A Phase 1 Study of Hypofractionated Stereotactic Radiotherapy and Concurrent HIV Protease Inhibitor Nelfinavir as Part of a Neoadjuvant Regimen in Patients With Locally Advanced Pancreatic Cancer
试验速览
- 阶段
- 1 期
- 状态
- 已完成
- 入组人数
- 46
- 试验地点
- 1
- 主要终点
- Maximally tolerated dose (MTD) of stereotactic radiotherapy and concurrent nelfinavir mesylate
研究概览
简要总结
This phase I trial is studying the side effects and best dose of stereotactic radiation therapy and nelfinavir mesylate when given together with gemcitabine hydrochloride, leucovorin calcium, and fluorouracil in treating patients with locally advanced pancreatic cancer. Stereotactic radiation therapy may be able to send x-rays directly to the tumor and cause less damage to normal tissue. Drugs, such as nelfinavir mesylate, may make tumor cells more sensitive to radiation therapy. Drugs used in chemotherapy, such as gemcitabine hydrochloride, leucovorin calcium, and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving stereotactic radiation therapy and nelfinavir mesylate together with combination chemotherapy may kill more tumor cells.
详细描述
PRIMARY OBJECTIVES:
I. To establish the safety, dose-limiting toxicities and maximally tolerated dose of hypofractionated stereotactic radiotherapy concurrently with nelfinavir in patients with locally advanced pancreatic cancer given as part of a neoadjuvant chemoradiation therapy regimen.
SECONDARY OBJECTIVES:
I. To evaluate the surgical complete resection rate. II. To evaluate the pathological response. III. To evaluate tumor response on computed tomography (CT)/magnetic resonance imaging (MRI).
IV. To evaluate the correlation between the radiologic response and pathologic response.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 19 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •The time between other investigational agents and enrollment on this study is at least 30 days
- •Pathologically confirmed adenocarcinoma of the pancreas
- •Patients have localized or locally advanced disease with no evidence of distant metastases
- •The maximum dimension of the tumor must be =< 8 cm
- •Karnofsky Performance Status of 60% or better
- •Patients with biliary or gastroduodenal obstruction must have drainage or surgical bypass prior to starting chemoradiation
- •Patients who received chemotherapy > 5 years ago for malignancies other than pancreatic cancer are eligible, provided that chemotherapy was completed > 5 years ago and that there is no evidence of the second malignancy at the time of study entry
- •Patients who received radiation therapy > 5 years ago for malignancies other than pancreatic cancer and whose radiation therapy field is not overlapping with the 20% isodose line of current radiation field are eligible, provided that radiation therapy was completed > 5 years ago and that there is no evidence of the second malignancy at the time of study entry
- •All malignant disease must be able to be encompassed within a single irradiation field
- •All patients must have radiographically assessable disease
- •Patients must have a absolute granulocyte count (AGC) greater than or equal to 1500/uL and platelet count greater than or equal to 100,000/uL
- •Patients must have a serum creatinine less than or equal to 2 mg/dL and total bilirubin less than or equal to 2.0 mg/dL in the absence of biliary obstruction
- •If the patient has biliary obstruction, biliary decompression will be required; either endoscopic placement of biliary stent (7 French or greater) or percutaneous transhepatic drainage are acceptable; once biliary drainage has been established, institution of gemcitabine therapy may proceed when the total bilirubin falls to below 4.0 mg/dL
- •The patient must be aware of the neoplastic nature of his/her disease and willingly provide written, informed consent after being informed of the procedure to be followed, the experimental nature of the therapy, alternatives, potential benefits, side-effects, risks, and discomforts
- •Patients may have had prior chemotherapy for pancreatic cancer
- •Any prior therapy is acceptable except radiation to the abdomen
排除标准
- •Patients receiving the following drugs will be clinically evaluated as to whether dosage/medication can be changed to permit patient on study: carbamazepine; phenobarbital; phenytoin; rifabutin; sildenafil; atorvastatin; cyclosporine; tacrolimus; sirolimus; methadone; ethinyl estradiol; azithromycin
