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Pancreatic CancerPhase 1NCT02159248

Tolfenamic Acid, Gemcitabine and Radiation for Locally Advanced or Metastatic Pancreatic Cancer Requiring Radiation

A Phase 1 study testing Tolfenamic acid + gemcitabine + radiation in people with Pancreatic Cancer, run by Orlando Health, Inc. at 1 site in United States.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial summary

The purposes of this study are to: Evaluate the safety and toxicity of tolfenamic acid when used with gemcitabine and radiation therapy in patients with locally advanced or metastatic pancreatic cancer. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Pancreatic Cancer
What is being tested?
Tolfenamic acid + gemcitabine + radiation
Could I receive a placebo?
No, everyone receives an active treatment
How many people
0 participants
Where
1 siteUnited States
Study dates
Mar 2014to Dec 2019
Phase
Phase 1
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Primary Inclusion Criteria:

  1. Patients must have histologically or cytologically confirmed:
  2. Locally advanced (potentially resectable) pancreatic adenocarcinoma requiring neoadjuvant radiation or
  3. Locally advanced (nonresectable) or metastatic pancreatic adenocarcinoma requiring definitive or palliative radiation therapy
  4. Patients may have either measurable or non-measurable disease (according to RECIST criteria, Version 1.1).
  5. Age ≥ 18 years
  6. ECOG performance status of 0 or 1.
  7. A life expectancy of at least 12 weeks.
  8. No other concurrent radiotherapy, chemotherapy or immunotherapy.
  9. A minimum of 4 weeks must have elapsed since completion of any prior chemotherapy or immunotherapy.
  10. Patient must have:
  11. Absolute neutrophil count (ANC) ≥1,000/mm3
  12. Platelets ≥100,000/mm3
  13. Hemoglobin ≥10 g/dL [Transfusion to meet the hemoglobin requirement is acceptable]
  14. Serum creatinine ≤ 1.5 X ULN
  15. Total bilirubin ≤ 1.5 X ULN
  16. Aspartate aminotransferase (AST) ≤ 2.5 X ULN
  17. Alanine aminotransferase (ALT) ≤ 2.5 X ULN
  18. Alkaline phosphatase ≤ 2.5 X ULN
  19. PT/INR ≤ 1.5 X ULN
  20. aPTT ≤ 1.5 X ULN
  21. Urine Protein ≤ Grade 1
  22. For patients on warfarin: Must have maintained a stable INR on a stable dose of warfarin for at least 4 weeks prior to start of treatment.

Primary Exclusion Criteria:

  1. Patients who have received prior radiation for their current malignancy at the location of interest.
  2. Patients who have not recovered (to Grade 1 or less) from adverse events, other than alopecia and neuropathy, caused by previously administered chemotherapeutic agents, at the discretion of the PI/treating physician.
  3. Tolfenamic acid use concurrent with, or within 8 weeks prior to the diagnosis of pancreatic cancer.
  4. Current use of any non-steroidal anti-inflammatory agents (NSAIDs), including aspirin, (other than tolfenamic acid) within 4 weeks prior to the start of active treatment.
  5. Previous history of hypersensitivity reactions (e.g. asthma, rhinitis, angioedema or urticaria) in response to ibuprofen, aspirin or other NSAIDs.
  6. History of recurrent peptic ulcer/hemorrhage (two or more distinct episodes).
  7. History of gastrointestinal bleeding or perforation related to previous use of NSAIDS.
  8. New York Heart Association Functional Classification of 3 or 4.
  9. Known autoimmune disease that could preclude the use of radiation, at the discretion of the treating physician.
  10. History or evidence of CNS disease (e.g., any brain metastases, primary brain tumor, seizures not controlled with standard medical therapy, or history of stroke).
  11. Known HIV positive.
  12. Active systemic infection requiring parenteral antibiotic therapy.
  13. Receiving systemic steroid therapy. (Inhaled steroid therapy is allowable.)
  14. History of other malignancies within the last 5 years with the exception of non- melanoma skin cancer or cervical cancer in situ that has been successfully treated.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • UF Health Cancer Center at Orlando Health

    Orlando, Florida, 32806

Other trials in United States

About this study

Official title: 09.017 - A Phase I Study of Tolfenamic Acid With Gemcitabine and Radiation in Patients With Locally Advanced or Metastatic Pancreatic Cancer Requiring Definitive or Palliative Radiation Therapy

The purposes of this study are to:

  • Evaluate the safety and toxicity of tolfenamic acid when used with gemcitabine and radiation therapy in patients with locally advanced or metastatic pancreatic cancer.
  • Determine the maximum-tolerated dose (MTD) of tolfenamic acid when used with gemcitabine and radiation in pancreatic cancer.
  • Characterize the pharmacokinetic profile of tolfenamic acid when used with gemcitabine and radiation.
  • Assess the anti-tumor response to tolfenamic acid when used with gemcitabine and radiation in patients with advanced pancreatic malignancies.
Read the detailed description

This is a phase I, open-label, non-randomized, single-center, dose-escalation study which utilizes tolfenamic acid in combination with gemcitabine and radiation in patients with locally advanced or metastatic pancreatic malignancies which require definitive or palliative radiation.

