Pancreatic Cancer
Conditions
Keywords
stage II pancreatic cancer, stage III pancreatic cancer, stage IV pancreatic cancer
Brief summary
RATIONALE: Pemetrexed may stop the growth of tumor cells by blocking some of the enzymes needed for their growth. Drugs used in chemotherapy, such as gemcitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high energy x-rays to kill tumor cells. PURPOSE: This phase I trial is studying the side effects and best dose of pemetrexed when given together with radiation therapy in treating patients with locally advanced pancreatic cancer.
Detailed description
OBJECTIVES: Primary * Determine the maximum tolerated dose of pemetrexed disodium when given in combination with upper abdominal radiotherapy after induction therapy comprising gemcitabine hydrochloride and pemetrexed disodium followed by consolidation therapy with gemcitabine hydrochloride in patients with locally advanced pancreatic cancer. * Determine the quantitative toxicity of this regimen in these patients. Secondary * Determine the quantitative and qualitative dose-limiting toxicities of pemetrexed disodium in combination with upper abdominal radiation therapy. * Evaluate patterns of failure, response, and survival of these patients at 1 year OUTLINE: This is an open-label, nonrandomized, dose-escalation study of pemetrexed disodium. * Induction therapy: Patients receive pemetrexed disodium IV over 10 minutes and gemcitabine hydrochloride IV over 30 minutes on day 1. Treatment repeats every 14 days for 3 courses. Approximately 2 weeks later, patients without disease progression proceed to chemoradiotherapy. * Chemoradiotherapy: Patients receive pemetrexed disodium IV over 10 minutes on days 1, 15, and 29 and undergo radiotherapy once daily 5 days a week for 5 ½ weeks. Approximately 2-3 weeks later, patients without disease progression proceed to consolidation therapy. Cohorts of 3-9 patients receive escalating doses of pemetrexed disodium during chemoradiotherapy until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose at which ≤ 20% or ≤ 2 of 9 patients experience dose-limiting toxicity. * Consolidation therapy: Patients receive gemcitabine hydrochloride IV over 30 minutes on days 1 and 8. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed periodically. PROJECTED ACCRUAL: A total of 25 patients will be accrued for this study.
Interventions
DRUGpemetrexed disodium
500 milligrams per meter squared day will be given during weeks 1, 3 and 5 of the radiation (3 total doses of Pemetrexed during the radiation therapy).
DEVICERadiotherapy
During the chemoradiation, the radiotherapy will be administered in 1.8 Gy/fractions after completion of the Pemetrexed infusion, and continue daily (Monday through Friday) for 5 1/2 weeks for a total delivered dose of 50.4 Gy (Total of 28 radiation treatments).
Sponsors
National Cancer Institute (NCI)
Wake Forest University Health Sciences
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 120 Years
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Histologically or cytologically confirmed carcinoma arising from the pancreas * Stage II or III disease, meeting 1 of the following criteria: * Nonresectable disease * Potentially resectable disease * Resectable disease * Stage IV disease with symptomatic back pain requiring palliation allowed at the discretion of the principal investigator * Measurable, evaluable, or nonmeasurable disease * No neuroendocrine tumor of the pancreas * No documented brain metastasis * No clinically significant pleural or peritoneal effusions that cannot be drained PATIENT CHARACTERISTICS: * ECOG performance status 0-1 * Life expectancy ≥ 12 weeks * Absolute neutrophil count ≥ 1,500/mm³ * Platelet count ≥ 100,000/mm³ * Hemoglobin ≥ 9 g/dL * Serum bilirubin ≤ 1.5 times upper limit of normal (ULN) * Alkaline phosphatase ≤ 3 times ULN (5 times ULN if liver has tumor involvement) * AST and ALT ≤ 3 times ULN (5 times ULN if liver has tumor involvement) * Creatinine clearance ≥ 45 mL/min * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception during and for 3 months after completion of study treatment * No active infection * No serious systemic disorders that would preclude study treatment * No significant cardiovascular disease in the form of abnormal electrocardiogram coupled with clinical features of recent or recurrent cardiac disease (including myocardial infarction, angina, or hypertension) PRIOR CONCURRENT THERAPY: * More than 4 weeks since prior investigational agents * No prior chemotherapy for pancreatic cancer * Must be able to discontinue aspirin, dexamethasone, and other nonsteroidal anti-inflammatory agents for 2 days before, the day of, and 2 days after pemetrexed disodium dose (5 days before for long-acting agents such as piroxicam) * Must be able and willing to take folic acid and cyanocobalamin (vitamin B12) supplementation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Determine Maximum Tolerated Dose of Pemetrexed When Administered With Concomitant Radiation Therapy | 42 days |
| Quantitative Toxicity of Pemetrexed When Administered With Concomitant Radiation Therapy | 42 days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Qualitative Dose-limiting Toxicities of Pemetrexed in Combination With Radiation Therapy | 42 days | Toxicity will be determined using the revised NCI Common Toxicity Criteria (CTC) version 3.0 for Toxicity and Adverse Event Reporting. Number of events with grade 1-5 will be reported. |
| Patterns of Failure | 1 year | — |
| Patterns of Response | 1 year | — |
| Number of Participants That Survived | 1 year | — |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Pemetrexed in Combination With Concomitant Radiotherapy Patients will receive Pemetrexed plus Radiotherapy.
