Prospective Screening for Pancreatic Ductal Adenocarcinoma in High-Risk Individuals

Overview

The purpose of this research is to see if adding blood-based tests and symptom review to standard-of-care pancreatic cancer screening procedures can identify cancer early among individuals with increased risk.

Detailed description

In this research study, investigators will combine blood-based tests and review of symptoms with standard-of-care pancreatic cancer screening procedures to see if pancreatic cancer can be detected early among individuals with increased risk. Pancreatic cancer screening procedures include Endoscopic Ultrasound (EUS), Magnetic Resonance Imaging (MRI), or Magnetic Resonance Cholangiopancreatography (MRCP).

The research study procedures include screening for eligibility, questionnaires, clinic visits, endoscopic ultrasound (EUS) or Magnetic Resonance (MRI)/Magnetic Resonance Cholangiopancreatography (MRCP), and collection of blood, stool, and saliva samples.

Participation in this research study will be a minimum of 30 months and up to 20 years via review of medical records and the annual collection of blood and stool samples.

It is expected that about 5,000 people will take part in this research study.

This study is supported by the Hale Family Research Center at Dana-Farber Cancer Institute.

Interventions

• Other Screening Blood Tests
  Carbohydrate antigen (CA) 19-9, and Hemoglobin A1C (HbA1c) per standard-of-care.
• Diagnostic test Endoscopic Ultrasound
  Annually and per National Comprehensive Cancer Network Guidelines (NCCN) guidelines.
• Combination product Magnetic Resonance Imaging
  Annually and per National Comprehensive Cancer Network Guidelines (NCCN) guidelines.
• Combination product Magnetic Resonance Cholangiopancreatography
  Annually and per National Comprehensive Cancer Network Guidelines (NCCN) guidelines.

Primary outcome measures

• Number of Incident Pancreatic Cancers or High-Grade Pancreatic Neoplasms [Time frame: 6-monthly for 3 years with 5-year follow-up]
• Number of Imaging-Positive Pancreatic Cancers or High-Grade Neoplasms [Time frame: 6-monthly for 3 years with 5-year follow-up]
• Number of Imaging-Negative, Assay-Positive Pancreatic Cancers or High-Grade Neoplasms [Time frame: 6-monthly for 3 years with 5-year follow-up]

Secondary outcome measures (8)

• Positive Predictive Value of Blood Assays [Time frame: 6-monthly for 3 years]
• Negative Predictive Value of Blood Assays [Time frame: 6-monthly for 3 years]
• Proportion of Screen-Detected, Resected Pancreatic Lesions [Time frame: 6-monthly for 3 years]
• Proportion of Non-Worrisome Pancreatic Lesions [Time frame: 6-monthly for 3 years]
• Incremental Yield of Blood-Based Assays over Standard-of-Care Screening [Time frame: 6-monthly for 3 years]
• Number of False-Positive Assay Results [Time frame: 6-monthly for 3 years]
• Number of Non-PDAC Cancer Diagnoses [Time frame: 6-monthly for 3 years]
• Clinical Predictors of Neoplastic Development [Time frame: up to 8 years]

Eligibility criteria

Inclusion criteria

Participants must meet any of the following:

• Individuals with pathogenic/likely pathogenic germline variants in STK11, and age ≥30 years.
• Individuals with pathogenic/likely pathogenic germline variants in CDKN2A, and age ≥40 years (or 10 years younger than the earliest exocrine pancreatic cancer diagnosis in the family, whichever is earlier).
• Individuals with pathogenic/likely pathogenic germline variants in one of the other pancreatic cancer susceptibility genes (ATM, BRCA1, BRCA2, MLH1, MSH2, MSH6, EPCAM, PALB2, TP53), and age ≥50 years (or 10 years younger than the earliest exocrine pancreatic cancer diagnosis in the family, whichever is earlier) AND

• Exocrine pancreatic cancer in ≥1 first- or second-degree relative from the same side of (or presumed to be from the same side of) the family as the identified pathogenic/likely pathogenic germline variant.
• Individuals with pathogenic/likely pathogenic variants in PRSS1 AND a clinical phenotype consistent with hereditary pancreatitis, and age ≥40 years (or 20 years after onset of pancreatitis, whichever is earlier).
• Individuals with familial pancreatic cancer including:

• Family history of exocrine pancreatic cancer in ≥2 first-degree relatives from the same side of the family, even in the absence of a known pathogenic/likely pathogenic germline variant, OR
• Family history of exocrine pancreatic cancer in 1 affected first-degree relative and 1 second-degree relative, even in the absence of a known pathogenic/likely pathogenic germline variant, OR
• Family history of exocrine pancreatic cancer in ≥3 first- and/or second-degree relatives from the same side of the family, even in the absence of a known pathogenic/likely pathogenic germline variant.
• Individuals who are undergoing clinically recommended pancreatic cancer surveillance.

Exclusion criteria

• Individuals with active or prior pancreatic ductal adenocarcinoma diagnosis.
• Individuals with any active metastatic cancer.
• Individuals who are unable to give informed consent.
• Individuals who are under the age of 18 (infants, children, teenagers).
• Individuals unable to tolerate Magnetic Resonance Imaging/Magnetic Resonance Cholangiopancreatography and Endoscopic Ultrasound.
• Pregnant women are unlikely to be undergoing screening procedures and will not be considered eligible but can consent to the study at a later date.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Screening

Study locations

United States · 2 centers

• Brigham and Women's Hospital — Boston
• Dana Farber Cancer Institute — Boston

Identifiers

NCT: NCT06122896 · 23-147

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