Pancreatic cancer first-line NALIRIFOX optimization with 5-FU maintenance and role of antibiotics and microbiota exploration in second-line treatment – A non-comparative, randomized phase II PANORAMIX GERCOR G-116 PRODIGE 105 study

Overview

Sponsor-declared trial summary

Key facts

Sponsor

Association Gercor

Participant type

Patients

Age range

18-64 years, 65+ years

Gender

Male and Female

Therapeutic area

Diseases [C] - Digestive System Diseases [C06]

Trial duration

17 Feb 2026 → ongoing

Decision date (initial)

2025-05-27

Transition trial

No

Low-intervention

No

Rare-disease indication

No

Vulnerable population

No

Trial design

CTIS Part I — objectives, methods, condition coding

Main objective

Scope: Efficacy

- Step1 : To assess the efficacy of NALIRIFOX with LV5FU2 (5-FU/LV) maintenance strategy in patients with metastatic PDAC who received L1 in terms of 6-month PFS rate post first randomization (R1) during Step 1 (Arm 1A).
- Step2 : The primary objective of Step 2 of the study is to assess the efficacy of adding fluoroquinolone (ciprofloxacin) to gemcitabine-based chemotherapy in L2 in terms of rate of patients alive at 6 months following second randomization (R2) in Arm 2A.

Secondary objectives 18

1. To assess a 6-month PFS post R1 of standard NALIRIFOX in Arm 1B
2. To assess PFS-L1 post R1 in Arm 1A and Arm 1B
3. To assess OS post R1 (OS-R1) in Arm 1A and Arm 1B
4. To assess the overall response of L1 (ORR-L1) at 4 months in Arm 1A and Arm 1B, according to RECIST 1.1 criteria
5. To assess ORR of post NALIRIFOX reintroduction (ORR-RI) in Arm 1A
6. To assess the best response rate of L1 (BRR-L1) in Arm 1A and Arm 1B
7. To assess the BRR from reintroduction of NALIRIFOX to PD post-reintroduction (BRR-L1R) in Arm 1A
8. To assess duration of disease control (DDC) in Arm 1A and Arm 1B, including NALIRIFOX reintroduction after maintenance LV5FU2 in Arm 1A
9. To assess safety (only grade 3-4 adverse events [AEs])/serious AEs [SAEs] related to treatment in Arm 1A and Arm 1B, according to the National Cancer Institute Common Terminology Criteria for Event (NCI CTCAE) v5.0
10. To assess the rate of peripheral neuropathy (all grade and severe [grade 3-5] adverse events [AEs] in Arm 1A and Arm 1B, according to NCI CTCAE v5.0
11. To assess HRQoL in Arm 1A and Arm 1B (the EORTC QLQC30 and EORTC QLQ-PAN26 questionnaires)
12. To assess OS post R2 (OS-R2) in Arm 2A and Arm 2B
13. To assess PFS of L2 (PFS-L2) post R2, according to RECIST 1.1 criteria in Arm 2A and Arm 2B
14. To assess ORR of L2 (ORR-L2) in Arm 2A and Arm 2B
15. To assess the BRR-L2 in Arm 2A and Arm 2B
16. To assess safety in Arm 2A and Arm 2B
17. To assess the effect of study treatment on the development of bacterial resistance in the gut microbiome (multi-resistant bacteria [MRB])
18. To assess the pharmacokinetics of gemcitabine and gemcitabine’s metabolite, 2’,2’-difluorodeoxyuridine (dFdU) in Arm 2A and Arm 2B

Conditions and MedDRA coding

Patients with metastatic pancreatic ductal adenocarcinoma.

