ClinicalTrials.gg
CompletedNCT01494506NAPOLI-1Updated Jun 17, 2016Results posted

Study of MM-398 With or Without 5-FU/LV, Versus 5-FU/LV in Patients With Metastatic Pancreatic Cancer

A Phase 3 interventional study of MM-398 and 5 Fluorouracil in Metastatic Pancreatic Cancer, sponsored by Merrimack Pharmaceuticals. Completed at 79 sites in 15 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2016-06-17.

Sponsored by Merrimack Pharmaceuticals · Phase 3, Interventional, and Treatment

Phase
Phase 3
Study type
Interventional
Enrollment
417
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

The study is an open label, randomized phase 3 study of MM-398 with or without 5-Fluorouracil (5-FU) and Leucovorin (also known as folinic acid), versus 5-FU and leucovorin in metastatic pancreatic cancer patients who have progressed on prior gemcitabine based therapy.

02

Conditions studied

  • Metastatic Pancreatic Cancer

Keywords

  • Pancreatic cancer
  • MM-398
  • PEP02
  • Metastatic pancreatic cancer
  • Gemcitabine refractory pancreatic cancer
  • Second line pancreatic cancer treatment
  • Pancreatic cancer post gemcitabine therapy
03

In context

Pancreatic Neoplasms

3,310 studies on the registry are indexed under Pancreatic Neoplasms; 910 are open to participants now.

This study's enrollment of 417 is above the median of 46 across 2,480 interventional studies indexed under Pancreatic Neoplasms.

Browse Pancreatic Neoplasms studies →

Lead sponsor

Merrimack Pharmaceuticals is the lead sponsor of 25 studies on the registry; none are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Histologically or cytologically confirmed adenocarcinoma of the exocrine pancreas
  • Metastatic disease
  • Documented disease progression after prior gemcitabine based therapy
  • KPS >/= 70
  • Adequate bone marrow function
  • Adequate hepatic function
  • Adequate renal function

Exclusion criteria

Exclusion Criteria:

  • Active CNS metastasis
  • Clinically significant GI disorders
  • Severe arterial thromboembolic events less than 6 months before inclusion
  • NYHA Class III or IV congestive heart failure, ventricular arrhythmias or uncontrolled blood pressure
  • Active infection or uncontrolled fever
  • Pregnant or breast feeding patients
05

Study design

Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
417 participants (actual)

Study arms

  • Experimental
    MM-398

    MM-398 120 mg/m2 Q3W IV. Note: The published dose of ONIVYDE was expressed as the irinotecan hydrochloride trihydrate until October 2015. It is now expressed as the irinotecan free base. Converting a dose based on irinotecan hydrochloride trihydrate to a dose based on irinotecan free base is accomplished by substituting the Molecular Weight of irinotecan hydrochloride trihydrate (677.19 g/mole) with the Molecular Weight of irinotecan free base (586.68 g/mole), which results in a conversion factor of 0.866. 120 mg/m2 dose of irinotecan hydrochloride trihydrate is equivalent to 100 mg/ m2 of irinotecan free base.

    Drug: MM-398

  • Active comparator
    5 Fluorouracil and Leucovorin IV

    5 Fluorouracil and Leucovorin IV

    Drug: 5 Fluorouracil · Drug: Leucovorin

  • Experimental
    MM-398, 5-FU and Leucovorin

    MM-398 80 mg/m2, 5-FU and Leucovorin Q2W IV. Note: The published dose of ONIVYDE was expressed as the irinotecan hydrochloride trihydrate until October 2015. It is now expressed as the irinotecan free base. Converting a dose based on irinotecan hydrochloride trihydrate to a dose based on irinotecan free base is accomplished by substituting the Molecular Weight of irinotecan hydrochloride trihydrate (677.19 g/mole) with the Molecular Weight of irinotecan free base (586.68 g/mole), which results in a conversion factor of 0.866. 80 mg/m2 dose of irinotecan hydrochloride trihydrate is equivalent to 70 mg/ m2 of irinotecan free base.

