A phase II, open-label pilot study evaluating the safety and activity of liposomal irinotecan (Nal-IRI) in combination with 5-FU and oxaliplatin (NALIRIFOX) in preoperative treatment of pancreatic adenocarcinoma (NEO-Nal-IRI Study).

Authors

null

Sherise C. Rogers

University of Florida/UF Health Cancer Center, Gainesville, FL;

Sherise C. Rogers , Ilyas Sahin , Jesus C. Fabregas , Ibrahim Nassour , Brian Hemendra Ramnaraign , Kathryn Hitchcock , Steven J. Hughes , Ji-Hyun Lee , Omar Roger Kayaleh , Anita Ahmed Turk , Z. Hugh Fan , Karen Bullock Russell , David L. DeRemer , Thomas J. George

Organizations

University of Florida/UF Health Cancer Center, Gainesville, FL; , University of Florida Health, Gainesville, FL; , Orlando Health, Orlando, FL; , Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN; , University of Florida, Gainesville, FL; , Tallahassee Memorial Hospital, Tallahassee, FL;

Research Funding

Pharmaceutical/Biotech Company
Ipsen Pharmaceuticals and UF Health Cancer Center

Background: Neoadjuvant treatment for potentially curable pancreatic cancer (PDAC) is increasing in acceptability, but a standard regimen has yet to be established. Multiple studies have demonstrated feasibility and effectiveness of the FOLFIRINOX (5-fluorouracil, leucovorin, oxaliplatin and irinotecan) regimen in the perioperative setting. However, FOLFIRINOX often requires dose modifications, delays and growth factor support due to excessive toxicity which can complicate care delivery when given neoadjuvantly. Liposomal irinotecan injection (Nal-IRI) is FDA approved with a well-tolerated safety profile in relapsed, refractory metastatic PDAC. The current study aims to substitute Nal-IRI for traditional irinotecan in the standard FOLFIRINOX regimen (NALIRIFOX) and to demonstrate safe and effective neoadjuvant delivery. Methods: This phase 2, open-label, multicenter single-arm study focuses on patients (pts) with operable PDAC without metastatic disease. Other key eligibility criteria include age ≥18 years, resectability confirmed by multidisciplinary GI tumor board (resectable vs. borderline), adequate cardiac, renal, hepatic function and ECOG performance status of 0 to 1. Pts receive NEO-N-IRI regimen as per Table every 2 weeks for four months followed by disease reassessment. Pts who remain surgical candidates will undergo surgical resection within 4 to 8 weeks following last dose of therapy. The primary endpoint is to assess safety and feasibility of regimen in perioperative setting. Secondary endpoints include R0 resection rate, clinical, biochemical and radiological response rate and patient-reported quality of life during treatment as measured by the NCI validated FACT-G scale. Enrollment continues to a maximum of 28 evaluable pts to demonstrate a reduction in historical 30-day postoperative complication rate. Microbiota specimens will be collected for exploratory analysis. Clinical trial information: NCT03483038.

NALIRIFOX regimen components given intravenously (IV) every 14 days.

AgentDoseRoute/Duration
Nal-IRI50 mg/m2IV over 90 minutes
Oxaliplatin60 mg/m2IV over 120 minutes
Leucovorin400 mg/m2IV over 120 minutes
5-fluorouracil infusion2400 mg/m2IV continuous infusion for 46 hours

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Abstract Details

Meeting

2023 ASCO Gastrointestinal Cancers Symposium

Session Type

Trials in Progress Poster Session

Session Title

Trials in Progress Poster Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract

Track

Pancreatic Cancer,Hepatobiliary Cancer,Neuroendocrine/Carcinoid,Small Bowel Cancer

Sub Track

Therapeutics

Clinical Trial Registration Number

NCT03483038

Citation

J Clin Oncol 41, 2023 (suppl 4; abstr TPS778)

DOI

10.1200/JCO.2023.41.4_suppl.TPS778

Abstract #

TPS778

Poster Bd #

Q14

Abstract Disclosures