Pancreatic Cancer Non-resectable
Conditions
Brief summary
This study is testing a new way to deliver the chemotherapy drug Gemcitabine in pancreatic tumors using the catheter Extroducer® Infusion Catheter System. The study will include patients with Locally Advanced Pancreatic Cancer that cannot be removed with surgery. Patients will receive four treatment sessions, given every two weeks, in which Gemcitabine is infused directly into or near the tumor. The study will test up to three increasing dose levels of Gemcitabine (200 mg, 400 mg, and 100 mg). The study will enroll three groups of three patients each. After each group completes treatment, an independent safety committee will review the results to decide whether it is safe to move to the next dose per predefined study criteria. After finishing treatment, patients will be followed for six months. Each patient's total participation in the study will last about 8-9 months. The main goal of the study is to evaluate the safety and feasibility of this treatment approach.
Detailed description
This is a prospective, interventional, non-randomized, open-label pilot study designed to evaluate the safety and performance of the Extroducer® Infusion Catheter System for peri- and intratumoral delivery of Gemcitabine in patients with unresectable Locally Advanced Pancreatic Cancer (LAPC). The study uses a dose-escalation design with three sequential cohorts to assess the feasibility and safety of repeated peri-/intratumoral Gemcitabine infusions at dose levels of 100 mg, 200 mg, and 400 mg. Each patient is planned to receive four study treatment sessions administered every two weeks. Following completion of the treatment phase, patients will be followed for 6 months until study completion. The total study participation per patient is expected to be approximately 8-9 months. Each cohort will include three patients. After completion of study treatment by all patients in a cohort, the Data Safety Monitoring Board (DSMB) will review safety data and determine whether dose escalation is appropriate based on the occurrence of study-defined dose-limiting toxicities (DLTs), and will recommend the dose level for the next cohort. A total of nine eligible participants are planned to be enrolled at one study site in Sweden.
Interventions
DRUGGemcitabine
Gemcitabine administered via the Extroducer Infusion Catheter System for targeted delivery.
DEVICEExtroducer Infusion Catheter System
Infusion catheter system for delivery of diagnostic or therapeutic agents into the extravascular space or peripheral vasculature.
Sponsors
Smartwise Sweden AB
Study design
Allocation
NA
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Able to comply with scheduled visits, treatment plan, able to undergo catheterization, imaging procedures, laboratory tests, required follow up visits, the filling out of required forms, and have the ability to understand and give written informed consent. * Voluntarily agrees to participate and has duly singed the Informed Consent Form. * Age 18 years or older. * Histologically confirmed, locally advanced pancreatic cancer. * Systemic treatment with IV chemotherapy for at least six months. * Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. * The target tumor is a measurable tumor according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria v1.1 prior to initiating Extroducer® Gemcitabine treatment. * Stable disease or locally progressive disease without signs of metastatic disease as evaluated at a multidisciplinary tumor board within 4 weeks prior to first dose. * Locally Advanced Pancreatic Cancer not amenable to resection as evaluated at a multidisciplinary tumor board within 4 weeks prior to first dose. * Have acceptable organ and marrow function as defined below: i. Absolute neutrophil count (ANC) ≥ 1500 cells/mm³ (1.5x109 cells/L) ii. Hemoglobin ≥ 9.0 g/dL iii. Platelets ≥ 100,000/µL iv. Total bilirubin ≤ 2 × upper limit of normal (ULN). v. AST (Aspartate Aminotransferase) ≤ 3 × ULN. vi. ALT (Alanine Aminotransferase) ≤ 3 × ULN vii. Creatinine Within 1.5 x ULN OR Creatinine clearance ≥ 60 mL/min for patients with creatinine levels above 1.5 x ULN. * Women of childbearing potential (defined as all women who are not surgically sterile or postmenopausal for at least 1 year prior to enrollment) must have a negative urine pregnancy test at enrollment and must agree to use a medically acceptable and highly effective contraception from enrollment until 6 months after final study treatment of Gemcitabine. * Male subjects who are planning to father a child (i.e., planning a pregnancy with a partner) during the clinical investigation. i. Male subjects must agree to use highly effective contraception with female partners of childbearing potential during the clinical investigation and for 3 months after the last dose of Gemcitabine and must not donate sperm during this period. ii. Acceptable methods include: a condom in addition to combined hormonal contraception, progestogen-only contraception, intrauterine device (IUD), intrauterine hormone-releasing system (IUS), bilateral tubal occlusion in the female partner, or vasectomy of the male participant (confirmed azoospermia). iii. Sexual abstinence is acceptable only if it is the subject's usual and preferred lifestyle; periodic abstinence and withdrawal are not acceptable.
