- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06078709
Preoperative Hypofractionated Radiotherapy With FOLFOX for Esophageal or Gastroesophageal Junction Adenocarcinoma (PHOX)
Preoperative Hypofractionated Radiotherapy With FOLFOX for Esophageal/Gastroesophageal Junction Adenocarcinoma (PHOX)
Study Overview
Status
Conditions
- Clinical Stage III Gastroesophageal Junction Adenocarcinoma AJCC v8
- Clinical Stage I Esophageal Adenocarcinoma AJCC v8
- Clinical Stage II Esophageal Adenocarcinoma AJCC v8
- Clinical Stage III Esophageal Adenocarcinoma AJCC v8
- Clinical Stage II Gastroesophageal Junction Adenocarcinoma AJCC v8
- Clinical Stage I Gastroesophageal Junction Adenocarcinoma AJCC v8
Intervention / Treatment
- Procedure: Biospecimen Collection
- Other: Survey Administration
- Drug: Fluorouracil
- Drug: Oxaliplatin
- Drug: Leucovorin Calcium
- Radiation: Hypofractionated Radiation Therapy
- Procedure: Endoscopic Ultrasound
- Procedure: Esophagogastroduodenoscopy
- Procedure: Computed Tomography
- Procedure: Positron Emission Tomography
Detailed Description
PRIMARY OBJECTIVE:
I. To demonstrate non-inferiority of pathologic complete response (pCR) with hypofractionated radiotherapy and concurrent FOLFOX compared to historical controls.
SECONDARY OBJECTIVES:
I. Report acute grade ≥ 3 gastrointestinal (GI) toxicity, per Common Terminology Criteria for Adverse Events (CTCAE) version (v)5.0.
II. Assess post-operative toxicity for patients undergoing esophagectomy, as determined by the Clavien-Dindo Classification.
III. Analyze patient-reported quality of life, per Functional Assessment of Cancer Therapy- Esophageal (FACT-E).
IV. Determine the financial toxicity of hypofractionated radiotherapy, using Comprehensive Score for Financial Toxicity (COST-FACIT).
V. Report overall survival and progression-free survival. VI. Report long-term toxicity secondary to trimodality therapy. VII. Report event-free survival. VIII. Assess outcomes for patients treated with hypofractionated radiotherapy and FOLFOX but who did not proceed to esophagectomy.
IX. Compare toxicity of chemoradiation between patients receiving proton based versus (vs.) photon-based radiotherapy.
CORRELATIVE OBJECTIVES:
I. Explore the predictive and prognostic role for circulating tumor DNA in esophageal cancer.
II. Study the utility of whole exome and germline sequencing to predict chemoradiation treatment response.
III. Explore the predictive power of whole exome sequencing regarding chemoradiotherapy toxicity.
IV. Implement whole exome and germline sequencing to personalize immunotherapy in esophageal cancer.
V. Study the predictive and prognostic role of tumor-derived extracellular vesicles in esophageal cancer.
OUTLINE:
Patients receive oxaliplatin intravenously (IV) over 2-6 hours on day 1, leucovorin calcium IV over 10-120 minutes on day 1, and and fluorouracil IV over 46-48 hours on days 1 and 2. Treatment repeats every 2 weeks for a total of 3 cycles in the absence of disease progression or unacceptable toxicity. Starting at cycle 2, patients undergo radiation therapy daily on Monday through Friday for a total of 15 treatments. Patients undergo esophagogastroduodenoscopy (EGD) and/or endoscopic ultrasound (EUS) during screening and undergo computed tomography (CT)/position emission tomography (PET) scan and CT scan as well as blood sample collection throughout the study.
After completion of study treatment, patients are followed up at 6,12 and 24 months and then up to 5 years.
Study Type
Enrollment (Estimated)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Arizona
-
Scottsdale, Arizona, United States, 85259
- Not yet recruiting
- Mayo Clinic in Arizona
-
Contact:
- Clinical Trials Referral Office
- Phone Number: 855-776-0015
- Email: mayocliniccancerstudies@mayo.edu
-
Principal Investigator:
- Jonathan B. Ashman, M.D., Ph.D.
