A Pilot, Prospective, Non-randomized Evaluation of the Safety of Anakinra Plus Standard Chemotherapy

NCT ID: NCT02021422

Last Updated: 2017-01-31

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: PHASE1
• Total Enrollment: 13 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2013-06-30
• Study Completion Date: 2017-12-31

Brief Summary

The study's overall objectives are to evaluate the safety of anakinra in combination with standard chemotherapy regimens in patients with pancreatic ductal adenocarinoma, as well as to collect preliminary immune modulation and clinical activity information, overall survival, and serious adverse events related to the study drug.

Detailed Description

Kineret (anakinra) is a FDA-approved drug indicated for rheumatoid arthritis. Anakinra is a recombinant, nonglycosylated form of the human interleukin-1 receptor antagonist (IL-1Ra). Anakinra blocks the biologic activity of IL -1 by competitively inhibiting IL-1 binding to the interleukin-1 type I receptor (IL-1RI), which is expressed in a wide variety of tissues and organs. IL-1 production is induced in response to inflammatory stimuli and mediates various physiologic effects including inflammatory and immunological responses.

This is a pilot, prospective, non-randomized, consecutive enrollment study that will enroll up to 12 subjects who meet the study defined inclusion and exclusion criteria.

Subjects will undergo standard of care chemotherapy treatment/regimens (i.e., modified FOLFIRINOX). Subjects will be dispensed a 2 weeks supply of anakinra the day they begin chemotherapy. They will be instructed to begin self-administering the anakinra (study drug) injections the day after their first dose of chemotherapy.

They will have a blood sample collected at baseline and 6 months follow up. If they have surgery for their disease, they may have a tissue sample collected for later analysis.

Conditions

Pancreas Cancer

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Anakinra with Modified Folfirinox

8-weeks of anakinra and modified FOLFIRINOX regimen (refer to Appendix 9 for regimen) as follows

Kineret (anakinra) Dosage Route Administration 100 mg SC Every Other Day

Modified FOLFIRINOX Drug Dose Administration Oxaliplatin 85 mg/m2 2-4 hours Irinotecan 180 mg/m2 90 minutes fluorouracil 2400 mg/m2 48 hours

Group Type: OTHER

anakinra

Intervention Type: DRUG

Dosage Route Administration 100 mg SC Every Other Day

Oxaliplatin

Intervention Type: DRUG

Oxaliplatin 85 mg/m2 2-4 hours

Irinotecan

Intervention Type: DRUG

Irinotecan 180 mg/m2 90 minutes

fluorouracil

Intervention Type: DRUG

fluorouracil 2400 mg/m2 48 hours

Interventions

anakinra

Dosage Route Administration 100 mg SC Every Other Day

Intervention Type: DRUG

Oxaliplatin

Oxaliplatin 85 mg/m2 2-4 hours

Intervention Type: DRUG

Irinotecan

Irinotecan 180 mg/m2 90 minutes

Intervention Type: DRUG

fluorouracil

fluorouracil 2400 mg/m2 48 hours

Intervention Type: DRUG

Other Intervention Names

Kineret; Camptosar; 5 FU

Eligibility Criteria

Inclusion Criteria

• 18 years of age or older
• Male or non-pregnant and non-lactating female
• Confirmed metastatic/inoperable metastatic pancreas cancer and/or Histologically/cytologically confirmed metastatic adenocarcinoma of pancreas
• Patients' blood counts and blood chemistry levels at baseline must be not clinically significant (NCS) as determined by the enrolling investigator.
• Patient has Eastern Cooperative Oncology Group( ECOG ) Performance Status 0 to 2 (refer to Appendix 5):
• Signed study consent form

Exclusion Criteria

• <18 years of age
• Pregnant or lactating female
• Patient has islet cell neoplasms
• Active secondary malignancies (2nd cancer not treated/present)
• Active, uncontrolled bacterial, viral, or fungal infection(s) requiring systemic therapy
• Known infection with hepatitis B, hepatitis C, or cirrhosis
• Major surgery or vascular device placement (excluding ports for IV medication/chemotherapy) within 2 weeks prior to Day 1 of treatment in study
• History of allergy or hypersensitivity to the study drugs
• Patient is enrolled in any concurrent-outside (outside Baylor University Medical Center or Texas Oncology) clinical protocol or investigational trial
• Significant cardiac disease as defined as New York Heart Association (NYHA) classification III or IV, uncontrolled CHF, or prior MI last 6-months
• Any prior gastrointestinal (GI) disease or history of prior pelvic or abdominal radiation which in the opinion of the investigator may place the patient at increased risk
• Peripheral sensory neuropathy ≥ to grade 2 at baseline
• Significant co-morbidities deemed by investigator as unsuitable for participation/enrollment
• Study consent form not signed

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Baylor Research Institute

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Carlos Becerra, MD

Role: PRINCIPAL_INVESTIGATOR

Baylor Sammons Cancer Center

Locations

Baylor Sammons Cancer Center

Dallas, Texas, United States

Countries

United States

References

Allantaz F, Chaussabel D, Stichweh D, Bennett L, Allman W, Mejias A, Ardura M, Chung W, Smith E, Wise C, Palucka K, Ramilo O, Punaro M, Banchereau J, Pascual V. Blood leukocyte microarrays to diagnose systemic onset juvenile idiopathic arthritis and follow the response to IL-1 blockade. J Exp Med. 2007 Sep 3;204(9):2131-44. doi: 10.1084/jem.20070070. Epub 2007 Aug 27.

