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Panitumumab, Chemotherapy, and External-Beam Radiation Therapy in Treating Patients With Locally Advanced Pancreatic Cancer That Cannot be Removed by Surgery

Phase II Study of Panitumumab, Chemotherapy, and External Beam Radiation in Patients With Locally Advanced Pancreatic Cancer

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00601627
Enrollment
52
Registered
2008-01-28
Start date
2009-06-30
Completion date
2013-05-31
Last updated
2017-04-05

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Pancreatic Cancer

Keywords

adenocarcinoma of the pancreas, stage II pancreatic cancer, stage III pancreatic cancer

Brief summary

RATIONALE: Monoclonal antibodies, such as panitumumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Drugs used in chemotherapy, such as fluorouracil, capecitabine, and gemcitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. External-beam radiation therapy uses high-energy x-rays to kill tumor cells. Panitumumab may also stop the growth of pancreatic cancer by blocking blood flow to the tumor and make tumor cells more sensitive to radiation therapy. Giving panitumumab together with chemotherapy and radiation therapy may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving panitumumab together with chemotherapy and external-beam radiation therapy works in treating patients with locally advanced pancreatic cancer that cannot be removed by surgery.

Detailed description

OBJECTIVES: Primary * To evaluate the 1-year survival rate in patients with locally advanced pancreatic cancer treated with panitumumab and continuous infusion fluorouracil administered concurrently with external-beam radiotherapy followed by gemcitabine and panitumumab. Secondary * To determine overall survival, time to disease progression, confirmed response rate, duration of response, and time to treatment failure in patients treated with this regimen. * To determine adverse events in patients treated with this regimen. OUTLINE: * Panitumumab and chemoradiotherapy : Patients undergo external-beam radiotherapy once daily on days 1-5, 8-12, 15-19, 22-26, 29-33, and 36-38. Patients also receive panitumumab IV over 1 hour on days 1, 15, and 29 and fluorouracil IV continuously over 24 hours daily OR oral capecitabine twice daily beginning on day 1 and continuing through the last day of radiotherapy. * Panitumumab and chemotherapy: Beginning 4-6 weeks after completion of panitumumab and chemoradiotherapy, patients receive panitumumab IV over 1 hour on days 1 and 15 and gemcitabine IV over 30 minutes on days 1, 8, and 15. Treatment repeats every 28 days for 3 courses. Patients then proceed to maintenance therapy. * Maintenance therapy: Patients receive panitumumab IV over 1 hour on days 1 and 15. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed every 3 months for 2 years and then every 6 months for 1 year.

Interventions

BIOLOGICALpanitumumab
DRUGcapecitabine
DRUGfluorouracil
DRUGgemcitabine hydrochloride
RADIATIONradiation therapy

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Alliance for Clinical Trials in Oncology
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Histologically or cytologically confirmed unresectable adenocarcinoma of the pancreas * Including subtotal resection and gross residual disease * No microscopic residual disease only * Measurable disease is not required * Disease is encompassable within standard radiotherapy fields for pancreatic cancer * No evidence of metastatic disease outside of the planned radiotherapy field * No cystadenocarcinoma of the pancreas or pancreatic tumors of neuroendocrine origin * No distant metastases (i.e., liver or lung metastases or peritoneal spread) * No history or known presence of CNS metastases PATIENT CHARACTERISTICS: * Eastern Cooperative Oncology Group (ECOG) performance status 0-1 * ANC ≥ 1,500/mm³ * Hemoglobin ≥ 9.0 g/dL * Platelet count ≥ 100,000/mm³ * Total bilirubin ≤ 3 times upper limit of normal (ULN)\* NOTE: \*Biliary stent placement or surgical bypass should be considered prior to treatment if impending bile duct obstruction by tumor * AST ≤ 3 times ULN * Creatinine ≤ 2.0 times ULN * Magnesium normal * Willing to return to an North Central Cancer Treatment Group (NCCTG) institution for follow-up * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception during and for at least 6 months after treatment with panitumumab * No prior or concurrent malignancy unless disease-free ≥ 3 years except for non-melanoma skin cancer, carcinoma in situ of the cervix, or organ confined prostate cancer with Gleason score \< 7 * No nausea or vomiting \> grade 1 * No uncontrolled intercurrent illness including, but not limited to, any the following: * Ongoing or active infection * Psychiatric illness or social situations that would limit compliance with study requirements * No New York Heart Association clinically significant cardiovascular disease ≥ grade 2, including any of the following within the past year: * Myocardial infarction * Unstable angina * Symptomatic congestive heart failure * Serious, uncontrolled cardiac arrhythmia * No known HIV positivity * No known hepatitis C virus or acute or chronic active hepatitis B infection * Adequate oral nutrition PRIOR CONCURRENT THERAPY: * More than 21 days since prior laparotomy * No prior anti-epidermal growth factor receptor (EGFR) antibody therapy (e.g., cetuximab) * No prior small molecule EGFR inhibitors (e.g., gefitinib, erlotinib, or lapatinib) * No prior radiotherapy that would overlap with planned radiotherapy fields * No prior or other concurrent chemotherapy * No prior or other concurrent biologic therapy * More than 4 weeks since prior and no concurrent or planned participation in another experimental drug study except studies with specific interventions intended to treat rashes associated with EGFR agents (e.g., N05C4) * No concurrent enteral hyperalimentation * No concurrent chronic immunosuppressive agents (e.g., methotrexate, cyclosporine, or corticosteroids) * No concurrent colony-stimulating factors during the first course of therapy * No other concurrent immunotherapy or radiotherapy

Design outcomes

Primary

MeasureTime frameDescription
One Year Survival RateBaseline to 12 monthsThe proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. Confidence intervals for the true success proportion will be calculated according to the exact binomial method.