    Drug: MM-398 · Drug: 5 Fluorouracil · Drug: Leucovorin

Interventions

  • DrugMM-398

    Arm A: MM-398 120 mg/m2 IV Q3W Arm C: MM-398 80mg/m2 IV Q2W

    Also known as: PEP02

  • Arm B: 5 Fluorouracil 2000 mg/m2 IV for 4 weeks followed by 2 weeks of rest every 6 weeks Arm C: 5 Fluorouracil 2400 mg/m2 IV every 2 weeks

    Also known as: 5-FU

  • Arm B: Leucovorin 200 mg/m2 IV for 4 weeks followed by 2 weeks of rest every 6 weeks Arm C: Leucovorin 400 mg/m2 IV every 2 weeks

    Also known as: Folinic Acid

06

What researchers measure

Primary outcomes

  1. Overall Survival

    Overall survival was the primary efficacy endpoint of the study and was defined as the time from the date of patient randomization to the date of death or the date the patient was last known to be alive. OS was summarized by Kaplan-Meier methodology for each treatment group. Pairwise treatment group comparisons were carried out using unstratified log rank analyses on the ITT population. Hazard ratio estimates are from Cox regression analysis. The comparison of Arm C is based only on patients who were randomized under the 3-arm version of the protocol. Consequently, the 5-FU+Leucovorin (Combo Therapy Comparison) group is a subset of all patients randomized to 5-FU+Leucovorin, which is the Mono Therapy Comparison control and contains patients randomized under both the 2-arm and 3-arm versions of the protocol.

    Time frame: From randomization to death; until the data cut off 14 Feb 2014. The maximum time in follow up was 25 months.

Secondary outcomes

  1. Progression Free Survival

    Progression-free survival was defined as the time from the date of randomization to the date of disease progression, or death (any cause) on or prior to the clinical cutoff date, whichever occurred earlier. Participants who did not have disease progression or had not died were censored at the date of the last tumor assessment. Patients with two or more consecutive missing response assessments prior to a visit with documented progression (or death) were censored at the last date of tumor assessment when the patient was documented to be progression free. PFS was summarized using Kaplan-Meier methods. The comparison of Arm C is based only on patients who were randomized under the 3-arm version of the protocol. Consequently, the 5-FU+Leucovorin (Combo Therapy Comparison) group is a subset of all patients randomized to 5-FU+Leucovorin, which is the Mono Therapy Comparison control and contains patients randomized under both the 2-arm and 3-arm versions of the protocol.

    Time frame: Randomization until disease progression or death from any cause; Until the data cut off of 14 Feb 2014. The maximum time in follow up was 25 months.

  2. Objective Response Rate

    The objective response rate was a secondary efficacy endpoint of the study and was defined by the percentage of patients in the study population with a best overall response of Complete Response (CR) or Partial Response (PR) as assessed by the investigator. Best overall response was defined per RECIST (version 1.1) recorded from randomization until progression or end of study. RECIST (v 1.1) criteria does not require confirmation of response, but an additional, more stringent analysis was also conducted, with designation of CR (or PR) requiring confirmation of response at least 4 weeks following the initial assessment of CR (or PR). Stable disease (SD) required an assessment of SD at least 6 weeks after starting treatment. Subjects with insufficient data for response classification were classified as Not Evaluable for best overall response, and as a non-responder for objective response, in the ITT population. Treatment groups are as indicated for the primary outcome of OS.

    Time frame: Assessment every 6 weeks after initial response; Day 1 to data cut off of 14 Feb 2014; maximum time on study 25 months.

  3. Time to Treatment Failure

    Time from randomization to discontinuation of treatment for any reason, including disease progression, treatment toxicity or death.

    Time frame: Randomization to treatment discontinuation (any cause). The maximum time in follow up was 25 months

  4. Percentage of Patients With Clinical Benefit Response

    Composite measure based on patient-reported pain (per VAS), patient-reported pain medication, KPS, and weight. Clinical benefit is indicated by either: (a) improvement in pain (less pain intensity with stable or decreased pain medication; or less pain medication with stable or decreased pain intensity) with stable or improved KPS; or (b) improvement in KPS with stable or improved pain. With stable for KPS and pain, clinical benefit may be indicated with an observation of positive weight change. Clinical benefit response (CBR) was classified weekly and a patient was considered a clinical benefit responder if clinical benefit was observed and maintained over a 4 week period.

    Time frame: Randomization to treatment discontinuation.The maximum time in follow up was 25 months

  5. Percentage of Patients With Tumor Marker (CA 19-9) Response

    Tumor marker response (TMR) was evaluated by the change in CA19-9 serum levels. Response was defined as a decrease of 50% of CA19-9 in relation to the baseline level at least once during the treatment period.