Reference Type: BACKGROUND

PMID: 17724127 (View on PubMed)

Aspord C, Pedroza-Gonzalez A, Gallegos M, Tindle S, Burton EC, Su D, Marches F, Banchereau J, Palucka AK. Breast cancer instructs dendritic cells to prime interleukin 13-secreting CD4+ T cells that facilitate tumor development. J Exp Med. 2007 May 14;204(5):1037-47. doi: 10.1084/jem.20061120. Epub 2007 Apr 16.

Reference Type: BACKGROUND

PMID: 17438063 (View on PubMed)

Beatty GL, Chiorean EG, Fishman MP, Saboury B, Teitelbaum UR, Sun W, Huhn RD, Song W, Li D, Sharp LL, Torigian DA, O'Dwyer PJ, Vonderheide RH. CD40 agonists alter tumor stroma and show efficacy against pancreatic carcinoma in mice and humans. Science. 2011 Mar 25;331(6024):1612-6. doi: 10.1126/science.1198443.

Reference Type: BACKGROUND

PMID: 21436454 (View on PubMed)

Bennett L, Palucka AK, Arce E, Cantrell V, Borvak J, Banchereau J, Pascual V. Interferon and granulopoiesis signatures in systemic lupus erythematosus blood. J Exp Med. 2003 Mar 17;197(6):711-23. doi: 10.1084/jem.20021553.

Reference Type: BACKGROUND

PMID: 12642603 (View on PubMed)

Chaussabel D, Quinn C, Shen J, Patel P, Glaser C, Baldwin N, Stichweh D, Blankenship D, Li L, Munagala I, Bennett L, Allantaz F, Mejias A, Ardura M, Kaizer E, Monnet L, Allman W, Randall H, Johnson D, Lanier A, Punaro M, Wittkowski KM, White P, Fay J, Klintmalm G, Ramilo O, Palucka AK, Banchereau J, Pascual V. A modular analysis framework for blood genomics studies: application to systemic lupus erythematosus. Immunity. 2008 Jul 18;29(1):150-64. doi: 10.1016/j.immuni.2008.05.012.

Reference Type: BACKGROUND

PMID: 18631455 (View on PubMed)

Coussens LM, Zitvogel L, Palucka AK. Neutralizing tumor-promoting chronic inflammation: a magic bullet? Science. 2013 Jan 18;339(6117):286-91. doi: 10.1126/science.1232227.

Reference Type: BACKGROUND

PMID: 23329041 (View on PubMed)

De Monte L, Reni M, Tassi E, Clavenna D, Papa I, Recalde H, Braga M, Di Carlo V, Doglioni C, Protti MP. Intratumor T helper type 2 cell infiltrate correlates with cancer-associated fibroblast thymic stromal lymphopoietin production and reduced survival in pancreatic cancer. J Exp Med. 2011 Mar 14;208(3):469-78. doi: 10.1084/jem.20101876. Epub 2011 Feb 21.

Reference Type: BACKGROUND

PMID: 21339327 (View on PubMed)

Kalos M, Levine BL, Porter DL, Katz S, Grupp SA, Bagg A, June CH. T cells with chimeric antigen receptors have potent antitumor effects and can establish memory in patients with advanced leukemia. Sci Transl Med. 2011 Aug 10;3(95):95ra73. doi: 10.1126/scitranslmed.3002842.

Reference Type: BACKGROUND

PMID: 21832238 (View on PubMed)

Kuraishy A, Karin M, Grivennikov SI. Tumor promotion via injury- and death-induced inflammation. Immunity. 2011 Oct 28;35(4):467-77. doi: 10.1016/j.immuni.2011.09.006.

Reference Type: BACKGROUND

PMID: 22035839 (View on PubMed)

La Torre M, Nigri G, Ferrari L, Cosenza G, Ravaioli M, Ramacciato G. Hospital volume, margin status, and long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg. 2012 Feb;78(2):225-9.

Reference Type: BACKGROUND

PMID: 22369834 (View on PubMed)

Laheru D, Jaffee EM. Immunotherapy for pancreatic cancer - science driving clinical progress. Nat Rev Cancer. 2005 Jun;5(6):459-67. doi: 10.1038/nrc1630.

Reference Type: BACKGROUND

PMID: 15905855 (View on PubMed)

Lee HC, Ziegler SF. Inducible expression of the proallergic cytokine thymic stromal lymphopoietin in airway epithelial cells is controlled by NFkappaB. Proc Natl Acad Sci U S A. 2007 Jan 16;104(3):914-9. doi: 10.1073/pnas.0607305104. Epub 2007 Jan 9.

