Patient case: 54-year-old male with Pancreatic cancer. Genetic variant: CDKN2A. Other conditions: Diabetes, Hypertension.

Clinical trial: Metastatic Advanced Pancreas Sorafenib

Summary: This is multicentre, open-label, randomized, phase II trial in patients with locally advanced or metastatic pancreatic cancer. Subjects will be randomized in a 1:1 ratio to receive gemcitabine/cisplatin in combination with Sorafenib (arm A) or gemcitabine/cisplatin alone (arm B), as first-line chemotherapy.

Detailed description: Up to date no standard treatment is available for pancreatic cancer. Although gemcitabine is commonly used in patients with pancreatic cancer with the purpose of symptom palliation, there is no clear evidence of efficacy in terms of survival increase or progression control. Furthermore, attempts at improving results by combining gemcitabine with other cytotoxic drugs failed to obtain any advantage. Recently, an EGFR inhibitor (erlotinib) showed a small survival advantage when combined with gemcitabine. results obtained with a combination of gemcitabine and oxaliplatin seem more promising. A meta-analysis of randomised trials comparing gemcitabine versus gemcitabine and platinum analogues showed a statistical significant survival advantage for the combination.
  Sorafenib is an inhibitor of the RAS/RAF signalling pathway. Furthermore, sorafenib is able to inhibit both VEGFR and PDGFR.
  Since RAS and RAF mutations are quite common in pancreatic cancer, Sorafenib could be useful in the management of these tumours. Furthermore, it may be combined with gemcitabine and cisplatin without any pharmacokinetic interaction or enhanced toxicity.

Eligibility: Inclusion Criteria:
  -  Signed written informed consent prior to beginning protocol specific procedures
  -  Male or female 18 to 75 years of age
  -  Diagnosis of histologically confirmed adenocarcinoma of the pancreas
  -  Locally advanced (non-resectable) or metastatic pancreatic cancer
  -  Presence of at least one uni-dimensional indicator lesion measurable by CT scan or MRI in not an irradiated area (RECIST criteria)
  -  Karnofsky performance status of ≥ 70 at study entry
  -  Neutrophils ≥ 1.5 x 109/L, platelets ≥ 100 x 109/L, and hemoglobin ≥ 9 g/dL
  -  Bilirubin level either normal or < 1.5 x ULN
  -  ASAT and ALAT ≤ 2.5 X ULN (≤ 5 x ULN if liver metastasis are present)
  -  Serum creatinine < 1.5 x ULN
  -  Amylase and lipase ≤ 1.5 x the upper limit of normal
  -  PT or INR and PTT < 1.5 x upper limit of normal (subjects who receive anti-coagulation treatment with an agent such as warfarin or heparin will be allowed to participate provided that no evidence of underlying abnormality in these parameters exists).
  -  Effective contraception for both male and female patients if the risk of conception exists
  Exclusion Criteria:
  -  Brain metastases
  -  Previous chemotherapy for locally advanced or metastatic pancreatic cancer.
  -  Adjuvant therapy if documented recurrence is within 6 months after the end of adjuvant treatment)
  -  Radiotherapy within 4 weeks prior to study entry
  -  Major surgery within 4 weeks of first dose of study drug
  -  Concurrent chronic systemic immune therapy
  -  Any investigational agent(s) 4 weeks prior to entry
  -  Clinically relevant coronary artery disease or a history of a myocardial infarction within the last 6 months
  -  Thrombotic or embolic events such as cerebrovascular accident including transient ischemic attacks within the past 6 months
  -  Acute or subacute intestinal occlusion or history of inflammatory bowel disease
  -  Known grade 3 or 4 allergic reaction to any of the components of the treatment
  -  Known drug abuse/ alcohol abuse
  -  Legal incapacity or limited legal capacity
  -  Medical or psychological condition which in the opinion of the investigator would not permit the patient to complete the study or sign meaningful informed consent
  -  Women who are pregnant or breastfeeding
  -  Acute or subacute intestinal occlusion
  -  Any concurrent malignancy other than non-melanoma skin cancer, or carcinoma in situ of the cervix. (Patients with a previous malignancy but without evidence of disease for ≥ 5 years will be allowed to enter the trial).

Relevance to patient case: not relevant