 cycles; three fractions of external beam radiation to the pancreas and and regional lymph nodes; pancreaticoduodenectomy (surgical resection) for eligible patients.
Intervention: Gemcitabine
Immunochemoradiotherapy
Immunotherapy with oral tadalafil daily; three doses of chemotherapy with IV Gemcitabine in 21-day cycles for up to 4 cycles; three fractions of external beam radiation to the pancreas and and regional lymph nodes; pancreaticoduodenectomy (surgical resection) for eligible patients.
Intervention: Radiation
Immunochemoradiotherapy
Immunotherapy with oral tadalafil daily; three doses of chemotherapy with IV Gemcitabine in 21-day cycles for up to 4 cycles; three fractions of external beam radiation to the pancreas and and regional lymph nodes; pancreaticoduodenectomy (surgical resection) for eligible patients.
Intervention: Pancreaticoduodenectomy
Outcomes
Primary Outcomes
Safety
Time Frame: 135 Days
Patients will return be seen in the clinic 8 times over the first 50 days for an evaluation of adverse events and toxicities before being evaluated for surgery. Patients who are not candidates for surgery will be seen in clinic 10 more times over the next 85 days for safety evaluations, and patients who have surgery will be seen 10 times over the 85 days following recovery from surgery for safety evaluations.
Secondary Outcomes
- Immune Infiltration in pancreaticoduodenectomy tissue(50 Days)
- Quantification of T cells in peripheral blood pre- and post-treatment(135 Days)