Combining radiation therapy with immune-targeting drugs for pancreatic cancer

A Phase 2, Open-Label, Multicenter, Randomized Study Evaluating Neoadjuvant Therapy Targeting the Adenosine Immunosuppressive Pathway in Combination With Immune Checkpoint Blockade and Radiation Therapy in Patients With Advanced PANCreatic Ductal Adenocarcinoma Who Are Candidates for Surgical Resection

This study is testing if combining radiation therapy with immune-targeting drugs can help people with localized pancreatic cancer feel better and improve their treatment outcomes before surgery.

Quick facts

• Phase: PHASE2
• Study type: Interventional
• Enrollment: 60 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Columbia University (other)
• Drugs / interventions: radiation, zimberelimab
• Locations: 5 sites (Lake Success, New York and 4 other locations)
• Trial ID: NCT06048484 on ClinicalTrials.gov

What this trial studies

This study aims to evaluate the safety and effectiveness of combining stereotactic body radiation therapy (SBRT) with immune-modulating drugs, zimberelimab, quemliclustat, and etrumadenant, in patients with localized pancreatic ductal adenocarcinoma. Participants will first receive SBRT and the drugs for 7 weeks before surgery, with the study divided into two stages to assess safety and efficacy. The goal is to enhance the immune response against the tumor while also targeting pathways that allow the tumor to evade the immune system.

Who should consider this trial

Good fit: Ideal candidates are patients with histologically confirmed, surgically resectable pancreatic ductal adenocarcinoma who have completed neoadjuvant modified FOLFIRINOX chemotherapy.

Not a fit: Patients with unresectable pancreatic cancer or those who have undergone prior surgical, systemic, or radiotherapy may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could improve treatment outcomes for patients with localized pancreatic cancer by enhancing the immune response and reducing tumor evasion.

How similar studies have performed: Other studies have shown promise in combining radiation therapy with immune checkpoint inhibitors, suggesting potential for success in this novel approach.

Eligibility criteria

Inclusion Criteria:

* Histological or pathological confirmation of pancreatic adenocarcinoma Cytologic or histologic proof of pancreatic ductal adenocarcinoma (PDAC) needs to be verified by the treating institution pathologist. A pathological report from non-treating institutions is sufficient to consent and to initiate investigational therapy if tissue sample is unavailable for evaluation at time of consent or enrollment. However, in such a case, PDAC diagnosis should be confirmed by the treating institution pathologist at a later time.
* Completed 8 cycles of neoadjuvant modified FOLFIRINOX. Omission of oxaliplatin due to adverse events may be allowed in cycles 5-8 with consultation with the principal investigator.
* Patients with surgically resectable PDAC who are considered appropriate to undergo the applicable operation.
* Eligible to undergo SBRT.
* Measurable disease as per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1.
* No prior surgical, systemic, or radiotherapy for PDAC except for mFOLFIRINOX.
* Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
* Age ≥ 18 years.
* Adequate hematological and end-organ function, defined by the following laboratory test results, obtained within 14 days prior to initiation of investigational treatment:

Exclusion Criteria:

* Prior treatment with T-cell co-stimulating or immune checkpoint blockade therapies, including but not limited to anti-CTLA-4, anti-PD-1, and anti-PD-L1 therapeutic antibodies.
* Patients who are receiving any other investigational agents concurrently.
* Concomitant treatment with other anti-neoplastic agents (hormonal therapy acceptable).
* Uncontrolled pleural effusion, pericardial effusion, or ascites.
* Uncontrolled hypercalcemia (ionized calcium \> 1.5 mmol/L, calcium \> 12 mg/dL, or corrected serum calcium \> ULN) or symptomatic hypercalcemia requiring continued use of bisphosphonate therapy.
* Active or history of autoimmune disease or immune deficiency, including, but not limited to, myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease (Crohn's disease or ulcerative colitis), antiphospholipid antibody syndrome, Wegener granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, or multiple sclerosis (some exceptions permissible as outlined per protocol).
* History of idiopathic pulmonary fibrosis, interstitial lung disease, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, or idiopathic pneumonitis, or evidence of active pneumonitis on screening chest CT scan.

  • History of radiation pneumonitis in the radiation field (fibrosis) is permitted.
* Positive HIV test at screening or at any time prior to screening.
* Active hepatitis B virus (HBV) infection (chronic or acute), defined as having a positive hepatitis B surface antigen (HBsAg) test at screening.

  --Note: Patients with a past or resolved HBV infection, defined as having a negative HBsAg test and a positive total hepatitis B core antibody test at screening, are eligible for the study.
* Active hepatitis C virus (HCV) infection, defined as having a positive HCV antibody test followed by a positive HCV RNA test at screening. The HCV RNA test will be performed only for patients who have a positive HCV antibody test.
* Known clinically significant liver disease, including alcoholic hepatitis, cirrhosis, fatty liver disease, and inherited liver disease.
* Known active tuberculosis.
* Inability to swallow medication or malabsorption condition that would alter the absorption of orally administered medications.
* Pregnant women are excluded from this study because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with these agents and breastfeeding should be discontinued.
* History of allergy or hypersensitivity to oxaliplatin, irinotecan, leucovorin, fluorouracil, pegfilgrastim, or any excipients.
* History of Gilbert's disease or known genotype UGT1A1 \*28/\*28.
* Inflammatory disease of the colon or rectum, or severe uncontrolled diarrhea.
* Active or history of celiac disease.
* Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial.

Where this trial is running

Lake Success, New York and 4 other locations

• Northwell Health R.J. Zuckerberg Cancer Center — Lake Success, New York, United States (RECRUITING)
• Columbia University Irving Medical Center — New York, New York, United States (RECRUITING)
• UNC Hospitals, The University of North Carolina at Chapel Hill — Chapel Hill, North Carolina, United States (RECRUITING)
• University of Pennsylvania, Abramson Cancer Center — Philadelphia, Pennsylvania, United States (RECRUITING)
• Medical College of Wisconsin — Milwaukee, Wisconsin, United States (RECRUITING)

Study contacts

• Principal investigator: Gulam Manji, MD, PhD — Columbia University
• Study coordinator: Research Nurse Navigator

Conditions: Pancreatic Ductal Adenocarcinoma