CDX-301 and CDX-1140 for the Treatment of Patients with Resectable Pancreatic Cancer
This phase II trial studies the effects of CDX-1140 alone or in combination with CDX-301 in treating patients with pancreatic cancer that can be removed by surgery (resectable). CDX-1140 is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. CDX-301 may interfere with growth factors and help cause tumor cells to die. Giving CDX-1140 together with CDX-301 may work better in treating patients with resectable pancreatic cancer compared to CDX-1140 alone.
Inclusion Criteria
- Histologically or cytologically confirmed surgically resectable pancreatic ductal adenocarcinoma, but not adenosquamous/squamous pancreas cancers (as determined by operating surgeon or tumor board). Patients who have previously received chemotherapy for his/her pancreas cancer within the past 6 months and who are now deemed resectable are also eligible for this trial
- At least 18 years of age
- Eastern Cooperative Oncology Group (ECOG) performance status =< 1
- Absolute neutrophil count >= 1,500 /cumm
- Platelets >= 100,000 /cumm
- Hemoglobin >= 9.0 g/dL
- Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase[SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT) =< 2.5 x institutional upper limit of normal (IULN)
- Creatinine clearance =< 1.5 x IULN or glomerular filtration rate of >= 60 mL/min
- International normalized ratio (INR) =< 1.5 x IULN unless patient is receiving anticoagulant therapy as long as INR or partial thromboplastin time (PTT) is within therapeutic range of intended use of anticoagulants
- Activated (a)PTT =< 1.5 x IULN unless patient is receiving anticoagulant therapy as long as INR or PTT is within therapeutic range of intended use of anticoagulants
- Albumin >= 3.0 mg/dL
- The effects of CDX-301 and CDX-1140 on the developing human fetus are unknown. For this reason, women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry, for the duration of study participation, and for 3 months after the last dose of either study drug. Should a woman become pregnant or suspect she is pregnant while participating in this study or for 3 months after the last dose of either study drug, she must inform her treating physician immediately
- Ability to understand and willingness to sign an Institutional Review Board (IRB) approved written informed consent document (or that of legally authorized representative, if applicable)
Exclusion Criteria
- Immune deficiencies such as human immunodeficiency virus (HIV)
- A history of other malignancy with the exception of malignancies for which all treatment was completed at least 2 years before registration and the patient has no evidence of disease
- Currently receiving any other investigational agents or has received any other investigational agents within 4 weeks or 5 half-lives of the planned first dose of study treatment
- Receipt of chemotherapy within 2 weeks of planned first dose of study treatment
- A history of allergic reactions attributed to compounds of similar chemical or biologic composition to CDX-301 or CDX-1140 or other agents used in the study
- Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (for > 1 month of 10 mg prednisone daily, or equivalent) or any other form of immunosuppressive therapy not routinely associated with chemotherapeutic regimen
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, immunosuppression, autoimmune conditions, or underlying pulmonary disease
- Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, immunosuppression, autoimmune conditions, or underlying pulmonary disease
- Has an autoimmune disease requiring systemic treatment within the past 2 years (i.e. with use of disease modifying agents, corticosteroids, or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency, etc.) is not considered a form of systemic treatment
- Known history of hepatitis B (defined as hepatitis B surface antigen [HBsAg] reactive) or known active hepatitis C virus (defined as hepatitis C virus [HCV] ribonucleic acid [RNA] [qualitative] is detected)
- Has a history of (non-infectious) pneumonitis that required steroids or current pneumonitis
- Has a known history of active tuberculosis (TB) (bacillus tuberculosis)
- Major surgery within 28 days prior to the first study treatment
- Pregnant and/or breastfeeding. Women of childbearing potential must have a negative pregnancy test within 14 days of study entry
- History of bone marrow or solid organ transplant
- Patients with a history of myocardial infarction, cerebral vascular accident, thrombosis or pulmonary embolus within 12 months prior to the first dose of study treatment are excluded from this study
- Patients with known mutations/amplifications in Flt3
Additional locations may be listed on ClinicalTrials.gov for NCT04536077.
See trial information on ClinicalTrials.gov for a list of participating sites.
PRIMARY OBJECTIVE:
I. To determine the amount of intratumor conventional dendritic cells in patients with resectable pancreatic cancer treated with neoadjuvant anti-CD40 agonist monoclonal antibody CDX-1140 (CDX- 1140) versus (vs.) patients with resectable pancreatic cancer treated with neoadjuvant recombinant Flt3 ligand (CDX-301) + CDX-1140.
EXPLORATORY OBJECTIVES:
I. To report immunologic correlates in both groups before and after therapy.
II. To assess local control of resectable pancreatic cancer treated with neoadjuvant CDX-1140 vs. resectable pancreatic cancer treated with neoadjuvant CDX-301 + CDX-1140.
III. To assess distant metastasis free survival of patients with resectable pancreatic cancer treated with neoadjuvant CDX-1140 vs. resectable pancreatic cancer treated with neoadjuvant CDX-301 + CDX1140.
IV. To assess overall survival of patients with resectable pancreatic cancer treated with neoadjuvant CDX-1140 vs. resectable pancreatic cancer treated with neoadjuvant CDX-301 + CDX-1140.
V. To assess extent of resection in patients with resectable pancreatic cancer treated with neoadjuvant CDX-1140 vs. resectable pancreatic cancer treated with neoadjuvant CDX-301 + CDX-1140.
VI. To assess the safety and tolerability profile of CDX-1140 vs. CDX-301 plus CDX-1140 in surgically resectable pancreatic cancer patients.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients receive CDX-1140 intravenously (IV) over 90 minutes, then undergo surgery 7-12 days later. Patients also undergo collection of blood samples at screening and on study.
ARM II: Patients receive CDX-301 subcutaneously (SC) daily on days 1-5 and CDX-1140 IV on day 8. Patients undergo surgery 7-12 days after receipt of CDX-1140. Patients also undergo collection of blood samples at screening and on study.
After completion of study treatment, patients are followed up every 6 months for 2 years.
Trial PhasePhase II
Trial Typetreatment
Lead OrganizationSiteman Cancer Center at Washington University
Principal InvestigatorRoheena Z. Panni
- Primary ID202011125
- Secondary IDsNCI-2020-13898
- ClinicalTrials.gov IDNCT04536077