- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04554771
Blood-borne Assessment of Stromal Activation in Esophageal Adenocarcinoma to Guide Tocilizumab Therapy (BASALT)
December 15, 2022 updated by: H.W.M. van Laarhoven, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Blood-borne Assessment of Stromal Activation in Esophageal Adenocarcinoma to Guide Tocilizumab Therapy: a Randomized Phase II Proof-of-concept Study
The primary objective of this study is to demonstrate that stroma-targeting by tocilizumab in patients with adenocarcinoma of the esophagus or gastroesophageal junction with highly activated stroma increases efficacy of chemoradiotherapy measured by pathological response according to the Mandard criteria.
Patients will be grouped for ADAM12, a non-invasive blood-borne marker of stromal activation.
Study Overview
Status
Active, not recruiting
Detailed Description
Randomized phase II proof-of-concept study with tocilizumab and standard of care paclitaxel, carboplatin and radiation followed by surgical resection of the oesophagus for patients with surgically resectable adenocarcinomas of the oesophagus or oesophageal junction.
Patients will be grouped for serum ADAM12 with a cutoff of 203 ng/mL.
Patients in both groups will be randomized to receive tocilizumab 8mg/kg on day 1, 15 and 29 or not in addition to paclitaxel 50mg/m2, carboplatin dosed with area under the curve (AUC) 2 on day 1, 8, 15, 22 and 29 and radiation 41.4 Gy in 23 fractions.
Surgery will be planned approximately in week 13-15, which is 8 to 10 weeks after the end of chemoradiation.
Study Type
Interventional
Enrollment (Actual)
41
Phase
- Phase 2
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Benthe H. Doeve, MD, MSc
- Phone Number: 0204447810
- Email: b.h.doeve@amsterdamumc.nl
Study Contact Backup
- Name: Hanneke WM van Laarhoven, MD, PhD, PhD
- Phone Number: 0205665955
- Email: h.vanlaarhoven@amsterdamumc.nl
Study Locations
-
-
-
Amsterdam, Netherlands, 1100 DD
- Academic Medical Center, Medical Oncology
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
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 proven adenocarcinoma of the esophagus or gastroesophageal junction.
- Surgical resectable (<T4b, N0 or N+, M0), as determined by Endoscopic UltraSound (EUS) and/or CT scan of neck, thorax and abdomen. Tumors that cannot be passed with an endoscope for endoscopic ultrasound are eligible if all other criteria are fulfilled.
- T1N+ tumors are eligible.
- Tumor length longitudinal ≤ 10 cm; if larger than 10 cm, inclusion should be discussed with the principal investigator.
- If the tumor extends below the gastroesophageal (GE) junction into the proximal stomach, the bulk of the tumor must involve the esophagus or GE junction.
- Age ≥ 18.
- Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
Adequate hematological, renal and hepatic functions defined as:
- neutrophiles ≥ 1.5 x 109/L
- platelets ≥ 100 x 109/L
- hemoglobin ≥ 5.6 mmol
- total bilirubin ≤ 1.5 x upper normal limit
- creatinine clearance (Cockroft) > 60 ml/min
- Written, voluntary informed consent
- Patients must be accessible to follow up and management in the treatment center
Exclusion Criteria:
- Past (within 5 years) or current history of malignancy other than entry diagnosis interfering with prognosis of esophageal cancer, not including superficial and adequately treated skin and cervical malignancies.
- Previous chemotherapy, radiotherapy and/or treatment with Interleukin-6 (IL6) receptor blockers for esophageal cancer
- Previous radiation to the mediastinum precluding full dose radiation of the currently present esophageal tumor.
- Previous chemotherapy and/or treatment with targeted agents and/or IL6 receptor blockers for other forms of cancer within the last six months.
- Invasion of the tracheobronchial tree or presence of tracheoesophageal fistula.
- T1N0 tumors or in situ carcinoma.
- Pregnancy (positive serum pregnancy test), planning to become pregnant, and lactation.
- Patient (male or female) is not willing to use highly effective methods of contraception (per institutional standard) during treatment and for 6 months (male or female) after the end of treatment.
- Clinically significant cardiovascular disease (including myocardial infarction, unstable angina, symptomatic congestive heart failure, serious uncontrolled cardiac arrhythmia) precluding major surgery.
- Pulmonary fibrosis and/or severely impaired lung function precluding major surgery.
