Treatment of unresectable locally advanced pancreatic cancer with percutaneous irreversible electroporation (IRE) following initial systemic chemotherapy (LAP-PIE) trial: study protocol for a feasibility randomised controlled trial

Abstract

Background: Approximately 30% of patients with pancreas cancer have unresectable locally advanced disease, which is currently treated with systemic chemotherapy. A new treatment option of irreversible electroporation (IRE) has been investigated for these patients since 2005. Cohort studies suggest that IRE confers a survival advantage, but with associated, procedure-related complications. Selection bias may account for improved survival and there have been no prospective randomised trials evaluating the harms and benefits of therapy. The aim of this trial is to evaluate the feasibility of a randomised comparison of IRE therapy with chemotherapy versus chemotherapy alone in patients with locally advanced pancreatic cancer (LAPC).

Methods and analysis: Eligible patients with LAPC who have undergone first-line 5-FluoroUracil, Leucovorin, Irinotecan and Oxaliplatin chemotherapy will be randomised to receive either a single session of IRE followed by (if indicated) further chemotherapy or to chemotherapy alone (standard of care). Fifty patients from up to seven specialist pancreas centres in the UK will be recruited over a period of 15 months. Trial follow-up will be 12 months. The primary outcome measure is ability to recruit. Secondary objectives include practicality and technical success of treatment, acceptability of treatment to patients and clinicians and safety of treatment. A qualitative study has been incorporated to evaluate the patient and clinician perspective of the locally advanced pancreatic cancer with percutaneous irreversible electroporation trial. It is likely that the data obtained will guide the structure, the primary outcome measure, the power and the duration of a subsequent multicentre randomised controlled trial aimed at establishing the clinical efficiency of pancreas IRE therapy. Indicative procedure-related costings will be collected in this feasibility trial, which will inform the cost evaluation in the subsequent study on efficiency.

Ethics and dissemination: The protocol has received approval by London-Brent Research Ethics Committee reference number 21/LO/0077.Results will be analysed following completion of trial recruitment and follow-up. Results will be presented to international conferences with an interest in oncology, hepatopancreaticobiliary surgery and interventional radiology and be published in a peer-reviewed journal.

Trial registration number: ISRCTN14986389.

Keywords: Adult oncology; Clinical trials; Interventional radiology; Pancreatic surgery; SURGERY.

Figure 1

Trial flow diagram. CTCAP, CT chest abdomen pelvis; FOLFIRINOX, 5-FluoroUracil, Leucovorin, Irinotecan and Oxaliplatin; IRE, irreversible electroporation; LAPC, Locally Advanced Pancreatic Cancer; OS, overall survival; PFS; progression free survival; QoL, quality of life; SoC, standard of care; sMDT, specialist multidisciplinary team.

Figure 2

Inclusion and exclusion criteria of the LAP-PIE trial. CKD, chronic kidney disease; FOLFIRINOX, 5-FluoroUracil Leucovorin, Irinotecan and Oxaliplatin; Hb, haemoglobin; IR; interventional radiologist; IRE, irreversible electroporation; LAP-PIE, locally advanced pancreatic cancer with percutaneous irreversible electroporation; sMDT, specialist multidisciplinary team.