Præoperativ hypofraktioneret strålebehandling med FOLFOX til adenokarcinom i spiserøret eller gastroøsofageal Junction (PHOX)
Præoperativ hypofraktioneret strålebehandling med FOLFOX til esophageal/gastroøsofageal Junction Adenocarcinoma (PHOX)
This phase II trial tests how well preoperative (prior to surgery) radiation therapy with fluorouracil, oxaliplatin, and leucovorin calcium (FOLFOX) works for the treatment of stage I-III esophageal or gastroesophageal junction adenocarcinoma. Hypofractionated radiation therapy delivers higher doses of radiation therapy over a shorter period of time and may kill more tumor cells and have fewer side effects. Fluorouracil stops cells from making deoxyribonucleic acid (DNA) and it may kill tumor cells. Leucovorin is not a chemotherapy medication but is given in conjunction with chemotherapy. Leucovorin is used with the chemotherapy medication fluorouracil to enhance the effects of the fluorouracil, in other words, to make the drug work better. Oxaliplatin is in a class of medications called platinum-containing antineoplastic agents. It damages the cell's DNA and may kill tumor cells. Giving preoperative hypofractionated radiation with fluorouracil and oxaliplatin may kill more tumor cells in patients with stage I-III esophageal or gastroesophageal junction adenocarcinoma.
Studieoversigt
Status
Status
Betingelser
Betingelser
- Klinisk trin III Gastroøsofageal Junction Adenocarcinoma AJCC v8
- Klinisk fase I esophageal adenokarcinom AJCC v8
- Klinisk fase II esophageal adenokarcinom AJCC v8
- Klinisk trin III esophagealt adenokarcinom AJCC v8
- Klinisk fase II Gastroøsofageal Junction Adenocarcinoma AJCC v8
- Klinisk fase I Gastroøsofageal Junction Adenocarcinoma AJCC v8
Intervention / Behandling
Intervention / Behandling
- Medicin: Docetaxel
- Medicin: Fluorouracil
- Procedure: Biospecimen Collection
- Medicin: Leucovorin Calcium
- Medicin: Oxaliplatin
- Stråling: Hypofractionated Radiation Therapy
- Andet: Survey Administration
- Biologisk: Durvalumab
- Procedure: Esophagogastroduodenoscopy
- Procedure: Computed Tomography
- Procedure: Endoscopic Ultrasound
- Procedure: Positron Emission Tomography
Detaljeret beskrivelse
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 targeted 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.
X. Compare clinical outcomes and pCR for patients receiving hypofractioned radiotherapy but different induction chemo (immuno) therapy regimens: no induction vs. fluorouracil, oxaliplatin, leucovorin, docetaxel (FLOT) vs. FLOT + durvalumab.
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:
INDUCTION CHEMOTHERAPY: Patients receive 5-FU intravenously (IV) over 24 hours on day 1, leucovorin calcium IV over 10-120 minutes on day 1, oxaliplatin IV over 2-6 hours on day 1, and docetaxel IV over 1 hour on day 1 of each cycle. Treatment repeats every 2 weeks for a total of up to 6 cycles in the absence of disease progression or unacceptable toxicity. Eligible patients also receive durvalumab IV over 1 hour every 4 weeks in the absence of disease progression or unacceptable toxicity. After completion of FLOT, patients undergo radiation therapy daily for 3 weeks with 2 concurrent cycles of FOLFOX.
