Title
Metastatic Advanced Pancreas Sorafenib
A Randomized Phase II Study of Gemcitabine/Cisplatin With or Without Sorafenib to Evaluate the Efficacy and Safety in Patients With Locally Advanced or Metastatic Pancreatic Cancer. MAPS Trial
Phase
Phase 2Study Type
InterventionalStatus
Unknown statusIndication/Condition
Locally Advanced Pancreatic CancerIntervention/Treatment
sorafenib gemcitabine cisplatin ...Study Participants
114This is multicentre, open-label, randomized, phase II trial in patients with locally advanced or metastatic pancreatic cancer. Subjects will be randomized in a 1:1 ratio to receive gemcitabine/cisplatin in combination with Sorafenib (arm A) or gemcitabine/cisplatin alone (arm B), as first-line chemotherapy.
Up to date no standard treatment is available for pancreatic cancer. Although gemcitabine is commonly used in patients with pancreatic cancer with the purpose of symptom palliation, there is no clear evidence of efficacy in terms of survival increase or progression control. Furthermore, attempts at improving results by combining gemcitabine with other cytotoxic drugs failed to obtain any advantage. Recently, an EGFR inhibitor (erlotinib) showed a small survival advantage when combined with gemcitabine. results obtained with a combination of gemcitabine and oxaliplatin seem more promising. A meta-analysis of randomised trials comparing gemcitabine versus gemcitabine and platinum analogues showed a statistical significant survival advantage for the combination.
Sorafenib is an inhibitor of the RAS/RAF signalling pathway. Furthermore, sorafenib is able to inhibit both VEGFR and PDGFR.
Since RAS and RAF mutations are quite common in pancreatic cancer, Sorafenib could be useful in the management of these tumours. Furthermore, it may be combined with gemcitabine and cisplatin without any pharmacokinetic interaction or enhanced toxicity.
NEXAVAR*112CPR RIV 200MG Titolare AIC: BAYER SpA Numero di AIC dell'IMP: 037154010
Gemcitabina 1000 mg/mq, Cisplatino 25 mg/mq day 1 and 8 every 21 days
Sorafenib 400 mg po bid, continuously Gemcitabine 1000 mg/m2, Cisplatin 25 mg/m2 day 1, and 8 every 21 days.
Gemcitabine 1000 mg/m2, Cisplatin 25 mg/m2 day 1, and 8 every 21 days
Inclusion Criteria: Signed written informed consent prior to beginning protocol specific procedures Male or female 18 to 75 years of age Diagnosis of histologically confirmed adenocarcinoma of the pancreas Locally advanced (non-resectable) or metastatic pancreatic cancer Presence of at least one uni-dimensional indicator lesion measurable by CT scan or MRI in not an irradiated area (RECIST criteria) Karnofsky performance status of ≥ 70 at study entry Neutrophils ≥ 1.5 x 109/L, platelets ≥ 100 x 109/L, and hemoglobin ≥ 9 g/dL Bilirubin level either normal or < 1.5 x ULN ASAT and ALAT ≤ 2.5 X ULN (≤ 5 x ULN if liver metastasis are present) Serum creatinine < 1.5 x ULN Amylase and lipase ≤ 1.5 x the upper limit of normal PT or INR and PTT < 1.5 x upper limit of normal (subjects who receive anti-coagulation treatment with an agent such as warfarin or heparin will be allowed to participate provided that no evidence of underlying abnormality in these parameters exists). Effective contraception for both male and female patients if the risk of conception exists Exclusion Criteria: Brain metastases Previous chemotherapy for locally advanced or metastatic pancreatic cancer. Adjuvant therapy if documented recurrence is within 6 months after the end of adjuvant treatment) Radiotherapy within 4 weeks prior to study entry Major surgery within 4 weeks of first dose of study drug Concurrent chronic systemic immune therapy Any investigational agent(s) 4 weeks prior to entry Clinically relevant coronary artery disease or a history of a myocardial infarction within the last 6 months Thrombotic or embolic events such as cerebrovascular accident including transient ischemic attacks within the past 6 months Acute or subacute intestinal occlusion or history of inflammatory bowel disease Known grade 3 or 4 allergic reaction to any of the components of the treatment Known drug abuse/ alcohol abuse Legal incapacity or limited legal capacity Medical or psychological condition which in the opinion of the investigator would not permit the patient to complete the study or sign meaningful informed consent Women who are pregnant or breastfeeding Acute or subacute intestinal occlusion Any concurrent malignancy other than non-melanoma skin cancer, or carcinoma in situ of the cervix. (Patients with a previous malignancy but without evidence of disease for ≥ 5 years will be allowed to enter the trial).
