Combination Therapy for Pancreatic Cancer

(ARC-8 Trial)

Recruiting at28 trial locations

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 1

Recruiting

Sponsor: Arcus Biosciences, Inc.

Must not be taking: Immunosuppressants, Corticosteroids

Disqualifiers: Cardiovascular disease, Autoimmune disease, others

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial tests a new drug, AB680, combined with three other drugs in patients with advanced pancreatic cancer. The goal is to enhance the immune system's response and use chemotherapy to fight the cancer.

Will I have to stop taking my current medications?

The trial requires that you stop taking immunosuppressive medications, like high doses of corticosteroids, at least 2 weeks before starting the study. Other medications are not specifically mentioned, so it's best to discuss your current medications with the study team.

What data supports the effectiveness of the drug combination therapy for pancreatic cancer?

Research shows that combining nab-paclitaxel (a form of the drug paclitaxel) with gemcitabine has significantly improved survival in patients with advanced pancreatic cancer. This combination has demonstrated substantial antitumor activity and increased survival rates compared to using gemcitabine alone. ^{1 2 3 4 5}

Is the combination therapy for pancreatic cancer safe for humans?

The combination of nab-paclitaxel and gemcitabine has been studied in patients with advanced pancreatic cancer and has shown an acceptable safety profile, meaning it is generally safe for use in humans. ^{1 3 6 7 8}

What makes the combination therapy for pancreatic cancer unique?

This combination therapy is unique because it includes AB680, a CD73 inhibitor, along with gemcitabine, nab-paclitaxel, and zimberelimab, which together may enhance the immune response against pancreatic cancer, offering a novel approach compared to standard treatments that typically involve only chemotherapy drugs like gemcitabine and nab-paclitaxel. ^{1 3 5 8 9}

Research Team

Medical Director

Principal Investigator

Arcus Biosciences, Inc.

Eligibility Criteria

This trial is for adults with advanced pancreatic cancer who haven't had treatment for metastatic disease. They must be able to consent, not pregnant, and have adequate organ function. Prior therapy is okay if it was over 6 months ago. Participants can't join if they've recently used certain steroids, had live vaccines, or have active infections or autoimmune diseases.

Inclusion Criteria

I have at least one tumor that can be measured and it's not in an area treated with radiation.

I have not received any treatment for my metastatic disease.

I had treatment for pancreatic cancer that ended over 6 months ago.

Exclusion Criteria

I do not have any health conditions that would make taking new medications dangerous.

I do not have an active autoimmune disease or a history that required strong immune system medications, except for vitiligo or childhood asthma.

Has known psychiatric or substance abuse disorders that would interfere with cooperation with the requirements of the trial

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Dose Escalation

Participants receive escalating doses of AB680 in combination with Zimberelimab, nab-paclitaxel, and gemcitabine to determine the recommended phase 2 dose

Approximately 12 weeks

Multiple visits for dose escalation and monitoring

Dose Expansion

Participants receive AB680 at the recommended phase 2 dose in combination with Zimberelimab, nab-paclitaxel, and gemcitabine

Approximately 24 weeks

Regular visits for treatment and monitoring

Follow-up

Participants are monitored for safety and effectiveness after treatment

Up to 1 year

Periodic visits for follow-up assessments

Treatment Details

Interventions

• AB680 (Other)
• Gemcitabine (Anti-cancer agent)
• Nab-paclitaxel (Anti-cancer agent)
• Zimberelimab (Monoclonal Antibodies)

Trial Overview The study tests AB680 combined with Zimberelimab, Nab-paclitaxel, and Gemcitabine in patients with advanced pancreatic cancer. It's a Phase 1 trial focusing on safety and how the body processes the drugs (pharmacokinetics), as well as their effects on the body (pharmacodynamics) and early signs of effectiveness.

Participant Groups

Group I: Dose Expansion(AB680+Zimberelimab+nab-paclitaxel(NP) & gemcitabine (Gem):Cohort A1 (front-line/1L) Experimental Treatment 4 Interventions

Participants with advance pancreatic cancer, naïve to any prior treatment will receive AB680 (at the RP2D identified during dose escalation) combined with Zimberelimab and the standard nab-paclitaxel (NP) and gemcitabine (Gem) (NP/Gem) chemotherapy regimen

Group II: Dose Expansion (AB680 + Zimberelimab + NP/Gem): Cohort C (front-line/1L) Experimental Treatment 4 Interventions

Participants with advance pancreatic cancer naïve to any prior treatment will receive AB680 combined with Zimberelimab and NP-Gem chemotherapy regimen.

