This clinical trial tests the safety and feasibility of endoscopic ultrasound-guided pulsed electric field ablation for the treatment of pancreatic neoplasms. Pancreatic cancer is a fatal disease that is difficult to diagnose at an early stage. The approach for pancreatic neoplasm treatment has changed and the recognition of minimally invasive treatments is growing. One such minimally invasive treatment, known as endoscopic ultrasound-guided pulsed electric field ablation, offers an alternative to surgery for managing certain precancerous or high-risk pancreatic cysts. The Aliya Pulsed Electric Field system uses brief, strong bursts of electricity, delivered through a thin needle, to destroy targeted tissue, such as tumors, without using heat. These electric pulses damage only the cells inside the treatment zone, leaving the healthy tissues and important nearby structures unharmed. This makes the treatment safer and less likely to cause harm to sensitive areas around the tumor. Endoscopic ultrasound-guided pulsed electric field ablation may be safe and feasible for the treatment of pancreatic neoplasms.
Age > 18 years
A diagnosis of a pancreatic neoplasm confirmed by EUS-fine needle aspiration (FNA) - (a) pancreatic cystic lesion such as intraductal papillary-mucinous neoplasm (IPMN), (b) World Health Organization (WHO) grade I neuroendocrine tumor
Lesion size estimation by computed tomography (CT) or magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) or EUS: (a) pancreatic cystic lesion such as IPMN - at least 2 cm in diameter. (b) WHO grade I neuroendocrine tumor - at least 1 cm in diameter
The patient is not a surgical candidate. Common clinical scenarios include -
Any evidence of severe or uncontrolled systemic diseases, or laboratory findings that, in the investigator's opinion, make it unsafe for the patient to participate in the study study
Pregnancy or breast-feeding
Clinical frailty scale
Contraindication to general anesthesia after review by OSU Preoperative Assessment Clinic (OPAC)
Single group
Clinical Intervention or Procedure
Other interventionUndergo endoscopic ultrasound-guided pulsed electric field ablation
Electronic Health Record Review
Other interventionAncillary studies
Endoscopic Ultrasound-Guided Fine-Needle Aspiration of the Pancreas
Procedure/SurgeryUndergo endoscopic ultrasound-guided fine needle aspiration
PEF-ablation of pancreatic cyst
DevicePatients undergo standard of care endoscopic ultrasound-guided fine needle aspiration followed by endoscopic ultrasound-guided pulsed electric field ablation on day 0.
Incidence of procedure-related adverse events
Incidence, type, and severity of adverse events will be assessed and graded per the American Gastrointestinal Endoscopy Event classification system (and Atlanta Classification for pancreatitis). All adverse events will be collected and tabulated by type, severity, and relationship to the procedure. Results will be reported as counts, rates, and percentages. Where appropriate, 95% confidence intervals for proportions will be provided.
Technical success rate (feasibility)
Defined as successful delivery of pulsed electric field energy to the target pancreatic lesion with completion of the planned ablation protocol, including adequate coverage of the intended lesion and absence of major technical failure. The proportion of cases in which the EUS-PEF procedure is successfully completed (technical feasibility) will be described as a percentage.
Efficacy of EUS-PEF
Defined as at least a 50% decrease in the lesion diameter. The response will be evaluated by cross-sectional imaging and endoscopic ultrasound (EUS) based on the change in the diameter and/or cyst fluid aspiration (biopsy if there is fibrosis) based on next generation sequencing (NGS) - persistence or absence of mutations (molecular markers) or cytology - results can include either: mucin, atypical/suspicious cells, necrotic material, or inflammatory debris and/or serological changes based on chromogranin A (for cystic-neuroendocrine tumor \[NET\]) and/or serum cancer antigen (CA) 19-9 (if elevated before intervention). Paired descriptive statistics (mean, median, interquartile range, range) will be reported. Where feasible, exploratory paired nonparametric tests (e.g., Wilcoxon signed-rank test) may be used to assess changes, but these analyses will be interpreted conservatively.
Long-term response to EUS-PEF
Defined as at least a 50% decrease in the lesion diameter. Durable response is defined as continued response with further decrease in lesion diameter beyond the first calendar year. The response will be evaluated by cross-sectional imaging and EUS based on the change in the diameter and/or cyst fluid aspiration (biopsy if there is fibrosis) based on NGS - Persistence or absence of mutations (molecular markers) or cytology - results can include either: mucin, atypical/suspicious cells, necrotic material, or inflammatory debris and/or serological changes based on chromogranin A (for cystic-NET) and/or serum CA 19-9 (if elevated before intervention). Paired descriptive statistics (mean, median, interquartile range, range) will be reported. Where feasible, exploratory paired nonparametric tests (e.g., Wilcoxon signed-rank test) may be used to assess changes, but these analyses will be interpreted conservatively.
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Ohio State University Comprehensive Cancer Center
Lead sponsor
Galvanize Therapeutics, Inc.
Collaborator