    Time frame: Baseline to treatment discontinuation every 6 weeks; The maximum time in follow up was 25 months

  6. EORTC-QLQ-C30

    This patient recorded outcome consists of 15 subscales in 3 independent domains: global health-related quality of life (HRQoL), functional scales (cognitive, emotional, physical, role and social functioning), and symptom scales (appetite loss, constipation, diarrhea, dyspnea, fatigue, insomnia, nausea and vomiting, and pain). For each subscale, patients were classified as improved, worsened or stable. Improvement is indicated by achievement of subscale score at least 10% improved from baseline and maintained for at least 6 weeks. Worsened is indicated by subscale score at least 10% worse than baseline. Stable is indicated by neither improvement nor worsened. Achievement of improvement prior to worsening was classified as improvement.

    Time frame: Baseline to treatment discontinuation every 6 weeks; The maximum time in follow up was 25 months

  7. Pharmacokinetic Measurements of Total Irinotecan

    Plasma concentration-time data for MM-398 will be analyzed using population pharmacokinetic methods.

    Time frame: 6 weeks after first study drug administration

07

Results

Posted Feb 12, 2016

Participant flow

Patients were randomized over a period of 1.9 years starting from 2012-01-11 to 2013-09-11. The study was initially a two-arm study with MM-398 monotherapy and 5-FU/LV control (protocol version 1) . A third arm of MM-398+5-FU/LV was added later (protocol version 2).

Participant flow — Overall Study
MilestoneMM-398 (Arm A)5-FU + Leucovorin (Arm B)MM-398 + 5-FU + Leucovorin (Arm C)
Started151149117
Treated population147134117
Completed3614
Not completed148143103
Withdrew: Lack of efficacy778357
Withdrew: Adverse event171011
Withdrew: Death952
Withdrew: Physician decision754
Withdrew: Withdrawal by subject172014
Withdrew: Clinical deterioration211713
Withdrew: Sponsor decision001
Withdrew: Other031

Outcome measures

PrimaryOverall Survival

Overall survival was the primary efficacy endpoint of the study and was defined as the time from the date of patient randomization to the date of death or the date the patient was last known to be alive. OS was summarized by Kaplan-Meier methodology for each treatment group. Pairwise treatment group comparisons were carried out using unstratified log rank analyses on the ITT population. Hazard ratio estimates are from Cox regression analysis. The comparison of Arm C is based only on patients who were randomized under the 3-arm version of the protocol. Consequently, the 5-FU+Leucovorin (Combo Therapy Comparison) group is a subset of all patients randomized to 5-FU+Leucovorin, which is the Mono Therapy Comparison control and contains patients randomized under both the 2-arm and 3-arm versions of the protocol.

Time frame:
From randomization to death; until the data cut off 14 Feb 2014. The maximum time in follow up was 25 months.
Reported as:
Median · months
Overall Survival
monthsMM-398 Arm A (Mono Therapy Comparison)5-FU + Leucovorin (Arm B) (Mono Therapy Comparison)MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison5-FU + Leucovorin (Combo Therapy Comparison)
Overall Survival4.9 (4.23 to 5.62)4.2 (3.58 to 4.86)6.1 (4.76 to 8.87)4.2 (3.29 to 5.32)
Statistical analysis
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Log Rank · p = 0.9416 · Hazard ratio (hr): 0.99 · 95% CI 0.77 to 1.28Unstratified logrank test.
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Log Rank · p = 0.012 · Hazard ratio (hr): 0.67 · 95% CI 0.49 to 0.92Unstratified logrank test.
SecondaryProgression Free Survival

Progression-free survival was defined as the time from the date of randomization to the date of disease progression, or death (any cause) on or prior to the clinical cutoff date, whichever occurred earlier. Participants who did not have disease progression or had not died were censored at the date of the last tumor assessment. Patients with two or more consecutive missing response assessments prior to a visit with documented progression (or death) were censored at the last date of tumor assessment when the patient was documented to be progression free. PFS was summarized using Kaplan-Meier methods. The comparison of Arm C is based only on patients who were randomized under the 3-arm version of the protocol. Consequently, the 5-FU+Leucovorin (Combo Therapy Comparison) group is a subset of all patients randomized to 5-FU+Leucovorin, which is the Mono Therapy Comparison control and contains patients randomized under both the 2-arm and 3-arm versions of the protocol.

