Trial Comparing Adjuvant Chemotherapy With Gemcitabine Versus mFolfirinox to Treat Resected Pancreatic Adenocarcinoma
Study Details
Study Description
Brief Summary
This is a multicentric randomized phase III trial comparing adjuvant chemotherapy with gemcitabine versus 5-fluorouracil, leucovorin, irinotecan and oxaliplatin (mFolfirinox) in patients with resected pancreatic adenocarcinoma.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
| Phase 3 |
Detailed Description
STUDY DESIGN/ Evaluation criteria Main criterion: efficacy The main criterion is the disease-free survival at 3 years. Disease-free survival is the time delay between the date of randomization and the date at which the 1st cancer-related event such as local relapse, distant metastasis, a second cancer or death from any cause is observed. Patients without event at the time of anlaysis will be censored at the date of last follow-up visit.
Locoregional relapse is a disease relapse occurring at the site of primary resection, in the pancreas or in the associated regional lymph nodes.
Metastatic relapse is the distant disease recurrence involving any possible sites of relapse (peritoneal, hepatic, pulmonary, and distant lymph nodes).
Secondary criteria Overall and specific survival Overall survival is the time delay between the date of randomization and the patient's death, irrespective of its cause. Patients who are still living at the time of analysis will be censored at the date of last follow-up visit.
Specific survival is the time delay between the date of randomization and the patient's death due to the treated cancer or a treatment-related complication.
Metastasis-free survival Metastasis-free survival is the time delay between the date of randomization and the date of the 1st distant event occurrence (peritoneal, hepatic, pulmonary, and lymph nodes). Loco-regional events will be discarded and patients still living without metastasis at the time of analysis will be censored at the date of last follow-up examination objectively assessing this type of event.
Tolerance Patients evaluable for toxicity must have received at least one course or injection of the treatment.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Arm A GEMCITABINE Arm A : Gemcitabine 1000 mg/m² IV infusion over 30 minutes, weekly, during 3 weeks + 1 week of rest (= 1 cycle) repeated 6 times (i.e., 6 cycles) during 24 weeks |
Drug: Gemcitabine
Gemcitabine 1000 mg/m² IV infusion over 30 minutes, weekly, during 3 weeks + 1 week of rest (= 1 cycle) repeated 6 times (i.e., 6 cycles) during 24 weeks
|
| Experimental: Arm B mFOLFIRINOX Arm B : mFOLFIRINOX every 14 days, 12 cycles, 24 weeks. Oxaliplatin (Eloxatin®) 85 mg/m² D1 over 2 hours, followed by Irinotecan (Campto®) 150 mg/m² D1 over 90 minutes to begin 30 min. after the Folinic acid infusion is started. Folinic acid 400 mg/m² (racemic mixture) (or 200 mg/m² if L-folinic acid is used), IV infusion over 2 hours. 5-FU 2.4 g/m² IV continuous infusion over 46 hours (1200 mg/m²/ day) |
Drug: mFolfirinox
mFolfirinox every 14 days, 12 cycles, 24 weeks.
mFolfirinox : Oxaliplatin (Eloxatin®) 85 mg/m² D1 over 2 hours, followed by Irinotecan (Campto®) 150 mg/m² D1 over 90 minutes to begin 30 min. after the Folinic acid infusion is started.
Folinic acid 400 mg/m² (racemic mixture) (or 200 mg/m² if L-folinic acid is used), IV infusion over 2 hours.
5-FU 2.4 g/m² IV continuous infusion over 46 hours (1200 mg/m²/ day)
|
Outcome Measures
Primary Outcome Measures
- disease-free survival (DFS) [3 YEARS]
to compare disease-free survival (DFS) at 3 years between the experimental and control arms.
Secondary Outcome Measures
- Overall survival [36 MONTHS]
- Specific survival [36 MONTHS]
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Histologically proven pancreatic ductal adenocarcinoma. Intraductal papillary mucinous tumor of the pancreas (IPMT) with invasive components are eligible.
-
Macroscopically complete resection (R0 or R1 resection).
-
Patients aged from 18 to 79 years.
-
WHO performance status 0-1.
-
No prior radiotherapy and no previous chemotherapy.
-
Full recovery from surgery and patient able to receive chemotherapy: adequate oral nutrition of ≥1500 calories per day and free of significant nausea and vomiting.
-
Adequate hematologic function (Absolute neutrophil count ANC ≥1,500 cells/mm³, platelets ≥100 000 cells/mm³ and hemoglobin ≥10 g/L - possibly after transfusion -).
-
Serum total bilirubin ≤1.5 times the institutional upper limit of normal.
-
Creatinine level <130 micromol/L (14.7 mg/L).
-
Patient of child-bearing potential (for female patient: study entry after a menstrual period and a negative pregnancy test) must agree to use two medically acceptable methods of contraception (one for the patient and one for the partner) during the study and for 4 months after the last study treatment intake for women and 6 months for men.
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Interval since surgery between 21 and 84 days.
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Patient information and signed informed consent.
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Public or private health insurance coverage.
Exclusion Criteria:
-
Other types of non-ductal tumor of the pancreas, including endocrine tumors or acinar cell adenocarcinoma, cystadenocarcinoma and malignant ampulloma.
-
Metastases (including ascites or malignant pleural effusion).
-
Macroscopic incomplete tumor removal (R2 resection).
-
CA 19-9 > 180 U/ml within 21 days of registration on study.
-
No heart failure or coronary heart disease symptoms.
-
No major comorbidity that may preclude the delivery of treatment or active infection (HIV or chronic hepatitis B or C) or uncontrolled diabetes.
