Nivolumab Adding on Gemcitabine/S-1 in Metastatic Pancreatic Cancer

Study Overview
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Brief Summary
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This study assumes that to achieve significant therapeutic efficacy in advanced pancreatic cancer with immunotherapy, the immune system must remain relatively intact. Therefore, early use, low tumor load, adequate organ function, and slow growth of the tumor are the key points. Stage IV pancreatic adenocarcinoma patients with limited metastatic lesions and adequate organ function will be enrolled. Gemcitabine plus S-1 (GS) will be administered initially, and then CA 19-9 will be evaluated. Those fulfilling pre-defined criteria of CA 19-9 will receive nivolumab add-on therapy.

Official Title
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Nivolumab as add-on to Gemcitabine/S-1 in Metastatic Pancreatic Cancer: a Phase II Trial

Conditions
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Stage IV Pancreatic Cancer

Intervention / Treatment
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* Drug: Nivolumab
* Drug: Gemcitabine
* Drug: Tegafur-Gimeracil-Oteracil


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: histologically proven pancreatic adenocarcinoma newly diagnosed, stage IV pancreatic cancer with limited metastases and tumor burden no previous radiotherapy, chemotherapy, targeted therapy, curative surgery, local therapy (eg. radiofrequency ablation, irreversible electroporation, etc.), immunotherapy, cell therapy (autologous or allogenic) used for pancreatic cancer presence of at least one measurable lesion at the pancreas and at least one measurable metastatic lesion age between 20 and 75 years at registration ECOG performance status of 0 or 1 adequate major organ functions baseline CA 19-9 > upper limit of normal Glasgow prognostic score of 0 (ie. albumin ≥ 3.5 g/dL and CRP ≤ 1 mg/dL) ability to take study medication (S-1) orally no clinically significant abnormal ECG findings within 28 days prior to registration Women of childbearing potential (including women with chemical menopause or no menstruation for other medical reasons) must agree to use contraception from the time of informed consent until 5 months or more after the last dose of investigational products. Also, women must agree not to breastfeed from the time of informed consent until 5 months or more after the last dose of the investigational product. Men must agree to use contraception from the start of study treatment until 7 months or more after the last dose of the investigational product. Sign written informed consent Exclusion Criteria: interstitial lung disease that is symptomatic or may interfere with the detection or management of suspected treatment-related pulmonary toxicity within 28 days prior to registration presence of diarrhea ≥ CTCAE v.5.0 grade 2 concomitant systemic infection requiring treatment clinically significant co-morbid medical conditions, including cardiovascular disease known autoimmune disease concurrent autoimmune disease or history of chronic or recurrent autoimmune disease prior organ allograft or allogeneic bone marrow transplantation received systemic corticosteroids (except for temporary use, e.g., for examination or prophylaxis of allergic reactions) or immunosuppressants within 28 days before registration HBV (positive HBsAg or HBV DNA) or HCV carrier (positive anti-HCV or HCV RNA) known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome moderate or severe ascites, pleural effusion, or pericardial effusion requiring treatment central nervous system metastasis prior or concurrent malignancies within the last 3 years, with the exception of carcinoma in situ of the cervix, or basal type skin cancer concomitant treatment with flucytosine, phenytoin or warfarin any major surgery within 4 weeks of study treatment. Participants must have recovered from the effects of major surgery or significant traumatic injury at least 14 days before the first dose of study treatment. transfusion from 72 hours prior to registration to the first dose of study drug administration pregnant women or nursing mothers, or positive pregnancy tests severe mental disorder treatment with botanical preparations (eg, herbal supplements or traditional Chinese medicines) intended for general health support or to treat the disease under study within 2 weeks prior to registration vaccine therapies for prevention of infectious diseases within 4 weeks of study drug administration except inactivated seasonal influenza vaccine any condition requiring anti-platelet or anticoagulant therapy within 12 weeks prior to registration oral or iv antibiotic use within 2 weeks prior to registration uncontrollable pain caused by a tumor receiving antineoplastic agents within 28 days before registration patients judged by the principal investigator or subinvestigators to be inappropriate as subjects of this study

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 75 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
Interventional Model Description: Simon's two-stage design
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nivolumab/GS<br>Part-1: GS Induction Patients will receive GS for 1 cycle. S-1: 60/80/100 mg per day (based on body surface area, BSA); D1-12; 3 weeks per cycle BSA < 1.25 m2: 60 mg/day; 1.25 m2 ≤ BSA < 1.5 m2: 80 mg/day; BSA ≥ 1.5 m2: 100 mg/day Gemcitabine: 850 mg/m2; D1, 8; 3 weeks per cycle After GS, patients fulfilling the pre-defined CA 19-9 criteria will enter the Add-On part. Part-2: Nivolumab Add-On Nivolumab: 3 mg/kg every 2 weeks, 6 weeks per cycle S-1: according to the individualized dose on D8 of cycle 1 in Part-1, 6 weeks per cycle Gemcitabine: according to the individualized dose on D8 of cycle 1 in Part-1, 6 weeks per cycle The treatment will be continued until disease progression, intolerance to study treatment or death. | Drug: Nivolumab<br>* as described in NGS Arm<br>Drug: Gemcitabine<br>* as described in NGS Arm<br>Drug: Tegafur-Gimeracil-Oteracil<br>* as described in NGS Arm<br>* Other names: S-1;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| response rate | overall response rate of gemcitabine/S-1/nivolumab | 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pancreatic adenocarcinoma, chemotherapy, nivolumab