Time frame:
Randomization until disease progression or death from any cause; Until the data cut off of 14 Feb 2014. The maximum time in follow up was 25 months.
Reported as:
Median · months
Progression Free Survival
monthsMM-398 Arm A (Mono Therapy Comparison)5-FU + Leucovorin (Arm B) (Mono Therapy Comparison)MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison5-FU + Leucovorin (Combo Therapy Comparison)
Progression Free Survival2.7 (2.13 to 2.89)1.6 (1.41 to 1.84)3.1 (2.69 to 4.17)1.5 (1.41 to 1.84)
Statistical analysis
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Log Rank · p = 0.100 · Hazard ratio (hr): 0.81 · 95% CI 0.63 to 1.04
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Log Rank · p = <0.001 · Hazard ratio (hr): 0.56 · 95% CI 0.41 to 0.75
SecondaryObjective Response Rate

The objective response rate was a secondary efficacy endpoint of the study and was defined by the percentage of patients in the study population with a best overall response of Complete Response (CR) or Partial Response (PR) as assessed by the investigator. Best overall response was defined per RECIST (version 1.1) recorded from randomization until progression or end of study. RECIST (v 1.1) criteria does not require confirmation of response, but an additional, more stringent analysis was also conducted, with designation of CR (or PR) requiring confirmation of response at least 4 weeks following the initial assessment of CR (or PR). Stable disease (SD) required an assessment of SD at least 6 weeks after starting treatment. Subjects with insufficient data for response classification were classified as Not Evaluable for best overall response, and as a non-responder for objective response, in the ITT population. Treatment groups are as indicated for the primary outcome of OS.

Time frame:
Assessment every 6 weeks after initial response; Day 1 to data cut off of 14 Feb 2014; maximum time on study 25 months.
Reported as:
Number · percentage with confirmed response
Objective Response Rate
percentage with confirmed responseMM-398 Arm A (Mono Therapy Comparison)5-FU + Leucovorin (Arm B) (Mono Therapy Comparison)MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison5-FU + Leucovorin (Combo Therapy Comparison)
Objective Response Rate3.31 (0.46 to 6.17)0.67 (0.0 to 1.98)7.69 (2.86 to 12.52)0.84 (0.0 to 2.48)
Statistical analysis
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Fisher Exact · p = 0.214 · Risk difference (rd): 0.0264 · 95% CI -0.005 to 0.058
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Fisher Exact · p = 0.010 · Risk difference (rd): 0.069 · 95% CI 0.018 to 0.120
SecondaryTime to Treatment Failure

Time from randomization to discontinuation of treatment for any reason, including disease progression, treatment toxicity or death.

Time frame:
Randomization to treatment discontinuation (any cause). The maximum time in follow up was 25 months
Reported as:
Median · months
Time to Treatment Failure
monthsMM-398 Arm A (Mono Therapy Comparison)5-FU + Leucovorin (Arm B) (Mono Therapy Comparison)MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison5-FU + Leucovorin (Combo Therapy Comparison)
Time to Treatment Failure1.7 (1.5 to 2.7)1.4 (1.3 to 1.4)2.3 (1.6 to 2.8)1.4 (1.3 to 1.4)
Statistical analysis
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Log Rank · p = 0.1008 · Hazard ratio (hr): 0.82 · 95% CI 0.65 to 1.03Unstratified log rank test.
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Log Rank · p = 0.0002 · Hazard ratio (hr): 0.60 · 95% CI 0.45 to 0.78Unstratified log rank test
SecondaryPercentage of Patients With Clinical Benefit Response

Composite measure based on patient-reported pain (per VAS), patient-reported pain medication, KPS, and weight. Clinical benefit is indicated by either: (a) improvement in pain (less pain intensity with stable or decreased pain medication; or less pain medication with stable or decreased pain intensity) with stable or improved KPS; or (b) improvement in KPS with stable or improved pain. With stable for KPS and pain, clinical benefit may be indicated with an observation of positive weight change. Clinical benefit response (CBR) was classified weekly and a patient was considered a clinical benefit responder if clinical benefit was observed and maintained over a 4 week period.