Non-steroidal anti-inflammatory drugs (NSAIDs) are known to have a variety of anti-neoplastic mechanisms, including inhibition of cell growth, promotion of apoptosis and inhibition of angiogenesis. Tolfenamic acid is an oral (NSAID) migraine medication which has demonstrated anti-tumor activity in preclinical pancreatic models when used with Gem/XRT (gemcitabine and radiation therapy) and as a single agent.

Each patient enrolled will receive tolfenamic acid in combination with Gem/XRT. Depending on cohort assignment, patients will self-administer tolfenamic acid at either 200mg, 400mg, 600mg or 800mg three times per day. Gemcitabine will be administered intravenously at 400 mg/m2, every seven days for a maximum of 5 doses, starting with the second week of tolfenamic acid administration. Radiation will be given 5 days per week (Monday-Friday) for up to 5 ½ weeks for a maximum dose of 50.4 Gy, beginning with the second week of tolfenamic acid administration.

A maximum of 24 patients will be enrolled in the dose escalation portion of the study. After the maximum tolerated dose (MTD) of tolfenamic acid has been determined, patients will be enrolled in an expansion cohort (at the MTD or the highest dose level achieved if the MTD is not reached) to further assess safety and the anti-tumor response to treatment with tolfenamic acid plus Gem/XRT.

Being tested
Tolfenamic acid + gemcitabine + radiation
Keywords
pancreatic, gemcitabine, radiation, tolfenamic acid
Medical subject headings
Pancreatic Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Tolfenamic acid + gemcitabine + radiationDrug

    Cohort 1: 200mg of oral tolfenamic acid, three times per day for 6 1/2 weeks, in combination with weekly intravenous gemcitabine at 400mg/m2 for 5 doses and external beam radiation for 5 1/2 weeks (28 doses at 1.8 Gy/Fx/day).

    Cohort 2: 400mg of oral tolfenamic acid, three times per day for 6 1/2 weeks, in combination with weekly intravenous gemcitabine at 400mg/m2 for 5 doses and external beam radiation for 5 1/2 weeks (28 doses at 1.8 Gy/Fx/day).

    Cohort 3: 600mg of oral tolfenamic acid, three times per day for 6 1/2 weeks, in combination with weekly intravenous gemcitabine at 400mg/m2 for 5 doses and external beam radiation for 5 1/2 weeks (28 doses at 1.8 Gy/Fx/day).

    Cohort 4: 800mg of oral tolfenamic acid, three times per day for 6 1/2 weeks, in combination with weekly intravenous gemcitabine at 400mg/m2 for 5 doses and external beam radiation for 5 1/2 weeks (28 doses at 1.8 Gy/Fx/day).

Study groups in NCT02159248
Study groupRoleWhat they receive
Tolfenamic acid + gemcitabine + radiationExperimentalNot described
Receives: Drug: Tolfenamic acid + gemcitabine + radiation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Evaluate safety and toxicity

    Evaluate the safety and toxicity of escalating doses of tolfenamic acid when used with gemcitabine and radiation in patients with advanced pancreatic malignancies.

    Measured: Approximately 16 weeks

Secondary outcomes (1)
  1. Assess the anti-tumor response.

    Assess the anti-tumor response to tolfenamic acid when used with gemcitabine and radiation in patients with locally advanced or metastatic pancreatic malignancies.

    Measured: Approximately 16 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted9 Jun 2014 (estimated)
  2. Study startMar 2014
  3. Primary completionAug 2017 (estimated)
  4. Study completionDec 2019 (estimated)

Why it stopped: The study closed prior to enrolling any participants.

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 1
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02159248
Sponsor's protocol ID
09.017
Status last verified
Apr 2015
First submitted
5 Jun 2014
Last updated
28 Apr 2015
Results posted
No
Data monitoring committee
Yes

Publications

  • Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009 Jan;45(2):228-47. doi: 10.1016/j.ejca.2008.10.026.

    PubMed 19097774
  • Jutooru I, Chadalapaka G, Abdelrahim M, Basha MR, Samudio I, Konopleva M, Andreeff M, Safe S. Methyl 2-cyano-3,12-dioxooleana-1,9-dien-28-oate decreases specificity protein transcription factors and inhibits pancreatic tumor growth: role of microRNA-27a. Mol Pharmacol. 2010 Aug;78(2):226-36. doi: 10.1124/mol.110.064451. Epub 2010 May 20.

    PubMed 20488920
  • Abdelrahim M, Baker CH, Abbruzzese JL, Safe S. Tolfenamic acid and pancreatic cancer growth, angiogenesis, and Sp protein degradation. J Natl Cancer Inst. 2006 Jun 21;98(12):855-68. doi: 10.1093/jnci/djj232.

    PubMed 16788159
  • Abdelrahim M, Baker CH, Abbruzzese JL, Sheikh-Hamad D, Liu S, Cho SD, Yoon K, Safe S. Regulation of vascular endothelial growth factor receptor-1 expression by specificity proteins 1, 3, and 4 in pancreatic cancer cells. Cancer Res. 2007 Apr 1;67(7):3286-94. doi: 10.1158/0008-5472.CAN-06-3831.

