- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03161522
Chemotherapy With or Without Radiation or Surgery in Treating Participants With Oligometastatic Esophageal or Gastric Cancer
A Randomized Trial Comparing Early Local Chemoradiation Therapy +/- Surgery Versus Systemic Therapy for Patients With Esophageal or Gastric Cancer With Oligometastases
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate whether esophageal or gastric patients with oligometastatic cancer without disease progression after first line chemotherapy therapy will demonstrate improved overall survival (OS) with early local therapy (concurrent chemotherapy/radiation and surgery).
SECONDARY OBJECTIVES:
I. Assess the relationships between progression-free survival and overall survival between both treatment arms.
II. Report local control, loco-regional control. III. Report time to progression of distant metastases. IV. Report toxicity.
OUTLINE:
Participants receive induction chemotherapy for a minimum of 6 cycles and a maximum of 8 cycles in the absence of disease progression or unacceptable toxicity. Participants are then randomized to 1 of 2 groups.
GROUP I (MAINTENANCE CHEMOTHERAPY): Participants receive fluorouracil and capecitabine per instructions of the treating physician in the absence of disease progression or unacceptable toxicity.
GROUP II (LOCAL THERAPY): Participants receive fluorouracil and capecitabine and undergo radiation therapy (RT) per instructions of the treating physician in the absence of disease progression or unacceptable toxicity. Participants may also undergo surgery to some or all of the remaining sites of disease as is clinically prudent and indicated by treating physician.
After completion of study treatment, participants are followed up at 4-8 weeks, 2-3 months, every 3-6 months for up to 3 years, and then every 6-12 months thereafter.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Contact
- Name: Quynh Nhu Nguyen, MD
- Phone Number: 713-563-2300
- Email: qnnguyen@mdanderson.org
Study Locations
-
-
Texas
-
Houston, Texas, United States, 77030
- Recruiting
- M D Anderson Cancer Center
-
Contact:
- Quynh-Nhu Nguyen
- Phone Number: 713-563-2300
-
Principal Investigator:
- Quynh-Nhu Nguyen
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- The patient has a pathologic diagnosis of tumor biopsy or FNA of esophageal or gastric cancer of adenocarcinoma histology
- The patient is staged with EGD and PET/CT scan.
The patient has three or less observable metastatic lesions. Patients may have three or less radiographically visible metastatic lesions at diagnosis or if have regressed to three or less metastatic lesions after induction chemotherapy at time of randomization. The patient must have pathologic confirmation and or radiologically visible disease. For esophageal tumors, the maximal dimension of the primary tumor may not provide reproducible measurements for RECIST and may not be visible on CT or PET/CT at diagnosis or after induction chemotherapy. Accordingly, patients are eligible regardless of the imaging measurements of the primary tumor. Additionally, in patients with non-measurable metastases, patients are eligible if there is pathology confirming metastases from a distant site. However, biopsy of a metastatic site is not required if there are visible metastases on imaging (such as ultrasound, diagnostic CT , EUS, PET/CT).
- The patient has three or less observable metastatic lesions by diagnostic scans (CT scan, PET/CT, eEndoscopic ultrasound, MRI, or bone scan). Metastatic lesions include distant M1 lymph node group; which will be counted as one site (M1 metastatic lymph nodes to include cervical, mediastinal, gastric, retroperitoneal lymph nodes will be counted as one lesion).
- Osseous metastases or visceral metastases will each count as one metastatic site.
- Each CNS metastases will count as one metastatic site.
- Satellite lesions in the primary esophageal malignancy such as skipped esophageal primaries are not considered metastatic sites. Symptomatic metastatic sites can be treated locally prior to randomization or by palliative radiation.
- Symptomatic metastatic sites may be treated with radiation or surgery prior to enrollment.
- Patient ECOG of 0-2, with life expectancy of at least 6 months
- Patients age >18 yrs old but <80 yrs old and signed informed consent
- Women of child-bearing age must have pregnancy test at time of enrollment, agree to use of adequate contraception (birth control hormone or barrier method) for the duration of the study and for six months after discontinuation of systemic agents.