Group III: Dose Expansion (AB680 + Zimberelimab + NP/Gem): Cohort B (second-line/2L) Experimental Treatment 4 Interventions

Participants with advance pancreatic cancer who have received 1 prior line of treatment will receive AB680 (at the RP2D identified during dose escalation) combined with Zimberelimab and NP-Gem chemotherapy regimen.

Group IV: Dose Expansion (AB680 + NP/Gem): Cohort D (front-line/1L) Experimental Treatment 3 Interventions

Participants with advance pancreatic cancer naïve to any prior treatment will receive AB680 combined with NP-Gem chemotherapy regimen.

Group V: Dose Expansion (AB680 + NP/Gem): Cohort A2 (front-line/1L) Experimental Treatment 3 Interventions

Participants with advance pancreatic cancer who are naïve to any prior treatment will receive AB680 (at the RP2D identified during dose escalation) and the standard NP/Gem chemotherapy regimen.

Group VI: Dose Escalation Experimental Treatment 4 Interventions

Dose escalation is a 3+3 design, including a Dose Limiting Toxicity (DLT) evaluation period. The dose expansion dose level will be determined in this part with escalating doses of AB680 in combination with Zimberelimab at the recommended phase 2 dose (RP2D) and the standard nab-paclitaxel and gemcitabine chemotherapy regimen in participants with advanced pancreatic cancer.

Who Is Running the Clinical Trial?

Arcus Biosciences, Inc.

Lead Sponsor

Trials

44

Recruited

7,500+

Findings from Research

In a phase 3 trial involving 861 patients with metastatic pancreatic cancer, the combination of nab-paclitaxel and gemcitabine significantly improved overall survival (8.5 months) compared to gemcitabine alone (6.7 months), with a hazard ratio for death of 0.72, indicating a 28% reduction in the risk of death.

The combination therapy also resulted in better progression-free survival (5.5 months vs. 3.7 months) and a higher overall response rate (23% vs. 7%), although it was associated with increased rates of adverse events like neutropenia and neuropathy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. Von Hoff, DD., Ervin, T., Arena, FP., et al.[2022]

In a study using 10 patient-derived pancreatic cancer xenograft mouse models, the combination of S-1 and nab-paclitaxel showed significantly greater tumor growth inhibition (103.56%) compared to either treatment alone, indicating enhanced antitumor activity.

Biomarkers such as thymidylate synthase, OPRT, and DPD were identified as potential predictors of S-1 efficacy, while HER2 was linked to improved efficacy of nab-paclitaxel, suggesting that these markers could help tailor treatment strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nab-Paclitaxel Plus S-1 Shows Increased Antitumor Activity in Patient-Derived Pancreatic Cancer Xenograft Mouse Models. Li, JA., Xu, XF., Han, X., et al.[2017]

In a retrospective study of 29 patients with advanced pancreatic carcinoma and elevated bilirubin levels, treatment with nanoparticle albumin-bound paclitaxel and gemcitabine (nab-P/G) was found to be safe, showing no unexpected toxicities.

The median overall survival for patients treated with nab-P/G was 11.7 months, with no significant differences in survival based on bilirubin levels, indicating that nab-P/G is a feasible treatment option for this challenging patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and efficacy of Nab-paclitaxel plus gemcitabine in patients with advanced pancreatic cancer suffering from cholestatic hyperbilirubinaemia-A retrospective analysis. Pelzer, U., Wislocka, L., Jühling, A., et al.[2022]

The recent phase III MPACT trial demonstrated that nab-paclitaxel, when added to gemcitabine, significantly improved survival rates in patients with metastatic pancreatic cancer, indicating its efficacy in a previously challenging area.

The success of nab-paclitaxel highlights the importance of innovative drug delivery technologies, such as albumin nanoparticle formulations, in enhancing the effectiveness of anticancer therapies while minimizing toxicities associated with traditional formulations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The winning formulation: the development of paclitaxel in pancreatic cancer. Ma, WW., Hidalgo, M.[2022]

The combination of nab-paclitaxel, gemcitabine, and capecitabine was found to be well tolerated in a phase I study with 15 patients, establishing a maximum-tolerated dose (MTD) but showing only modest antitumor activity in metastatic pancreatic cancer.