- •Patients who can not undergo staging laparoscopy and marker implantation; this may include patients with a prior history of multiple abdominal operations in which laparoscopy may not be technically feasible or potentially harmful
- •The patient is eligible if they have a common bile duct stent adjacent to the tumor that may be used as an internal marker, or if the patient has already had a staging laparoscopy without marker implantation and the markers can be implanted (by interventional radiology) prior to the beginning of radiation therapy
- •History of allergy to chemotherapy agents or to antiemetics appropriate for administration in conjunction with protocol-directed chemotherapy
- •Uncontrolled inter-current illness including, but not limited to ongoing or active infection requiring intravenous antibiotics, symptomatic congestive heart failure, unstable angina pectoris, or serious, uncontrolled cardiac arrhythmia, that might jeopardize the ability of the patient to receive the chemotherapy program outlined in this protocol with reasonable safety
- •Patients with human immunodeficiency virus (HIV) infection, or hepatic insufficiency
- •Patients may not be receiving or have received any other investigational agents during/or within 1 month prior to treatment with NFV (nelfinavir mesylate)
- •Patients who can not take oral medications
- •Patients with active duodenal ulcer or bleeding or history of a gastrointestinal fistula or perforation or other significant bowel problems (severe nausea, vomiting, inflammatory bowel disease and significant bowel resection)
- •Patients with prior malignancy will be excluded EXCEPT for adequately treated basal cell or squamous cell skin cancer, adequately treated noninvasive carcinomas, or other cancers from which the patient has been disease-free for at least 5 years
- •Patients receiving the following drugs that are contraindicated with NFV will be excluded: amiodarone; quinidine; rifampin; dihydroergotamine; ergonovine; ergotamine; methylergonovine; St. John's wort (hypericum perforatum); lovastatin; simvastatin; pimozide; midazolam; triazolam
- •Pregnant and nursing women are excluded from this study
研究组 & 干预措施
Treatment (SRT, radiosensitizer, and chemotherapy)
See Detailed Description
干预措施: gemcitabine hydrochloride (Drug)
Treatment (SRT, radiosensitizer, and chemotherapy)
See Detailed Description
干预措施: leucovorin calcium (Drug)
Treatment (SRT, radiosensitizer, and chemotherapy)
See Detailed Description
干预措施: fluorouracil (Drug)
Treatment (SRT, radiosensitizer, and chemotherapy)
See Detailed Description
干预措施: nelfinavir mesylate (Drug)
Treatment (SRT, radiosensitizer, and chemotherapy)
See Detailed Description
干预措施: stereotactic body radiation therapy (Radiation)
Treatment (SRT, radiosensitizer, and chemotherapy)
See Detailed Description
干预措施: hypofractionated radiation therapy (Radiation)
Treatment (SRT, radiosensitizer, and chemotherapy)
See Detailed Description
干预措施: therapeutic conventional surgery (Procedure)
结局指标
主要结局
Maximally tolerated dose (MTD) of stereotactic radiotherapy and concurrent nelfinavir mesylate
时间窗: 3 patients will initially be treated at each dose level (4 levels); a minimum of 1 month of observation after surgery is required in all 3 patients before escalation
The MTD of SRT/nelfinavir mesylate is defined as the highest dose level at which no greater than one dose-limiting toxicity is observed in 6 patients.
Dose-limiting toxicity as assessed by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v3.0
时间窗: Within 1 month of surgery
Due to delayed toxicities attributable to radiotherapy, all toxicities observed within 1 month of surgery will be scored. Toxicity will be graded and tabled by dose levels.
次要结局
- Phospho-AKT expression in pancreatic tumor tissue (correlative)(Pre- to post-nelfinavir mesylate)
- Rate of complete surgical resection(At the time of surgery (2-3 weeks after completion of SRT))
- Tumor response on CT/MRI(Change from pre- to post-treatment)
- Radiologic response and pathologic response(Pre- to post-treatment)
- Pathological response(Pre- to post-treatment)
- Pharmacogenomic status of CYP2C19*2 (G681A) (correlative)(Enrollment, at the time of planned tumor tissue procurement, and at the time that re-staging studies are done)
- Pharmacokinetics of nelfinavir mesylate (correlative)(After at least 1 week of NFV: *0 h (trough); *After NFV dosing: 1, 2, 3, 4, 5, 6, 8, and 12 h)