A Phase II Study of Neoadjuvant FOLFIRINOX
Condition: Resectable Pancreatic Ductal Adenocarcinoma
MeSH terms: Adenocarcinoma
Intervention: FOLFIRINOX
Intervention description: FOLFIRINOX consists of the following combination of drugs:
Oxaliplatin, 85 mg/m2, IV over 2 hours prior to irinotecan, administered on days 1 and 15 of each 28 day cycle
Leucovorin, 400 mg/m2, IV over 2 hours with irinotecan, administered on days 1 and 15 of each 28 day cycle
Irinotecan, 180 mg/m2, IV over 90 minutes with leucovorin, administered on days 1 and 15 of each 28 day cycle 4.5 FU, 400 mg/m2, IV bolus over 2 minutes after irinotecan, administered on days 1 and 15 of each 28 day cycle.
5.5FU, 2400 mg/m2, IV infusion over 46 hours after 5FU bolus injection, administered on days 1 and 15 of each 28 day cycle.
Intervention MeSH terms: Leucovorin; Oxaliplatin; Irinotecan; Folfirinox
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 48.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Pancreatic; Cancer; Resectable

Summary:

      The primary objective of this study is to evaluate the rate of pathologic complete response
      to neoadjuvant FOLFIRINOX in patients with resectable pancreatic cancer using a tissue
      collection component.
    

Eligibility criteria:

        Inclusion Criteria:

          1. ≥ 18 years old at the time of informed consent

          2. Able to provide written informed consent and HIPAA authorization

          3. ECOG performance status of 0 or 1

          4. Patient must be eligible for abdominal surgery

          5. Histologically confirmed adenocarcinoma of the pancreas that has been documented to be
             resectable by standardized radiographic criteria by a pancreatic surgeon

          6. Patients must to have tumor tissue collected prior to enrolling on this trial. Up to
             10 patients will be accepted with no pre-treatment research tissue collection or
             tissue collection from an outside institution.

             a.If the tissue is from an outside institution, it must be reviewed at Indiana
             University Health Pathology Department if a biopsy was performed outside of this
             institution.

          7. Women of childbearing potential definition (WOCBP) must have a negative serum or urine
             pregnancy test performed within 14 days prior to initiation of FOLFIRINOX.

             Any woman (regardless of sexual orientation, having undergone a tubal ligation, or
             remaining celibate by choice) is classified as WOCBP if she meets the following
             criteria:

               1. Has not undergone a hysterectomy or bilateral oophorectomy; or

               2. Has not been naturally postmenopausal for at least 24 consecutive months (i.e.,
                  has had menses at any time in the preceding 12 consecutive months).

          8. WOCBP and men must agree to use adequate contraception prior, to study entry, for the
             duration of study participation, and 8 weeks after the end of treatment.

          9. Patients must have adequate organ function as defined by the following laboratory
             values at study entry:

               1. Hemoglobin ≥ 9 g/dL (transfusions are acceptable)

               2. ANC ≥ 1.5 x 109/L

               3. Platelets ≥ 100 x 109/L

               4. Creatinine ≤ 1.5 x ULN, or creatinine clearance ≥ 50 mL/min (estimated by
                  Cockcroft-Gault or measured)

               5. Total bilirubin ≤ 1.5 x ULN

               6. AST/ALT ≤ 3 x ULN

        Exclusion Criteria:

          1. Prior therapy for pancreatic adenocarcinoma

          2. Other malignancies within the past 3 years except for the following: adequately
             treated cervical or vulvar carcinoma in situ, treated basal cell or squamous carcinoma
             of the skin, superficial bladder tumors (Ta, Tis & T1), ductal carcinoma in situ
             (DCIS) of the breast and low grade prostate cancer. Any cancer curatively treated >3
             years prior to entry with no clinical evidence of recurrence is permitted.

          3. Hypersensitivity to 5FU, oxaliplatin (or other platinum agents), irinotecan (or to
             their excipients).

          4. Participation in any investigational drug study within 4 weeks preceding the start of
             study treatment. Patients are not permitted to participate in another investigational
             drug study while being treated on this protocol.

          5. Inability to receive a port or PICC line.

          6. History of or suspected Gilbert's Disease (testing not required if presence is not
             suspected).

          7. Baseline peripheral neuropathy/paresthesia grade ≥ 1.

          8. Active hepatitis B, unless patient has been on antiviral agents for at least 2 months
             (baseline testing not required).

          9. Active clinically serious infections (> grade 2).

         10. Major surgery or significant traumatic injury within 8 weeks of first study drug. A
             core pancreatic or liver biopsy does not preclude the patient from the study.

         11. Unable or unwilling to discontinue use of ketoconazole or St John's wort. Use of
             phenytoin, carbamazepine, phenobarbital, rifampin and rifabutin is discouraged, but
             not contraindicated. If patients require phenytoin, carbamazepine or phenobarbital
             monitoring of drug levels is suggested during the study.

         12. Pregnant or lactating women.

         13. Psychological, familial, sociological or geographical condition potentially hampering
             compliance with the study protocol and follow-up schedule; those conditions should be
             discussed with the patient before registration in the trial.