Reference Type: BACKGROUND

PMID: 17213320 (View on PubMed)

Maker AV, Katabi N, Qin LX, Klimstra DS, Schattner M, Brennan MF, Jarnagin WR, Allen PJ. Cyst fluid interleukin-1beta (IL1beta) levels predict the risk of carcinoma in intraductal papillary mucinous neoplasms of the pancreas. Clin Cancer Res. 2011 Mar 15;17(6):1502-8. doi: 10.1158/1078-0432.CCR-10-1561. Epub 2011 Jan 25.

Reference Type: BACKGROUND

PMID: 21266527 (View on PubMed)

Palucka AK, Gatlin J, Blanck JP, Melkus MW, Clayton S, Ueno H, Kraus ET, Cravens P, Bennett L, Padgett-Thomas A, Marches F, Islas-Ohlmayer M, Garcia JV, Banchereau J. Human dendritic cell subsets in NOD/SCID mice engrafted with CD34+ hematopoietic progenitors. Blood. 2003 Nov 1;102(9):3302-10. doi: 10.1182/blood-2003-02-0384. Epub 2003 Jul 17.

Reference Type: BACKGROUND

PMID: 12869510 (View on PubMed)

Palucka AK, Ueno H, Connolly J, Kerneis-Norvell F, Blanck JP, Johnston DA, Fay J, Banchereau J. Dendritic cells loaded with killed allogeneic melanoma cells can induce objective clinical responses and MART-1 specific CD8+ T-cell immunity. J Immunother. 2006 Sep-Oct;29(5):545-57. doi: 10.1097/01.cji.0000211309.90621.8b.

Reference Type: BACKGROUND

PMID: 16971810 (View on PubMed)

Palucka K, Banchereau J. Cancer immunotherapy via dendritic cells. Nat Rev Cancer. 2012 Mar 22;12(4):265-77. doi: 10.1038/nrc3258.

Reference Type: BACKGROUND

PMID: 22437871 (View on PubMed)

Pascual V, Allantaz F, Arce E, Punaro M, Banchereau J. Role of interleukin-1 (IL-1) in the pathogenesis of systemic onset juvenile idiopathic arthritis and clinical response to IL-1 blockade. J Exp Med. 2005 May 2;201(9):1479-86. doi: 10.1084/jem.20050473. Epub 2005 Apr 25.

Reference Type: BACKGROUND

PMID: 15851489 (View on PubMed)

Pedroza-Gonzalez A, Xu K, Wu TC, Aspord C, Tindle S, Marches F, Gallegos M, Burton EC, Savino D, Hori T, Tanaka Y, Zurawski S, Zurawski G, Bover L, Liu YJ, Banchereau J, Palucka AK. Thymic stromal lymphopoietin fosters human breast tumor growth by promoting type 2 inflammation. J Exp Med. 2011 Mar 14;208(3):479-90. doi: 10.1084/jem.20102131. Epub 2011 Feb 21.

Reference Type: BACKGROUND

PMID: 21339324 (View on PubMed)

Ramilo O, Allman W, Chung W, Mejias A, Ardura M, Glaser C, Wittkowski KM, Piqueras B, Banchereau J, Palucka AK, Chaussabel D. Gene expression patterns in blood leukocytes discriminate patients with acute infections. Blood. 2007 Mar 1;109(5):2066-77. doi: 10.1182/blood-2006-02-002477. Epub 2006 Nov 14.

Reference Type: BACKGROUND

PMID: 17105821 (View on PubMed)

Sebens Muerkoster S, Werbing V, Sipos B, Debus MA, Witt M, Grossmann M, Leisner D, Kotteritzsch J, Kappes H, Kloppel G, Altevogt P, Folsch UR, Schafer H. Drug-induced expression of the cellular adhesion molecule L1CAM confers anti-apoptotic protection and chemoresistance in pancreatic ductal adenocarcinoma cells. Oncogene. 2007 Apr 26;26(19):2759-68. doi: 10.1038/sj.onc.1210076. Epub 2006 Nov 6.

Reference Type: BACKGROUND

PMID: 17086212 (View on PubMed)

Vence L, Palucka AK, Fay JW, Ito T, Liu YJ, Banchereau J, Ueno H. Circulating tumor antigen-specific regulatory T cells in patients with metastatic melanoma. Proc Natl Acad Sci U S A. 2007 Dec 26;104(52):20884-9. doi: 10.1073/pnas.0710557105. Epub 2007 Dec 18.

Reference Type: BACKGROUND

PMID: 18093940 (View on PubMed)

Yu CI, Gallegos M, Marches F, Zurawski G, Ramilo O, Garcia-Sastre A, Banchereau J, Palucka AK. Broad influenza-specific CD8+ T-cell responses in humanized mice vaccinated with influenza virus vaccines. Blood. 2008 Nov 1;112(9):3671-8. doi: 10.1182/blood-2008-05-157016. Epub 2008 Aug 19.

Reference Type: BACKGROUND

PMID: 18713944 (View on PubMed)

Other Identifiers

013-018

Identifier Type: -

Identifier Source: org_study_id