    PubMed 17409437
  • Konduri S, Colon J, Baker CH, Safe S, Abbruzzese JL, Abudayyeh A, Basha MR, Abdelrahim M. Tolfenamic acid enhances pancreatic cancer cell and tumor response to radiation therapy by inhibiting survivin protein expression. Mol Cancer Ther. 2009 Mar;8(3):533-42. doi: 10.1158/1535-7163.MCT-08-0405. Epub 2009 Mar 3.

    PubMed 19258429
  • Maliakal P, Abdelrahim M, Sankpal UT, Maliakal C, Baker CH, Safe S, Herrera LJ, Abudayyeh A, Kaja S, Basha R. Chemopreventive effects of tolfenamic acid against esophageal tumorigenesis in rats. Invest New Drugs. 2012 Jun;30(3):853-61. doi: 10.1007/s10637-010-9622-0. Epub 2011 Jan 4.

    PubMed 21197621
  • Rich TA, Shepard RC, Mosley ST. Four decades of continuing innovation with fluorouracil: current and future approaches to fluorouracil chemoradiation therapy. J Clin Oncol. 2004 Jun 1;22(11):2214-32. doi: 10.1200/JCO.2004.08.009.

    PubMed 15169811
  • A multi-institutional comparative trial of radiation therapy alone and in combination with 5-fluorouracil for locally unresectable pancreatic carcinoma. The Gastrointestinal Tumor Study Group. Ann Surg. 1979 Feb;189(2):205-8.

    PubMed 426553
  • Atasoy BM, Dane F, Ucuncu Kefeli A, Caglar H, Cingi A, Turhal NS, Abacioglu U, Yegen C. Concomitant chemoradiotherapy with low-dose weekly gemcitabine for nonmetastatic unresectable pancreatic cancer. Turk J Gastroenterol. 2011 Feb;22(1):60-4. doi: 10.4318/tjg.2011.0158.

    PubMed 21480113
  • Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, Vauthey JN, Wang H, Cleary KR, Staerkel GA, Charnsangavej C, Lano EA, Ho L, Lenzi R, Abbruzzese JL, Wolff RA. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008 Jul 20;26(21):3496-502. doi: 10.1200/JCO.2007.15.8634.

    PubMed 18640930
  • Joensuu TK, Kiviluoto T, Karkkainen P, Vento P, Kivisaari L, Tenhunen M, Westberg R, Elomaa I. Phase I-II trial of twice-weekly gemcitabine and concomitant irradiation in patients undergoing pancreaticoduodenectomy with extended lymphadenectomy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2004 Oct 1;60(2):444-52. doi: 10.1016/j.ijrobp.2004.03.026.

    PubMed 15380578
  • Moertel CG, Frytak S, Hahn RG, O'Connell MJ, Reitemeier RJ, Rubin J, Schutt AJ, Weiland LH, Childs DS, Holbrook MA, Lavin PT, Livstone E, Spiro H, Knowlton A, Kalser M, Barkin J, Lessner H, Mann-Kaplan R, Ramming K, Douglas HO Jr, Thomas P, Nave H, Bateman J, Lokich J, Brooks J, Chaffey J, Corson JM, Zamcheck N, Novak JW. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer. 1981 Oct 15;48(8):1705-10. doi: 10.1002/1097-0142(19811015)48:83.0.co;2-4.

    PubMed 7284971
  • Tarnawski AS, Jones MK. Inhibition of angiogenesis by NSAIDs: molecular mechanisms and clinical implications. J Mol Med (Berl). 2003 Oct;81(10):627-36. doi: 10.1007/s00109-003-0479-y. Epub 2003 Sep 6.

    PubMed 13679997
  • Fan F, Wey JS, McCarty MF, Belcheva A, Liu W, Bauer TW, Somcio RJ, Wu Y, Hooper A, Hicklin DJ, Ellis LM. Expression and function of vascular endothelial growth factor receptor-1 on human colorectal cancer cells. Oncogene. 2005 Apr 14;24(16):2647-53. doi: 10.1038/sj.onc.1208246.

    PubMed 15735759
  • Wey JS, Fan F, Gray MJ, Bauer TW, McCarty MF, Somcio R, Liu W, Evans DB, Wu Y, Hicklin DJ, Ellis LM. Vascular endothelial growth factor receptor-1 promotes migration and invasion in pancreatic carcinoma cell lines. Cancer. 2005 Jul 15;104(2):427-38. doi: 10.1002/cncr.21145.

    PubMed 15952180

Questions about this trial

What is this clinical trial studying?

A Phase 1 study testing Tolfenamic acid + gemcitabine + radiation in people with Pancreatic Cancer, run by Orlando Health, Inc. at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: withdrawn, as of the sponsor's last update on 28 Apr 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study was withdrawn before enrolling participants, so there are no results.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Evaluate safety and toxicity (time frame: Approximately 16 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02159248, which also lists 39 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 28 Apr 2015.

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