Eligibility criteria

Principal inclusion / exclusion criteria as submitted by sponsor

Inclusion criteria 14

1. Written informed consent obtained from the patient prior to performing any protocol-related procedures, including screening evaluations (only after interim analysis at Step 2 for patients who were not randomized in R1)
2. Age ≥18 years old. The patient over 75 years of age is eligible only if the patient’s G8 score (G8 questionnaire) is ≥14
3. Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1,
4. Histologically or cytologically proven PDAC,
5. ≥1 measurable lesion according to RECIST v 1.1 (Computed tomography thorax-abdomen-pelvis [TAP-CT] scan ≤ 4 weeks)
6. Availability of archival tissue samples for exploratory research. Step 2: can be the same as in Step 1 or it can be newly obtained sample
7. Adequate organ function, obtained within 21 days prior to randomization of study treatment, as defined by the following: 1) Serum aspartate aminotransferase (AST) and serum alanine aminotransferase (ALT) ≤3 x upper limit of normal (ULN; (≤ 5 x ULN in case of liver metastases) ꟷ STEP 2: if paclitaxel administration, 2) Total serum bilirubin ≤ 1.5 x ULN (Step 2 if paclitaxel administration) 3) albumin ≥ 28 g/L 4) Hemoglobin ≥ 9.0 g/dl 5) Absolute neutrophil count (ANC) ≥ 1.5 x 109L 6) Platelets ꟷ STEP 1: ≥ 150 x 109L; STEP 2: ≥ 100 x 109L 7) Creatinine clearance ≥ 50 mL/min (Modification of the Diet in Renal Disease [MDRD]
8. Evidence of post-menopausal status or negative serum pregnancy test within 7 days before starting study treatment for female pre-menopausal patients. Women of childbearing potential (WOCBP) should use effective contraception during study treatment and: 1 month (paclitaxel), 6 months (5FU, LV), 7 months (NAL-IRI), 15 months (oxaliplatin), and 6 months (gemcitabine+/-paclitaxel and ciprofloxacin/placebo) after the patient’s last dose of treatment. Males who are fertile should use effective contraception during study treatment and 4 months (NAL-IRI), 6 months (5-FU, LV), 12 months (oxaliplatin), and 6 months (gemcitabine+/-paclitaxel and ciprofloxacin/placebo) after the patient’s last dose of treatment.
9. Willing and able to comply with the protocol for the duration of the study including undergoing treatment and scheduled visits and examinations including follow up
10. Registration in a National Health Care System (PUMa – Protection Universelle Maladie included
11. Distinct inclusion criteria for STEP 1 and STEP 2 : STEP 1 : No prior first-line therapy for metastatic disease; if treatment with any investigational medicinal product (IMP) the delay before the last dose and inclusion more than or equal to 28 days
12. Distinct inclusion criteria for STEP 1 and STEP 2 : STEP 1 : No dihydropyrimidine dehydrogenase (DPD) deficiency (uracilemia dosage >16 ng/ml), Uracilemia dosing results must be available before inclusion)
13. Distinct inclusion criteria for STEP 1 and STEP 2 : STEP 2 : Metastatic disease
14. Distinct inclusion criteria for STEP 1 and STEP 2 : STEP 2 : • L2 therapy after progression under 5-FU-based chemotherapy for localized/locally advanced or metastatic stage

