A Randomized Phase II Study of Gemcitabine Versus Reduced-dose Combination Chemotherapy in Fragile Patients with Non-resectable Pancreatic Cancer
Overview
- Phase
- Phase 2
- Intervention
- Gemcitabine
- Conditions
- Pancreas Cancer
- Sponsor
- Morten Ladekarl
- Enrollment
- 98
- Locations
- 1
- Primary Endpoint
- PFS (Progression Free Survival)
- Status
- Recruiting
- Last Updated
- last year
Overview
Brief Summary
The aim of the study is to compare the efficacy and toxicity of full-dose Gemcitabine and reduced-dose combination chemotherapy in patients with non-resectable pancreatic cancer, who are unfit for full-dose combination chemotherapy.
The patients will be equally randomized to arm A or arm B:
Arm A: Full-dose single agent treatment with Gemcitabine 1000 mg/m2 weekly on days 1, 8,and 15 every 4 weeks.
Arm B: Reduced-dose (80%) combination-treatment with Gemcitabine plus Nab-Paclitaxel (Gemcitabine: 800 mg/m2 plus Nab-Paclitaxel: 100 mg/m2 on day 1, 8 and 15 every 4 weeks)
Progression-free survival, overall survival and response rate will be estimated for each group, as well as toxicity and quality of life will be prospectively registered.
Detailed Description
According to guidelines the recommended treatment for patients with non-resectable pancreatic cancer (PC) is combination chemotherapy, whereas old and/or fragile patients can be offered Gemcitabine monotherapy, if they are fit for treatment. Phase III trials show improved effect of combination chemotherapy compared to Gemcitabine, but these trials were restricted to fit patients younger than 75 years of age, as full-dose combination chemotherapy is more toxic. Studies in colorectal cancer and a post-hoc analysis of Gemcitabine plus Nab-Paclitaxel in PC suggest that reduced-dose of combination chemotherapy may be more efficient in terms of progression-free survival and less toxic as compared to monotherapy in elderly and/or frail patients, but reduced start-dosing of GemNab is not currently labelled. Moreover, a recent Danish register-based study showed that more use of combination chemotherapy at oncological departments was associated with improved outcome of patients with PC. Elderly and frail patients with PC are in great need of better treatment results. Hence, a comparative study of reduced-dose combination chemotherapy is warranted and may be practice changing. The aim of the study is to compare the efficacy and toxicity of full-dose Gemcitabine and reduced-dose combination chemotherapy in patients with non-resectable PC, who are unfit for full-dose combination chemotherapy. The study is a national multicenter prospective randomized phase II trial, endorsed by the Danish Pancreas Cancer Group (DPCG). 98 patients with non-resectable PC, unfit for full-dose combination chemotherapy, but eligible for first-line chemotherapy, will be included. The patients will be equally randomized to arm A or arm B: Arm A: Full-dose single agent treatment with Gemcitabine 1000 mg/m2 weekly on days 1, 8 and 15 every 4 weeks. Arm B: Reduced-dose (80%) combination-treatment with GemNab (Gemcitabine: 800 mg/m2 plus Nab-Paclitaxel: 100 mg/m2 on day 1, 8 and 15 every 4 weeks). Progression-free survival, overall survival and response rate will be estimated for each group, as well as toxicity and quality of life will be prospectively registered.
Investigators
Morten Ladekarl
Professor, MD, Phd
Aalborg University Hospital
Eligibility Criteria
Inclusion Criteria
- •Age ≥ 18 years
- •Adenocarcinoma of the pancreas, histopathologically or cytologically verified
- •Non-resectable (locally advanced or metastatic) PC
- •Patients unfit or not candidate for full-dose combination chemotherapy
- •Patients eligible for full dose gemcitabine or reduced dose combination chemotherapy
- •Performance status (PS) ≤2
- •Measurable or non-measurable disease
- •Adequate hematologic function defined as absolute neutrophil count (ANC) ≥1.5 x 10\^9/l and platelets count ≥100x10\^9/l within 2 weeks prior to enrollment
- •Adequate organ function (bilirubin ≤1.5 x UNL (Upper Normal Limit) and eGFR (estimated Glomerular Filtration Rate) \>50ml/min within 2 weeks prior to enrollment
- •Toxicity of prior chemotherapy, including neurotoxicity, resolved to CTCAE \<grade 2
Exclusion Criteria
- •Patients eligible for downstaging/preoperative chemotherapy followed by resection or local ablation or irradiation
- •Prior chemotherapy for PC (However, patients treated with adjuvant therapy with recurrence occurring more than 6 months after end of this treatment are eligible)
- •Concurrent, non-curatively treated malignant neoplasm other than pancreatic adenocarcinoma
- •Concurrent treatment with any other anti-cancer therapy
- •Pregnant or breast-feeding patients
- •Patients clearly intending to withdraw from the study if not randomized in the willing arm or patients who cannot be regularly followed up for psychological, social, familiar, or geographic reasons.
- •Other condition or therapy, which in the investigator's opinion may pose a risk to the patient or interfere with the study objectives.
- •Known allergy or intolerance to any of the drugs used in DPCG-01 (Gemcitabine, S1 or Nab-Paclitaxel)
Arms & Interventions
A: "Full dose single agent strategy"
Gemcitabine monotherapy, 1000 mg/m2 weekly on days 1, 8, and 15 every 4 weeks
Intervention: Gemcitabine
B: "Reduced dose (80%) combination-therapy strategy"
Nab-Paclitaxel: 100mg/m2 plus gemcitabine: 800 mg/m2 on day 1, 8 and 15 every 4 weeks
Intervention: Gemcitabine
B: "Reduced dose (80%) combination-therapy strategy"
Nab-Paclitaxel: 100mg/m2 plus gemcitabine: 800 mg/m2 on day 1, 8 and 15 every 4 weeks
Intervention: Nab paclitaxel
Outcomes
Primary Outcomes
PFS (Progression Free Survival)
Time Frame: 1 year from end of study accrual.
PFS is defined in the ITT population as the date of the randomization to the date of disease progression or date of death, whichever comes first. The date of PD is the date of scan, if progression is found on a CT scan, or date of visit at which clinical progression is found. PD at CT is defined according to RECIST version 1.1.
Secondary Outcomes
- OS (Overall Survival)(1 year from end of study accrual.)
- RR (Response rate)(1 year from end of study accrual.)
- Hospitalizations(Through study completion, an average of 6 months.)
- Quality of Life (QOL) assessed by EORTC QLQ-C30 at baseline and after 8, 16, and 24weeks(At baseline and at 8, 16, and 24 weeks.)
- Cumulative worst toxicity during treatment(From date of first treatment until 1 year from end of study treatment.)