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    Clinical Trial Results:
    PHASE II TRIAL OF THE EFFECT OF GEMCITABINE WITH INTRAVENOUS OMEGA 3 FISH OIL INFUSION IN PATIENTS WITH UNRESECTABLE PANCREATIC ADENOCARCINOMA.

    Summary
    EudraCT number
    2009-009470-27
    Trial protocol
    GB  
    Global end of trial date
    01 Jun 2014

    Results information
    Results version number
    v1(current)
    This version publication date
    22 Mar 2020
    First version publication date
    22 Mar 2020
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    Version 4 27/06/2011
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01019382
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    University Hospitals of Leicester NHS Trust
    Sponsor organisation address
    Gwendolen Road, Leicester, United Kingdom, LE5 4PW
    Public contact
    Mrs Carolyn Maloney R&D department Leicester General Hospital Leicester LE5 4PW, University Hospitals of Leicester, +44116 2584109, carolyn.maloney@uhl-tr.nhs.uk
    Scientific contact
    Chris Mann Leicester General Hospital Gwendolen Road Leicester LE5 4PW , Department of Surgery , chris.mann@doctors.org.uk
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    06 Aug 2014
    Is this the analysis of the primary completion data?
    Yes
    Primary completion date
    01 Jun 2014
    Global end of trial reached?
    Yes
    Global end of trial date
    01 Jun 2014
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Objective response rate (complete + partial response) of response of patients receiving gemcitabine plus parenteral omega-3. To asses the effect of intravenous (given by a drip into the blood vessels) omega-3 fish oil, in combination with standard gemcitabine chemotherapy protocol upon patients with advanced pancreatic cancer.
    Protection of trial subjects
    This study provides little potential risk over and above standard clinical care. The main ethical issue anticipated is the desire of patients to continue fish oils despite careful explanation of the lack of proven benefit. Since the side effect profile of taking oral fish oils is very safe, oral preparation will be offered to these patients. Otherwise this study is felt to be very safe and of potential benefit. Rare complications of study treatments aside, little harm can be expected to come to patients, and the potential benefits should be explored.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    23 Nov 2009
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 50
    Worldwide total number of subjects
    50
    EEA total number of subjects
    50
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    15
    From 65 to 84 years
    35
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    50 patients will be recruited to the study. This number has been calculated to give the study sufficient power. There will be no control group as this is a phase IIa exploratory therapeutic trial.Results will be reviewed after 21 patients have been recruited. If two or fewer patients have a response of CT scan to treatment, the trial will be stop

    Pre-assignment
    Screening details
    Eligible patients (>18 years of age) had an ECOG performance status of 0 or 1, histologically proven locally advanced and or metastatic pancreatic adenocarcinoma, measurably disease on CT by RECIST 1.1 criteria and have not received prior chemotherapy. Patients could not have undergone any major surgical procedure within 4 weeks

    Period 1
    Period 1 title
    Recruitment (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Not applicable
    Blinding used
    Not blinded

    Arms
    Arm title
    Arm 1
    Arm description
    A single arm trial
    Arm type
    Experimental

    Investigational medicinal product name
    Lipidem
    Investigational medicinal product code
    PR 1
    Other name
    Pharmaceutical forms
    Emulsion for infusion
    Routes of administration
    Intravenous use
    Dosage and administration details
    10 ml of lipidem 200mg/ml per kilogram body weight per day by intravenous infusion. Total dose per day 500 ml

    Number of subjects in period 1
    Arm 1
    Started
    50
    Completed
    35
    Not completed
    15
         early death and withdrawal from treatment
    15

    Baseline characteristics

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    End points

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    End points reporting groups
    Reporting group title
    Arm 1
    Reporting group description
    A single arm trial

    Primary: objective response rate which is a percentage of patients experiencing a 30% or greater reduction in the size of their target lesion at any point subsequent to commencing on treatment on CT

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    End point title
    objective response rate which is a percentage of patients experiencing a 30% or greater reduction in the size of their target lesion at any point subsequent to commencing on treatment on CT [1]
    End point description
    End point type
    Primary
    End point timeframe
    objective response rate which is a percentage of patients experiencing a 30% or greater reduction in the size of their target lesion at any point subsequent to commencing on treatment on CT (which is measured)
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: Statistical analysis title: simon’s two stage design. Description : This design was used so there is no formal statistical analysis for the primary outcome measure. Type: optimal design p0 (0.10), and p1 (0.25) were parameters used for the design with rejection parameters of 2/21 patients for the first stage and 7/50 patients for the complete trial.
    End point values
    Arm 1
    Number of subjects analysed
    50
    Units: number of patients (0-50)
        number (not applicable)
    50
    No statistical analyses for this end point

    Adverse events

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    Adverse events information [1]
    Timeframe for reporting adverse events
    This varies between patients. Assuming toleration of chemotherapy, the minimal amount of time each patient will be in the trial is 8 weeks. Patients will exit on disease progression and will continue until this occurs, or consent withdrawn
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    23.0
    Reporting groups
    Reporting group title
    Arm 1
    Reporting group description
    -

    Notes
    [1] - There are no non-serious adverse events recorded for these results. It is expected that there will be at least one non-serious adverse event reported.
    Justification: non-serious adverse events were not recorded for this study
    Serious adverse events
    Arm 1
    Total subjects affected by serious adverse events
         subjects affected / exposed
    28 / 50 (56.00%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    0
    Vascular disorders
    Hypotension
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Surgical and medical procedures
    Elective ERCP & stent change
         subjects affected / exposed
    5 / 50 (10.00%)
         occurrences causally related to treatment / all
    0 / 5
         deaths causally related to treatment / all
    0 / 0
    surgical gastro jejunostomy
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    3 / 50 (6.00%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Hypothermia
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Elevated temperature
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Respiratory, thoracic and mediastinal disorders
    SOB unknown cause
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Investigations
    raised LFTs
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Cardiac disorders
    Tachycardia
         subjects affected / exposed
    3 / 50 (6.00%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    ST elevated MI
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Nervous system disorders
    Vertigo
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Nausea
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Vomiting
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infective enteritis
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Diarrhoea
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Hepatobiliary disorders
    Cholangitis
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Biliary colic
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    obstructive jaundice
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Liver failure
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Biliary obstruction
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Blocked biliary stent
         subjects affected / exposed
    4 / 50 (8.00%)
         occurrences causally related to treatment / all
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    External biliary drain
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Skin and subcutaneous tissue disorders
    Cellulitis
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Bilateral cellulitis
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Renal and urinary disorders
    acute renal failure
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Deteriorating renal function
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Endocrine disorders
    Newly diagnosed IDDM
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Empirical infection
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Biliary sepsis
         subjects affected / exposed
    3 / 50 (6.00%)
         occurrences causally related to treatment / all
    0 / 3
         deaths causally related to treatment / all
    0 / 0
    Infected biliary stent
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Sepsis
         subjects affected / exposed
    1 / 50 (2.00%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Neutropenic sepsis
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Chest infection
         subjects affected / exposed
    2 / 50 (4.00%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 0%
    Non-serious adverse events
    Arm 1
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    0 / 50 (0.00%)

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    01 Jun 2010
    Protocol Variation and Lipidem Dose Reduction The dose of IV ω-3 could be reduced in the interest of patient safety at the discretion of the investigator should any adverse events occur thought to be attributable to the infusion. The infusion would be discontinued and subsequent treatments given at a 25% or 50% dose reduction. Dose reductions below 50% were not allowed.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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