A Study of Hydroxychloroquine in Combination With Gemcitabine/Abraxane in Pancreatic Cancer

NCT01506973 | Completed Phase 1 DMC

• 1 other identifier: UPCC 19211
• Study Type: interventional
• Target: 119
• Locations: 1 country
• Sites: 1

Brief Summary

In this Phase I/II clinical trial, the investigators seek to pilot the addition of Hydroxychloroquine (HCQ) to a commonly-used front-line therapy of pancreatic cancer, gemcitabine/nab-paclitaxel. The investigators plan a run-in to define tolerable doses, and will explore doses of 800 and 1200 mg/day in successive cohorts of 6 patients. The investigators will assess toxicity continuously, and determine the dose for the Phase II trial based on standard toxicity criteria. The correlative endpoints of this trial are directed to the pharmacokinetics of HCQ, and pharmacokinetic model of HCQ based on data from several ongoing trials, and the data from these patients will contribute to refining the model. The investigators will analyze both measured and model-predicted indices for their relationship to autophagy induction. Autophagy will be assessed as the accumulation of autophagocytic vesicles in the PMNs of treated patients, together with the induction of the expression of autophagy-related proteins on western analysis, quantitated by densitometry. The investigators will document the rates of metabolic response as a consequence of treatment, as a therapeutic marker that may be related to the degree of autophagy inhibition. Since the investigators have previously demonstrated a key role of JNK1 in the induction of autophagy by chemotherapy, the investigators will analyze archival tumor materials to determine variability in this marker, as a baseline for potential future trials. Finally, this study will incorporate metabolic profiling by mass spectrometry, which will be related to mutations (including Kras) in pretreatment tumor specimens. Mutational analysis will be accomplished by targeted sequencing or by next-generation sequencing, and the need for fresh tissue for all these endpoints will require patients to have a biopsy performed before treatment at at 6-8 weeks after beginning treatment. In the previous study of the Hh inhibitor GDC-0973 with the same chemotherapy, the investigators were able to obtain repeat biopsies successfully on all patients. The importance of these biopsies, to move the science forward in an era in which the tools now exist to provide meaningful correlative science, cannot be overstated.

Conditions

Advanced Adenocarcinoma; Metastatic Adenocarcinoma

Keywords

histologically or cytologically documented

Outcome Measures

Primary Outcomes (1)

• Overall survival

  one year

Study Arms (2)

Gemcitabine/Abraxane/Hydroxychloroquine

EXPERIMENTAL

Abraxane: 125mg/m2 IV infusion over 30 minutes on Days 1, 8, 15 Gemcitabine: 1000mg/m2 IV infusion over 30-100 minutes on Days 1, 8, 15 Hydroxychloroquine: 1200 mg/day PO daily (600mg BID) Daily from D1

Drug: Hydroxychloroquine (HCQ); Drug: Gemcitabine; Drug: Abraxane

Gemcitabine/Abraxane

EXPERIMENTAL

Abraxane: 125mg/m2 IV infusion over 30 minutes on Days 1, 8, 15 Gemcitabine: 1000mg/m2 IV infusion over 30-100 minutes on Days 1, 8, 15

Drug: Gemcitabine; Drug: Abraxane

Interventions

Hydroxychloroquine (HCQ) DRUG

no other names

Gemcitabine/Abraxane/Hydroxychloroquine

Gemcitabine DRUG

no other names

Gemcitabine/Abraxane; Gemcitabine/Abraxane/Hydroxychloroquine

Abraxane DRUG

no other names

Gemcitabine/Abraxane; Gemcitabine/Abraxane/Hydroxychloroquine

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients must have histologically or cytologically documented advanced or metastatic adenocarcinoma of the pancreas.
• Patients must have measurable disease as defined by the RECIST criteria as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as 20mm with conventional techniques on either CT or MRI. Marker (CA19-9 or CEA) elevation alone is insufficient for entry.
• Patients may have had prior adjuvant treatment for pancreatic cancer. The last dose of chemotherapy must have been 4 months prior to study entry.
• Patients with prior radiotherapy are acceptable. It must be at least 4 months since administration of radiation therapy and all signs of toxicity must have abated.
• Patients must be age 18 years or older.
• Patients must have an ECOG performance status of 0-1.
• The following required Initial Laboratory Values should be obtained within 4 weeks of the start of treatment:
• Granulocytes 1,500/ml
• Platelet Count 100,000/ml
• Creatinine 1.5 x upper limit of normal
• Bilirubin 1.5 x upper limit of normal
• AST 5 x upper limit of normal
• Patients must not be pregnant or lactating as chemotherapy is thought to present substantial risk to the fetus/infant.
• Patients must have an accessible primary tumor or metastasis, and be willing to have a pre-treatment and post-treatment tumor biopsy (at 6 to 8 weeks after beginning).
• Patients must have a life expectancy of greater than three months.

You may not qualify if:

• Patients may not be receiving any other investigational agents
• Known allergy to HCQ
• Patients with previous treatment with abraxane.
• Patients on therapeutic doses of Coumadin ( 1 mg daily). The use of therapeutic or prophylactic low molecular weight heparin or fragmin is permitted.
• Patients with known G6PD deficiency, severe psoriasis, porphyria, macular degeneration or severe diabetic retinopathy are ineligible because of the potential for greater HCQ toxicity.

Sponsors & Collaborators

• Abramson Cancer Center at Penn Medicine: lead

Study Sites (1)

Abramson Cancer Center of the University of Pennsylvania

Philadelphia, Pennsylvania, 19104, United States

Location

Related Publications (1)

• Karasic TB, O'Hara MH, Loaiza-Bonilla A, Reiss KA, Teitelbaum UR, Borazanci E, De Jesus-Acosta A, Redlinger C, Burrell JA, Laheru DA, Von Hoff DD, Amaravadi RK, Drebin JA, O'Dwyer PJ. Effect of Gemcitabine and nab-Paclitaxel With or Without Hydroxychloroquine on Patients With Advanced Pancreatic Cancer: A Phase 2 Randomized Clinical Trial. JAMA Oncol. 2019 Jul 1;5(7):993-998. doi: 10.1001/jamaoncol.2019.0684.

  PMID: 31120501 DERIVED

MeSH Terms

Conditions

Adenocarcinoma

Interventions

Hydroxychloroquine; Gemcitabine; Albumin-Bound Paclitaxel

Condition Hierarchy (Ancestors)

Carcinoma; Neoplasms, Glandular and Epithelial; Neoplasms by Histologic Type; Neoplasms

Intervention Hierarchy (Ancestors)

Chloroquine; Aminoquinolines; Quinolines; Heterocyclic Compounds, 2-Ring; Heterocyclic Compounds, Fused-Ring; Heterocyclic Compounds; Deoxycytidine; Cytidine; Pyrimidine Nucleosides; Pyrimidines; Heterocyclic Compounds, 1-Ring; Paclitaxel; Taxoids; Cyclodecanes; Cycloparaffins; Hydrocarbons, Alicyclic; Hydrocarbons, Cyclic; Hydrocarbons; Organic Chemicals; Diterpenes; Terpenes; Albumins; Proteins; Amino Acids, Peptides, and Proteins

Study Officials

• Peter O'Dwyer, MD

  Abramson Cancer Center at Penn Medicine

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: phase 1
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 3, 2012
• First Posted: January 10, 2012
• Study Start: December 1, 2011
• Primary Completion: March 1, 2022
• Study Completion: March 1, 2022
• Last Updated: July 25, 2025

Record last verified: 2025-07

Locations

US (1)