Safety and Tolerance of Epigenetic and Immunomodulating Drugs Combined With Chemotherapeutics in Patients Suffering From Advanced Pancreatic Cancer

Prior treatment

• Patients who have had radiotherapy within 4 weeks prior to entering the study or those who have not recovered from adverse events from agents administered more than 4 weeks earlier
• Patients receiving any other investigational agents.
• Patients who have previously received Romidepsin, Azacitidine, Lenalidomide or Durvalumab or any programmed cell death-1 (PD1) or programmed cell death ligand 1 (PD-L1) inhibitor or participate currently on another clinical trial
• Myocardial infarction within 6 months prior to cycle 1, day 1 (C1D1).
• Concomitant use of strong CYP3A4 inhibitors
• Prior thromboembolic events
• Major surgery within 4 weeks prior to first dose of study drug
• History of stroke or intracranial hemorrhage within 6 months prior to enrollment
• Concomitant use of warfarin or other Vitamin K antagonists
• Current or prior use of immunosuppressive medication within 14 days before the first dose of Durvalumab.
• Active or prior documented autoimmune or inflammatory disorders
• Any unresolved toxicity NCI CTCAE Grade ≥ 2 from previous anticancer therapy
• Receipt of live attenuated vaccine within 30 days prior to the first dose of Investigational medicinal product (IMP)

Other illness

• Patients with untreated or uncontrolled brain metastases or leptomeningeal disease
• Presence of other active illnesses
• Symptomatic coronary artery disease (CAD)
• A known history of sustained ventricular tachycardia (VT), ventricular fibrillation (VF), Torsade de Pointes, or cardiac arrest unless currently addressed with an automatic implantable cardioverter defibrillator (AICD)
• Patients with any other medical or psychological condition deemed by the investigator to be likely to interfere with a patient's ability to sign informed consent, cooperate and participate in the study, or interfere with the interpretation of the results
• Diagnosis of immunodeficiency or any condition that requires systemic steroid therapy or other forms of immunosuppressive therapy
• History of other malignancies
• Any uncontrolled active systemic infection
• Any life-threatening illness, medical condition, or organ system dysfunction that, in the investigator's opinion, could compromise the subject's safety or put the study outcomes at undue risk.
• History of interstitial lung disease, idiopathic pulmonary fibrosis, or pulmonary hypersensitivity pneumonitis
• Unable to swallow oral medication or malabsorption syndrome, disease significantly affecting gastrointestinal function, or resection of the stomach or small bowel, symptomatic inflammatory bowel disease or ulcerative colitis, or partial or complete bowel obstruction
• Known allergy or hypersensitivity to any study drug or any of the study drug excipients
• History of allogenic organ transplantation
• Active infection including tuberculosis

Lab values

• Any known cardiac abnormalities such as: congenital long QT syndrome; corrected QT interval (QTc interval) ≥ 470 milliseconds. Calculated from 3 ECGs using Fridericia's Correction
• Congestive heart failure (CHF) that meets New York Heart Association (NYHA) Class II to IV definitions and/or known ejection fraction \<40% by multiple gated acquisition scan (MUGA) or \<50% by echocardiogram and/or MRI
• Concomitant use of any drug known to prolong QT interval

Other

• Other significant ECG abnormalities including 2nd degree atrio-ventricular (AV) block type II, 3rd degree AV block, or bradycardia (ventricular rate less than 50 beats/min)
• Lactating, pregnant or breast feeding
• Unwilling or unable to participate in all required study evaluations and procedures. Unable to understand the purpose and risks of the study and to provide a signed and dated informed consent form (ICF) and authorization to use protected health information.
• Subject is an employee of the sponsor

• Patients must have histologically confirmed PDAC
• Patients must have metastatic disease (stage IV) and not received prior chemotherapy for stage IV disease
• Patients must not have received the following drugs before: Azacitidine, Romidepsin, any checkpoint-inhibitor or immunomodulating agents such as Immunomodulatory imide drugs (IMiDs)
• Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension in accordance with RECIST criteria v. 1.1
• Male or female, age ≥ 18 years
• Body weight \> 30 kg for inclusion into Part 2
• Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
• Patients must have normal organ and marrow function
• Patients must be recovered from the effects of any prior surgery
• Patient is 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
• All subjects must agree to refrain from donating blood while on study drug and for 90 days after discontinuation from this study treatment
• All subjects must have a life expectancy of at least 12 weeks
• Females of childbearing potential (FCBP) must agree to utilize two reliable forms of contraception simultaneously without interruption for at least 28 days before starting study drug, while participating in the study, and for at least 90 days after study treatment discontinuation
• Males must agree to use a latex condom during any sexual contact with FCBP or a pregnant female, refrain from donating semen or sperm and not to father a child