Clinical trial NCT02070705: DCE MRI in Patients With Pancreatic Cancer
Official title: The Use of Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE MRI) in the Management of Pancreatic Cancer
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: NA
Conditions: Familial Pancreatic Cancer
Pancreatic Adenocarcinoma
Pancreatic Intraductal Papillary-Mucinous Neoplasm
Lead sponsor: OHSU Knight Cancer Institute
Sponsor class: OTHER
Collaborators: name: National Institute for Biomedical Imaging and Bioengineering (NIBIB)
name: Oregon Health and Science University
name: National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK)
name: National Cancer Institute (NCI)
First posted: 2014-02-25
Enrollment: 77
Sex: ALL
Minimum age (years): 18
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: DIAGNOSTIC

Brief summary: This clinical trial studies an imaging technique known as dynamic contrast enhanced magnetic resonance imaging (DCE MRI) in identifying the presence of pancreatic cancer. DCE MRI is a procedure that takes detailed pictures of functional and structural properties inside the body using magnetic field imaging. These images may better characterize pancreatic cancer in patients at high risk or in patients who may have undergone chemotherapy for pancreatic cancer.

Detailed description: PRIMARY OBJECTIVES:

I. Assess the ability of DCE-MRI to identify the presence of pancreatic cancer in patients at high risk for hereditary pancreatic cancer.

II. Assess the ability of DCE-MRI to identify the presence of pancreatic cancer in patients with cystic lesions of the pancreas.

III. Assess the ability of DCE-MRI to accurately predict tumor margins in patients who have undergone chemotherapy for pancreatic cancer.

IV. Obtain DCE-MRI scans of from healthy volunteers (Group 4), to establish baseline imaging parameters of the normal, non-diseased pancreas for use as a comparator to affected pancreata.

SECONDARY OBJECTIVE:

I. Clinical factors associated with the presence of pancreatic cancer will be assessed in each of the three experimental groups, including disease free survival and overall survival.

II. Additional MRI pulses sequences (e.g. MR fingerprinting, etc.) will be acquired for the assessment of tissue contrast before and after the administration of contrast agents.

OUTLINE: Patients are assigned to 1 of 4 groups.

ARM I (High-risk for familial or hereditary pancreatic cancer): Patients undergo DCE MRI yearly for a minimum of 3 scans.

ARM II (Intraductal papillary mucinous neoplasms \[IPMN\]): Patients undergo DCE MRI prior to surgery for resection of IPMN.

ARM III (Pancreatic cancer): Patients who undergo chemotherapy prior to resection will have 2 DCE MRI scans; one study scan prior to undergoing neoadjuvant therapy, as well as one study scan following neoadjuvant therapy as part of their pre-operative work up in addition to the standard imaging studies. For patients that do not require chemotherapy treatment prior to resection they will have just one DCE MRI scan prior to surgical resection. Patients currently undergoing neoadjuvant therapy or who have already completed neoadjuvant therapy that were unable to undergo imaging at baseline and are now proceeding to resection will have one DCE MRI scan prior to surgical resection.

ARM IV (Healthy volunteers): Patients undergo a single DCE MRI examination.

Eligibility criteria: Inclusion Criteria:

* ALL PARTICIPANTS: A negative serum or urine pregnancy test for woman of childbearing potential
* ALL PARTICIPANTS: Ability to understand and the willingness to sign a written informed consent document
* GROUPS 1, 2, AND 3: "All participants" described above
* GROUPS 1, 2, AND 3: Must be consented for the Oregon Pancreatic Tumor Registry (OPTR)
* GROUPS 1, 2, AND 3: Group 1: participants identified as being high-risk for familial or hereditary pancreatic cancer, and must conform to one or more of the following requirements:

  * Have a strong family history of pancreatic cancer; this is defined as pancreatic cancer occurring in one first- degree relative and two other relatives, or two first- degree relatives; or,
  * Have a known high-risk genetic syndrome (e.g., BRCA 1\&2, STK11, CDNK2A, PRSS1, and MSH 2\&6)
* GROUPS 1, 2, AND 3: Group 2 participants identified as having IPMN on standard radiographic imaging that meets criteria for resection based on symptoms or on conventional imaging (computed tomography \[CT\] or MRI) findings
* GROUPS 1, 2, AND 3: Group 3 participants must have pathologically- confirmed pancreatic adenocarcinoma, with or without the need for neoadjuvant chemotherapy prior to surgical resection.
* HEALTHY VOLUNTEERS (Group 4): Must meet inclusion criteria for "all participants" described above
* HEALTHY VOLUNTEERS (Group 4): Group 4 participants must have no history of cancer, pancreatic disease, or family history of pancreatic cancer.

