Monthly Alternating NALIRIFOX and GnP in the First-Line Setting for Metastatic Pancreatic Ductal Adenocarcinoma

Purpose

A prospective, interventional, single-center, single-arm, open-label, phase II study for patients with metastatic pancreatic cancer. The intervention consists of monthly alternating standard chemotherapy regimens-NALIRIFOX and GnP. The hypothesis is that induction therapy with alternating NALIRIFOX and GnP has better efficacy compared to historical observation.

Condition

  • Pancreatic Ductal Adenocarcinoma

Eligibility

Eligible Ages
Over 18 Years
Eligible Sex
All
Accepts Healthy Volunteers
No

Criteria

Inclusion:

- >18 years of age

- Histologically proven pancreatic ductal adenocarcinoma, poorly differentiated
carcinoma, or adenosquamous carcinoma

- Radiographic evidence of metastatic disease

- At least 1 measurable target lesion per Response Evaluation Criteria in Solid Tumors
(RECIST) 1.1

- Metastatic relapse of previously resected pancreatic cancer is allowed provided the
patient is more than 6 months from last SOC adjuvant treatment

- ECOG PS 0-1

- Laboratory assessments within 14 days as indicated below:

- Hemoglobin > 9.0 g/dL (patients with hemoglobin < 9 g/dL may be transfused
prior to study enrollment)

- Platelet count > 100 x 10^9/L

- Absolute neutrophil count (ANC) > 1.5 x 10^9/L

- Total bilirubin < 3 x upper limit of normal (ULN)

- Aspartate transaminase (AST) and alanine transaminase (ALT) < 3 x ULN (if liver
metastases are present, AST and ALT < 5 x ULN is permitted.

- Creatinine ≤1.5 ULN

- Creatinine clearance > 40 mL/min as calculated by Cockcroft-Gault formula

- APTT (aPTT) ≤ 1.5 × ULN. For subjects receiving unfractionated heparin < 2.5 ×
ULN, or within acceptable range considered by the investigator.

- PT/INR INR ≤ 1.5 × ULN. For subjects receiving warfarin, 2.0 -3.0, or within
acceptable range considered by the investigator.

- Women of childbearing potential must be surgically sterile or postmenopausal or must
have a negative pregnancy test (serum or urine) prior to study enrolment and must
use effective barrier contraception or abstinence during the treatment period. Oral,
implantable, or injectable contraceptives may be affected by cytochrome P450
interactions and therefore are not considered effective for this study. Male
patients must be surgically sterile or use effective contraception or abstinence
during the treatment period. The definition of effective contraception will be based
on investigator discretion. Female and male patients are advised to use effective
contraceptives for at least 9 months after the last treatment dose.

- Ability to understand and willing to sign informed consent form

Exclusion:

- A history of other disease, metabolic dysfunction, physical examination finding or
clinical laboratory test result suspicious of a disease or condition which, in the
opinion of the investigator, would compromise patient safety due to risk of
treatment complications or could affect interpretation of the study results

- Ampullary, acinar, squamous, and neuroendocrine histology

- Presence of central nervous system metastases

- Life expectancy < 12 weeks

- Pregnant or breastfeeding women

- Prior neuropathy > grade 1 as per CTCAE v5

- Patients with known history or current symptoms of cardiac disease, or history of
treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac
function using the New York Heart Association Functional Classification. To be
eligible for this trial, patients should be class 2B or better.

- Major surgery within 4 weeks prior to initiation of the study treatment, without
full recovery

- Any past chemotherapy delivered for metastatic pancreatic cancer

- Known somatic or germline mutations in BRCA1, BRCA2, or PALB2

- Active second malignancy whose prognosis has a high likelihood of impacting survival

- Any other medical or social condition deemed by the investigator to be likely to
interfere with a subject's ability to sign informed consent, cooperate and
participate in the study, or interfere with the interpretation of the results.
Patients also unwilling or unable to comply with study procedures and/or study
visits, including long-term follow-up for survival.

Study Design

Phase
Phase 2
Study Type
Interventional
Allocation
Non-Randomized
Intervention Model
Single Group Assignment
Primary Purpose
Treatment
Masking
None (Open Label)

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
NALIRIFOX
NALIRIFOX consists of 5-FU 2400 mg/m2 over 46 hours, liposomal irinotecan 50 mg/m2, and oxaliplatin 60 mg/m2, which would be given on Day 1 and Day 15
  • Drug: NALIRIFOX
    NALIRIFOX consists of 5-FU 2400 mg/m2 over 46 hours, liposomal irinotecan 50 mg/m2, and oxaliplatin 60 mg/m2, which would be given on Day 1 and Day 15
    Other names:
    • 5fu/ leucovorin / oxaliplatin / liposomal irinotecan
Active Comparator
Gemcitabine plus nab-Paclitaxel (GnP)
GnP consists of gemcitabine 1000 mg/m2 and nab-paclitaxel 125 mg/m2, given on Days 1, 8, and 15.
  • Drug: Gemcitabine plus nab-Paclitaxel (GnP)
    GnP consists of gemcitabine 1000 mg/m2 and nab-paclitaxel 125 mg/m2, given on Days 1, 8, and 15.
    Other names:
    • Gemcitabine/nab-Paclitaxel

Recruiting Locations

Zuckerberg Cancer Center
New Hyde Park 5128514, New York 5128638 11042
Contact:
Alison Zapata, RN
516-734-8896
azapata6@northwell.edu

More Details

Status
Recruiting
Sponsor
Northwell Health

Study Contact

GI Trial Referral
5167348896
gitrialreferral@northwell.edu