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This study is a Prospective Single Arm, dual cohort Open Label Feasibility trial to evaluate the initial safety and signal of efficacy of a novel extracorporeal blood purification (EBP) procedure in either mPDAC or mCRC refractory to systemic therapy. Site selection will be dependent upon the site's familiarity with extracorporeal blood purification platforms as well as the diagnosis and management of mPDAC and mCRC. Adults (18 years old and older, ECOG PS of equal or less than 2) with a diagnosis of either mPDAC as defined histologically (microscopically) as a "pancreatobiliary type" adenocarcinoma who experienced disease progression or not tolerating fluoropyrimidine-, oxaliplatin- and irinotecan- based regimens or prior treatment with gemcitabine and nab-paclitaxel or are not candidates for chemotherapy or mCRC patients who experienced disease progression on 5-fluorouracil (5-FU), capecitabine, oxaliplatin and irinotecan as FOLFIRI and/or FOLFOX and/or XELOX and/or XELIR and/or FOLFOXIRI/FOLFIRINOX or who are not candidates for chemotherapy with at least 5 cells/mL CTCs in peripheral blood and/or portal vein.
Study Intervention: All study patients will be assigned to receive procedure with the investigational device (ONCObind ) Study Duration: Our target enrollment is 30 patients with mPDAC and 30 patients with mCRC. The study will last for up to two years. Interim analyses will determine early stopping for safety. This is detailed in Section 22: Data Safety Monitoring Board (DSMB). Furthermore, as the safety and effectiveness of the experimental use of the ONCObind device for treatment of patients with mPDAC and/or mCRC is unknown, patients will be followed for up to 5 years to inform oncological outcomes.
Procedure Setting: Extracorporeal blood purification utilizing ONCObind can be performed either on an outpatient or an in-patient basis as HD/CRRT procedure is performed routinely in both settings. Whether the procedure will be performed in a setting of an outpatient or in-patient setting would mainly depend on the personalized approach that the Site Investigator choses related to individual patient enrolled in the study. Location of the ONCObind treatment will be recorded, and data analysis will include consideration of the setting as it relates to study endpoints. If the Study Procedure is implemented in an outpatient setting, the subject will be monitored for up to 4 hours post procedure per PI discretion.
Procedure Duration for ONCObind : A sufficient blood flow rate and exposure of patient's blood to the ONCObind adsorption media was initially established based on the experience in implementing procedure in patients with blood stream infections. However, target procedure duration is further optimized based on data collected in EU oncology patients as listed below:
the average procedure duration and blood flow rates targeted in patients with blood stream infections or oncology are as follows:
Subjects will be assessed per study visits and as part of routine, standard of care for mPDAC or mCRC. All subjects enrolled in this study will undergo clinical efficacy, safety, and laboratory assessments. Blood, and clinical data collection samples will be obtained at Screening, Induction Phase, and Procedure Follow up Phase in accordance to Schedule of Events. . Demographic and baseline clinical parameters will be recorded at the time of enrollment. Pertinent clinical parameters will be recorded in accordance to Schedule of Events . Outcomes data will be recorded on in accordance to Schedule of Events . Subject status will be in accordance to Schedule of Events to include adverse event evaluation and a targeted medication review. Survival follow-up will be assessed at 60, 120, 180 and 210 days after enrollment and/or at the time of death.
Patients will receive standard of care follow-up for up to 5 years and this data collected will be made available for FDA review.
A subset of the protocol team will review Grade 3 and 4 adverse event or serious adverse event (AE / SAE) data every 2 weeks. If there is a pattern of unexpected AEs that is out of proportion to the current understanding of the natural history of the disease, the DSMB will be asked to review un-blinded safety data in an ad hoc meeting. If an ad hoc meeting of the DSMB is convened to review a serious, device-related adverse event, enrollment will be halted pending the DSMB review to ensure subject safety in the trial. The DSMB will review the event to ensure subject safety. After the review, the DSMB will determine if enrollment may resume.