-
Pre-existing neuropathy, Gilbert's disease or genotype UGT1A1 * 28 / * 28.
-
Inflammatory disease of the colon or rectum, or occlusion or sub-occlusion of the intestine or severe postoperative uncontrolled diarrhea.
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Concomitant occurrence of another cancer, or history of cancer except in situ carcinoma of the cervix treated or basal cell carcinoma or squamous cell carcinoma.
-
Fructose intolerance.
-
Persons deprived of liberty or under guardianship.
-
Psychological, familial, sociological or geographical condition potentially. hampering compliance with the study protocol and follow-up schedule.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Tom Baker Cancer Centre | Calgary | Alberta | Canada | T2N 4N2 |
| 2 | BCCA - Vancouver Cancer Centre | Vancouver | British Columbia | Canada | V5Z 4E6 |
| 3 | CancerCare Manitoba, St. Boniface General Hospital | Winnipeg | Manitoba | Canada | R2H 2A6 |
| 4 | Dr Leon Richard Oncology Centre | Moncton | New Brunswick | Canada | E1C 8X3 |
| 5 | The Royal Victoria Hospital - Cancer Care Program | Barrie | Ontario | Canada | L4M 6M2 |
| 6 | Juravinski Cancer centre at Hamilton Health Sciences | Hamilton | Ontario | Canada | L8V 5C2 |
| 7 | Cancer Centre of Southeastern Ontario at Kingston General Hospital | Kingston | Ontario | Canada | K7L 5P9 |
| 8 | Ottawa Health Research Institute | Ottawa | Ontario | Canada | K1H 8L6 |
| 9 | Niagara Health System | St. Catharines | Ontario | Canada | L2S 0A9 |
| 10 | Department of Medical Oncology Health Sciences North | Sudbury | Ontario | Canada | P3E 5J1 |
| 11 | General Surgery - TGH Site, Univ. Health Network | Toronto | Ontario | Canada | M5G 2C4 |
| 12 | CHUM - Hopital Notre-Dame | Montreal | Quebec | Canada | H2L 4M1 |
| 13 | McGill University (Department of Oncology) | Montreal | Quebec | Canada | H2W 1S6 |
| 14 | Centre Hospitalier Universitaire de Sherbrooke | Sherbrooke | Quebec | Canada | J1H 5N4 |
| 15 | Allain Blair Cancer Centre | Regina | Saskatchewan | Canada | S4T 7T1 |
| 16 | Saskatoon Cancer Centre, University of Saskatchewan | Saskatoon | Saskatchewan | Canada | S7N 4H4 |
| 17 | The Moncton Hospital | Moncton | Canada | E1C 6Z8 | |
| 18 | CHUQ - Hotel-Dieu de Quebec | Quebec | Canada | G1R 2J6 | |
| 19 | Algoma District Cancer Program, Sault Area Hospital | Sault Ste. Marie | Canada | P6B 0A8 | |
| 20 | CHU Nord | Amiens | France | ||
| 21 | ICO Paul Papin | Angers | France | ||
| 22 | Hôpital Avicenne | Bobigny | France | ||
| 23 | Institut Bergonié | Bordeaux | France | ||
| 24 | CHU Côte de Nacre | Caen | France | ||
| 25 | Hôpital Beaujon | Clichy | France | ||
| 26 | Hôpital Louis Pasteur | Colmar | France | ||
| 27 | CHU de Dijon - Site Bocage | Dijon | France | ||
| 28 | CHD Vendée | La Roche Sur Yon | France | ||
| 29 | Hôpital Huriez | Lille | France | ||
| 30 | Centre Léon Bérard | Lyon | France | ||
| 31 | Hôpital de la Croix-Rousse | Lyon | France | ||
| 32 | Hôpital Privé Jean Mermoz | Lyon | France | ||
| 33 | CHU Nord | Marseille | France | ||
| 34 | CHU Timone Adulte | Marseille | France | ||
| 35 | Fondation Ambroise Paré / Hôpital Européen | Marseille | France | ||
| 36 | Institut Paoli Calmettes | Marseille | France | ||
| 37 | CH Layné | Mont de Marsan | France | ||
| 38 | CHU De ST Eloi | Montpellier | France | ||
| 39 | CRCL Val d'Aurelle | Montpellier | France | ||
| 40 | Centre Antoine-Lacassagne | Nice | France | ||
| 41 | CHR Orléans - La Source | Orleans | France | ||
| 42 | Groupe Hospitalier Paris Saint Joseph | Paris | France | ||
| 43 | Groupe Hospitalier Pitié-Salpêtrière | Paris | France | ||
| 44 | Hôpital Saint-Jean | Perpignan | France | ||
| 45 | Hôpital Haut-Lévêque | Pessac | France | ||
| 46 | Centre hospitalier de Reims | Reims | France | ||
| 47 | CHU Rouen | Rouen | France | ||
| 48 | Centre René Gauducheau | Saint Herblain | France | ||
| 49 | Centre Paul Strauss | Strasbourg | France | ||
| 50 | Hôpital Trousseau | Tours | France | ||
| 51 | Centre Alexis Vautrin | Vandoeuvre Les Nancy | France | ||
| 52 | Hôpital de Brabois-CHU de Nancy | Vandœuvre-lès-Nancy | France |
Sponsors and Collaborators
- UNICANCER
- Canadian Cancer Trials Group
Investigators
- Principal Investigator: Thierry CONROY, PROF, Centre Alexis Vautrin-VANDOEUVRE LES NANCY
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- Prodige 24 / Accord 24
- NCIC CTG PA.6
- 2011-002026-52