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Protocol Details

A Phase 1 Clinical Trial of CA-4948 in Combination with Gemcitabine and Nab-Paclitaxel in Metastatic or Unresectable Pancreatic Ductal Carcinoma

This study is currently recruiting participants.

Summary | Eligibility | Citations | Contacts




Sponsoring Institute

National Cancer Institute (NCI)

Recruitment Detail

Type: Participants currently recruited/enrolled
Gender: Male & Female
Min Age: 18 Years
Max Age: 100 Years

Referral Letter Required


Population Exclusion(s)

Pregnant Women


IRAK inhibitor;

Recruitment Keyword(s)



Pancreatic Ductal Carcinoma

Investigational Drug(s)

CA-4948 (emavusertib)

Investigational Device(s)



Drug: CA-4948
Drug: Gemcitabine
Drug: Nab-Paclitaxel

Supporting Site

National Cancer Institute


Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer that grows quickly and spreads rapidly to other parts of the body. About two-thirds of PDACs are a form of cancer that resists standard treatments.


To test a study drug (CA-4948) combined with gemcitabine and nab-paclitaxel.


People aged 18 years and older with PDAC that does not respond to standard care.


Participants will be screened for eligibility. They will have a physical exam with blood tests. They will have an imaging scan and x-rays. They will have a test of their heart function. Their ability to perform everyday activities will be assessed. A sample of tissue will be removed from their tumor.

CA-4948 is a pill taken by mouth. Participants will take the pill twice a day, every day. They will keep a diary to record each dose.

Gemcitabine and nab-paclitaxel are both administered through a tube attached to a needle inserted into a vein in the arm. Participants in different stages of the study will receive these treatments on different schedules. Some will receive these drugs once a week for the first 2 weeks of a 21-day cycle; some will receive these drugs once a week for the first 3 weeks of a 28-day cycle.

Participants may remain in the study as long as the treatments are helping them.

Participants will have follow-up visits every 3 months for 1 year after stopping treatment. These visits may be in person or by phone.

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-Patients must have histologically or cytologically confirmed adenocarcinoma of the pancreas that is metastatic or unresectable and for which standard curative or palliative measures do not exist or are no longer effective.

-Patients must have had disease progression on or after 5-FU-based therapy for metastatic or unresectable PDAC. If received gemcitabine-based regimen as adjuvant therapy, then gemcitabine and nab-paclitaxel (if used) should be >12 months from study enrollment. Prior use of gemcitabine/nab-paclitaxel for metastatic or unresectable disease is not allowed.

-Age >=18 years. Because no dosing or adverse event data are currently available on the use of CA-4948 in combination with gemcitabine and nab-paclitaxel in patients <18 years of age, children are excluded from this study.

-ECOG performance status <=2 (Karnofsky >=60%.

-Patients must have adequate organ and marrow function as defined below:

--absolute neutrophil count >= 1,500/mcL

--platelets >= 100,000/mcL

--total bilirubin <= 1.5 X institutional upper limit of normal (ULN)

--AST(SGOT)/ALT(SGPT) <= 3 X institutional ULN

--glomerular filtration rate (GFR) >= 60 mL/min (based on the calculated CKD-EPI glomerular filtration rate estimation

-Creatine phosphokinase (CPK) elevation at the screening < Grade 2 [CPK <= 2.5 ULN].

-Patients on a cholesterol lowering statin must be on a stable dose with no dose changes within 3 weeks prior to study start.

-Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial as long as their anti-retroviral therapy does not have the potential for drug-drug interactions as judged by the treating investigator.

-For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated.

-Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load.

-Patients with treated brain metastases are eligible if follow-up brain imaging after at least 4 weeks following central nervous system (CNS)-directed therapy shows no evidence of progression.

-Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial.

-Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better.

-Patients must have lesions amenable to research biopsy for those enrolling to the expansion cohort. The biopsy should be deemed feasible and safe.

-The effects of CA-4948, nab-paclitaxel, and gemcitabine on the developing human fetus are unknown. For this reason and because gemcitabine is known to be teratogenic, embryotoxic, and fetotoxic in mice and rabbits, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and 6 months after completion of CA-4948, nab-paclitaxel, and gemcitabine administration. Should a woman become pregnant or suspect she is pregnant while she or her partner is participating in this study, she should inform her treating physician immediately. Men treated or enrolled on this protocol must also agree to use adequate contraception prior to the study, for the duration of study participation, and 3 months after completion of CA-4948, nab-paclitaxel, and gemcitabine administration.

-Ability to understand and the willingness to sign a written informed consent document. Participants with impaired decision-making capacity who have a legally-authorized representative (LAR) and/or family member available will also be eligible.

Exclusion Criteria:

-Patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study.

-Patients who have not recovered from clinically significant adverse events due to prior anti-cancer therapy (i.e., have residual toxicities > Grade 1) with the exception of alopecia.

-History of other malignancy with the exception of 1) malignancies for which all treatment was completed at least 2 years before registration and the patient has no evidence of disease; 2) or known indolent malignancies that do not require treatment and will likely not alter the course of treatment of disease under treatment.

-History of allogeneic organ or stem cell transplant.

-Current use or anticipated need for alternative, holistic, naturopathic, or botanical formulations used for the purpose of cancer treatment.

-Patients who are receiving any other investigational agents.

-History of allergic reactions attributed to compounds of similar chemical or biologic composition to CA-4948 or other agents used in study.

-Patients receiving any medications or substances that are inhibitors or inducers of CYP3A4 are ineligible due to CA-4948 and nab-paclitaxel. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference. As part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product.

-Patients with uncontrolled intercurrent illness.

-Pregnant women are excluded from this study because gemcitabine is nucleoside analogue with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with gemcitabine, breastfeeding should be discontinued if the mother is treated with gemcitabine. These potential risks may also apply to other agents used in this study.

-Prolonged QTcF (>470 in females, >450 in males) on screening ECG.

-Gastrointestinal condition which could impair absorption of CA-4948 or inability to ingest CA-4948.

-Severe obstructive pulmonary disease or interstitial lung disease

-History of rhabdomyolysis or elevated creatine phosphokinase (CPK).

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Chaudhary D, Robinson S, Romero DL. Recent advances in the discovery of small molecule inhibitors of interleukin-1 receptor-associated kinase 4 (IRAK4) as a therapeutic target for inflammation and oncology disorders. J Med Chem. 2015 Jan 8;58(1):96-110. doi: 10.1021/jm5016044. Epub 2014 Dec 5. PMID: 25479567.

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Principal Investigator

Referral Contact

For more information:

Naoko Takebe, M.D.
National Cancer Institute (NCI)
(240) 541-4515

Nancy Moore, R.N.
National Cancer Institute (NCI)
National Institutes of Health
Building 10
Room 8D53
10 Center Drive
Bethesda, Maryland 20892
(240) 760-6045

NCI Referral Office
National Institute of Health Clinical Center (CC), 9000 Rockville Pike, Bethesda, Maryland 20892, United States: NCI Clinical Trials Referral Office

Clinical Trials Number:


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