FOLFIRINOX Plus PF-04136309 in Patients With Borderline Resectable and Locally Advanced Pancreatic Adenocarcinoma

Study Overview
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Brief Summary
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This phase I trial studies the side effects and optimal dose of PF-04136309 when given with combination chemotherapy (FOLFIRINOX; 5-fluorouracil, leucovorin, irinotecan, oxaliplatin) in treating patients with locally advanced or borderline resectable pancreatic cancer. These patients are not candidates for surgical resection which is the most effective treatment for pancreatic cancer. Giving PF-04136309 together with FOLFIRINOX may shrink pancreatic tumors in some patients so that surgery becomes an option

Detailed Description
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PRIMARY OBJECTIVES: To define the optimal dose and toxicity of PF-04136309 in combination with FOLFIRINOX (fluorouracil, leucovorin calcium, irinotecan hydrochloride, and oxaliplatin) in patients with borderline resectable and locally advanced pancreatic cancer. SECONDARY OBJECTIVES: To evaluate the safety of PF-04136309 and FOLFIRINOX by grade 3 or 4 toxicity for clinical use. To determine the tumor control rate (TCR) as defined by stable disease (SD), partial response (PR), and complete response (CR): TCR = SD + PR + CR. EXPLORATORY OBJECTIVES: To determine the prevalence and function of myeloid-derived suppressor cells (MDSC) in the bone marrow, peripheral circulation, and tumor before and after treatment with PF-04136309 and FOLFIRINOX. To determine the prevalence and function of MDSC in the bone marrow, peripheral circulation, and tumor before and after treatment with FOLFIRINOX.

Official Title
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Phase IB Study of FOLFIRINOX Plus PF-04136309 in Patients With Borderline Resectable and Locally Advanced Pancreatic Adenocarcinoma

Conditions
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Pancreatic Neoplasms

Intervention / Treatment
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* Drug: Oxaliplatin
* Drug: Irinotecan
* Drug: Leucovorin
* Drug: Fluorouracil
* Other: laboratory biomarker analysis
* Other: flow cytometry
* Other: immunohistochemistry staining method
* Other: pharmacological study
* Drug: PF-04136309


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient must have histologically or cytologically confirmed pancreatic adenocarcinoma which is borderline resectable or locally advanced; tumors considered borderline include the following: (a) no distant metastases; (b) venous involvement of the superior mesenteric vein/portal vein demonstrating tumor abutment with or without impingement and narrowing of the lumen, encasement of the superior mesenteric vein/portal vein but without encasement of the nearby arteries, or short segment venous occlusion resulting from either tumor thrombus or encasement but with suitable vessel proximal and distal to the area of vessel involvement, allowing for safe resection and reconstruction; (c) gastroduodenal artery encasement up to the hepatic artery with either short segment encasement or direct abutment of the hepatic artery, without extension to the celiac axis; (d) tumor abutment of the superior mesenteric artery not to exceed 180 degrees of the circumference of the vessel wall Patient must have radiographically measurable disease defined as lesions that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 10 mm with computed tomography (CT) scan or magnetic resonance imaging (MRI) or >= 10 mm with calipers by clinical exam Patient myst be >= 18 years of age. Patient must have life expectancy of > 6 months Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status =< 1 Patient must have normal bone marrow and organ function as defined below: Absolute neutrophil count >= 1,500/mcl Platelets >= 100,000/mcl Hemoglobin >= 9.0 g/dL Creatinine should be below the upper limit of normal OR creatinine clearance >= 60 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal limits Patient not on anticoagulation must have International Normalized Ratio (INR) and activated partial thromboplastin time (PTT) < 1.5 x ULN Patients who have had a stent placed for biliary obstruction can be included in the study Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately Patient must be able to understand and willing to sign an institutional review board (IRB) approved written informed consent document Exclusion Criteria: Patient must not have evidence of neuroendocrine tumor, duodenal adenocarcinoma, or ampullary adenocarcinoma Patient must not have a history of other malignancy =< 3 years previous with the exception of basal cell or squamous cell carcinoma of the skin which were treated with local resection only or carcinoma in situ of the cervix Patient must not have received any chemotherapy or radiation for pancreatic cancer Patient must not be receiving any other investigational agents Patient must not have brain metastases; such patients must be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events Patient must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to PF-04136309, 5FU (fluorouracil), oxaliplatin, or irinotecan Patient must not be on any CYP3A4 inhibitors or inducers as they may have interaction with PF-04136309 and/or irinotecan Patient must not have an uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, any clinically active malabsorption syndrome, inflammatory bowel disease, any condition that increases the risk of severe irinotecan gastrointestinal toxicity, or psychiatric illness/social situations that would limit compliance with study requirements Patient must not be pregnant and/or breastfeeding Patient must not be known to be human immunodeficiency virus (HIV)-positive on combination antiretroviral therapy