Time frame:
Randomization to treatment discontinuation.The maximum time in follow up was 25 months
Reported as:
Number · percentage of participants with CBR
Percentage of Patients With Clinical Benefit Response
percentage of participants with CBRMM-398 Arm A (Mono Therapy Comparison)5-FU + Leucovorin (Arm B) (Mono Therapy Comparison)MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison5-FU + Leucovorin (Combo Therapy Comparison)
Percentage of Patients With Clinical Benefit Response14131412
Statistical analysis
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Fisher Exact · p = 0.82
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Fisher Exact · p = 0.80
SecondaryPercentage of Patients With Tumor Marker (CA 19-9) Response

Tumor marker response (TMR) was evaluated by the change in CA19-9 serum levels. Response was defined as a decrease of 50% of CA19-9 in relation to the baseline level at least once during the treatment period.

Time frame:
Baseline to treatment discontinuation every 6 weeks; The maximum time in follow up was 25 months
Reported as:
Number · percent of participants with TMR
Percentage of Patients With Tumor Marker (CA 19-9) Response
percent of participants with TMRMM-398 Arm A (Mono Therapy Comparison)5-FU + Leucovorin (Arm B) (Mono Therapy Comparison)MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison5-FU + Leucovorin (Combo Therapy Comparison)
Percentage of Patients With Tumor Marker (CA 19-9) Response23.611.428.98.6
Statistical analysis
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Fisher Exact · p = 0.024
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Fisher Exact · p = <0.001
SecondaryEORTC-QLQ-C30

This patient recorded outcome consists of 15 subscales in 3 independent domains: global health-related quality of life (HRQoL), functional scales (cognitive, emotional, physical, role and social functioning), and symptom scales (appetite loss, constipation, diarrhea, dyspnea, fatigue, insomnia, nausea and vomiting, and pain). For each subscale, patients were classified as improved, worsened or stable. Improvement is indicated by achievement of subscale score at least 10% improved from baseline and maintained for at least 6 weeks. Worsened is indicated by subscale score at least 10% worse than baseline. Stable is indicated by neither improvement nor worsened. Achievement of improvement prior to worsening was classified as improvement.

Time frame:
Baseline to treatment discontinuation every 6 weeks; The maximum time in follow up was 25 months
Reported as:
Number · percent of patients in category
EORTC-QLQ-C30
percent of patients in categoryMM-398 Arm A (Mono Therapy Comparison)5-FU + Leucovorin (Arm B) (Mono Therapy Comparison)MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison5-FU + Leucovorin (Combo Therapy Comparison)
Global Health Status: Improved10111712
Global Health Status: Stable31413844
Global Health Status: Worsened57484544
Physical Functioning: Improved10111011
Physical Functioning: Stable29374140
Physical Functioning: Worsened61524949
Role Functioning: Improved6101511
Role Functioning: Stable29393237
Role Functioning: Worsened66525253
Emotional Functioning:Improved108209
Emotional Functioning:Stable32594658
Emotional Functioning:Worsened56333433
Cognitive Functioning:Improved126117
Cognitive Functioning:Stable32424844
Cognitive Functioning:Worsened54524149
Social Functioning:Improved11111311
Social Functioning:Stable26433447
Social Functioning:Worsened62465442
Fatigue:Improved13111412
Fatigue:Stable18302033
Fatigue:Worsened69596654
Nausea and Vomiting:Improved56134
Nausea and Vomiting:Stable37423246
Nausea and Vomiting:Worsened58525551
Pain:Improved20102711
Pain:Stable30373440
Pain:Worsened50533949
Dyspnoea:Improved10675
Dyspnoea:Stable47695168
Dyspnoea:Worsoned44244225
Insomnia:Improved94185
Insomnia:Stable43493449
Insomnia:Worsened48474846
Appetite Loss:Improved96115
Appetite Loss:Stable38424546
Appetite Loss:Worsened53524449
Constipation:Improved134134
Constipation:Stable47635667
Constipation:Worsened39343130
Diarrhoea:Improved4464
Diarrhoea: Stable35583958
Diarrhoea: Worsened59395539
Financial Difficulties: Improved6180
Financial Difficulties: Stable51675174
Financial Difficulties: Worsened42314126
Statistical analysis
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6388 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison · Cochran-Mantel-Haenszel · p = 0.8445 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6388 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.9435 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.2654 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.7674 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.1628 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6712 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.7738 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6712 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.3408 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6712 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6766 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6712 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6388 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.7674 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.4993 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6712 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.2654 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6712 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.7617 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6712
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.9123 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6712 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.7617 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6712 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.1628 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6712 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 Arm A (Mono Therapy Comparison) vs 5-FU + Leucovorin (Arm B) (Mono Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.6388 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
  • MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison vs 5-FU + Leucovorin (Combo Therapy Comparison) · Cochran-Mantel-Haenszel · p = 0.7308 (For each experimental arm comparison p-values were adjusted for multiple domain comparisons using the Hochberg method.)
SecondaryPharmacokinetic Measurements of Total Irinotecan

