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Thymidylate Synthase (TS) Genotype-Directed Phase II Trial of Oral Capecitabine for 2-Line Treatment of Advanced Pancreatic Cancer


Phase 2
18 Years
N/A
Not Enrolling
Both
Pancreatic Cancer

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Trial Information

Thymidylate Synthase (TS) Genotype-Directed Phase II Trial of Oral Capecitabine for 2-Line Treatment of Advanced Pancreatic Cancer


OBJECTIVES:

Primary

- Characterize the 6-month survival of patients with stage IV pancreatic cancer
(progressing after at least 1 prior gemcitabine-containing chemotherapy regimen) who
carry the double tandem repeat (S/S) variant of the thymidylate synthase (TS) gene
enhancer region (TSER) treated with capecitabine.

- Characterize toxicity of capecitabine in patients with stage IV pancreatic cancer who
carry the S/S variant of the TSER.

Secondary

- Explore the association between capecitabine exposure at steady-state, allelic variants
in candidate genes (carboxylesterase 1, carboxylesterase 2, cytidine deaminase,
thymidine phosphorylase [TP], dihydropyrimidine dehydrogenase [DPD],
methylenetetrahydrofolate reductase) and drug response (toxicity and efficacy) in this
patient population.

- Determine the relationship between expression of TS, TP, and DPD in tumor tissues and
the response to capecitabine in this patient population.

- Analyze response rate to capecitabine, based on the presence of homozygous S/S variant
of the TSER.

OUTLINE: This is an open-label, multicenter study.

Patients receive oral capecitabine twice daily on days 1-14. Courses repeat every 21 days in
the absence of disease progression or unacceptable toxicity.

PROJECTED ACCRUAL: A total of 65 patients will be accrued for this study.

Inclusion Criteria


DISEASE CHARACTERISTICS:

- Histologically confirmed pancreatic cancer

- Stage IV disease

- Measurable disease (≥ 1 cm or > 10 mm lesion(s) by spiral CT scan)

- Disease progression after ≥ 1 gemcitabine-based treatment regimen for
advanced/metastatic disease

- Patient carries the double tandem repeat (S/S) variant of the thymidylate synthase
gene enhancer region (TSER)

- No active CNS metastases (indicated by clinical symptoms, cerebral edema, steroid
requirement, or progressive growth)

PATIENT CHARACTERISTICS:

- ECOG performance status 0-2

- Absolute neutrophil count ≥ 1,500/mm^3

- Platelet count ≥ 100,000/mm^3

- AST/ALT ≤ 2.5 times upper limit of normal (ULN) (5 times ULN if attributable to liver
metastases)

- Total bilirubin ≤ 1.5 times ULN

- Creatinine normal OR creatinine clearance > 50 mL/min

- Fertile patients must use effective contraception during and for 30 days after
completion of study treatment

- Not pregnant or nursing

- Negative pregnancy test

- Asymptomatic HIV infection allowed

- No recent or ongoing clinically significant gastrointestinal disorder (e.g.,
malabsorption, bleeding, inflammation, emesis, or diarrhea > grade 1)

- Able to swallow capecitabine tablets

- No known hypersensitivity to fluorouracil

- No dihydropyrimidine dehydrogenase (DPD) deficiency

- No clinically significant cardiac disease (e.g., congestive heart failure,
symptomatic coronary artery disease, or cardiac arrhythmias not well controlled with
medication)

- No myocardial infarction within the past 6 months

- No serious, uncontrolled, concurrent infection(s)

- No prior unanticipated severe reaction to fluoropyrimidine therapy

- No other malignancy within the past 5 years except cured nonmelanoma skin cancer or
treated carcinoma in situ of the cervix

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- At least 3 weeks since prior chemotherapy

- No prior capecitabine except in the adjuvant setting

- At least 3 weeks since prior radiotherapy or major surgery

- At least 4 weeks since prior participation in any investigational drug study

- At least 4 weeks since prior sorivudine or brivudine

- No concurrent sorivudine or brivudine

- No concurrent cimetidine or azidothymidine (AZT)

- Concurrent radiotherapy for bone pain allowed to a limited field provided ≥ 1
indicator lesion remains outside of the field

- No other concurrent chemotherapy or immunotherapy

Type of Study:

Interventional

Study Design:

Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

Survival at 6-months

Safety Issue:

No

Principal Investigator

Wells Messersmith, MD

Investigator Role:

Study Chair

Investigator Affiliation:

Sidney Kimmel Comprehensive Cancer Center

Authority:

United States: Federal Government

Study ID:

CDR0000462118

NCT ID:

NCT00303927

Start Date:

December 2005

Completion Date:

Related Keywords:

  • Pancreatic Cancer
  • recurrent pancreatic cancer
  • stage IV pancreatic cancer
  • Pancreatic Neoplasms

Name

Location

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore, Maryland  21231-2410