Exclusion criteria 32

1. Concurrent enrolment in another clinical study, unless it is an observational (non-interventional) clinical study or the follow-up period of an interventional study
2. History of allogenic organ transplantation or active autoimmune, connective tissue disorder, or inflammatory disease requiring systemic treatment
3. Diagnosis of any second malignancy that required any treatment within the last 3 years, except for adequately treated basal cell or squamous cell skin cancer, or in situ carcinoma of the cervix uteri
4. History of idiopathic pulmonary fibrosis, interstitial lung disease (ILD), drug-induced pneumonitis, organizing pneumonia, or evidence of active pneumonitis on screening (TAP-CT-scan)
5. Current systemic steroid therapy (> 10 mg daily dose of prednisone or equivalent; minimal wash-out of 1 week [7 days]) or immunosuppressive therapy
6. Prior radiotherapy treatment to more than 30% of the bone marrow or a wide field of radiation within 4 weeks (30 days) prior to the first dose of study drug
7. Major surgical procedure (as defined by the Investigator) within 4 weeks (30 days) prior to the first dose of trial treatment (Step 1 and Step 2)
8. Uncontrolled central nervous system metastases and/or carcinomatous meningitis,
9. Uncontrolled massive pleural effusion or massive ascites
10. Uncontrolled intercurrent illness, including but not limited to, symptomatic congestive heart failure or coronary disease, peripheral artery disease, severe chronic obstructive pulmonary disease, decompensated cirrhosis, serious chronic gastrointestinal conditions (e.g. bleeding, inflammation, occlusion, malabsorption syndrome, ulcerative colitis, gastrointestinal ulceration, infection or sepsis, inflammatory bowel disease or partial bowel obstruction) associated with diarrhea, or geographical/social/ psychiatric illness situations that would limit compliance with study requirement and study follow-up, substantially increase risk of incurring AEs, or compromise the ability of the patient to give written informed consent
11. History or current evidence of any condition, therapy, laboratory abnormality that might confound the results of the trial, interfere with participation for the full duration of the trial, or is not in the best interest of the participant in the opinion of the treating investigator
12. Known or suspected allergy or hypersensitivity to any of the study drugs or any of the study drug excipients
13. Active bacterial, viral, or fungal infection requiring systemic therapy, including tuberculosis, hepatitis B (HBV, known positive HBV surface antigen [HbsAg] result), hepatitis C (HBC, with positive RNA), or human immunodeficiency virus (HIV positive 1/2 antibodies)
14. Live vaccine administration within 4 weeks (30 days) prior to the first dose of study treatment,
15. Pregnancy/breast-feeding/lactation
16. Under a legal protection measure (guardianship, curatorship, or judicial safeguard), administrative decision, and/or incapable of giving his/her consent
17. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP1 : Any unresolved NCI CTCAE toxicity of grade ≥ 2 from previous anticancer therapy (including peripheral neuropathy of grade ≥ 1) except for alopecia or vitiligo
18. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP1 : Any previous chemotherapy for advanced disease
19. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP1 : Previous adjuvant chemotherapy (by gemcitabine based or FOLFIRINOX) is NOT authorized
20. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP1 : Uncontrolled central nervous system metastases and/or carcinomatous meningitis
21. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP1 : Clinically significant active heart disease or myocardial infarction within 6 months given the cardiotoxicity of 5-FU
22. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP1 : Patients with known homozygous UGT1A1*28 (Gilbert’s disease)
23. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP1 : Any use of strong CYP3A4 inducers/inhibitors and/or strong UGT1A1 inhibitors (patients are ineligible if unable to discontinue the use of strong CYP3A4 or UGT1A1 inhibitors at least 1 week or strong CYP3A4 inducers at least 2 weeks prior to receiving first dose of NAL-IRI injection), or presence of any other contraindications for irinotecan)
24. Prolongation of QTc interval >470 milliseconds, previous ventricular arrhythmia, known or suspected long-QT syndrome
25. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP 2 : Antibiotics use in the month before the day of treatment initiation or for > 5 days within 3 months before the day of treatment initiation
26. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP 2 : Previous gemcitabine-based chemotherapy
27. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP 2 : Known previous colonization or infection with K. pneumoniae resistant to quinolones
28. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP 2 : Prophylactic phenytoin within 1 week (7 days) prior to the first dose of study treatment
29. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP 2 : Any contra-indication to ciprofloxacin: history of fluoroquinolone-related severe side effects (muscle, tendons, joint…), severe aortic disease (aneurysm, dissection), myasthenia, epilepsy
30. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP 2 : Inability to take oral treatment
31. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP 2 : Concomitant medication with CYP1A2 substrates (e.g., theophylline, clozapine, duloxetine, tizanidine, olanzapine, propranolol, amitryptilin, and methotrexate
32. Distinct exclusion criteria for STEP 1 and STEP 2 : STEP 2 : Known glucose-6-phosphate dehydrogenase deficiency

Endpoints

Primary and secondary outcome measures (English text)

Primary endpoints 2

1. STEP 1 The 6-month PFS post R1 in patients with L1 NALIRIFOX followed by LV5FU2 (5-FU/LV) in Arm 1A defined by the number of patients free of radiological progression or death at 6 post R1 divided by the total number of patients assessable for the PFS status at 6 months.
2. STEP 2: The 6-month OS of L2 in Arm 2A (gemcitabine-based chemotherapy combination with ciprofloxacin) post R2, defined by the number of patients alive at 6 months divided by the total number of patients assessable for the OS status at 6 months.

