Gemcitabine in Combination With the Oral Irreversible ErbB Inhibitor Afatinib Versus Gemcitabine Alone in Patients With Metastatic Pancreatic Cancer: an Explorative Randomized Phase II Trial
Inclusion Criteria:
- Written informed consent in advance of any study-specific procedure
- Histologically (not cytologically) confirmed diagnosis of metastatic pancreatic
adenocarcinoma (stage IV according to UICC 2009 classification: each T, each N, M1)
- Availability of tumour samples
- Informed consent that tumour- and blood samples are centrally collected and will
serve for translational analyses according to the study protocol.
- Age >= 18 years
- ECOG 0-1
- Life expectancy at least 3 months
- No option for surgical resection or radiation in curative intent
- At least one measurable tumour lesion (CT-scan or MRI) according to RECIST Version
1.1
- Possibility of long-term follow-up
- Negative pregnancy test in fertile females
- Given legal capacity of the patient
- Adequate hepatic, renal and bone marrow function
Exclusion Criteria:
- Evidence of weight loss > 15% within one month
- Active brain metastases (stable for <28 days, symptomatic, or requiring concurrent
steroids) or leptomeningeal disease. Patients who have received prior whole brain
irradiation and whose brain metastases are stable according to the criteria above
will not be excluded
- Previous gemcitabine treatment is allowed only if applied as monotherapy in the
adjuvant setting and if the adjuvant single-agent gemcitabine chemotherapy was
terminated at least 6 months before study entry
- Previous systemic treatment with chemotherapy or radiotherapy for locally advanced,
non resectable or metastatic pancreatic cancer
- Radiotherapy within four weeks prior to randomization or radiation of target lesions
- Prior treatment with EGFR targeting therapies or treatment with EGFR- or HER2
inhibiting drugs within the past 4 weeks before start of therapy or concomitantly
with this trial
- Hypersensitivity to afatinib or to gemcitabine or to any of the excipients or to
compounds with similar chemical or biologic composition
- Contraindications against the use of gemcitabine
- Severe renal insufficiency (baseline creatinine clearance < 30 ml/mi)
- LDH elevated by > 2.5 ULN
- Severe hepatic dysfunction
- Any disease e. g. active infection, uncontrolled hypertension, clinically significant
cardiovascular disease for example CVA (<= 6 months before study start), myocardial
infarction (<= 6 months before study start), unstable angina, NYHA >= grade 2 CHF,
arrhythmia requiring medication, metabolic dysfunction giving reasonable suspicion of
a disease or condition that contra-indicates the use of the study drugs or puts the
patient at high risk for treatment-related complications
- Significant or recent acute gastrointestinal disorders with diarrhoea as a major
symptom e.g. Crohn's disease, malabsorption or CTC grade > 2 diarrhoea of any
aetiology
- Pregnant or lactating females, non-effective contraception in men and women of
childbearing potential (an effective contraceptive measure has a Pearl Index < 1)
- Any major surgery within the last 2 weeks before study entry
- Chemo- or immunotherapy within the past 4 weeks
- Treatment with an investigational drug in another clinical study within the past 28
days prior to the start of therapy or concomitantly with this study
- Any persisting toxicities which are deemed to be clinically significant from the
previous therapy
- Patients with pre-existing interstitital lung disease
- Psychological, familial, social or geographic conditions that may prevent an adequate
compliance with the study protocol
- Known or suspected alcohol- or drug abuse
- Patients unable to comply with the protocol
- Known hepatitis B infection, known hepatitis C infection or HIV carrier
- Requirement for treatment with any of the prohibited concomitant medications
- Any other malignancies within the last 5 years before study start, except for
adequately treated carcinoma in situ of the cervix, basal or squamous cell skin
cancer