Despite the regimen being generally safe, with a low incidence of severe hematologic toxicities, only 14.3% of patients had a partial response, indicating that optimizing dose intensity may be crucial for improving treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A phase I trial of nab-paclitaxel, gemcitabine, and capecitabine for metastatic pancreatic cancer. Ko, AH., Truong, TG., Kantoff, E., et al.[2022]

In a small study of 6 women with heavily pretreated HER2-negative metastatic breast cancer, the combination of nab-paclitaxel (nab-P) and bevacizumab (B), with or without gemcitabine (G), showed promising safety and preliminary efficacy, with only one patient experiencing significant toxicity.

Out of the 6 patients, 2 achieved partial responses and 4 had stable disease, indicating that this combination therapy may be effective, warranting further investigation in a formal phase II trial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Paclitaxel albumin-bound particles (abraxane) in combination with bevacizumab with or without gemcitabine: early experience at the University of Miami/Braman Family Breast Cancer Institute. Lobo, C., Lopes, G., Silva, O., et al.[2022]

Gemcitabine-loaded human serum albumin nanoparticles (Gem-HSA-NPs) were successfully developed and showed a favorable controlled release, with an encapsulation rate of approximately 83% and a particle size of about 150 nm.

In vivo studies demonstrated that Gem-HSA-NPs significantly inhibited tumor growth in pancreatic cancer while exhibiting lower toxicity compared to other treatment groups, indicating their potential as a safer and more effective delivery method for gemcitabine.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An in vitro and in vivo study of gemcitabine-loaded albumin nanoparticles in a pancreatic cancer cell line. Yu, X., Di, Y., Xie, C., et al.[2022]

Itacitinib, a selective JAK1 inhibitor, combined with nab-paclitaxel and gemcitabine, showed an acceptable safety profile and clinical activity in patients with advanced solid tumors, including pancreatic cancer, with a 24% overall response rate across various doses.

The study indicated that while itacitinib was tolerated at lower doses, treatment-related toxicities such as neutropenia and fatigue were common, leading to dose adjustments; however, the study was terminated early due to negative results from a related phase III trial.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Phase Ib/II Study of the JAK1 Inhibitor, Itacitinib, plus nab-Paclitaxel and Gemcitabine in Advanced Solid Tumors. Beatty, GL., Shahda, S., Beck, T., et al.[2022]

A 71-year-old woman with unresectable pancreatic cancer and peritoneal metastases was successfully treated with a combination of nab-paclitaxel and gemcitabine, leading to the conversion of her cancer to a resectable state after 8 months of chemotherapy.

The treatment was well-tolerated, and imaging studies showed no evidence of the tumor or metastases, allowing for a successful surgical resection of the affected areas.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Successful conversion surgery for unresectable pancreatic cancer with peritoneal metastases after neoadjuvant albumin-bound paclitaxel and gemcitabine chemotherapy: case report and literature review. Kobayashi, Y., Maeda, S., Hama, N., et al.[2020]

References

1. United States pubmed.ncbi.nlm.nih.gov

Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Nab-Paclitaxel Plus S-1 Shows Increased Antitumor Activity in Patient-Derived Pancreatic Cancer Xenograft Mouse Models. [2017]

3. England pubmed.ncbi.nlm.nih.gov

Safety and efficacy of Nab-paclitaxel plus gemcitabine in patients with advanced pancreatic cancer suffering from cholestatic hyperbilirubinaemia-A retrospective analysis. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

The winning formulation: the development of paclitaxel in pancreatic cancer. [2022]

5. Germany pubmed.ncbi.nlm.nih.gov

A phase I trial of nab-paclitaxel, gemcitabine, and capecitabine for metastatic pancreatic cancer. [2022]

6. France pubmed.ncbi.nlm.nih.gov

Paclitaxel albumin-bound particles (abraxane) in combination with bevacizumab with or without gemcitabine: early experience at the University of Miami/Braman Family Breast Cancer Institute. [2022]

7. New Zealand pubmed.ncbi.nlm.nih.gov

An in vitro and in vivo study of gemcitabine-loaded albumin nanoparticles in a pancreatic cancer cell line. [2022]

8. England pubmed.ncbi.nlm.nih.gov

A Phase Ib/II Study of the JAK1 Inhibitor, Itacitinib, plus nab-Paclitaxel and Gemcitabine in Advanced Solid Tumors. [2022]

9. Singapore pubmed.ncbi.nlm.nih.gov

Successful conversion surgery for unresectable pancreatic cancer with peritoneal metastases after neoadjuvant albumin-bound paclitaxel and gemcitabine chemotherapy: case report and literature review. [2020]