Secondary endpoints 18

1. STEP 1: The 6-month PFS rate of standard NALIRIFOX in Arm 1B, defined by the number of patients free of radiological progression or death at 6 months post R1 divided by the total number of patients assessable for the PFS status at 6 months
2. STEP 1 : PFS-L1 in Arm 1A and in Arm 1B, defined as the time between the date of R1 and the date of the first documented disease progression (PD; per RECIST 1.1) determined by the Investigator or death due to any cause, whichever occurs first
3. STEP 1 : OS-R1 in Arm 1A and in Arm 1B, defined as the time between the date of R1 and the date of death from any cause
4. STEP 1 :ORR-L1 at 4 months of L1 in Arm 1A and in Arm 1B, defined as the number of patients with a response of complete response (CR) or partial response (PR) divided by the number of patients with measurable target lesion at baseline
5. STEP 1 : ORR-RI in Arm 1A, defined as the number of patients with CR or PR divided by the number of patients with measurable target lesions at baseline
6. STEP 1 : BRR-L1 in Arm 1A and in Arm 1B, defined as the best response designation, recorded between the date of R1 and the date of objectively documented PD (per RECIST 1.1) or the date of subsequent anti-cancer therapy, whichever occurs first
7. STEP 1 : BRR-L1R in Arm 1A, defined as the best response designation, recorded between the date of reintroduction of NALIRIFOX and the date of objectively documented PD post NALIRIFOX reintroduction (per RECIST 1.1)
8. STEP 1 : DDC in Arm 1A and in Arm 1B
9. STEP 1 : Only grade 3-4 AEs/SAEs related to treatment according to the NCI CTCAE v 5.0
10. STEP 1: The rate of peripheral neuropathy
11. STEP 1 : HRQoL (EORTC QLQ-C30 [Appendix 25.2] and EORTC QLQ-PAN26 in Arm 1A and in Arm 1B
12. Step 2 : OS-R2 in in Arm 2A and Arm 2B, defined as the time between the date of R2 and the date of death from any cause
13. Step 2 : PFS-L2 according to RECIST 1.1 in Arm 2A and Arm 2B, defined as the time from R2 to the date of the first documented PD (per RECIST 1.1) determined by the Investigator or death due to any cause, whichever occurs first
14. STEP 2 : ORR-L2 in Arm 2A and Arm 2B, defined as the number of patients with CR/PR divided by the number of patients with measurable target lesions at baseline.
15. STEP 2 : BRR-L2 of L2 in Arm 2A and Arm 2B, defined as the best response designation (CR/PR/SD), recorded between the date of R2 and the date of objectively documented PD (per RECIST 1.1) or the date of subsequent anti-cancer therapy, whichever occurs first
16. STEP 2 : All grade AEs and severe (grade 3-5) AEs in Arm 2A and Arm 2B, according to the NCI CTCAE v 5.0
17. STEP2 : The rate (percentage) of occurrence of MRB
18. STEP 2 : The pharmacokinetics of gemcitabine clearance and gemcitabine’s metabolite, dFdU, between Arm 2A and Arm 2B

Investigational products

Investigational medicinal products (IMPs), comparators, placebo, auxiliary

Test 2

Placebo 1

Auxiliary 5

Sponsors and contacts

Sponsor organisations, regulatory contacts, third parties

Association Gercor

Sponsor organisation

Association Gercor

Address

151 Rue Du Faubourg Saint Antoine

City

Paris

Postcode

75011

Country

France

Scientific contact point

Organisation

Association Gercor

Contact name

Dr GARCIA-LARNICOL

Public contact point

Organisation

Association Gercor

Contact name

Dr GARCIA-LARNICOL

Locations

1 EU/EEA country · 12 investigational sites

By country

Investigational sites

Country notifications

Trial-start, recruitment-start, end and early-termination notifications submitted per Member State

Results and documents

Annex IV summary of results, Annex V layperson summary, and all documents registered in CTIS for this trial

Documents 18 files

Public protocol annexes, IB summaries, regulatory submissions and post-authorisation documents registered in CTIS.

Application history

1 submissions — initial application plus substantial / non-substantial modifications