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This is a prospective, multicenter, non-randomized, open label light dose escalation phase I trial to evaluate the safety and preliminary efficacy of Padeliporfin vascular targeted photodynamic therapy (VTP) applied via endovascular fiber placement within a dilatation catheter, through the target artery(superior mesenteric artery (SMA), celiac artery (CA) or common hepatic artery (CHA)). The investigators will evaluate safety and preliminary efficacy of Padeliporfin VTP administered endovascularly using light dose escalation.
This is a prospective, multicenter, non-randomized, open label light dose escalation phase I trial to evaluate the safety and preliminary efficacy of Padeliporfin vascular targeted photodynamic therapy (VTP) applied via endovascular fiber placement within a dilatation catheter, through the the target artery(superior mesenteric artery (SMA), celiac artery (CA) or common hepatic artery (CHA)).The investigators will evaluate safety and preliminary efficacy of Padeliporfin VTP administered endovascularly using light dose escalation.
Study Intervention: Patients enrolled in the study will undergo endovascular VTP, using Padeliporfin (WST-11) activated via endovascular fiber placement through the target artery(superior mesenteric artery (SMA), celiac artery (CA) or common hepatic artery (CHA))., with intravenous administration of Padeliporfin at a fixed dose of 4 mg/kg of padeliporfin di-potassium, followed by total of 10 min illumination at 753 nm.
For light dose escalation (Part A), a 3+3 dose-escalation schema will be used. In a subsequent expansion phase (Part B), the optimal light dose as per light dose escalation, will be used in an additional cohort of patients to further evaluate preliminary efficacy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Part A | Experimental | will be a monotherapy light dose escalation with single dose of Padeliporfin at light laser doses of 200, 400 and 600 mW/cm for 10 minutes. Part A will proceed with light dose escalation and will continue until the maximum tolerated light dose (MTD) and/or recommended phase 2 dose (RP2D) is defined. |
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| Part B | Experimental | will be a dose expansion part at MTD/RP2D dose level identified in Part A to further assess the safety, tolerability, and treatment effect of the MTD and/ or RP2D |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Padeliporfin Vascular Targeted Photodynamic (VTP) therapy | Combination Product | The laser light fiber with inflatable balloon to dam SMA blood flow during light illumination will be placed by an Interventional Radiologist in the SMA via a transfemoral artery approach. The balloon will be inflated to impede blood flow for total of 10 minutes during light illumination |
| Measure | Description | Time Frame |
|---|---|---|
| Safety of endovascularly applied Padeliporfin VTP ablation | Safety of endovascularly applied Padeliporfin VTP ablation will be assessed using the CTCAE version 5.0. All adverse events (AEs) will be coded using the Medical Dictionary for Regulatory Activities (MedDRA) for being included in analyses. | Day 30 |
| Determination of the Maximum Tolerated Light Dose (MTD) and/or Recommended Phase 2 light dose (RP2D) in Part A | MTD is defined as the dose level associated with <33% of DLT-evaluable patients experiencing a DLT. If the MTD is reached, the RP2D will be defined as MTD. If the MTD is not reached, the RP2D will be selected based on integrated evaluation of safety and clinical benefit for all dose levels tested. | Day 30 |
| Measure | Description | Time Frame |
|---|---|---|
| Descriptive features of treatment response to ablation in tumor tissue based on pre- and post -VTP CT scans | Rate of resectability and downstaging (as per NCCN Clinical Practice Guidelines V1, May 4, 2023) | Day 2 |
| Tumor Response by CT scans |
| Measure | Description | Time Frame |
|---|---|---|
| Exploratory endpoints | Rate of resectability and downstaging will be evaluated by determining the percentage of patients who were initially deemed to have unresectable LA PDAC and following Padeliporfin VTP treatment, were subsequently deemed to have borderline resectable or resectable disease | 60 days |
Inclusion Criteria:
1Patient is 18 years of age and older 2. Patient is capable of giving written informed consent 3. Patients with a diagnosis of Stage III pancreatic ductal adenocarcinoma, cytologically or histologically confirmed per American Joint Committee on Cancer (AJCC) staging criteria 4. Patients have an unresectable tumor, evaluated as Stage III according to National Comprehensive Cancer Network (NCCN) guidelines resectability criteria, based on radiographic imaging or exploratory surgery as a locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) 5. Patients with LA PDAC located in the head/uncinate process of the pancreas 6. Patient with target artery solid tumor contact ˃180° for a total contact length up to 3cm, and with entire target artery internal diameter 5-10 mm. 7. All patients will be approved by a multi-disciplinary team (including medical oncologist, surgeon, interventional radiologist) as appropriate for endovascular VTP treatment. 8. Measurable disease as defined by the Response Evaluation Criteria in Solid Tumors according to RECIST 1.1 9. ECOG performance status ≤ 1 10. Life expectancy at least 6 months 11. No evidence of metastatic disease by CT scan chest, abdomen and pelvis performed within 28 days prior to treatment 12. Adequate organ system function including:
a. Absolute neutrophil count (ANC) ≥1500/mm3 without the use of hemopoietic growth factors within the 7 days before VTP treatment b. Absolute white blood cell count ≥3.0*109/L c. Hemoglobin at least 10g/dL d. Platelet count ≥75,000/mm3 e. International normalized ratio (INR) <1.5 unless the patient is receiving anticoagulation therapy, in which case a therapeutic INR is acceptable. Anticoagulation therapy with low- molecular-weight heparin whether medically indicated, is permitted. f. Creatinine clearance ≥60 mL/min using Cockcroft-Gault equation g. Amylase and lipase <1.5xULN h. ALT/AST ≤2.5*ULN and total bilirubin ≤2*ULN (benign hereditary hyperbilirubinemias, e.g., Gilbert's syndrome, are permitted, those patients must have total bilirubin <3 mg/dL).
13. Patient may have received prior neoadjuvant systemic therapy (chemotherapy and/or immunotherapy) 14. Patient with no prior external beam radiation therapy to the pancreas 15. Patient with prior attempted surgical resection is permitted 16. No comorbidities which would preclude access to the target artery by endovascular catheterization 17. Male or nonpregnant and nonlactating female aged ≥18 years
Participant exclusion criteria
21. VEGF-targeted therapy within 2 months prior to planned VTP treatment 22. Prohibited medication that could not be adjusted or discontinued prior to study treatment (See Section 16 for instructions) 23. Patients with photosensitive skin diseases or porphyria.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Eyal Morag, MD | Contact | +972 54 2056619 | eyal.morag@impactbiotech.com |
| Name | Affiliation | Role |
|---|---|---|
| Nadine Abi-Jaoudeh, MD | University of California, Irvine | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| City of Hope | Recruiting | Duarte | California | 91010 | United States |
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| ID | Term |
|---|---|
| D013812 | Therapeutics |
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Part B recruitment will be opened upon completion of Part A light dose escalation.
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Based on CT scan according to RECIST 1.1
| Day 30 |
| Tumor Response by CT scans | Based on CT scan according to RECIST 1.1 | Day 60 |
| University of California Irvine | Recruiting | Irvine | California | 92697 | United States |
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