Lapatinib and Capecitabine for Second Line Treatment of Pancreas Cancer

Phase 2

Terminated

Brief Summary: Patients are being asked to participate in this study who have locally advanced or metastatic pancreatic cancer (cancer of the pancreas that has spread to another part of the body) that has gotten worse after first-line chemotherapy.

The purpose of this study is to see if the drugs, Capecitabine and Lapatinib (two chemotherapy agents), prolong survival and improve quality of life as compared to supportive care alone.

Lapatinib in combination with a drug called capecitabine, has been approved by the Food and Drug Administration (FDA) for the treatment of metastatic breast cancer. It has not yet been approved to treat this type of cancer. Both of these drugs are pills.

This research is being done because it is not known if the combination of Capecitabine and Lapatinib is better than supportive care alone for pancreatic cancer.

Detailed Description: This is an open-label single-arm Phase II trial for patients with metastatic pancreatic cancer who have failed first line Gemcitabine-based therapy. Patients will be treated with a combination of Capecitabine and Lapatinib, a dual tyrosine-kinase inhibitor of EGFR and HER-2.

Recruitment & Eligibility

Inclusion Criteria

Histologically confirmed adenocarcinoma of the pancreas
Prior failed 1st line gemcitabine therapy for metastatic disease or relapsed within six months of completion of gemcitabine adjuvant therapy
Prior capecitabine or 5fu is allowed in the setting of radiation
Must either be able to swallow or receive enteral nutrition via gastrostomy feeding tube
Cardiac ejection fraction within institutional range of normal as measured by echocardiogram
ECOG performance status 0-2
Signed informed consent form
Adequate hepatic, bone marrow, and renal function

Exclusion Criteria

Any prior treatment with lapatinib, or any anti-HER2 treatment or any anti-EGFR treatment
Not recovered from adverse events to a toxicity grade </= 1 due to prior chemotherapy
More than one prior chemotherapy regimens
Known brain metastases, uncontrolled seizure disorders, encephalitis, or multiple sclerosis
HIV positive on antiretroviral therapy
Pregnant or lactating
History of allergic reactions attributed to compounds of similar chemical or biologic composition to lapatinib or capecitabine
Malabsorption syndrome or uncontrolled inflammatory GI disease (Crohn's or ulcerative colitis)
Known history of uncontrolled or symptomatic angina, arrhythmia, or congestive heart failure
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection or psychiatric illness/ social situations that would limit compliance with study requirements
Known dihydropyrimidine dehydrogenase deficiency
Concurrent malignancy unless the subject has been curatively treated and disease free for >/= 2 years or the cancer was non-melanoma skin cancer or early cervical cancer.
Creatinine clearance < 30 mL/min
Absolute neutrophil count < 1500, platelets < 75,000
Transaminases > 3.0 times the upper limit of normal, except in known hepatic metastasis, wherein they must be < 5.0 times the upper limit of normal
Total bilirubin > 1.5 times the ULN, > 2.5 x ULN if patient has Gilbert's syndrome

Arm && Interventions

Group	Intervention	Description
Lapatinib and Capecitabine	Lapatinib and Capecitabine	Treatment

Primary Outcome Measures

Name	Time	Method
Overall Survival	24 months	Time of study entry to time of death

Secondary Outcome Measures

Name	Time	Method
Clinical Benefit Response	3 months	number of participants who had stable disease or partial response or complete response per Response Evaluation Criteria In Solid Tumors. Complete Response: Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \<10 mm. Partial Response: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. Progressive Disease: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. Stable Disease: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum diameters while on study.
Progression Free Survival	24 months	Time of study entry to cancer progression.
Adverse Events	2 years	Grade 3 or 4 toxicities