pemetrexed disodium: 500 milligrams per meter squared day will be given during weeks 1, 3 and 5 of the radiation (3 total doses of Pemetrexed during the radiation therapy).
Radiotherapy: During the chemoradiation, the radiotherapy will be administered in 1.8 Gy/fractions after completion of the Pemetrexed infusion, and continue daily (Monday through Friday) for 5 1/2 weeks for a total delivered dose of 50.4 Gy (Total of 28 radiation treatments). | 4 |
| Total | 4 |
Baseline characteristics
| Characteristic | Pemetrexed in Combination With Concomitant Radiotherapy |
|---|---|
| Age, Continuous | 61.5 years STANDARD_DEVIATION 2.645 |
| Sex: Female, Male Female | 2 Participants |
| Sex: Female, Male Male | 2 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 1 / 4 |
| other Total, other adverse events | 2 / 4 |
| serious Total, serious adverse events | 0 / 4 |
Outcome results
Primary
Determine Maximum Tolerated Dose of Pemetrexed When Administered With Concomitant Radiation Therapy
Time frame: 42 days
Population: data were not collected
Primary
Quantitative Toxicity of Pemetrexed When Administered With Concomitant Radiation Therapy
Time frame: 42 days
Population: data were not collected
Secondary
Number of Participants That Survived
Time frame: 1 year
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Pemetrexed in Combination With Concomitant Radiotherapy | Number of Participants That Survived | 2 Participants |
Secondary
Patterns of Failure
Time frame: 1 year
Population: Data not collected.
Secondary
Patterns of Response
Time frame: 1 year
Population: Data not collected on all participants.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Pemetrexed in Combination With Concomitant Radiotherapy | Patterns of Response | Partial Response | 1 Participants |
| Pemetrexed in Combination With Concomitant Radiotherapy | Patterns of Response | Stable disease | 2 Participants |
Secondary
Qualitative Dose-limiting Toxicities of Pemetrexed in Combination With Radiation Therapy
Toxicity will be determined using the revised NCI Common Toxicity Criteria (CTC) version 3.0 for Toxicity and Adverse Event Reporting. Number of events with grade 1-5 will be reported.
Time frame: 42 days
Population: Data available for 2 participants.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Pemetrexed in Combination With Concomitant Radiotherapy | Qualitative Dose-limiting Toxicities of Pemetrexed in Combination With Radiation Therapy | Grade 5 | 0 events |
| Pemetrexed in Combination With Concomitant Radiotherapy | Qualitative Dose-limiting Toxicities of Pemetrexed in Combination With Radiation Therapy | Grade 4 | 0 events |
| Pemetrexed in Combination With Concomitant Radiotherapy | Qualitative Dose-limiting Toxicities of Pemetrexed in Combination With Radiation Therapy | Grade 3 | 3 events |
| Pemetrexed in Combination With Concomitant Radiotherapy | Qualitative Dose-limiting Toxicities of Pemetrexed in Combination With Radiation Therapy | Grade 1 | 22 events |
| Pemetrexed in Combination With Concomitant Radiotherapy | Qualitative Dose-limiting Toxicities of Pemetrexed in Combination With Radiation Therapy | Grade 2 | 7 events |