Secondary

MeasureTime frameDescription
Overall Survivalbaseline to 2 yearsSurvival time is defined as the time from registration to death due to any cause. The distribution of survival time will be estimated using the method of Kaplan-Meier
Progression Free Survival (PFS)baseline to 2 yearsProgression Free Survival is defined as the time from registration to the earliest documented evidence of disease progression.
Confirmed Response Ratebaseline to 2 yearsA confirmed tumor response is defined to be a complete response (CR) or partial response (PR) noted as the objective status on 2 consecutive evaluations at least 4 weeks apart according to the Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1. A complete response is defined as the disappearance of all target and non-target lesions. A partial response is defined as at least a 30% decrease in the sum of the longest diameter (LD) of the target lesion from baseline. Confirmed tumor response will be evaluated using the first 6 cycles of treatment.
Duration of Responsebaseline to 2 yearsDuration of response is defined for all evaluable patients who have achieved an objective response as the date at which the patient's earliest best objective status is first noted to be either a CR or PR to the earliest date progression is documented.
Time to Treatment Failurebaseline to 2 yearsTime to treatment failure is defined to be the time from the date of registration to the date at which the patient is removed from treatment due to progression, adverse events, or refusal. The distribution of survival time will be estimated using the method of Kaplan-Meier.

Countries

United States

Participant flow

Participants by arm

ArmCount
Panitumumab
Chemotherapy concurrent with radiation: Radiation 5 days per week for 5½ weeks; 6 mg/kg Panitumumab on days 1, 15, and 29 of radiation therapy 225 mg/m\^2 per day 5-fluorouracil (5FU) continuous infusion, starting on day 1 and through last day of radiation. 4-6 weeks after completion of radiation therapy: 1000 mg/m\^2 Gemcitabine on days 1, 8, and 15 of each cycle, for 3 cycles; 6 mg/kg Panitumumab on days 1 and 15 of each cycle, for 3 cycles. Maintenance therapy: 6 mg/kg Panitumumab on days 1 and 15 of each cycle, for 6 cycles.
51
Total51

Baseline characteristics

CharacteristicPanitumumab
Age, Continuous65 years
Region of Enrollment
United States
51 participants
Sex: Female, Male
Female
28 Participants
Sex: Female, Male
Male
23 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
51 / 51
serious
Total, serious adverse events
29 / 51

Outcome results

Primary

One Year Survival Rate

The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. Confidence intervals for the true success proportion will be calculated according to the exact binomial method.

Time frame: Baseline to 12 months

Population: All patients were evaluable for this endpoint.

ArmMeasureValue (NUMBER)
PanitumumabOne Year Survival Rate0.502 proportion of patients
Secondary

Confirmed Response Rate

A confirmed tumor response is defined to be a complete response (CR) or partial response (PR) noted as the objective status on 2 consecutive evaluations at least 4 weeks apart according to the Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1. A complete response is defined as the disappearance of all target and non-target lesions. A partial response is defined as at least a 30% decrease in the sum of the longest diameter (LD) of the target lesion from baseline. Confirmed tumor response will be evaluated using the first 6 cycles of treatment.

Time frame: baseline to 2 years

Population: All patients were analyzed for this endpoint.

ArmMeasureValue (NUMBER)
PanitumumabConfirmed Response Rate0.059 rate of confirmed response
Secondary

Duration of Response

Duration of response is defined for all evaluable patients who have achieved an objective response as the date at which the patient's earliest best objective status is first noted to be either a CR or PR to the earliest date progression is documented.

Time frame: baseline to 2 years

Population: Too few patients reported a confirmed response to provide meaningful information into the duration of response.

Secondary

Overall Survival

Survival time is defined as the time from registration to death due to any cause. The distribution of survival time will be estimated using the method of Kaplan-Meier

Time frame: baseline to 2 years

Population: All patients were evaluable for this endpoint.

ArmMeasureValue (MEDIAN)
PanitumumabOverall Survival12.1 months
Secondary

Progression Free Survival (PFS)

Progression Free Survival is defined as the time from registration to the earliest documented evidence of disease progression.

Time frame: baseline to 2 years

Population: All patients were evaluable for this endpoint.

ArmMeasureValue (MEDIAN)
PanitumumabProgression Free Survival (PFS)7.4 months
Secondary

Time to Treatment Failure

Time to treatment failure is defined to be the time from the date of registration to the date at which the patient is removed from treatment due to progression, adverse events, or refusal. The distribution of survival time will be estimated using the method of Kaplan-Meier.

Time frame: baseline to 2 years

Population: All patients were included in the analysis.

ArmMeasureValue (MEDIAN)
PanitumumabTime to Treatment Failure2.71 months

Source: ClinicalTrials.gov · Data processed: Feb 13, 2026