Study Intervention: All study patients will be assigned to receive procedure with the investigational device (ONCObind ) Study Duration: Our target enrollment is 30 patients with mPDAC and 30 patients with mCRC. The study will last for up to two years. Interim analyses will determine early stopping for safety. This is detailed in Section 22: Data Safety Monitoring Board (DSMB). Furthermore, as the safety and effectiveness of the experimental use of the ONCObind device for treatment of patients with mPDAC and/or mCRC is unknown, patients will be followed for up to 5 years to inform oncological outcomes.
Procedure Setting: Extracorporeal blood purification utilizing ONCObind can be performed either on an outpatient or an in-patient basis as HD/CRRT procedure is performed routinely in both settings. Whether the procedure will be performed in a setting of an outpatient or in-patient setting would mainly depend on the personalized approach that the Site Investigator choses related to individual patient enrolled in the study. Location of the ONCObind treatment will be recorded, and data analysis will include consideration of the setting as it relates to study endpoints. If the Study Procedure is implemented in an outpatient setting, the subject will be monitored for up to 4 hours post procedure per PI discretion.
Procedure Duration for ONCObind : A sufficient blood flow rate and exposure of patient's blood to the ONCObind adsorption media was initially established based on the experience in implementing procedure in patients with blood stream infections. However, target procedure duration is further optimized based on data collected in EU oncology patients as listed below:
the average procedure duration and blood flow rates targeted in patients with blood stream infections or oncology are as follows:
* At an average blood flow of 350mL/min, this would translate to approximately 5 hours of procedure time for patients with blood stream infection or 2.0 hours for an oncology patient; an average of 200mL/min translates to a procedure time of 8 hours for blood stream infection or 3.5 hrs for oncology patient.
* OSCAR I 1st Stage: Study Procedure will occur only once, followed by weekly follow up visits through day 28, followed by monthly follow up through Day 60
* OSCAR II 2nd Stage: Study Procedure s will occur up to 3-5 times for the first week followed by 1-3treatments through week 4, for a total of up to 8 treatments over the first 28 days of study participation. Study treatments will continue every 4 weeks (+/- 1 week) from week 5 through week 26.
* Study Procedure(s) will be held, if subjects are hemodynamically unstable and unable to tolerate extracorporeal procedure (defined as MAP\<65 and or sustained hypotension at enrollment as defined by two readings with systolic blood pressure (SBP) measurements below 100 mmHg or diastolic blood pressure (DBP) measurements below 50 mmHg. The measurements must be performed thirty minutes from one another, and the Subject must be resting for at least 5 minutes prior to obtaining each measurement. (If the first reading includes a SBP greater than 100 mmHg and a DBP greater than 50 mmHg, the second reading does not need to be taken).
Subjects will be assessed per study visits and as part of routine, standard of care for mPDAC or mCRC. All subjects enrolled in this study will undergo clinical efficacy, safety, and laboratory assessments. Blood, and clinical data collection samples will be obtained at Screening, Induction Phase, and Procedure Follow up Phase in accordance to Schedule of Events. . Demographic and baseline clinical parameters will be recorded at the time of enrollment. Pertinent clinical parameters will be recorded in accordance to Schedule of Events . Outcomes data will be recorded on in accordance to Schedule of Events . Subject status will be in accordance to Schedule of Events to include adverse event evaluation and a targeted medication review. Survival follow-up will be assessed at 60, 120, 180 and 210 days after enrollment and/or at the time of death.
Patients will receive standard of care follow-up for up to 5 years and this data collected will be made available for FDA review.
A subset of the protocol team will review Grade 3 and 4 adverse event or serious adverse event (AE / SAE) data every 2 weeks. If there is a pattern of unexpected AEs that is out of proportion to the current understanding of the natural history of the disease, the DSMB will be asked to review un-blinded safety data in an ad hoc meeting. If an ad hoc meeting of the DSMB is convened to review a serious, device-related adverse event, enrollment will be halted pending the DSMB review to ensure subject safety in the trial. The DSMB will review the event to ensure subject safety. After the review, the DSMB will determine if enrollment may resume.
The DSMB will conduct an interim analysis after the enrollment of 10 subjects in each mPDAC and mCRC cohort to evaluate for safety and efficacy prior to completion of enrollment (n=30 for each cohort) (as detailed in Data Safety Monitoring Board (DSMB) and will be available for ad hoc reviews for safety concerns as described above. As stated above, enrollment will be halted pending the convening of an ad hoc DSMB meeting to review a serious, device-related adverse event. The DSMB will review the event to ensure subject safety in the trial. The DSMB will determine if enrollment may resume. The DSMB may recommend temporary or permanent cessation of enrollment based on their safety reviews.