-
-
Florida
-
Jacksonville, Florida, United States, 32224-9980
- Recruiting
- Mayo Clinic in Florida
-
Contact:
- Clinical Trials Referral Office
- Phone Number: 855-776-0015
- Email: mayocliniccancerstudies@mayo.edu
-
Principal Investigator:
- Michael S. Rutenberg, M.D., Ph.D.
-
-
Minnesota
-
Rochester, Minnesota, United States, 55905
- Recruiting
- Mayo Clinic in Rochester
-
Principal Investigator:
- Christopher L. Hallemeier, M.D.
-
Contact:
- Clinical Trials Referral Office
- Phone Number: 855-776-0015
- Email: mayocliniccancerstudies@mayo.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥ 18 years
- Histological confirmation of esophageal or gastroesophageal junction adenocarcinoma, American Joint Committee on Cancer (AJCC) 8th edition stage T1-4N0-3M0
- Candidate for trimodality therapy: neoadjuvant chemotherapy, chemoradiation, and esophagectomy
- Surgical consultation has confirmed that patient is an appropriate candidate for esophagectomy
- Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1
- Negative pregnancy test done ≤ 7 days prior to chemotherapy, for women of childbearing potential only
- Ability to provide written informed consent and complete questionnaire(s) by themselves or with assistance
- Willing to return to enrolling institution for follow-up (during the active monitoring phase of the study)
- Willing to provide blood samples for correlative research purposes
Exclusion Criteria:
- Clinical or biopsy-proven distant metastatic disease (AJCC 8th edition stage TanyNanyM1)
- Cervical or upper esophageal tumor
- Prior chemotherapy or radiotherapy for esophageal cancer or history of radiotherapy to the thorax
- Co-morbid systemic illnesses or other severe concurrent disease which, in the judgement of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with proper assessment of adverse events
- Receiving any investigational agent which would be considered as a treatment for the primary neoplasm or other active malignancy ≤ 1 year prior to registration that is considered by the investigator to interfere with the current treatment or measurement of outcomes
Any of the following:
- Pregnant women
- Nursing women
- Men or women of childbearing potential who are unwilling to employ adequate contraception
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Treatment (Radiation and FOLFOX)
Patients receive oxaliplatin IV over 2-6 hours on day 1, leucovorin calcium IV over 10-120 minutes on day 1, and and fluorouracil IV over 46-48 hours on days 1 and 2. Treatment repeats every 2 weeks for a total of 3 cycles in the absence of disease progression or unacceptable toxicity.
Starting at cycle 2, patients undergo radiation therapy daily on Monday through Friday for a total of 15 treatments.
Patients undergo EGD and/or EUS during screening and undergo CT/PET scan and CT scan as well as blood sample collection throughout the study.
|
Undergo blood sample collection
Other Names:
Ancillary studies
Given IV
Other Names:
Given IV
Other Names:
Given IV
Other Names:
Undergo hypofractionated radiation therapy
Other Names:
Undergo EUS
Other Names:
Undergo EGD
Other Names:
Undergo CT and PET/CT scan
Other Names:
Undergo PET and PET/CT scan
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pathologic complete response
Time Frame: Up to 5 years after completion of chemoradiation
|
A single-group design will be used to test whether the proportion is potentially non-inferior, with a non-inferiority proportion (P0) of 0.13 (H0: P ≤ 0.13 versus H1: P > 0.13).
|
Up to 5 years after completion of chemoradiation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of acute ≥ gastrointestinal (GI) adverse events (AEs)
Time Frame: Up to 6 weeks after completion of chemoradiation
|
Report acute grade ≥ 3 GI AEs per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 criteria.
Will be summarized descriptively.
|
Up to 6 weeks after completion of chemoradiation
|
Incidence of post operative AEs
Time Frame: From surgery up to 6 months after completion of chemoradiation
|
Determined by the Clavien-Dindo Classification.
