Purpose

This phase III trial compares the effect of dose-escalated radiation therapy to usual care in patients with locally advanced unresectable pancreatic ductal adenocarcinoma who have received an initial 4-6 months of chemotherapy. Usual care options include additional chemotherapy, observation, or standard lower-dose radiation therapy. These treatments may delay tumor growth but have not been shown to improve survival. Radiation therapy uses high energy X-rays to kill cancer cells and shrink tumors. Dose-escalated radiation therapy involves the precise delivery of higher doses to the tumor, often over a shorter period of time. This trial assesses whether using dose-escalated radiation therapy can prolong survival.

Conditions

Eligibility

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

Criteria

Inclusion Criteria:

- At time of enrollment, the patient must have received 4-6 months of active
chemotherapy with FOLFIRINOX (8-12 cycles) or NALIRIFOX (8-12 cycles) or
gemcitabine/nab-paclitaxel (4-6 cycles) (1 regimen, no sequential chemotherapy).
"Active chemotherapy" refers to time on chemotherapy not counting treatment breaks
(i.e. if a patient had 1 month of chemotherapy followed by 1 month break, this would
count as 1 month chemotherapy). Study registration must occur within 45 days of last
day of chemotherapy cycle

- BASELINE PRE-ENTRY CHEMOTHERAPY REQUIREMENTS:

- Pathologically (histologically or cytologically) proven diagnosis of pancreatic
ductal adenocarcinoma

- Locally advanced unresectable disease (as defined per the National Comprehensive
Cancer Network [NCCN] guidelines and institutional tumor board review)

- Patients must have baseline pre-chemotherapy scans for staging. Options include: CT
chest/abdomen/pelvis, CT chest/MRI abdomen/pelvis, or CT chest/CT pelvis/MRI abdomen
performed prior to enrollment

- Age ≥ 18 years

- Performance status Eastern Cooperative Oncology Group (ECOG) 0-2

- Baseline CA19-9 with a normal bilirubin level (defined as ≤ 1.2 mg/dl)

- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3 x upper
limit of normal (ULN)

- POST PRE-ENTRY CHEMOTHERAPY REQUIREMENTS:

- If baseline CA19-9 is elevated (defined as > 37 u/mL) the post-pre-entry
chemotherapy CA19-9 must be less than 37 u/mL or a 50% decline from pre-chemotherapy
level with absolute value less than 100u/mL

- If baseline CA19-9 is not elevated (defined as ≤ 37 u/mL) the post-pre-entry
chemotherapy CA19-9 must remain ≤ 37 u/mL

- No active duodenal or gastric ulcers

- No direct tumor invasion of the bowel or stomach

- Restaging scans showing at least stable disease (no progression). Options for scans
include: CT chest/abdomen/pelvis, CT chest/MRI abdomen/pelvis, or CT chest/CT
pelvis/MRI abdomen performed prior to enrollment, with restaging CT showing at least
stable disease

- Not pregnant and not nursing

- No cardiac condition that was the primary reason for hospitalization in the last 6
months

- New York Heart Association Functional Classification II or better (NYHA Functional
Classification III/IV are not eligible) (Note: 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.)

- HIV-infected patients on effective anti-retroviral therapy with undetectable viral
load within 6 months are eligible for this trial

Study Design

Phase
Phase 3
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Treatment
Masking
None (Open Label)