Plasma concentration-time data for MM-398 will be analyzed using population pharmacokinetic methods.

Time frame:
6 weeks after first study drug administration
Reported as:
Geometric mean · Total irinotecan = ug/L; SN38= ug/L
Pharmacokinetic Measurements of Total Irinotecan
Total irinotecan = ug/L; SN38= ug/LMM-398 Arm A (Mono Therapy Comparison)MM-398 + 5-FU + Leucovorin(Arm C) Combo Therapy Comparison
Total Irinotecan-Cavg2550.00 ± 197.42120.00 ± 209.7
Total Irinotecan-Cmax40550.00 ± 172.328460.00 ± 69.3
Total SN38-Cavg0.82 ± 119.20.68 ± 132.7
Total SN38-Cmax3.93 ± 119.62.58 ± 121.9

Adverse events

Collected over Study drug initiation through 30 days after the last dose of study drug or EOS, whichever is later; Up to 764 days.. Non-serious events are listed at a 5% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
MM-398—90/147 (61.2%)145/147 (98.6%)
5 Fluorouracil and Leucovorin IV—58/134 (43.3%)132/134 (98.5%)
MM-398, 5-FU and Leucovorin—56/117 (47.9%)116/117 (99.1%)
Most frequent serious events
Showing 10 of 44
Most frequent serious events
EventMM-3985 Fluorouracil and Leucovorin IVMM-398, 5-FU and Leucovorin
DiarrhoeaGastrointestinal disorders19/1472/1347/117
VomitingGastrointestinal disorders14/1472/13411/117
Abdominal PainGastrointestinal disorders6/1476/1345/117
Febrile NeutropeniaBlood and lymphatic system disorders6/1471/1342/117
Decrease AppetiteMetabolism and nutrition disorders6/1471/1341/117
NauseaGastrointestinal disorders5/1471/1344/117
SepsisInfections and infestations3/1471/1344/117
PyrexiaGeneral disorders5/1472/1343/117
Abdominal Pain UpperGastrointestinal disorders4/1471/1341/117
Device Related InfectionInfections and infestations1/1470/1343/117
Most frequent other events
Showing 10 of 44
Most frequent other events
EventMM-3985 Fluorouracil and Leucovorin IVMM-398, 5-FU and Leucovorin
DiarrhoeaGastrointestinal disorders103/14735/134116/117
NauseaGastrointestinal disorders89/14746/13460/117
VomitingGastrointestinal disorders80/14735/13461/117
Decreased AppetiteMetabolism and nutrition disorders72/14743/13452/117
FatigueGeneral disorders54/14737/13447/117
AnaemiaBlood and lymphatic system disorders48/14731/13444/117
Abdominal PainGastrointestinal disorders50/14742/13427/117
ConstipationGastrointestinal disorders26/14732/13426/117
AstheniaGastrointestinal disorders35/14722/13424/117
PyrexiaGeneral disorders29/14715/13427/117

Baseline characteristics

All randomized patients.