Will be summarized descriptively.
|
From surgery up to 6 months after completion of chemoradiation
|
Patient-reported quality of life (QOL)
Time Frame: Up to 24 months after completion of chemoradiation
|
Per Functional Assessment of Cancer Therapy- Esophageal.
Will be assessed over time.
Wilcoxon signed-rank tests will be used to calculate p-values.
Descriptive statistics and graphical methods will also be used to summarize the data.
|
Up to 24 months after completion of chemoradiation
|
Overall survival (OS)
Time Frame: From study entry to death from any cause, up to 5 years after completion of chemoradiation
|
Will be assessed graphically using the Kaplan-Meier method.
Summary statistics will be reported, including medians, 95% confidence intervals, etc.
|
From study entry to death from any cause, up to 5 years after completion of chemoradiation
|
Progression-free survival (PFS)
Time Frame: From study entry to the first of either disease progression or death, up to 5 years after completion chemoradiation
|
Will be assessed graphically using the Kaplan-Meier method.
Summary statistics will be reported, including medians, 95% confidence intervals, etc.
|
From study entry to the first of either disease progression or death, up to 5 years after completion chemoradiation
|
Long-term toxicity secondary to trimodality therapy
Time Frame: Up to 5 years after completion of chemoradiation
|
Will be reported descriptively using CTCAE version 5.0 criteria.
|
Up to 5 years after completion of chemoradiation
|
Event free survival
Time Frame: From study entry to the first of either disease progression or recurrence or relapse or death, up to 5 years after completion of chemoradiation
|
Will be assessed graphically using the Kaplan-Meier method.
Summary statistics will be reported, including medians, 95% confidence intervals, etc.
|
From study entry to the first of either disease progression or recurrence or relapse or death, up to 5 years after completion of chemoradiation
|
Outcomes for patients treated with hypofractionated radiotherapy and FOLFOX but who did not proceed to esophagectomy
Time Frame: Up to 5 years after completion of chemoradiation
|
OS and PFS will be assess using Kaplan-Meier methodology.
Summary statistics will be reported, including medians, 95% confidence intervals, etc. AEs and QOL data will be reported with summary statistics and graphical methods, as appropriate.
|
Up to 5 years after completion of chemoradiation
|
Toxicity of chemoradiation between patients receiving proton based versus photon-based radiotherapy
Time Frame: Up to 5 years after completion of chemoradiation
|
Will be done descriptively, reporting frequencies and percentages between patients.
|
Up to 5 years after completion of chemoradiation
|
Toxicity of chemoradiation between groups receiving proton based versus photon-based radiotherapy
Time Frame: Up to 5 years after completion of chemoradiation
|
Will be done descriptively, reporting toxicity rates between groups using the chi-square test.
|
Up to 5 years after completion of chemoradiation
|
Financial toxicity
Time Frame: Up to 24 months after completion of chemoradiation
|
Financial toxicity will be measured using the COmprehensive Score for financial Toxicity (COST), a patient-reported outcome measure that describes the financial distress experienced by cancer patients.
The survey consists of 12 questions, each answered with a 0-4 scale where 0=Not at all, 1=A little bit, 2=Somewhat, 3=Quite a bit, and 4=Very much.
Results will be reported descriptively and include separate consideration of individual item scores.
|
Up to 24 months after completion of chemoradiation
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Christopher L. Hallemeier, M.D., Mayo Clinic in Rochester
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
- Head and Neck Neoplasms
- Esophageal Diseases
- Adenocarcinoma
- Esophageal Neoplasms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Protective Agents
- Micronutrients
- Vitamins
- Bone Density Conservation Agents
- Calcium-Regulating Hormones and Agents
- Antidotes
- Vitamin B Complex
- Hematinics
- Fluorouracil
- Oxaliplatin
- Leucovorin
- Calcium
- Levoleucovorin
- Folic Acid
- Calcium, Dietary
Other Study ID Numbers
- GMROR2241 (Other Identifier: Mayo Clinic Radiation Oncology)
- 23-001689 (Other Identifier: Mayo Clinic Institutional Review Board)
- NCI-2023-07432 (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
product manufactured in and exported from the U.S.
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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