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Arm I (Options 1, 2, or 3)
See Detailed Description.
  • Procedure: Biopsy Procedure
    Undergo tumor tissue biopsy
    Other names:
    • Biopsy
    • BIOPSY_TYPE
    • Bx
  • Procedure: Biospecimen Collection
    Undergo blood sample collection
    Other names:
    • Biological Sample Collection
    • Biospecimen Collected
    • Specimen Collection
  • Drug: Capecitabine
    Given capecitabine
    Other names:
    • Ro 09-1978/000
    • Xeloda
  • Procedure: Computed Tomography
    Undergo CT
    Other names:
    • CAT
    • CAT Scan
    • Computed Axial Tomography
    • Computerized Axial Tomography
    • Computerized axial tomography (procedure)
    • Computerized Tomography
    • Computerized Tomography (CT) scan
    • CT
    • CT Scan
    • Diagnostic CAT Scan
    • Diagnostic CAT Scan Service Type
    • tomography
  • Drug: Fluorouracil
    Given fluorouracil
    Other names:
    • 5 Fluorouracil
    • 5 Fluorouracilum
    • 5 FU
    • 5-Fluoro-2,4(1H, 3H)-pyrimidinedione
    • 5-Fluorouracil
    • 5-Fluracil
    • 5-Fu
    • 5FU
    • AccuSite
    • Carac
    • Fluoro Uracil
    • Fluouracil
    • Flurablastin
    • Fluracedyl
    • Fluracil
    • Fluril
    • Fluroblastin
    • Ribofluor
    • Ro 2-9757
    • Ro-2-9757
  • Drug: Gemcitabine
    Given gemcitabine
    Other names:
    • dFdC
    • dFdCyd
    • Difluorodeoxycytidine
  • Drug: Irinotecan Hydrochloride
    Given irinotecan hydrochloride
    Other names:
    • Campto
    • Camptosar
    • Camptothecin 11
    • Camptothecin-11
    • CPT 11
    • CPT-11
    • CPT11
    • Irinomedac
    • Irinotecan Hydrochloride Trihydrate
    • Irinotecan Monohydrochloride Trihydrate
    • U 101440E
    • U-101440E
    • U101440E
  • Drug: Irinotecan Sucrosofate
    Given liposomal irinotecan
    Other names:
    • inotecan Hydrochloride as Sucrosulfate Salt Form Liposomal Formulation
    • Irinotecan Liposome
    • Irinotecan Sucrosofate Liposome
    • Irinotecan Sucrosofate-containing Pegylated Liposomal Formulation
    • MM 398
    • MM-398
    • MM398
    • nal-IRI
    • Nanoliposomal Irinotecan
    • Nanoliposomal Irinotecan as Sucrosofate
    • Nanoparticle Liposome Formulation of Irinotecan
    • Onivyde
    • PEP 02
    • PEP-02
    • PEP02
  • Drug: Leucovorin Calcium
    Given leucovorin calcium
    Other names:
    • Adinepar
    • Calcifolin
    • Calcium (6S)-Folinate
    • Calcium Folinate
    • Calcium Leucovorin
    • Calfolex
    • Calinat
    • Cehafolin
    • Citofolin
    • Citrec
    • Citrovorum Factor
    • Cromatonbic Folinico
    • Dalisol
    • Disintox
    • Divical
    • Ecofol
    • Emovis
    • Factor, Citrovorum
    • Flynoken A
    • Folaren
    • Folaxin
    • FOLI-cell
    • Foliben
    • Folidan
    • Folidar
    • Folinac
    • Folinate Calcium
    • folinic acid
    • Folinic Acid Calcium Salt Pentahydrate
    • Folinoral
    • Folinvit
    • Foliplus
    • Folix
    • Imo
    • Lederfolat
    • Lederfolin
    • Leucosar
    • leucovorin
    • Rescufolin
    • Rescuvolin
    • Tonofolin
    • Wellcovorin
  • Procedure: Magnetic Resonance Imaging
    Undergo MRI
    Other names:
    • Magnetic Resonance
    • Magnetic Resonance Imaging (MRI)
    • Magnetic resonance imaging (procedure)
    • Magnetic Resonance Imaging Scan
    • Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance
    • MR
    • MR Imaging
    • MRI
    • MRI Scan
    • MRIs
    • NMR Imaging
    • NMRI
    • Nuclear Magnetic Resonance Imaging
    • sMRI
    • Structural MRI
  • Drug: Nab-paclitaxel
    Given nab-paclitaxel
    Other names:
    • ABI 007
    • ABI-007
    • ABI007
    • Abraxane
    • Albumin-bound Paclitaxel
    • Albumin-Stabilized Nanoparticle Paclitaxel