Age, Categorical
Age, Categorical(Participants)MM-3985 Fluorouracil and Leucovorin IVMM-398, 5-FU and LeucovorinTotal
<=18 years0000
Between 18 and 65 years151149117417
>=65 years0000
Age, Continuous
Age, Continuous(years)MM-3985 Fluorouracil and Leucovorin IVMM-398, 5-FU and LeucovorinTotal
Mean63.6 ± 10.1361.8 ± 9.6563.2 ± 9.0662.8 ± 9.68
Sex: Female, Male
Sex: Female, Male(Participants)MM-3985 Fluorouracil and Leucovorin IVMM-398, 5-FU and LeucovorinTotal
Female646848180
Male878169237
RACE (NIH/OMB)
RACE (NIH/OMB)(participants)MM-3985 Fluorouracil and Leucovorin IVMM-398, 5-FU and LeucovorinTotal
American Indian or Alaska Native1001
Asian525034136
Black or African American33410
White899272253
other race64717
Karnofsky Performance Status (Baseline KPS)[1]
Karnofsky Performance Status (Baseline KPS)[1](participants)MM-3985 Fluorouracil and Leucovorin IVMM-398, 5-FU and LeucovorinTotal
100% = normal, no complaints, no signs of disease22221862
90% = normal activity, few symptoms of disease645451169
80% = normal activity, some symptoms of disease506138149
70% = caring for self, unable to work1511733
60% [2] = needs help, can manage most tasks0022
50%[2]= needs help often and medical care0011
Not recorded0101
Pancreatic Primary Tumor Location
Pancreatic Primary Tumor Location(participants)MM-3985 Fluorouracil and Leucovorin IVMM-398, 5-FU and LeucovorinTotal
Head927770239
Body16261254
Tail24241462
Multiple locations including head74617
Multiple locations not including head714930
Unknown = not specified54615
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Study locations

79 sites
  • Gilbert, Arizona, United States
  • Glendale, Arizona, United States
  • Scottsdale, Arizona, United States
  • Burbank, California, United States
  • Duarte, California, United States
  • Fresno, California, United States
  • LaVerne, California, United States
  • San Luis Obispo, California, United States
  • Boyton Beach, Florida, United States
  • Atlanta, Georgia, United States
  • Kansas City, Missouri, United States
  • St Louis, Missouri, United States
  • Henderson, Nevada, United States
  • Albuquerque, New Mexico, United States
  • Buffalo, New York, United States
  • Columbus, Ohio, United States
  • Norman, Oklahoma, United States
  • Greenville, South Carolina, United States
  • Bedford, Texas, United States
  • Dallas, Texas, United States
  • Tyler, Texas, United States
  • Fairfax, Virginia, United States
  • Norfolk, Virginia, United States
  • Buenos Aires, Argentina
  • Rosario, Argentina
  • Santa Fe, Argentina
  • Westmead, New South Wales, Australia
  • Kurralta Park, South Australia, Australia
  • Boxhill, Victoria, Australia
  • Heidelberg, Victoria, Australia
  • Melbourne, Victoria, Australia
  • Nedlands, Western Australia, Australia
  • Belo Horizonte, Brazil
  • Ijuí, Brazil
  • Passo Fundo, Brazil
  • Porto Alegre, Brazil
  • São Paulo, Brazil
  • Montreal, Quebec, Canada
  • Hořovice, Czechia
  • Olomouc, Czechia
  • Prague, Czechia
  • Příbram, Czechia
  • Bordeaux, France
  • Lille, France
  • Marseille, France
  • Berlin, Germany
  • Jens, Germany
  • Munich, Germany
  • Ulm, Germany
  • Budapest, Hungary
  • Pécs, Hungary
  • Szeged, Hungary
  • Szolnok, Hungary
  • Szombathely, Hungary
  • Castellana Grotte, Italy
  • Genova, Italy
  • Legnano, Italy
  • Naples, Italy
  • Roma, Italy
  • Port Elizabeth, South Africa
  • Pretoria, South Africa
  • Western Cape, South Africa
  • Hwasun-gun, South Korea
  • Seoul, South Korea
  • Alicante, Spain
  • Barcelona, Spain
  • Madrid, Spain
  • Santander, Spain
  • Valencia, Spain
  • Chiayi City, Taiwan
  • Kaohsiung City, Taiwan
  • Taiching, Taiwan
  • Tainan, Taiwan
  • Taipei, Taiwan
  • Taoyuan, Taiwan
  • Liverpool, United Kingdom
  • London, United Kingdom
  • Manchester, United Kingdom
  • Sutton, United Kingdom
09

