A Phase I/II/Pharmacodynamic Study of Hydroxychloroquine in Combination With Gemcitabine/Abraxane to Inhibit Autophagy in Pancreatic Cancer
Recent strategies have focused on improving the efficacy of gemcitabine either by improving
the method of delivery, or by combining gemcitabine with other non-cross resistant agents. A
sequence of Phase III combination studies of gemcitabine in combination (with oxaliplatin,
and with the targeted therapies bevacizumab and cetuximab) have been negative, though based
on strikingly positive Phase II data generated in cancer centers. Several studies suggest
that taxanes are active in pancreatic cancer, but a randomized trial of gemcitabine with
taxanes has not been preformed, probably on the basis that the differences in Phase II were
insufficiently persuasive. The development of a novel taxane conjugate with albumin,
abraxane, with established activity in breast cancer, prompted a Phase II trial of
gemcitabine/abraxane by Von Hoff (6). Phase I/II data were highly promising, with response
rates of the order of 40%, with tolerable toxicity, and a one-year survival of about 48%. A
phase III trial of gemcitabine versus gemcitabine/abraxane is in progress, and based on
these promising data has served as the control chemotherapy for previous SU2C trials. The
development of a more intensive, but toxic regimen (FOLFIRINOX) in no way diminishes the
enthusiasm for this chemotherapy backbone, given the activity in Phase II trials that
appears comparable (7). Given the promise of this regimen, and the possibility of making a
substantial improvement in outcome with additional targeted interventions, we propose to
continue to use this regimen in the current study.
Of particular interest in extending these studies to pancreatic cancer is the finding that
autophagy inhibition is particularly deleterious to cell lines bearing a mutant Kras
protein. Additional studies as part of the SU2C pancreatic cancer project reveal that an
autophagy program is activated in the presence of mutant Kras, and thus prompts the testing
of this strategy in a setting in which Kras is commonly (about 85%) mutated (SU2C,
unpublished data).
Interventional
Primary Purpose: Treatment
Overall survival
one year
Yes
Peter O'Dwyer, MD
Principal Investigator
Abramson Cancer Center of the University of Pennsylvania
United States: Food and Drug Administration
UPCC 19211
NCT01506973
December 2011
December 2014
Name | Location |
---|---|
Abramson Cancer Center of the University of Pennsylvania | Philadelphia, Pennsylvania 19104-4283 |