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
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group A (FOLFIRINOX chemotherapy)<br>Patients receive FOLFIRINOX chemotherapy comprising of: oxaliplatin 85 mg/m2 IV on Day 1 irinotecan 180 mg/m2 IV on Day 1 leucovorin 400 mg/m2 IV on Day 1 5FU 400 mg/m2 bolus and 2400 mg/m2 CIVI over 46 hours beginning on Day 1 Treatment is repeated every 14 days for 6 cycles. | Drug: Oxaliplatin<br> <br> * Other names: L-OHP;Drug: Irinotecan<br> <br> * Other names: U-101440E;Drug: Leucovorin<br> <br> * Other names: LV;Drug: Fluorouracil<br> <br> * Other names: 5-FU;Other: laboratory biomarker analysis<br>* Correlative studies<br>Other: flow cytometry<br>* Correlative studies<br>Other: immunohistochemistry staining method<br>* Correlative studies<br>* Other names: immunohistochemistry;Other: pharmacological study<br>* Correlative studies<br>* Other names: pharmacological studies;|
| Experimental: Group B (FOLFIRINOX and PF-04136309)<br>Patients receive FOLFIRINOX chemotherapy comprising of: oxaliplatin 85 mg/m2 IV on Day 1 irinotecan 180 mg/m2 IV on Day 1 leucovorin 400 mg/m2 IV on Day 1 5FU 400 mg/m2 bolus and 2400 mg/m2 CIVI over 46 hours beginning on Day 1 PF-04136309 500 mg PO BID on days 1-14 Treatment is repeated every 14 days for 6 cycles. | Drug: Oxaliplatin<br> <br> * Other names: L-OHP;Drug: Irinotecan<br> <br> * Other names: U-101440E;Drug: Leucovorin<br> <br> * Other names: LV;Drug: Fluorouracil<br> <br> * Other names: 5-FU;Other: laboratory biomarker analysis<br>* Correlative studies<br>Other: flow cytometry<br>* Correlative studies<br>Other: immunohistochemistry staining method<br>* Correlative studies<br>* Other names: immunohistochemistry;Other: pharmacological study<br>* Correlative studies<br>* Other names: pharmacological studies;Drug: PF-04136309<br> <br> * Other names: PF-4136309;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Optimal dose and dose-limiting toxicity of PF-04136309 in combination with FOLFIRINOX | After completion of two cycles. To find the optimal dose, a 3+3 design will be used. | 28 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Safety of PF-04136309 and FOLFIRINOX by grade 3 or 4 toxicity for clinical use. |  | 120 days (30 days after completion of treatment) | 
| Disease response rate: TCR = SD + PR + CR |  | 90 days (completion of cycle 6) | 
| Prevalence and function of MDSC in the bone marrow and tumor before and after treatment with PF-04136309 plus FOLFIRINOX or with FOLFIRINOX alone |  | Baseline and end of cycle 2 | 
| Prevalence and function of MDSC in peripheral circulation before and after treatment with PF-04136309 plus FOLFIRINOX or with FOLFIRINOX alone |  | Baseline, before cycle 2, before cycle 4, and before cycle 6 |