    • Nanoparticle Albumin-bound Paclitaxel
    • Nanoparticle Paclitaxel
    • Naveruclif
    • Paclitaxel Albumin
    • paclitaxel albumin-stabilized nanoparticle formulation
    • Paclitaxel Nanoparticle Albumin-bound
    • Paclitaxel Protein-Bound
    • Protein-bound Paclitaxel
  • Other: Observation Activity
    Undergo observation
    Other names:
    • Observation
  • Drug: Oxaliplatin
    Given oxaliplatin
    Other names:
    • 1-OHP
    • Ai Heng
    • Aiheng
    • Dacotin
    • Dacplat
    • Diaminocyclohexane Oxalatoplatinum
    • Eloxatin
    • Eloxatine
    • Elplat
    • JM 83
    • JM-83
    • JM83
    • Oxalatoplatin
    • Oxalatoplatinum
    • RP 54780
    • RP-54780
    • RP54780
    • SR 96669
    • SR-96669
    • SR96669
  • Other: Questionnaire Administration
    Ancillary studies
  • Radiation: Radiation Therapy
    Undergo standard radiation therapy
    Other names:
    • Cancer Radiotherapy
    • Energy Type
    • ENERGY_TYPE
    • Irradiate
    • Irradiated
    • Irradiation
    • Radiation
    • Radiation Therapy, NOS
    • Radiotherapeutics
    • Radiotherapy
    • RT
    • Therapy, Radiation
Experimental
Arm II (dose-escalated RT)
Patients undergo dose-escalated RT daily, every other day, or twice weekly for 5 fractions or daily for 25 fractions (with or without concurrent fluorouracil or capecitabine for 25 fractions only). The 5-fraction regimen is preferred when feasible. After completing dose-escalated RT, patients who received less than 6 months of chemotherapy at study entry are encouraged to receive the remaining chemotherapy to total 6 months of chemotherapy. Patients may continue chemotherapy treatment beyond 6 months at physician's discretion. Additionally, patients undergo blood sample collection, CT, MRI and tumor tissue biopsy throughout the study.
  • Procedure: Biopsy Procedure
    Undergo tumor tissue biopsy
    Other names:
    • Biopsy
    • BIOPSY_TYPE
    • Bx
  • Procedure: Biospecimen Collection
    Undergo blood sample collection
    Other names:
    • Biological Sample Collection
    • Biospecimen Collected
    • Specimen Collection
  • Drug: Capecitabine
    Given capecitabine
    Other names:
    • Ro 09-1978/000
    • Xeloda
  • Procedure: Computed Tomography
    Undergo CT
    Other names:
    • CAT
    • CAT Scan
    • Computed Axial Tomography
    • Computerized Axial Tomography
    • Computerized axial tomography (procedure)
    • Computerized Tomography
    • Computerized Tomography (CT) scan
    • CT
    • CT Scan
    • Diagnostic CAT Scan
    • Diagnostic CAT Scan Service Type
    • tomography
  • Radiation: Dose-escalated Radiation Therapy
    Undergo dose-escalated radiation using intensity-modulated radiation therapy treatment planning
    Other names:
    • Dose-escalated RT
  • Drug: Fluorouracil
    Given fluorouracil
    Other names:
    • 5 Fluorouracil
    • 5 Fluorouracilum
    • 5 FU
    • 5-Fluoro-2,4(1H, 3H)-pyrimidinedione
    • 5-Fluorouracil
    • 5-Fluracil
    • 5-Fu
    • 5FU
    • AccuSite
    • Carac
    • Fluoro Uracil
    • Fluouracil
    • Flurablastin
    • Fluracedyl
    • Fluracil
    • Fluril
    • Fluroblastin
    • Ribofluor
    • Ro 2-9757
    • Ro-2-9757
  • Procedure: Magnetic Resonance Imaging
    Undergo MRI
    Other names:
    • Magnetic Resonance
    • Magnetic Resonance Imaging (MRI)
    • Magnetic resonance imaging (procedure)
    • Magnetic Resonance Imaging Scan
    • Medical Imaging, Magnetic Resonance / Nuclear Magnetic Resonance
    • MR
    • MR Imaging
    • MRI
    • MRI Scan
    • MRIs
    • NMR Imaging
    • NMRI
    • Nuclear Magnetic Resonance Imaging
    • sMRI
    • Structural MRI
  • Other: Questionnaire Administration
    Ancillary studies