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. of each cycle. 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 and tissue 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.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 2
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Clinical Trials Referral Office
- Telefonnummer: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
Studiesteder
-
-
Arizona
-
Scottsdale, Arizona, Forenede Stater, 85259
- Ikke rekrutterer endnu
- Mayo Clinic in Arizona
-
Kontakt:
- Clinical Trials Referral Office
- Telefonnummer: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
-
Ledende efterforsker:
- Jonathan B. Ashman, MD, PhD
-
-
Florida
-
Jacksonville, Florida, Forenede Stater, 32224-9980
- Aktiv, ikke rekrutterende
- Mayo Clinic in Florida
-
-
Minnesota
-
Rochester, Minnesota, Forenede Stater, 55905
- Rekruttering
- Mayo Clinic in Rochester
-
Kontakt:
- Clinical Trials Referral Office
- Telefonnummer: 855-776-0015
- E-mail: mayocliniccancerstudies@mayo.edu
-
Ledende efterforsker:
- Christopher L. Hallemeier, MD
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
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 chemo (immuno) therapy, 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 and tissue 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
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Eksperimentel: Treatment (FLOT and Radiation and FOLFOX)
Patients received Induction Chemotherapy [FLOT (5-FU/leucovorin/oxaliplatin/docetaxel)] following by radiation therapy daily for 3 weeks with 2 concurrent cycles of FOLFOX per protocol. See detailed description for more information. |
Given IV
Andre navne:
Given IV
Andre navne:
Undergo blood sample collection
Andre navne:
Given IV
Andre navne:
Given IV
Andre navne:
Undergo hypofractionated radiation therapy
Andre navne:
Ancillary studies Given IV
Andre navne:
Undergo EGD
Andre navne:
Undergo CT and PET/CT scan
Andre navne:
Undergo EUS
Andre navne:
Undergo PET and PET/CT scan
Andre navne:
|
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Pathologic complete response
Tidsramme: 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
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Incidence of acute ≥ gastrointestinal (GI) adverse events (AEs)
Tidsramme: 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
Tidsramme: 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)
Tidsramme: 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
|
|
Financial toxicity
Tidsramme: 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
|
|
Overall survival (OS)
Tidsramme: 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)
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
Tidsramme: 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
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: Christopher L. Hallemeier, MD, Mayo Clinic in Rochester
Publikationer og nyttige links
Hjælpsomme links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
- Aminosyrer, peptider og proteiner
- Proteiner
- Svovlforbindelser
- Organiske kemikalier
- Heterocykliske forbindelser, 1-ring
- Heterocykliske forbindelser
- Heterocykliske forbindelser, 2-ring
- Heterocykliske forbindelser, smeltet ring
- Undersøgelsesteknikker
- Terapeutik
- Kliniske laboratorieteknikker
- Diagnostiske teknikker og procedurer
- Diagnose
- Kirurgiske procedurer, operative
- Minimalt invasive kirurgiske procedurer
- Cytologiske teknikker
- Biopsi
- Cytodiagnose
- Kulbrinter
- Cycloparaffiner
- Kulbrinter, alicyklisk
- Kulbrinter, cyklisk
- Terpenes
- Fysiske fænomener
- Enzymer og coenzymer
- Antistoffer
- Immunoglobuliner
- Immunoproteiner
- Blodproteiner
- Serum globuliner
- Globuliner
- Uorganiske kemikalier
- Koordinationskomplekser
- Taxoider
- Cyclodecanes
- Diterpenes
- Pyrimidiner
- Diagnostiske teknikker, kirurgisk
- Endoskopi, gastrointestinal
- Diagnostiske teknikker, fordøjelsessystem
- Endoskopi
- Kirurgiske procedurer for fordøjelsessystem
- Diagnostisk billeddannelse
- Kemiteknikker, analytisk
- Spektrumanalyse
- Formyltetrahydrofolater
- Tetrahydrofolater
- Folinsyre
- Pterins
- Pteridiner
- Uracil
- Pyrimidinoner
- Coenzymer
- Immunoglobulin -isotyper
- Sulfider
- Anioner
- Ioner
- Elektrolytter
- Hydrogensulfid
- Elektromagnetiske fænomener
- Magnetiske fænomener
- Strålebehandling
- Elektromagnetisk stråling
- Stråling, ioniserende
- Dosisfraktionering, stråling
- Strålebehandlingsdosering
- Ultrasonografi
- Biopsi, fin-nål
- Biopsi, nål
- Billedstyret biopsi
- Ultrasonografi, interventionel
- Docetaxel
- Oxaliplatin
- Fluorouracil
- Leucovorin
- Immunoglobulin G
- Stråling
- Håndtering af eksemplar
- Magnetisk resonansspektroskopi
- Durvalumab
- Disulfider
- Røntgenstråler
- Strålingsdosishypofraktionering
- Dehydroftorafur
- Endoskopi, fordøjelsessystem
- Gastroskopi
- Endoskopisk ultralydstyret fin nålaspiration
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- GMROR2241
- 23-001689 (Anden identifikator: Mayo Clinic Institutional Review Board)
- NCI-2023-07432 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
- GMROR2241 (Anden identifikator: Mayo Clinic Radiation Oncology)
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