Stereotactic Body Radiation Therapy in Combination with TTI-101 for the Treatment of Borderline Resectable and Locally Advanced Pancreatic Ductal Cancer

Inclusion Criteria

• Patients must have pathologically confirmed pancreatic adenocarcinoma with borderline resectable or locally advanced pancreatic ductal adenocarcinoma (PDAC) as defined by National Comprehensive Cancer Network (NCCN) guidelines, with no expected arterial resection-reconstruction.
• Borderline resectable patients only: Completion of induction chemotherapy within 1-3 weeks of study treatment start. Patients that exceed this window should complete an additional cycle of induction chemotherapy prior to initiation of study treatment, per provider discretion
• Age ≥ 18 years at time of study entry.
• Provision to sign and date the consent form.
• Stated willingness to comply with all study procedures and be available for the duration of the study.
• Ability to swallow tablets by mouth.
• Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 or Karnofsky Performance Status (KPS) ≥ 60%.
• Absolute neutrophil count ≥ 1,000/mcL.
• Platelets ≥ 70,000/mcL.
• Hemoglobin ≥ 9 g/dL, patients may be transfused to meet this criterion.
• Serum albumin ≥ 2.8 g/dL.
• Total bilirubin ≤ 2 mg/dL.
• Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT)(serum glutamate pyruvate transaminase [SGPT])/alkaline phosphatase (ALP) ≤ 3 x institutional upper limit of normal (IULN).
• Measured creatinine clearance (CL) > 40 mL/min or calculated creatinine CL > 40 mL/min by the Cockcroft-Gault formula (Cockcroft and Gault 1976) or by 24-hour urine collection for determination of creatinine clearance.
• 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.
• Sexually active women of childbearing potential and men must agree to use at least 1 highly effective method of contraception from screening and for at least 30 days after administration of the last dose of the study treatment. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately.

Exclusion Criteria

• Pregnant or breastfeeding. Patients must have a negative serum or urine pregnancy test within 5 days of study treatment.
• Previous treatment of the current malignancy with a STAT inhibitor.
• Herbal preparations are not allowed throughout the study. These herbal medications include but are not limited to St. John's wort, kava, ephedra (Ma Huang), ginkgo biloba, dehydroepiandrosterone (DHEA), yohimbe, saw palmetto, and ginseng. Participants should stop using herbal medications 7 days prior to the first dose of study treatment. * Senna and flaxseed are permitted
• Is not fully recovered from all COVID-19-related symptoms for 2 weeks prior to cycle 1 day 1, if previously tested positive for COVID-19.
• Ongoing toxicity (except alopecia) due to a prior therapy, unless returned to baseline or grade 1 or less.
• Has had major surgery within 3 weeks prior to starting investigational product (IP) or has not recovered from major side effects due to surgery.
• Significantly impaired cardiac function such as unstable angina pectoris, symptomatic congestive heart failure with New York Heart Association class III or IV, myocardial infarction within the last 12 months prior to study entry; serious arrhythmia (including corrected QT [QTc] prolongation of > 470 ms and/or pacemaker) or prior diagnosis of congenital long QT syndrome.
• Pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently). Participants with indwelling catheters for control of effusions or ascites are allowed.
• History of cerebrovascular accident or stroke within the previous 2 years.
• History of hepatic encephalopathy.
• Uncontrolled or symptomatic hypercalcemia (ionized calcium > 1.5 mmol/L, calcium > 12 mg/dL, or corrected serum calcium > ULN).
• Evidence of bleeding diathesis or significant coagulopathy (in the absence of therapeutic anticoagulation).
• History of grade 3 or 4 allergic reactions attributed to compounds of similar chemical or biologic composition as TTI-101 (hydroxyl-naphthalene sulfonamides).
• Known active metastases in the central nervous system (unless stable by brain imaging studies for at least 1 month without evidence of cerebral edema and no requirements for corticosteroids or anticonvulsants).
• History of malabsorption, or other chronic gastrointestinal disease or conditions that may hamper compliance and/or absorption of the IP.
• Participants with chronic hepatitis B virus (HBV) infection, unless screening viral load < 500 IU/mL on stable doses of antiviral therapy. Note: Participants with chronic hepatitis C virus (HCV) infection are allowed to enroll into the study but do not have a defined maximum viral load requirement for study entry. Participants with both HBV and HCV infection are excluded unless they have negative HCV ribonucleic acid (RNA).
• History of malignancy other than PDAC within 3 years prior to screening, with the exception of malignancies with a negligible risk of metastasis or death (e.g., 5-year overall survival [OS] rate > 90%), such as adequately treated carcinoma in situ of the cervix, non-melanoma skin carcinoma, localized prostate cancer, ductal carcinoma in situ, or stage I uterine cancer.
• Has any other concurrent severe and/or uncontrolled medical condition that would, in the investigator’s judgment, cause unacceptable safety risks, contraindicate participation in the clinical study, or compromise compliance with the protocol such as: * Chronic pancreatitis. * Active untreated or uncontrolled fungal, bacterial, or viral infections (including COVID‑19), sepsis, etc. * Acute and chronic, active infectious disorders including viral and nonmalignant medical illnesses that are uncontrolled or whose control may be jeopardized by the complications of this study therapy.
• Prior treatment for pancreatic cancer in the past 2 years and outside of the induction chemotherapy received for the current diagnosis.
• Measurable distant metastases on re-staging imaging post chemotherapy
• Currently receiving any other investigational agents or has participated in a study of an investigational agent or using an investigational device overlapping with study treatments within 3-6 months preceding diagnosis at the discretion of the principal investigator (PI).
• A history of allergic reactions attributed to compounds of similar chemical or biologic composition to TTI-101.