Exclusion Criteria:
- Patients with prior chemotherapy or radiation therapy for their diagnosis of esophageal or gastric cancer. Patients with prior radiation therapy to same site for another diagnosis of cancer. Note: Patients may receive palliative radiation to their symptomatic sites of metastases but not definitive local therapy to esophageal or gastric primary prior to randomization. All patients may be enrolled on protocol then start systemic therapy; if they do not have evidence of disease progression at re-staging following initial therapy, they may be randomized.
- Patients with fistula documented radiographically or by EDG/EUS, EBUS.
- Patients with life expectancy less than 6 months, ECOG >3
- Female patients who are pregnant confirmed by bHCG lab test.
- Patient has history of uncontrolled angina, congestive heart failure or recent MI within 6 months.
- Patients established to have a tumor with Microsatellite Instability High (MSIH) status.
- Nursing females
- Patients in poor nutritional state
Patients with:
- Severely depressed bone marrow function
- Potentially serious infections
- Known hypersensitivity to 5-fluorouracil
- Known or suspected to have a dihydropyrimidine dehydrogenase deficiency (as these patients are at a greater risk of experiencing symptoms of toxicity)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Group I (maintenance chemotherapy)
Participants receive fluorouracil and capecitabine per instructions of the treating physician in the absence of disease progression or unacceptable toxicity.
|
Patients will receive 5-fluorouracil (5-FU) and capecitabine as maintenance chemotherapy.
Other Names:
Receive induction chemotherapy
Other Names:
Patients will receive 5-fluorouracil (5-FU) and capecitabine as maintenance chemotherapy.
Other Names:
|
Experimental: Group II (local therapy)
Participants receive fluorouracil and capecitabine and undergo RT per instructions of the treating physician in the absence of disease progression or unacceptable toxicity.
Participants may also undergo surgery to some or all of the remaining sites of disease as is clinically prudent and indicated by treating physician.
|
Undergo RT
Other Names:
Undergo surgery
Patients will receive 5-fluorouracil (5-FU) and capecitabine as maintenance chemotherapy.
Other Names:
Receive induction chemotherapy
Other Names:
Patients will receive 5-fluorouracil (5-FU) and capecitabine as maintenance chemotherapy.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall survival (OS)
Time Frame: Up to 6 years
|
OS distributions in the two arms will be estimated by the method of Kaplan and Meier.
Bayesian piecewise exponential regression will be used to assess the relationships between each of OS and PFS, and patients' covariates and treatment arm.
|
Up to 6 years
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Local progression-free survival (PFS)
Time Frame: Up to 6 years
|
PFS distributions in the two arms will be estimated by the method of Kaplan and Meier.
Bayesian piecewise exponential regression will be used to assess the relationships between each of OS and PFS, and patients' covariates and treatment arm.
|
Up to 6 years
|
Distant PFS
Time Frame: Up to 6 years
|
PFS distributions in the two arms will be estimated by the method of Kaplan and Meier.
Bayesian piecewise exponential regression will be used to assess the relationships between each of OS and PFS, and patients' covariates and treatment arm.
|
Up to 6 years
|
Incidence of adverse events
Time Frame: Up to 6 years
|
Graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.
|
Up to 6 years
|
Time to local or regional disease recurrence
Time Frame: Up to 6 years
|
To be analyzed by Bayesian piecewise regression to assess their relationships with treatment arm and prognostic covariates.
|
Up to 6 years
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to local disease recurrence
Time Frame: Up to 6 years
|
To be analyzed by Bayesian piecewise regression to assess their relationships with treatment arm and prognostic covariates.
|
Up to 6 years
|
Time to disease progression
Time Frame: Up to 6 years
|
To be analyzed by Bayesian piecewise regression to assess their relationships with treatment arm and prognostic covariates.
|
Up to 6 years
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Quynh-Nhu Nguyen, M.D. Anderson Cancer Center
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
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
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Fluorouracil
- Capecitabine
Other Study ID Numbers
- 2016-0972 (Other Identifier: M D Anderson Cancer Center)
- NCI-2018-01202 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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