The DSMB will conduct an interim analysis after the enrollment of 10 subjects in each mPDAC and mCRC cohort to evaluate for safety and efficacy prior to completion of enrollment (n=30 for each cohort) (as detailed in Data Safety Monitoring Board (DSMB) and will be available for ad hoc reviews for safety concerns as described above. As stated above, enrollment will be halted pending the convening of an ad hoc DSMB meeting to review a serious, device-related adverse event. The DSMB will review the event to ensure subject safety in the trial. The DSMB will determine if enrollment may resume. The DSMB may recommend temporary or permanent cessation of enrollment based on their safety reviews.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ONCObind (Onco-Seraph) 100 Filter is a single use | Experimental | The ONCObind Filter is a single use, disposable column packed with ultra-high molecular weight polyethylene beads which have been modified to contain endpoint attached heparin on the surface. The devices are sterilized using a standard ethylene oxide cycle, following ISO 11135-1:2007. Chemical Indicator labels are located near the product label. ONCObind is part of the Seraph platform technology that was also developed as an extracorporeal broad-spectrum sorbent hemoperfusion device for reduction of pathogens from the bloodstream. |
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| Matched Controls | Other | Study patients will be assigned to receive procedure with the investigational device (ONCObind) and will be matched with 60 site specific controls, 30 PDAC and 30 CRC. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ONCObind (Onco-Seraph) 100 Filter | Device | The ONCObind Microbind® Affinity Blood Filter ( ONCObind) manufactured by ExThera Medical Corporation in Martinez, CA. The ONCObind filter has been designed and manufactured to reduce residual risks as much as possible to ensure safe usage. Literature search results concluded that heparin-coated medical devices are safe and decrease platelet adhesion without affecting the adsorption of major adhesive proteins. Literature search yielded over 60 publications and 500 treated patients with Seraph platform technology for pathogen removals without and significant safety concern. The achieved results from the above-mentioned testing and studies support the performance and safety of ONCObind consistent with the intended use. ExThera Medical concludes that the known and potential benefits of ONCObind, when used to treat patients with PDAC, outweigh the known and potential risks when used according to the intended use. |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of procedure-emergent adverse events (AEs) graded using the NCI CTCAE Version 5.0 | Incidence of procedure-emergent adverse events (AEs) graded using the NCI CTCAE Version 5.0 | 210 days |
| Incidence of procedure-emergent serious adverse events (SAEs) graded using the NCI CTCAE Version 5.0 | Incidence of procedure-emergent serious adverse events (SAEs) graded using the NCI CTCAE Version 5.0 | 210 days |
| Evaluation of Survival | Survival follow-up will be assessed after enrollment (vital status check) | 60, 120, 180 and 210 days |
| Change in CTC Concentration | The change in CTC concentration from baseline to the end of the induction series as well as 180 days after baseline of Extracorporeal Procedure (ECPs) with ONCObind | 180 days |
| Capacity for the ONCObind filter to remove circulating tumor cells | Capacity for the ONCObind filter to remove circulating tumor cells (CTCs) when compared to baseline | 60 days |
| Evaluate the Quality of Life (QOL) | To evaluate the Quality of Life from baseline to end of study using the European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) | 210 days |
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Inclusion Criteria:
In order to be eligible to participate in this study, a patient must meet all of the following criteria:
Patients ≥ 18 years of age with
Patients with Eastern Cooperative Oncology Group (ECOG) performance status (PS) scores of 2 or less.
Patient or legally authorized representative is willing and able to understand and provide a signed informed consent that fulfills the relevant IRB or Independent Ethics Committee (IEC) guidelines.
Patients with a CTC concentration of at least 5 cells/mL
Must be willing to provide blood samples for prospective tumor molecular profiling and exploratory analyses.
Ability to attend required study visits and return for adequate follow-up, as required by this protocol.
Patients must be of non-childbearing potential or using a medically acceptable contraceptive regimen. Effective contraception includes surgical sterilization (e.g., vasectomy, tubal ligation), two forms of barrier methods (e.g., condom, diaphragm) used with spermicide, IUDs.
Exclusion Criteria:
An individual who meets any of the following criteria will be excluded from participation in this study:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Drina Aldana | Contact | (925) 839-2060 | drina@extheramedical.com |
| Name | Affiliation | Role |
|---|---|---|
| Lakhmir Chawla, M.D. | ExThera Medical | Principal Investigator |
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Following completion of the study, results of this research will be in a scientific journal. Data will be available immediately following publication, with no end date, with data sharing at the discretion of the Sponsor.
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| ID | Term |
|---|---|
| D015179 | Colorectal Neoplasms |
| ID | Term |
|---|---|
| D007414 | Intestinal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
| D009371 | Neoplasms by Site |
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Study patients will be assigned to receive procedure with the investigational device (ONCObind) and will be matched with site specific controls. 60 with ONCObind procedure and 60 Controlled
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Unblinded
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| Matched Controls | Other | Study patients will be assigned to receive procedure with the investigational device (ONCObind) and will be matched with 60 site specific controls, 30 PDAC and 30 CRC. |
|
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D003108 | Colonic Diseases |
| D007410 | Intestinal Diseases |
| D012002 | Rectal Diseases |