- Serious underlying medical condition which would impair the ability of the patient to receive the planned treatment, including prior allergic reactions to drugs containing Cremophor, such as teniposide or cyclosporine.
- Dementia or altered mental status that would prohibit the understanding and giving of informed consent
- Inadequate caloric- and/or fluid intake despite consultation of a dietician and/or tube feeding.
- Requires systemic treatment with IL6 receptor blockers or IL-6 antagonists, Tumor Necrosis Factor (TNF)-alpha blockers or other biologicals within the last six months before the first dose of trial treatment.
- Has evidence of interstitial lung disease or active, non-infectious pneumonitis.
- Has an active infection requiring systemic therapy which has not resolved 3 days (simple infection such as cystitis) to 7 days (severe infection such as pyelonephritis) prior to the first dose of trial treatment.
- Has a total cholesterol > 6.5 mmol/L despite adequate treatment with lipid-lowering agents.
- Has evidence of (latent) tuberculosis infection in patient history.
- Receiving a live or live weakened vaccine during treatment with tocilizumab
- Has evidence of acute or chronic infection with hepatitis B
- Patients with prior allogeneic stem cell or solid organ transplantation.
- Pre-existing motor or sensory neurotoxicity greater than World Health Organization (WHO) grade 1.
- Known allergy for tocilizumab or one of its excipients (sucrose, polysorbate 80, disodium phosphate dodecahydrate, sodium dihydrogen phosphate dehydrate)
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
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: ADAM12 high with tocilizumab and standard of care
Patients have serum ADAM12 higher than 203ng/mL.
Patients will receive tocilizumab 8 mg/kg with a maximum of 800 mg intravenously on day 1, 15 and 29 in addition to paclitaxel 50mg/m2 and carboplatin AUC 2 intravenously on day 1, 8, 15, 22 and 29.
External beam radiation of 41.4 Gy will be given in 23 fractions.
Surgery will be planned approximately in week 13-15, which is 8 to 10 weeks after the end of chemoradiation.
|
tocilizumab 8 mg/kg with a maximum of 800 mg intravenously on day 1, 15 and 29 of standard of care neoadjuvant chemoradiation
Other Names:
Paclitaxel 50 mg/m2 will be given intravenously on days 1, 8, 15, 22 and 29
Other Names:
Carboplatin AUC = 2 will be given intravenously on days 1, 8, 15, 22 and 29
Other Names:
External beam radiotherapy will be delivered to a total dose of 41.4 Gy in 23 fractions of 1.8 Gy, 5 fractions per week starting the first day of the first cycle of chemotherapy
|
Active Comparator: ADAM12 high with standard of care
Patients have serum ADAM12 higher than 203ng/mL.
Patients will receive paclitaxel 50mg/m2 and carboplatin AUC 2 intravenously on day 1, 8, 15, 22 and 29.
External beam radiation of 41.4 Gy will be given in 23 fractions.
Surgery will be planned approximately in week 13-15, which is 8 to 10 weeks after the end of chemoradiation.
|
Paclitaxel 50 mg/m2 will be given intravenously on days 1, 8, 15, 22 and 29
Other Names:
Carboplatin AUC = 2 will be given intravenously on days 1, 8, 15, 22 and 29
Other Names:
External beam radiotherapy will be delivered to a total dose of 41.4 Gy in 23 fractions of 1.8 Gy, 5 fractions per week starting the first day of the first cycle of chemotherapy
|
Experimental: ADAM12 low with tocilizumab and standard of care
Patients have serum ADAM12 lower than 203ng/mL.
Patients will receive tocilizumab 8 mg/kg with a maximum of 800 mg intravenously on day 1, 15 and 29 in addition to paclitaxel 50mg/m2 and carboplatin AUC 2 intravenously on day 1, 8, 15, 22 and 29.
External beam radiation of 41.4 Gy will be given in 23 fractions.
Surgery will be planned approximately in week 13-15, which is 8 to 10 weeks after the end of chemoradiation.
|
tocilizumab 8 mg/kg with a maximum of 800 mg intravenously on day 1, 15 and 29 of standard of care neoadjuvant chemoradiation
Other Names:
Paclitaxel 50 mg/m2 will be given intravenously on days 1, 8, 15, 22 and 29
Other Names:
Carboplatin AUC = 2 will be given intravenously on days 1, 8, 15, 22 and 29
Other Names:
External beam radiotherapy will be delivered to a total dose of 41.4 Gy in 23 fractions of 1.8 Gy, 5 fractions per week starting the first day of the first cycle of chemotherapy
|
Active Comparator: ADAM12 low with standard of care
Patients have serum ADAM12 lower than 203ng/mL.