References and documents

Publications

  • Chen LT, Macarulla T, Blanc JF, Mirakhur B, de Jong FA, Belanger B, Bekaii-Saab T, Siveke JT. Early dose reduction/delay and the efficacy of liposomal irinotecan with fluorouracil and leucovorin in metastatic pancreatic ductal adenocarcinoma (mPDAC): A post hoc analysis of NAPOLI-1. Pancreatology. 2021 Jan;21(1):192-199. doi: 10.1016/j.pan.2020.10.029. Epub 2020 Oct 10. PubMed 33214082 ↗
  • Macarulla Mercade T, Chen LT, Li CP, Siveke JT, Cunningham D, Bodoky G, Blanc JF, Lee KH, Dean A, Belanger B, Wang-Gillam A. Liposomal Irinotecan + 5-FU/LV in Metastatic Pancreatic Cancer: Subgroup Analyses of Patient, Tumor, and Previous Treatment Characteristics in the Pivotal NAPOLI-1 Trial. Pancreas. 2020 Jan;49(1):62-75. doi: 10.1097/MPA.0000000000001455. PubMed 31856081 ↗
  • Bang YJ, Li CP, Lee KH, Chiu CF, Park JO, Shan YS, Kim JS, Chen JS, Shim HJ, Rau KM, Choi HJ, Oh DY, Belanger B, Chen LT. Liposomal irinotecan in metastatic pancreatic adenocarcinoma in Asian patients: Subgroup analysis of the NAPOLI-1 study. Cancer Sci. 2020 Feb;111(2):513-527. doi: 10.1111/cas.14264. Epub 2019 Dec 20. PubMed 31789476 ↗
  • Macarulla T, Blanc JF, Wang-Gillam A, Chen LT, Siveke JT, Mirakhur B, Chen J, de Jong FA. Liposomal irinotecan and 5-fluorouracil/leucovorin in older patients with metastatic pancreatic cancer - A subgroup analysis of the pivotal NAPOLI-1 trial. J Geriatr Oncol. 2019 May;10(3):427-435. doi: 10.1016/j.jgo.2019.02.011. Epub 2019 Mar 4. PubMed 30842038 ↗
  • Wang-Gillam A, Hubner RA, Siveke JT, Von Hoff DD, Belanger B, de Jong FA, Mirakhur B, Chen LT. NAPOLI-1 phase 3 study of liposomal irinotecan in metastatic pancreatic cancer: Final overall survival analysis and characteristics of long-term survivors. Eur J Cancer. 2019 Feb;108:78-87. doi: 10.1016/j.ejca.2018.12.007. Epub 2019 Jan 14. PubMed 30654298 ↗
  • Chen LT, Siveke JT, Wang-Gillam A, Li CP, Bodoky G, Dean AP, Shan YS, Jameson GS, Macarulla T, Lee KH, Cunningham D, Blanc JF, Chiu CF, Schwartsmann G, Braiteh FS, Mamlouk K, Belanger B, de Jong FA, Hubner RA. Survival with nal-IRI (liposomal irinotecan) plus 5-fluorouracil and leucovorin versus 5-fluorouracil and leucovorin in per-protocol and non-per-protocol populations of NAPOLI-1: Expanded analysis of a global phase 3 trial. Eur J Cancer. 2018 Dec;105:71-78. doi: 10.1016/j.ejca.2018.09.010. Epub 2018 Nov 8. PubMed 30414528 ↗
  • Wang-Gillam A, Li CP, Bodoky G, Dean A, Shan YS, Jameson G, Macarulla T, Lee KH, Cunningham D, Blanc JF, Hubner RA, Chiu CF, Schwartsmann G, Siveke JT, Braiteh F, Moyo V, Belanger B, Dhindsa N, Bayever E, Von Hoff DD, Chen LT; NAPOLI-1 Study Group. Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial. Lancet. 2016 Feb 6;387(10018):545-557. doi: 10.1016/S0140-6736(15)00986-1. Epub 2015 Nov 29. PubMed 26615328 ↗
10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jun 17, 2016, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT01494506
Responsible party
Sponsor
First posted
Dec 19, 2011
Start date
Nov 2011
Primary completion
Feb 2014
Completion
Oct 2015
Results posted
Feb 12, 2016
Last update
Jun 17, 2016

Study contacts

Eliel Bayever, MD
study director · Merrimack Pharmaceuticals

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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Studies of the drugs tested here: Irinotecan sucrosofate · Fluorouracil · Leucovorin

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