Recruiting Locations

University of Kansas Cancer Center
Kansas City 4273837, Kansas 4273857 66160
Contact:
Site Public Contact
913-588-3671
KUCC_Navigation@kumc.edu

University of Kansas Hospital-Westwood Cancer Center
Westwood 4281639, Kansas 4273857 66205
Contact:
Site Public Contact
913-588-3671
KUCC_Navigation@kumc.edu

University of Kansas Cancer Center - North
Kansas City 4393217, Missouri 4398678 64154
Contact:
Site Public Contact
913-588-3671
KUCC_Navigation@kumc.edu

The University of Kansas Cancer Center - Olathe
Olathe 4276614, Kansas 4273857 66061
Contact:
Site Public Contact
913-588-1569
OlatheCCResearch@kumc.edu

University of Kansas Cancer Center-Overland Park
Overland Park 4276873, Kansas 4273857 66210
Contact:
Site Public Contact
913-588-3671
KUCC_Navigation@kumc.edu

University of Kansas Cancer Center - Lee's Summit
Lee's Summit 4394870, Missouri 4398678 64064
Contact:
Site Public Contact
913-588-3671
KUCC_Navigation@kumc.edu

University of Kansas Health System Saint Francis Campus
Topeka 4280539, Kansas 4273857 66606
Contact:
Site Public Contact
785-295-8000

More Details

Status
Recruiting
Sponsor
NRG Oncology

Study Contact

Detailed Description

PRIMARY OBJECTIVE: I. To evaluate whether dose-escalated radiation therapy (RT) improves 3-year overall survival (OS) compared to standard treatments without dose-escalated RT, in locally advanced pancreatic cancer patients without radiographic progression and with biochemical response after an initial interval of chemotherapy. SECONDARY OBJECTIVES: I. To evaluate and compare local progression between the two treatment arms. II. To evaluate and compare progression-free survival (PFS) between the two treatment arms. III. To evaluate and compare chemotherapy-free interval between the two treatment arms. IV. To evaluate and compare toxicity within and between the two treatment arms. HEALTH-RELATED QUALITY-OF-LIFE (HRQOL) OBJECTIVES: I. Primary: To compare Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) Total Score at 6 months between the two treatment arms. II. Secondary: To compare nadir of HRQoL scores over course of study participation between the two treatment arms. III. Secondary: To evaluate HRQoL scores over time between the two treatment arms. EXPLORATORY OBJECTIVE: I. Biospecimen collection for future correlative analyses. OUTLINE: Patients are randomized to 1 of 2 arms. ARM I (STANDARD OF CARE): Patients are assigned to 1 of 3 treatment options per physician's decision. OPTION 1: Patients continue to receive fluorouracil, irinotecan hydrochloride, leucovorin calcium, and oxaliplatin (FOLFIRINOX or modified FOLFIRINOX [mFOLFIRINOX]) or fluorouracil, liposomal irinotecan, leucovorin calcium, and oxaliplatin (NALIRIFOX) or gemcitabine/nab-paclitaxel per standard of care for a total of 6 months of treatment. Patients may continue treatment beyond 6 months at physician's discretion. OPTION 2: Patients undergo standard dose radiation therapy once daily for 28 or 30 fractions and receive concurrent fluorouracil or capecitabine per standard of care during radiation therapy. After completing concurrent chemoradiation, patients who received less than 6 months of chemotherapy at study entry are encouraged to receive the remaining chemotherapy to total 6 months of chemotherapy. Patients may continue chemotherapy treatment beyond 6 months at physician's discretion. OPTION 3: Patients undergo observation per standard of care. (It is recommended [but not required] that this option only be for patients that have already completed total 6 months chemotherapy pre-randomization.) Additionally, patients undergo blood sample collection, computed tomography (CT), magnetic resonance imaging (MRI) and tumor tissue biopsy throughout the study. ARM II (DOSE-ESCALATED RADIATION THERAPY): Patients undergo dose-escalated RT daily, every other day, or twice weekly for 5 fractions or daily for 25 fractions (with or without concurrent fluorouracil or capecitabine for 25 fractions only). The 5-fraction regimen is preferred when feasible. After completing dose-escalated RT, patients who received less than 6 months of chemotherapy at study entry are encouraged to receive the remaining chemotherapy to total 6 months of chemotherapy. Patients may continue chemotherapy treatment beyond 6 months at physician's discretion. Additionally, patients undergo blood sample collection, CT, MRI and tumor tissue biopsy throughout the study. Patients are followed every 3 months from study entry for 2 years then annually for 3 years.

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.