A Pilot, Prospective, Non-randomized Evaluation of the Safety of Anakinra Plus Standard Chemotherapy

Study Overview
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Brief Summary
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The study's overall objectives are to evaluate the safety of anakinra in combination with standard chemotherapy regimens in patients with pancreatic ductal adenocarinoma, as well as to collect preliminary immune modulation and clinical activity information, overall survival, and serious adverse events related to the study drug.

Detailed Description
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Kineret (anakinra) is a FDA-approved drug indicated for rheumatoid arthritis. Anakinra is a recombinant, nonglycosylated form of the human interleukin-1 receptor antagonist (IL-1Ra). Anakinra blocks the biologic activity of IL -1 by competitively inhibiting IL-1 binding to the interleukin-1 type I receptor (IL-1RI), which is expressed in a wide variety of tissues and organs. IL-1 production is induced in response to inflammatory stimuli and mediates various physiologic effects including inflammatory and immunological responses. This is a pilot, prospective, non-randomized, consecutive enrollment study that will enroll up to 12 subjects who meet the study defined inclusion and exclusion criteria. Subjects will undergo standard of care chemotherapy treatment/regimens (i.e., modified FOLFIRINOX). Subjects will be dispensed a 2 weeks supply of anakinra the day they begin chemotherapy. They will be instructed to begin self-administering the anakinra (study drug) injections the day after their first dose of chemotherapy. They will have a blood sample collected at baseline and 6 months follow up. If they have surgery for their disease, they may have a tissue sample collected for later analysis.

Official Title
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A Pilot, Prospective, Non-randomized Evaluation of the Safety of Anakinra Plus Standard Chemotherapy Regimens in Metastatic Pancreatic Ductal Adenocarcinoma Patients

Conditions
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Pancreas Cancer

Intervention / Treatment
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* Drug: anakinra
* Drug: Oxaliplatin
* Drug: Irinotecan
* Drug: fluorouracil


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years of age or older Male or non-pregnant and non-lactating female Confirmed metastatic/inoperable metastatic pancreas cancer and/or Histologically/cytologically confirmed metastatic adenocarcinoma of pancreas Patients' blood counts and blood chemistry levels at baseline must be not clinically significant (NCS) as determined by the enrolling investigator. Patient has Eastern Cooperative Oncology Group( ECOG ) Performance Status 0 to 2 (refer to Appendix 5): Signed study consent form Exclusion Criteria: <18 years of age Pregnant or lactating female Patient has islet cell neoplasms Active secondary malignancies (2nd cancer not treated/present) Active, uncontrolled bacterial, viral, or fungal infection(s) requiring systemic therapy Known infection with hepatitis B, hepatitis C, or cirrhosis Major surgery or vascular device placement (excluding ports for IV medication/chemotherapy) within 2 weeks prior to Day 1 of treatment in study History of allergy or hypersensitivity to the study drugs Patient is enrolled in any concurrent-outside (outside Baylor University Medical Center or Texas Oncology) clinical protocol or investigational trial Significant cardiac disease as defined as New York Heart Association (NYHA) classification III or IV, uncontrolled CHF, or prior MI last 6-months Any prior gastrointestinal (GI) disease or history of prior pelvic or abdominal radiation which in the opinion of the investigator may place the patient at increased risk Peripheral sensory neuropathy ≥ to grade 2 at baseline Significant co-morbidities deemed by investigator as unsuitable for participation/enrollment Study consent form not signed

Ages Eligible for Study
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Minimum Age: 18 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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Anakinra with Modified Folfirinox<br>8-weeks of anakinra and modified FOLFIRINOX regimen (refer to Appendix 9 for regimen) as follows Kineret (anakinra) Dosage Route Administration 100 mg SC Every Other Day Modified FOLFIRINOX Drug Dose Administration Oxaliplatin 85 mg/m2 2-4 hours Irinotecan 180 mg/m2 90 minutes fluorouracil 2400 mg/m2 48 hours | Drug: anakinra<br>* Dosage Route Administration 100 mg SC Every Other Day<br>* Other names: Kineret;Drug: Oxaliplatin<br>* Oxaliplatin 85 mg/m2 2-4 hours<br>Drug: Irinotecan<br>* Irinotecan 180 mg/m2 90 minutes<br>* Other names: Camptosar;Drug: fluorouracil<br>* fluorouracil 2400 mg/m2 48 hours<br>* Other names: 5 FU;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Number of Participants with SAEs and AEs. | Test the safety of Anakinra in combination with standard chemotherapy in patients with metastatic pancreatic ductal adenocarcinoma (PDAC) as evidenced by the Number of Participants with serious adverse events (SAEs) and adverse events (AEs). | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Survival | Overall Survival (OS) rate as defined by the percentage of people who are alive for a certain period of time after diagnosis | 6 months | 
| Adverse events associated with injection site reactions and the incidence of infections | Adverse events associated with injection site reactions and the incidence of infections | 6 Months | 
| Data Collection: tumor measurements by CT scans | Data Collection: tumor measurements by CT scans | 6 months | 
| Gather preliminary information on the immune modulation and clinical activity of this therapy | Blood transcriptional profiling Composition of white blood cells Assessment of PDAC antigen--specific T cell repertoire in the blood | 6 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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metastatic pancreatic ductal adenocarcinoma (PDAC), pancreatic cancer, pancreas cancer, pancreatic adenocarcinoma, metastatic pancreas cancer, metastatic pancreatic cancer