vapreotide in treating patients undergoing elective pancreatic resection

Conditions: Pancreatic Cancer; Perioperative/Postoperative Complications

Summary: rationale: drugs such as vapreotide may prevent complications following pancreatic resection. it is not yet known if vapreotide is more effective than no further therapy in preventing side effects of pancreatic resection. purpose: this randomized phase iii trial is studying vapreotide to see how well it works compared to a placebo in preventing complications in patients undergoing surgery for pancreatic cancer.

objectives: i. compare the efficacy of vapreotide versus placebo in reducing postoperative pancreatic complications in patients undergoing elective pancreatic resection. ii. compare the postoperative complications occurring within 45 days after surgery unrelated to the pancreas, days of hospitalization and survival at 45 days after surgery, number of rehospitalizations, and number of postoperative blood units or packed red blood cells administered in patients treated with these regimens. outline: this is a randomized, double-blind, placebo-controlled, multicenter study. patients are randomized to one of two treatment arms. arm i: patients undergo surgical resection on day 1 and receive vapreotide subcutaneously twice daily on days 1-7. arm ii: patients undergo surgical resection and receive a placebo as in arm i. patients are followed at days 28 and 45. projected accrual: a total of 580 patients (290 per arm) will be accrued for this study.

Eligibility criteria:
disease characteristics: planned elective pancreatic resection due to presumed pancreatic tumor (either proximal or distal pancreatic lesion) or presumed neoplasm of the ampullary or periampullary region require peri-anastomotic drain(s) near the pancreaticoenterostomy or near the pancreatic stump closure the following are excluded: emergency surgery of the pancreas (acute pancreatitis, pancreatic trauma) known chronic pancreatitis (pancreatic cancer with duct obstructive chronic pancreatitis allowed) need for total pancreatectomy need for pancreatic transplantation need for elective pancreatic-cyst anastomosis need for pancreatic duct drainage operation without resection (pancreatic stents allowed if performed with partial pancreatic resection) enucleation of a pancreatic neoplasm patient characteristics: age: 18 to 90 performance status: not specified life expectancy: not specified hematopoietic: not specified hepatic: bilirubin no greater than 2.0 mg/dl renal: creatinine no greater than 2 times upper limit of normal other: not pregnant or nursing negative pregnancy test fertile patients must use effective contraception prior concurrent therapy: biologic therapy: not specified chemotherapy: no neoadjuvant or postoperative adjuvant chemotherapy from 2 weeks before to 2 weeks after surgery endocrine therapy: at least 4 weeks since prior somatostatin or somatostatin analogue no other concurrent somatostatin or somatostatin analogues radiotherapy: no neoadjuvant or postoperative adjuvant radiotherapy from 2 weeks before to 2 weeks after surgery surgery: see disease characteristics other: no concurrent pancreatic enzyme inhibitors (e.g., antiproteases) no concurrent immunosuppressive agents

Keywords: perioperative/postoperative complications stage i pancreatic cancer