Irinotecan, Cisplatin, and Bevacizumab in Treating Patients With Unresectable or Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma

A Multicenter, Open-Label, Phase II Study of Irinotecan, Cisplatin, and Bevacizumab in Patients With Unresectable or Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma

This phase II trial is studying how well giving irinotecan and cisplatin together with bevacizumab works in treating patients with unresectable or metastatic gastric (stomach) or gastroesophageal junction adenocarcinoma (cancer). Drugs used in chemotherapy, such as irinotecan and cisplatin, work in different ways to stop tumor cells from dividing so they stop growing or die. Monoclonal antibodies such as bevacizumab can locate tumor cells and either kill them or deliver tumor-killing substances to them without harming normal cells. Giving chemotherapy together with a monoclonal antibody may kill more tumor cells.

Study Overview

• Status: Completed
• Conditions: Adenocarcinoma of the Gastroesophageal Junction; Stage IV Gastric Cancer; Recurrent Gastric Cancer; Diffuse Adenocarcinoma of the Stomach; Intestinal Adenocarcinoma of the Stomach; Mixed Adenocarcinoma of the Stomach; Stage IIIA Gastric Cancer; Stage IIIB Gastric Cancer; Stage IIIC Gastric Cancer
• Intervention / Treatment: Other: laboratory biomarker analysis; Biological: bevacizumab; Drug: cisplatin; Drug: irinotecan hydrochloride; Procedure: computed tomography

Detailed Description

PRIMARY OBJECTIVES:

I. Determine the efficacy of irinotecan, cisplatin, and bevacizumab, in terms of time to progression, in patients with unresectable or metastatic gastric or gastroesophageal junction adenocarcinoma.

SECONDARY OBJECTIVES:

I. Determine other measures of efficacy, including response rate and median and 1-year survival, in patients treated with this regimen.

II. Determine the toxicity of this regimen in these patients. III. Correlate CT perfusion imaging results with the efficacy of this regimen, in terms of time to progression, objective response, and survival, in these patients.

IV. Determine the feasibility of serial serum proteomic assays in predicting response to therapy, in terms of time to progression, objective response, and survival, in patients treated with this regimen.

V. To bank paraffin stored tumor biopsy material for future planned immunohistochemistry studies to correlate with sensitivity to bevacizumab based combination chemotherapy.

OUTLINE: This is an open-label, non-randomized, multicenter study.

Patients receive bevacizumab IV over 30-90 minutes on day 1. Patients also receive cisplatin IV over 30 minutes followed by irinotecan IV over 30 minutes on days 1 and 8. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients are followed every 3 months for 1 year.

• Study Type: Interventional
• Enrollment (Actual): 47
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10065
      • Memorial Sloan-Kettering Cancer Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Histologically or cytologically confirmed gastric or gastroesophageal junction (GEJ) adenocarcinoma

  • Metastatic or unresectable disease
  • Siewert's classification I, II, or III
• No ulcerated, non-healing tumors or tumors that have developed a malignant fistula
• No esophageal tumors
• No known or active brain metastases
• Performance status - Karnofsky 60-100%
• Performance status - ECOG 0-2
• Neutrophil count >= 1,500/mm^3
• Platelet count >= 75,000/mm^3
• No bleeding diathesis or coagulopathy
• Bilirubin =< 1.5 mg/dL
• AST and ALT =< 3 times upper limit of normal (ULN) (5 times ULN if liver metastases are present)
• PT (INR) =< 1.5
• PTT =< 3 seconds above ULN
• Creatinine =< 1.5 mg/dL
• Proteinuria < 1+
• Protein < 500 mg/24-hour urine collection
• No acute ischemia or significant conduction abnormality by EKG
• No clinically significant cardiovascular disease
• No uncontrolled hypertension (blood pressure > 160/90 mm Hg on medication)
• No myocardial infarction within the past 6 months
• No unstable angina within the past 6 months
• No transient ischemic attack within the past 6 months
• No cerebrovascular accident within the past 6 months
• No other arterial thromboembolic event within the past 6 months
• No New York Heart Association class II-IV congestive heart failure
• No serious cardiac dysrhythmia requiring medication
• No peripheral vascular disease (grade II or greater)
• No history of stroke
• No CNS disease within the past 5 years (e.g., uncontrolled seizures)
• No other concurrent uncontrolled illness
• No ongoing or active infection requiring parental antibiotics on Day 0 of study
• No serious, non-healing wound
• No serious wound healing by secondary intention
• No ulcer
• No bone fracture
• No psychiatric illness or social situation that would preclude study compliance
• No significant traumatic injury within the past 28 days
• No other neoplastic disease within the past 3 years except basal cell skin cancer, carcinoma in situ of the cervix, or nonmetastatic prostate cancer
• No known hypersensitivity to Chinese hamster ovary cell products or other recombinant human antibodies
• No other medical condition that would preclude study participation

