A Phase I Study of Nab-Paclitaxel, Gemcitabine and AZD1775 for Treatment of Metastatic Adenocarcinoma of the Pancreas: ECOG-ACRIN EA2131

Purpose Pancreatic adenocarcinoma is a devastating disease for which there are limited treatment options. Identification of novel agents to enhance the activity of existing regimens are much in need. We hypothesized that the disruption of the DNA damage response by AZD1775, an oral Wee1 inhibitor, added to the nab-paclitaxel and gemcitabine chemotherapy backbone would be safe and effective. Methods A phase I trial to evaluate the dose limiting toxicities and maximum tolerated dose of AZD1775 in combination with nab-paclitaxel and gemcitabine was conducted in patients with metastatic or locally advanced, unresectable pancreatic adenocarcinoma (NCT02194829). A total of 7 patients received nab-paclitaxel and gemcitabine intravenously on days 1, 8 and 15 of a 28-day treatment cycle along with AZD1775 by mouth on days 1, 2, 8, 9, 15 and 16. Toxicities were assessed using CTCAE version 4 criteria. Results Two patients were treated at the initial dose level of nab-paclitaxel, gemcitabine and AZD1775 and both experienced dose limiting toxicities (dehydration, elevated bilirubin, oral mucositis, increased AST and candida intertrigo). Under a revised study design, five patients were treated and two of them also developed dose limiting toxicities (anemia, thrombocytopenia, neutropenia, hyponatremia and febrile neutropenia). Progression-free survival (PFS) and overall survival (OS) among these seven patients was 5.26 months (95% CI [2.73, 12.16]) and 5.29 months (95% CI [2.73, 20.17]) respectively. Conclusion The combination of nab-paclitaxel, gemcitabine and AZD1775 was determined to be too toxic when administered in patients with metastatic or locally advanced, unresectable pancreatic adenocarcinoma.