Combination of Anti-PD-1 Antibody and Chemotherapy in Pancreatic Cancer

Study Overview
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Brief Summary
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The prognosis of pancreatic cancer is extremely poor. Current guidelines recommend FOLFIRINOX or modified-FOLFIRINOX as the first-line chemotherapeutic regimen. Studies have shown that immunotherapy with Anti-PD-1 antibody can effectively increase the response rate and prolong patient survival in a number of cancer diseases. Here investigators intend to compare the therapeutic effects of modified-FOLFIRINOX alone and the combination of modified-FOLFIRINOX and Anti-PD-1 antibody in patients with borderline resectable and locally advanced pancreatic cancer.

Detailed Description
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Investigators chose borderline resectable and locally advanced pancreatic cancer patients. The planned treatment was given to the participants after randomization. Response rate, recurrence-free survival, overall survival, drugs related side effects and other endpoints events were recorded and analyzed, to assess the combination treatment with modified-FOLFIRINOX and Anti-PD-1 antibody could or couldn't benefit the patients with borderline resectable and locally advanced pancreatic cancer.

Official Title
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Study on Therapeutic Effect of Combination of Anti-PD-1 Antibody and Chemotherapy in Locally Advanced or Borderline Resectable Pancreatic Cancer Patients: A Randomized Clinical Trial

Conditions
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Pancreatic Cancer

Intervention / Treatment
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* Drug: Anti-PD-1 monoclonal antibody


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pathologically (histologically or cytologically) confirmed pancreatic ductal adenocarcinoma (PDAC). No evidence of distant metastasis (such as liver, peritoneum, lung) evaluated by abdominal contrast-enhanced CT, MRI, and chest CT. PET/CT or other imaging examinations would be used if necessary. Initial assessment for definitive borderline resectable or locally advanced tumors (resectability judgment is based on CT enhanced scan or magnetic resonance imaging, NCCN2019 first edition standard). ECOG score 0 or 1. Serum creatinine level is normal, and serum total bilirubin level is less than 1.5 x ULN. ALT and AST are less than 2 x ULN. If biliary obstruction is observed, biliary decompression should be performed when the patient is randomly assigned to receive neoadjuvant chemotherapy. Leukocyte count (> 3.5 x 10^6 /mL), neutrophil count (> 1.5 x 10^6 /mL), platelet count (> 80 x 10^6 /mL), hemoglobin (> 9 g/dL). Signed informed consent. Exclusion Criteria: History of malignance treatment in the past, excluding basal and cutaneous squamous cell carcinoma, cervical carcinoma in situ, papillary thyroid carcinoma History of participation of other clinical trails within 4 weeks History of immunotherapy within 4 weeks History of receiving chemotherapy, radiotherapy and molecular target therapy within 2 weeks Tumor is a local recurrent lesion. Imaging confirmed severe portal hypertension / cavernous transformation. Ascites Gastric outlet obstruction Respiratory failure requires supplementation of oxygen. Immune deficiency syndrome, such as active tuberculosis and HIV infection. Hematological precancerous diseases, such as myelodysplastic syndromes. Major cardiovascular diseases (including myocardial infarction, unstable angina, congestive heart failure, severe uncontrolled arrhythmia) during the past six months of enrollment. Evidence of clinical-related or previous interstitial lung disease, such as noninfectious pneumonia or pulmonary fibrosis, or baseline chest CT scan or chest X-ray findings Previous or physical findings of central nervous system disease, except for adequately treated (e.g. primary brain tumors, uncontrolled seizures or strokes with standard medications) Preexisting neuropathy > 1 (NCI CTCAE). Allograft requires immunosuppressive therapy or other major immunosuppressive therapies. Severe serious wounds, ulcers or fractures. Confirmed coagulant disease. Clinical evaluation is unacceptable.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Chemotherapy group<br>Treatment with modified-FOLFIRINOX Folic acid 400mg/m^2, 5- fluorouracil 2400mg/m^2 for 46h, irinotecan 135mg/m^2 and oxaliplatin 68mg/m^2 | |
| Experimental: Combination group<br>Treatment with modified-FOLFIRINOX and Anti-PD-1 antibody Folic acid 400mg/m^2, 5- fluorouracil 2400mg/m^2 for 46h, irinotecan 135mg/m^2 and oxaliplatin 68mg/m^2, Anti-PD-1 antibody 3mg/kg | Drug: Anti-PD-1 monoclonal antibody<br>* Accompanying with modified-FOLFIRINOX, Anti-PD-1 antibody was applied biweekly.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression-free survival | The time of treatment until documented tumor progreesion. | Through the study peirod, for 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Resection rate | The proportion of patients with surgeical treatment after treatment | Through the study peirod, for 3 years | 
| R0 rate | The proportion of patients with completely tumor resection after treatment | Through the study peirod, for 3 years | 
| Objective response rate | The proportion of patients with tumor size reduction of a predefined amount and for a minimum time period | Through the study peirod, for 3 years | 
| Disease control rate | The proportion of patients with tumor size reduction or stable | Through the study peirod, for 3 years | 
| Overall survival | The time of treatment until death. | Through the study peirod, for 3 years | 
| EORTC QLQ - PAN26 score | QLQ score assessed by the European Organization for Research and Treatment of Cancer Quality of Life scale for pancreatic cancer | Through the study peirod, for 3 years | 
| Adverse effects | The most common hematologic and non-hemotologic adverse events | Through the study peirod, for 3 years | 
| Carbohydrate antigen 19-9 | Carbohydrate antigen 19-9 level | Through the study peirod, for 3 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pancreatic cancer, PD-1, FOLFIRINOX, combination therapy