Patients will receive paclitaxel 50mg/m2 and carboplatin AUC 2 intravenously on day 1, 8, 15, 22 and 29.
External beam radiation of 41.4 Gy will be given in 23 fractions.
Surgery will be planned approximately in week 13-15, which is 8 to 10 weeks after the end of chemoradiation.
|
Paclitaxel 50 mg/m2 will be given intravenously on days 1, 8, 15, 22 and 29
Other Names:
Carboplatin AUC = 2 will be given intravenously on days 1, 8, 15, 22 and 29
Other Names:
External beam radiotherapy will be delivered to a total dose of 41.4 Gy in 23 fractions of 1.8 Gy, 5 fractions per week starting the first day of the first cycle of chemotherapy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Efficacy defined as pathological response to chemoradiotherapy according to the Mandard criteria
Time Frame: 34 months
|
The primary outcome is efficacy of tocilizumab in patients with high and low stroma activation defined as pathological response according to the Mandard criteria
|
34 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
R0 resection rate
Time Frame: 34 months
|
Percentage of R0 resection at surgery
|
34 months
|
Progression free survival
Time Frame: 34 months
|
Average time to progression of disease
|
34 months
|
Overall survival
Time Frame: 34 months
|
average time to date of death
|
34 months
|
Interleukin 6- Signal Transducer and Activator of Transcription 3 (IL6-STAT3) pathway inhibition measured by gene expression analysis
Time Frame: 36 months
|
Analysis of gene expression to measure level of inhibition of IL6-STAT3 pathway
|
36 months
|
IL6-STAT3 pathway inhibition measured by immunohistochemistry
Time Frame: 36 months
|
Phosphorylated STAT3 and stromal abundance measured by immunohistochemistry in formalin-fixed paraffin-embedded tumor tissue
|
36 months
|
Levels of ADAM12 in tumor biopsies and serum
Time Frame: 36 months
|
average levels of ADAM12 in tumor biopsies and serum
|
36 months
|
Incidence and severity of toxicity
Time Frame: 34 months
|
Incidence of treatment-emergent adverse events according to CTCAE v5.0
|
34 months
|
Incidence and severity of radiation toxicity
Time Frame: 34 months
|
Incidence of treatment-emergent adverse events according to Radiation Oncology Group (RTOG) criteria
|
34 months
|
Incidence and severity of post-operative complications
Time Frame: 36 months
|
Incidence and severity of post-operative complications according to the Clavien - Dindo classification
|
36 months
|
Feasibility completion
Time Frame: 34 months
|
Percentage completion of chemotherapy and radiation treatment
|
34 months
|
Feasibility withdrawal rate
Time Frame: 34 months
|
Percentage withdrawal rate from surgery due to tocilizumab related complications
|
34 months
|
Feasibility delay
Time Frame: 36 months
|
Percentage delay of surgery due to tocilizumab related complications
|
36 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Predictive biomarkers using oa RNA sequencing
Time Frame: 54 months
|
Exploratory objectives are to identify additional predictive biomarkers based on tumor, fecal and blood samples.
Among others we will use RNA sequencing.
|
54 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Hanneke WM van Laarhoven, MD, PhD, PhD, Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
January 27, 2021
Primary Completion (Anticipated)
May 1, 2023
Study Completion (Anticipated)
January 1, 2024
Study Registration Dates
First Submitted
August 18, 2020
First Submitted That Met QC Criteria
September 17, 2020
First Posted (Actual)
September 18, 2020
Study Record Updates
Last Update Posted (Actual)
December 19, 2022
Last Update Submitted That Met QC Criteria
December 15, 2022
Last Verified
December 1, 2022
More Information
Terms related to this study
Keywords
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
- Head and Neck Neoplasms
- Esophageal Diseases
- Adenocarcinoma
- Esophageal Neoplasms
- Molecular Mechanisms of Pharmacological Action
- Antineoplastic Agents
- Tubulin Modulators
- Antimitotic Agents
- Mitosis Modulators
- Antineoplastic Agents, Phytogenic
- Carboplatin
- Paclitaxel
Other Study ID Numbers
- NL74310.018.20
- 2020-002909-25 (EudraCT Number)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
No
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
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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