• Not pregnant or nursing

  • No nursing during and for 4 months after study participation
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 4 months after study participation
• More than 8 weeks since prior immunotherapy and recovered
• No other concurrent biologic or immunologic agents
• No other concurrent bevacizumab
• No prior chemotherapy for metastatic disease
• No prior cisplatin or irinotecan
• Prior neoadjuvant and/or adjuvant chemotherapy or chemoradiotherapy allowed
• More than 3 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered
• No other concurrent chemotherapy
• More than 3 weeks since prior radiotherapy and recovered
• No concurrent radiotherapy
• More than 28 days since prior major surgical procedure or open biopsy
• More than 7 days since prior fine needle aspirations or core biopsies
• No concurrent major surgery
• No other concurrent investigational agents
• No other concurrent anticancer therapy
• No concurrent chronic daily aspirin (> 325 mg/day)
• No concurrent nonsteroidal anti-inflammatory medications that would inhibit platelet function at doses used to treat chronic inflammatory diseases

• Full-dose anticoagulants allowed, provided the following criteria are met:

  • INR in range (i.e., 2-3) while on a stable dose of warfarin or low molecular weight heparin
  • No active bleeding or pathologic condition that would confer a high risk of bleeding (e.g., tumor involving major blood vessels or known varices)
• No concurrent thrombolytic agents

• No concurrent vitamins, antioxidants, herbal preparations, or supplements

  • Single tablet multivitamin allowed

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Treatment (bevacizumab, cisplatin, irinotecan); Patients receive bevacizumab IV over 30-90 minutes on day 1. Patients also receive cisplatin IV over 30 minutes followed by irinotecan IV over 30 minutes on days 1 and 8. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Other: laboratory biomarker analysis; Correlative studies; Biological: bevacizumab; Given IV; Other Names: Avastin; anti-VEGF humanized monoclonal antibody; anti-VEGF monoclonal antibody; rhuMAb VEGF; Drug: cisplatin; Given IV; Other Names: CDDP; DDP; CACP; CPDD; Drug: irinotecan hydrochloride; Given IV; Other Names: irinotecan; Campto; Camptosar; U-101440E; CPT-11; Procedure: computed tomography; Correlative studies; Other Names: tomography, computed

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to progression, evaluated using RECIST	Kaplan-Meier estimates will be used.	Up to 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall response rate, evaluated using RECIST	95% exact binomial confidence intervals will be used to describe the distribution.	Up to 1 year
Complete response rate, evaluated using RECIST	95% exact binomial confidence intervals will be used to describe the distribution.	Up to 1 year
Duration of response, evaluated using RECIST		From the time measurement criteria are met for CR/PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented, assessed up to 1 year
Survival	Kaplan-Meier estimates will be used.	Up to 1 year
Incidence of toxicity, evaluated using CTCAE version 3.0		Up to 1 year

Collaborators and Investigators

• Sponsor: National Cancer Institute (NCI)
• Investigators: Principal Investigator: Manisha Shah, Memorial Sloan Kettering Cancer Center

Study record dates

Study Major Dates

• Study Start: April 1, 2004
• Primary Completion (Actual): October 1, 2007

Study Registration Dates

• First Submitted: June 10, 2004
• First Submitted That Met QC Criteria: June 10, 2004
• First Posted (Estimate): June 11, 2004

Study Record Updates

• Last Update Posted (Estimate): June 4, 2013
• Last Update Submitted That Met QC Criteria: June 3, 2013
• Last Verified: June 1, 2013

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms by Histologic Type; Neoplasms; Neoplasms by Site; Carcinoma; Neoplasms, Glandular and Epithelial; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Stomach Diseases; Stomach Neoplasms; Adenocarcinoma; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Immunologic Factors; Topoisomerase Inhibitors; Angiogenesis Inhibitors; Angiogenesis Modulating Agents; Growth Substances; Growth Inhibitors; Topoisomerase I Inhibitors; Antibodies; Immunoglobulins; Bevacizumab; Irinotecan; Antibodies, Monoclonal; Antineoplastic Agents, Immunological
• Other Study ID Numbers: NCI-2012-01450; U01CA099168 (U.S. NIH Grant/Contract); 04-021; NCI-6447; MSKCC-04021; CDR0000365463; N01CM17105 (U.S. NIH Grant/Contract)