Exclusion criteria
* Participating in another clinical investigation which may interfere with the results in this clinical investigation per investigator judgement. * Inability to consent. * Pancreatic tumor is different from adenocarcinoma (e.g., neuroendocrine, metastases). Adenosquamous is allowed. * Cancer has spread to other organs or non-regional lymph nodes (Metastases). * Unknown stage or recurrent pancreatic cancer. * Patient contraindication to Gemcitabine treatments. * Patients in which iodine contrast is contraindicated. * Presence of structures that impede tumor access. * Concurrent or prior malignancy unless disease-free for ≥3 years, with exceptions for nonmelanoma skin cancer, carcinoma in situ of the cervix or bladder, or Gleason Grade \< 7 organ-confined prostate cancer. This may be subject to investigator's judgement based on individual patient circumstances and the nature of the malignancy. * Unmanaged concurrent illnesses, encompassing psychiatric conditions or challenging social circumstances, that, as per the investigator's judgment, could undermine compliance to the study protocols or pose an unacceptable risk to the patient. * Pregnant or nursing individuals.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Extroducer® related Serious Adverse Events | From each study treatment until 72 hours post treatment. | Occurrence of Extroducer® related Serious Adverse Events within 72 hours post Extroducer® treatment infusion with Gemcitabine. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Gemcitabine related Serious Adverse Events | From first study treatment on Day 0 until study completion, ~8 Months. | Occurrence of Gemcitabine related Serious Adverse Events from first Extroducer® treatment infusion with Gemcitabine until study completion. |
| Overall Survival | Through study completion, ~8 Months. | Overall Survival (OS) at 6 months after final Extroducer® treatment infusion with Gemcitabine. |
| Progression Free Survival | Through study completion, ~8 Months. | Progression Free Survival (PFS) at 6 months after final Extroducer® treatment infusion with Gemcitabine. |
| Tumor resectability | Through study completion, ~8 Months. | Classification of tumor resectability according to NCCN resectability criteria before (baseline) and after (Visits 11-13) Extroducer® treatment infusion with Gemcitabine. |
| Tumor response | Through study completion, ~8 Months. | Classification of tumor response according to RECIST before (baseline) and after (Visits 11-13) Extroducer® treatment infusion with Gemcitabine. |
| Tumor marker | Through study completion, ~8 Months. | Evaluation of the tumor marker CA-19-9 before (baseline) and after (Visits 9, 11-13) Extroducer® treatment infusion with Gemcitabine. |
| Patient Quality of Life | Through study completion, ~8 Months. | Evaluation of subjects' quality of life using the EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 items) and EORTC PAN26 (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Pancreatic Cancer Module 26) questionnaires before (baseline) and after (Visits 11-13) Extroducer® treatment infusion with Gemcitabine. All scales and single-item measures are scored from 1 to 100. Higher scores indicate a higher level of the measured construct. For functional scales, a higher score represents better or healthier functioning. A higher score on the Global Health Status/Quality of Life scale indicates better quality of life, whereas a higher score on symptom scales or items reflects a greater level of symptoms or problems. The two questionnaires are intended to be used together as a single module and therefore constitute one combined outcome measure. |
| Incidence of Adverse Events and Device Deficiencies | Through study completion, ~8 Months. | The incidence, severity, and seriousness of Adverse Events and Device Deficiencies throughout the clinical investigation. |
Countries
Sweden
Contacts
CONTACTUlrik Birgersson, PhD, MSc
Outcome results
None listed