  * Family history will be defined as pancreatic cancer occurring in one first-degree relative and two other relatives, or two first-degree relatives

Exclusion Criteria:

* Participants unable or unwilling to give written, informed consent or to undergo MRI imaging
* Participants with multiple drug allergies, and/or subjects who have had an allergic reaction to any intravenous iron replacement product, or a known history of hypersensitivity to ferumoxytol
* Participants with concurrent clinical diagnosis, evidence of suspected hemochromatosis, or other diseases of iron metabolism (i.e., iron overload)
* Cirrhosis, cardiomyopathy, restrictive heart disease, or bronzing of the skin
* Pregnant women are excluded from this study because there is an unknown, but potential risk, for adverse events, as small animal trials have linked ferumoxytol administration (at very high doses) to birth defects (e.g., soft-tissue malformations and decreased fetal weights); it is not known whether ferumoxytol is present in human milk; breastfeeding, however, should be discontinued if the mother receives ferumoxytol while nursing
* Human immunodeficiency virus (HIV)-positive participants on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with ferumoxytol
* Participants with diagnosis of renal insufficiency or glomerular filtration rate (GFR) \< 60 ml/min/1.73m\^2
* Adult patients who require monitored anesthesia for MRI scanning
* Participants with any contraindications to gadolinium-based contrast agents
* Participants who have a contraindication for MRI (e.g. metal in their bodies, a cardiac pacemaker, or other incompatible device), or are severely agitated or claustrophobic. (For patients that are eligible but there is a concern of metal in their bodies, the will be given the option if interested to have a x-ray completed prior to study enrollment to determine if they can proceed with the study MRI. Patients with a concern of metal in their bodies that don't agree to a x-ray will not be enrolled into the study.)

Primary outcomes:
measure: Presence of pancreatic cancer (yes or no) for patients that are either at high risk for hereditary pancreatic cancer (Group I)
timeFrame: Up to 5 years
measure: Presence of pancreatic cancer (yes or no) for patients with cystic lesions of the pancreas (Group II)
timeFrame: Up to 5 years
measure: Change in tumor margins in patients who have undergone chemotherapy for pancreatic cancer (Group III)
timeFrame: Baseline to up to 2 years
Secondary outcomes:
measure: Disease free survival (Group I)
timeFrame: Time of enrollment to time of diagnosis, assessed up to 5 years
measure: Disease free survival (Group II)
timeFrame: Time of surgical resection to time of disease recurrence, if applicable, assessed up to 5 years
measure: Disease free survival (Group III)
timeFrame: Time of surgical resection to time of recurrence, assessed up to 5 years
measure: Overall survival (Group I)
timeFrame: Time of surgical resection to time of death, assessed up to 5 years
measure: Overall survival (Group II)
timeFrame: Time of surgical resection to time of death, assessed up to 5 years
measure: Overall survival (Group III)
timeFrame: Time of surgical resection to time of death, assessed up to 5 years
measure: Surgical pathological diagnosis and T & N stage according to the American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) staging system (Group II)
timeFrame: At time of surgery
measure: Surgical pathological diagnosis and T & N stage according to the AJCC TNM staging system (Group III)
timeFrame: At time of surgery
measure: Resection margin status (R0, R1 or R2) (Group III)
timeFrame: At time of surgery
measure: DCE- MRI imaging parameters (Group I)
timeFrame: Up to 5 years
measure: DCE- MRI imaging parameters (Group II)
timeFrame: Once prior to surgery
measure: DCE- MRI imaging parameters (Group III)
timeFrame: Up to 5 years
measure: DCE- MRI imaging parameters and descriptional analysis of normal pancreas DCE- MRI images (Group IV)
timeFrame: Once at time of enrollment
Other outcomes:
Locations:
city: Portland
country: United States
facility: OHSU Knight Cancer Institute
state: Oregon
Study officials:
affiliation: OHSU Knight Cancer Institute
name: Alexander Guimaraes
role: PRINCIPAL_INVESTIGATOR
References: