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Metastatic Pancreatic CancerPhase 2ALPACANCT02564146

First-line Treatment of Metastatic Pancreatic Cancer With Nab-paclitaxel and Gemcitabine

A Phase 2 study testing nab-paclitaxel and gemcitabine and gemcitabine mono and nab-paclitaxel and gemcitabine in people with Metastatic Pancreatic Cancer and Adenocarcinoma of the Pancreas, run by AIO-Studien-gGmbH at 1 site in Germany.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

ALPACA is an interventional, multicentre, open-label, randomized active-controlled phase II trial with two arms. To estimate the treatment effect on overall survival, feasibility, efficacy and safety of alternating treatment cycles of gemcitabine monotherapy followed by nab-paclitaxel/gemcitabine relative to standard… Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
nab-paclitaxel and gemcitabine and gemcitabine mono and nab-paclitaxel and gemcitabine
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
325 participants
Where
1 siteGermany
Study dates
Dec 2016to May 2022
Phase
Phase 2
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

Who may be able to join

  • Adult patients (≥ 18 years of age)
  • Histologically or cytologically confirmed metastatic adenocarcinoma of the pancreas. Patients with islet cell neoplasms are excluded.
  • Karnofsky Perfomance Status (KPS) ≥ 70%
  • At least one unidimensionally measurable lesion as assessed by CT- scan or Magnetic resonance imaging (MRI) according to Response Evaluation Criteria In Solid Tumors (RECIST1.1 ),
  • Total bilirubin ≤ 1.5 x ULN (Upper Limit of Normal). Patients with a biliary stent may be included provided that bilirubin level after stent insertion decreased to ≤ 1.5 x ULN and there is no cholangitis.
  • Adequate renal, hepatic and bone marrow function, defined as
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  • Calculated creatinine clearance ≥ 30 mL/min according to CKD-EPI formula (Chronic kidney Disease Epidemiology Collaboration)
  • AST/GOT and/or ALT/GPT ≤ 2.5 x ULN and ≤ 5.0 x ULN in case of liver metastasis
  • Absolute neutrophil count (ANC) ≥ 1.5 x 10^9/L
  • Haemoglobin ≥ 9 g/dL
  • Platelets ≥ 100 x 100 x 10^9/L
  • Females of Childbearing Potential (FCBP) must have a negative serum pregnancy test within 7 days of the first application of study treatment and they must agree to undergo further pregnancy tests before randomization and at the end of treatment visit and
  • FCBP must either agree to use and be able to take effective contraceptive birth control measures (Pearl Index < 1) or agree to practice complete abstinence from heterosexual intercourse during the course of the study and for at least 1 month after last application of study treatment. A female subject is considered to be of childbearing potential unless she is age ≥ 50 years and naturally amenorrhoeic for ≥ 2 years, or unless she is surgically sterile.
  • Males must agree not to father a child during the course of the trial and for at least 6 months after last administration of study drugs.
  • Signed and dated informed consent before the start of any specific protocol procedures Patient's legal capacity to consent to study participation

Who cannot join

  • Missing histological or cytological confirmation of metastatic adenocarcinoma of the pancreas Locally advanced pancreatic adenocarcinoma without metastases Any previous radiotherapy, surgery, chemotherapy or investigational therapy for the treatment of metastatic disease. (Prior adjuvant chemotherapy with gemcitabine or fluoropyrimidine in curative intent is allowed if terminated more than 6 months before first application of study treatment. Previous palliative radiotherapy of bonemetastases for alleviation of pain is permitted provided that irradiated bone metastases are no target lesions.) Known brain metastase/brain metastases. Brain imaging is required in symptomatic patients to rule out brain metastases, but is not required in asymptomatic patients.
  • Pre-existing peripheral neuropathy ≥ grade 2 according to CTCAE version 4 (Common Terminology Criteria for Adverse Events)
  • • Medical history of interstitial lung disease (ILD) or pulmonary fibrosis
  • Patients with high cardiovascular risk, including, but not limited to, recent coronary stenting or myocardial infarction in the past year.
  • Uncontrolled severe illness or medical condition (including uncontrolled diabetes mellitus)
  • Any other severe concomitant disease or disorder, which could influence patient's ability to participate in the study and his/her safety during the study or interfere with interpretation of study results e.g. severe hepatic, renal, pulmonary, metabolic, or psychiatric disorders Previous or concurrent tumor other than underlying tumor disease (pancreatic cancer) with the exception of cervical cancer in situ, adequately treated basal cell carcinoma or squamous cell carcinoma of the skin, superficial bladder tumors (Ta, Tis, and T1) or any curatively treated tumors > 5 years prior to enrolment Hypersensitivity against nab-paclitaxel, gemcitabine, or any excipients of these drugs
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  • Continuing abuse of alcohol, drugs, or medical drugs
  • Pregnant females, breast feeding females or females of childbearing potential unable to perform adequate contraceptive measures or practice complete abstinence from heterosexual intercourse
  • Participation in any other clinical trial or treatment with any experimental drug within 28 days before enrolment to the study or during study participation until the end of treatment visit.

Trial locations and contacts

1 site in 1 country.

Germany1 site
  • Kliniken Nordoberpfalz AG, Klinikum Weiden

    Weiden, 92637

Other trials in Germany

About this study

Official title: Induction Treatment With Nab-paclitaxel/Gemcitabine for First-line Treatment of Metastatic Pancreatic Cancer Followed by Either Alternating Application of Gemcitabine Monotherapy and Nab-paclitaxel/Gemcitabine or Continuing Application of Nab-paclitaxel/Gemcitabine: A Randomized Phase II Study

ALPACA is an interventional, multicentre, open-label, randomized active-controlled phase II trial with two arms.

To estimate the treatment effect on overall survival, feasibility, efficacy and safety of alternating treatment cycles of gemcitabine monotherapy followed by nab-paclitaxel/gemcitabine relative to standard continuing nab-paclitaxel/gemcitabine cycles in first-line treatment for metastatic pancreatic cancer in patients having received 3 cycles of induction therapy with standard nab-paclitaxel/gemcitabine.

Read the detailed description

ALPACA is an interventional, multicentre, open-label, randomized active-controlled phase II trial with two arms.

To estimate the treatment effect on overall survival, feasibility, efficacy and safety of alternating treatment cycles of gemcitabine monotherapy followed by nab-paclitaxel/gemcitabine relative to standard continuing nab-paclitaxel/gemcitabine cycles in first-line treatment for metastatic pancreatic cancer in patients having received 3 cycles of induction therapy with standard nab-paclitaxel/gemcitabine.

Being tested
nab-paclitaxel and gemcitabine, gemcitabine mono and nab-paclitaxel and gemcitabine
Medical subject headings
Pancreatic Neoplasms

What participants receive

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

  • nab-paclitaxel and gemcitabineDrug

    Induction treatment:

    3 cycles nab-paclitaxel and gemcitabine 125 mg/m^2, IV infusion over 30 minutes, followed by gemcitabine 1000 mg/m^2 as a 30-minute IV infusion; D1, D8, D15 of each 28-day cycle.

    Continouous treatment after randomization:

    Continuing application of nab-paclitaxel and gemcitabine treatment cycles until progression or unacceptable toxicity. Duration of each cycle is 28 days nab-paclitaxel 125 mg/m^2, IV infusion over 30 minutes, followed by gemcitabine 1000 mg/m^2 as a 30-minute IV infusion; D1, D8, D15 of each 28-day cycle.

  • gemcitabine mono and nab-paclitaxel and gemcitabineDrug

    Induction treatment:

    3 cycles nab-paclitaxel and gemcitabine 125 mg/m^2, IV infusion over 30 minutes, followed by gemcitabine 1000 mg/m^2 as a 30-minute IV infusion; D1, D8, D15 of each 28-day cycle.

    Continouous treatment after randomization:

    Alternating application of gemcitabine monotherapy and nab-paclitaxel and gemcitabine treatment cycles until progression or unacceptable toxicity, starting with a treatment cycle of gemcitabine monotherapy.

    Duration of each cycle irrespective of treatment cycle with gemcitabine monotherapy or treatment with nab-paclitaxel/gemcitabine is 28 days.

    Gemcitabine monotherapy treatment cycle: Gemcitabine 1000 mg/m^2 as a 30-minute IV infusion; D1, D8, D15 of each 28-day cycle.

    Nab-paclitaxel and gemcitabine treatment cycle: Nab-paclitaxel 125 mg/m^2, IV infusion over 30 minutes, followed by gemcitabine 1000 mg/m^2 as a 30-minute IV infusion; D1, D8, D15 of each 28-day cycle.

Study groups in NCT02564146
Study groupRoleWhat they receive
nab-paclitaxel and gemcitabine (A)Active comparatorInduction treatment: 3 cycles nab-paclitaxel and gemcitabine Continuous treatment after randomization: Continuing application of nab-paclitaxel and gemcitabine treatment cycles
Receives: Drug: nab-paclitaxel and gemcitabine
gemcitabine monotherapy and nab-paclitaxel and gemcitabine (B)ExperimentalInduction treatment: 3 cycles nab-paclitaxel and gemcitabine Continuous treatment after randomization: alternating application of gemcitabine monotherapy and nab-paclitaxel and gemcitabine treatment cycles
Receives: Drug: nab-paclitaxel and gemcitabine; Drug: gemcitabine mono and nab-paclitaxel and gemcitabine

What is being measured

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

  1. Overall survival (OS)

    To estimate the treatment effect of alternating treatment cycles of gemcitabine monotherapy followed by nab-paclitaxel/gemcitabine relative to standard continuing nab-paclitaxel/gemcitabine treatment cycles in first-line treatment for metastatic pancreatic cancer in patients having received 3 cycles of induction therapy with standard nab-paclitaxel/gemcitabine.

    Measured: After randomization until date of death or end of study wichever comes first. Assessed for up to 38.5 month

Secondary outcomes (17)
  1. Overall survival (OS)

    During induction phase.

    Measured: 3.5 month

  2. Overall survival (OS)

    Determined from first application of induction treatment.

    Measured: 42 month

  3. Progression-free survival (PFS)

    During induction phase.

    Measured: 3.5 month

  4. Progression-free survival (PFS)

    As time from randomization to objective tumor progression or death from any cause.

    Measured: Assessed for up to 38.5 month

  5. Progression-free survival (PFS)

    As time from randomization to objective tumor progression or death from any cause.

    Measured: Assessed for up to 42 month

  6. Overall response rate (ORR)

    According to RECISTv1.1 determined from first application of induction treatment.

    Measured: Assessed for up to 42 month

  7. Overall response rate (ORR)

    During induction phase.

    Measured: Assessed for up to 3.5 month

  8. Disease control rate (DCR)

    According to RECISTv1.1 determined from first application of induction treatment.

    Measured: Assessed for up to 42 month

  9. Disease control rate (DCR)

    During induction phase.

    Measured: Assessed for up to 3.5 month

  10. Quality of life QLQ-C30

    During induction phase.

    Measured: Assessed for up to 3.5 month

  11. Quality of life QLQ-C30

    As determined with EORTC QLQ-C30 determined from randomization.

    Measured: Assessed for up to 8 month

  12. Adverse Events (AE)

    Type, incidence, and severity according to NCI CTCAE version 4 with explicit consideration of any neurotoxicity.

    Measured: Assessed for up to 11.5 month

  13. Adverse Events (AE)

    Type, incidence, and severity according to NCI CTCAE version 4 with explicit consideration of any neurotoxicity during induction phase.

    Measured: Assessed for up to 3.5 month

  14. Time of treatment without toxicity

    Duration of treatment without toxicity leading to permanent discontinuation during induction and randomized phase.

    Measured: Assessed for up to 11.5 month

  15. Time of treatment without toxicity

    Duration of treatment during induction phase.

    Measured: Assessed for up to 3.5 month

  16. Neurotoxicity Assessment FACT taxane score

    Functional assessment of neurotoxicity (with FACT taxane score) during induction and randomized phase.

    Measured: Assessed for up to 11.5 month

  17. Neurotoxicity Assessment FACT taxane score

    Functional assessment of neurotoxicity (with FACT taxane score) during induction phase.

    Measured: Assessed for up to 3.5 month

Timeline

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

  1. First posted30 Sep 2015 (estimated)
  2. Study startDec 2016
  3. Primary completionMar 2022
  4. Study completionMay 2022

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 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
325 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02564146
Sponsor's protocol ID
AIO-PAK-0114
Other IDs
2014-004086-24, AX-CL-PANC-AIO-004415, 2014
Acronym
ALPACA
Status last verified
Nov 2022
First submitted
29 Sep 2015
Last updated
22 Nov 2022
Results posted
No
Data monitoring committee
Yes
Individual data sharing
No

Publications

  • Dorman K, Boeck S, Caca K, Reichert M, Ettrich TJ, Oettle H, Waidmann O, Modest DP, Muller L, Michl P, Kanzler S, Pink D, Reinacher-Schick A, Geissler M, Pelz H, Kunzmann V, Held S, Schichtl T, Heinemann V, Kullmann F. Alternating gemcitabine plus nab-paclitaxel and gemcitabine alone versus continuous gemcitabine plus nab-paclitaxel after induction treatment of metastatic pancreatic cancer (ALPACA): a multicentre, randomised, open-label, phase 2 trial. Lancet Gastroenterol Hepatol. 2024 Oct;9(10):935-943. doi: 10.1016/S2468-1253(24)00197-3. Epub 2024 Aug 16.

    PubMed 39159648

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing nab-paclitaxel and gemcitabine and gemcitabine mono and nab-paclitaxel and gemcitabine in people with Metastatic Pancreatic Cancer and Adenocarcinoma of the Pancreas, run by AIO-Studien-gGmbH at 1 site in Germany.

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

Who may be eligible to take part?

The sponsor lists 15 inclusion and 9 exclusion criteria. 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: finished, as of the sponsor's last update on 22 Nov 2022. 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 Germany. 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 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

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 is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Overall survival (OS) (time frame: After randomization until date of death or end of study wichever comes first. Assessed for up to 38.5 month). 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 NCT02564146, which also lists 1 linked publication.

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 22 Nov 2022.

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