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Phase Ib trial combining capecitabine, erlotinib and bevacizumab in pancreatic adenocarcinoma - REBECA trial

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Summary

Background Purpose of this phase Ib trial was to establish the maximum tolerable dose (MTD) of capecitabine and to escalate the dosages of erlotinib and bevacizumab to determine the recommended phase II dose (RP2D) in patients with advanced/metastatic pancreatic adenocarcinoma not pretreated for metastatic disease. Methods Starting doses were capecitabine 500 mg/m2 bid orally continuously, erlotinib 100 mg orally daily, and bevacizumab 5 mg/kg intravenously q 2 weeks. Dose escalation was performed according to a 3 + 3 design for capecitabine until MTD, for erlotinib and bevacizumab until the maximum doses registered by applying a substance-related, toxicity-based scheme accompanied by pharmacokinetic analysis. Circulating tumor cells (CTCs) were determined pretherapeutically by immunohistochemical identification after enrichment with immunomagnetic separation. Results Thirty patients were evaluable at six dose levels. 900 mg/m2 bid were determined as MTD for capecitabine based on dose-limiting toxicities: cutaneous in two patients and vascular in another. The most severe (Grade (G)3/4) drug-related treatment-emergent adverse events (toxicities) belonged to the categories gastrointestinal, vascular, cutaneous, cardiovascular, metabolic/nutritional or hematological. G3 toxicities occurred in 14 (47%), G3 + G4 in a single (3%) patient. 2 out of 28 patients (7%) exerted partial response, 17 (61%) stable disease. Pharmacokinetic evaluation revealed lack of drug-drug interaction between capecitabine and erlotinib and their metabolites. Presence of CTCs was associated with shorter progression-free survival (p = 0.009). Conclusions The study met the primary objective. RP2D was capecitabine 800 mg/m2 bid continuously, erlotinib 150 mg daily, and bevacizumab 10 mg/kg q 2 weeks. The regimen could be applied safely, but demonstrated limited efficacy.

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Acknowledgements

The authors would like to acknowledge the valuable contributions of Maria Lichtneckert and Guenther Nirnberger to the process of data management.

This trial was funded by the Central European Anticancer Drug Development Platform (CEADDP) via a grant (number 811590) of the Austrian Research Promotion Agency (FFG) in the frame of its SELP (Strategisches Exzellenz Leitprojekt) Structural Programme with added support from Roche Austria, the sponsor of the study (Roche Protocol # ML 20784).

Funding

This trial was funded by the Central European Anticancer Drug Development Platform (CEADDP) via a grant (number 811590) of the Austrian Research Promotion Agency (FFG) in the frame of its SELP (Strategisches Exzellenz Leitprojekt) Structural Programme with added support from Roche Austria, the sponsor of the study (Roche Protocol # ML 20784). Roche Austria was integrated into the design of the study, the collection of data, and the review of the manuscript. The company did not influence the production of the manuscript nor the data analysis nor the interpretation of the data presented.

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Authors and Affiliations

  1. Applied Cancer Research ― Institution for Translational Research Vienna (ACR-ITR VIEnna), Bernardgasse 24/2, 1070, Vienna, Austria

    Christian Dittrich & Robert Königsberg

  2. Ludwig Boltzmann-Institute for Applied Cancer Research, Centre for Oncology and Haematology, Kaiser Franz Josef-Spital, Kundratstrasse 3, 1100, Vienna, Austria

    Christian Dittrich & Robert Königsberg

  3. Section for Clinical Biometrics, Centre for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria

    Martina Mittlböck

  4. 5th Medical Department with Oncology and Palliative Medicine, Hietzing Hospital, Wolkersbergenstrasse 1, 1130, Vienna, Austria

    Klaus Geissler

  5. Division of Clinical Pharmacy, Department of Pharmaceutical Chemistry, Centre of Pharmacy, University of Vienna, Althanstrasse 14, 1090, Vienna, Austria

    Azra Sahmanovic-Hrgovcic, Martin Czejka & Philipp Buchner

  6. Medical and Regulatory Affairs, Roche Austria, Engelhorngasse 3, 1211, Vienna, Austria

    Johannes Pleiner-Duxneuner

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Contributions

Conception and design: CD, RK, JP-D, MC, PB.

Acquisition of data: CD, RK, MM, KG, AS-H, MC, PB.

Analysis and interpretation of data: MM, CD, PB, RK, MC.

Writing (CD, MM, PB), review and/or revision of the manuscript: all authors.

Approval of the final version: all authors.

Agreed to be responsible and accountable for the results presented: all authors.

Corresponding author

Correspondence to Christian Dittrich.

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Conflict of interest

CD’s non-profit research institutes (Ludwig Boltzmann-Institute for Applied Cancer Research (LBI-ACR VIEnna) and Applied Cancer Research – Institution for Translational Research Vienna, both forming the Central European Anticancer Drug Development Platform (CEADDP)) were funded by the Austrian Research Promotion Agency (FFG) – SELP (Strategisches Exzellenz Leitprojekt) Structural Programme, and the LBI-ACR VIEnna additionally by Roche Austria. CD received compensation as a member of a scientific advisory board of Roche Austria. He also consulted for Roche Austria and received compensation.

MM has received compensation for statistical analyses of the study from Roche Austria.

KG has received compensation as a member of scientific advisory boards and for presentations from Roche Austria.

JP-D is Roche Austria employee.

RK, AS-H, MC, and PB declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. The study protocol was approved by the Ethics Committee of the City of Vienna (reference number EK 08-159-0908).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Dittrich, C., Königsberg, R., Mittlböck, M. et al. Phase Ib trial combining capecitabine, erlotinib and bevacizumab in pancreatic adenocarcinoma - REBECA trial. Invest New Drugs 37, 127–138 (2019). https://doi.org/10.1007/s10637-018-0639-0

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  • DOI: https://doi.org/10.1007/s10637-018-0639-0

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