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Præoperativ hypofraktioneret strålebehandling med FOLFOX til adenokarcinom i spiserøret eller gastroøsofageal Junction (PHOX)

29. september 2026 opdateret af: Mayo Clinic

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

Rekruttering

Betingelser

Intervention / Behandling

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

Interventionel

Tilmelding (Anslået)

99

Fase

  • Fase 2

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiekontakt

Studiesteder

    • Arizona
      • Scottsdale, Arizona, Forenede Stater, 85259
        • Ikke rekrutterer endnu
        • Mayo Clinic in Arizona
        • Kontakt:
        • 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:
        • Ledende efterforsker:
          • Christopher L. Hallemeier, MD

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

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

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: N/A
  • Interventionel model: Enkelt gruppeopgave
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / 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:
  • Taxotere
  • Docecad
  • RP56976
  • RP 56976
  • RP-56976
  • 148408-66-6
  • N-debenzoyl-N-(tert-butoxycarbonyl)-10-deacetyltaxol

Given IV

Andre navne:
  • 5-Fluracil
  • Fluracil
  • 5 Fluorouracil
  • 5 Fluorouracilum
  • 5 FU
  • 5-fluor-2,4(1H,3H)-pyrimidindion
  • 5-Fluorouracil
  • 5-Fu
  • 5FU
  • AccuSite
  • Carac
  • Fluor Uracil
  • Fluouracil
  • Flurablastin
  • Fluracedyl
  • Fluril
  • Fluroblastin
  • Ribofluor
  • Ro 2-9757
  • Ro-2-9757
  • 2,4-Dioxo-5-fluorpyrimidin
  • 51-21-8

Undergo blood sample collection

Andre navne:
  • Biologisk prøvesamling
  • Bioprøve indsamlet
  • Prøvesamling

Given IV

Andre navne:
  • Wellcovorin
  • folinsyre
  • Adinepar
  • Calcifolin
  • Calcium (6S)-folinat
  • Calciumfolinat
  • Calcium Leucovorin
  • Calfolex
  • Calinat
  • Cehafolin
  • Citofolin
  • Citrec
  • Citrovorum faktor
  • Cromatonbic Folinico
  • Dalisol
  • Disintox
  • Divical
  • Ecofol
  • Emovis
  • Faktor, Citrovorum
  • Flynoken A
  • Folaren
  • Folaxin
  • FOLI-celle
  • Foliben
  • Folidan
  • Folidar
  • Folinac
  • Folinat Calcium
  • Folinsyre Calcium Salt Pentahydrat
  • Folinoral
  • Folinvit
  • Foliplus
  • Folix
  • Imo
  • Lederfolat
  • Lederfolin
  • Leucosar
  • leukovorin
  • Rescufolin
  • Rescuvolin
  • Tonofolin

Given IV

Andre navne:
  • 1-OHP
  • Dakotin
  • Dacplat
  • Eloxatin
  • Ai Heng
  • Aiheng
  • Diaminocyclohexan Oxalatoplatin
  • JM-83
  • Oxalatoplatin
  • RP 54780
  • RP-54780
  • SR-96669
  • SR96669
  • JM83
  • RP54780

Undergo hypofractionated radiation therapy

Andre navne:
  • Hypofraktioneret strålebehandling
  • hypofraktionering
  • Stråling, Hypofraktioneret
  • Hypofraktioneret

Ancillary studies

Given IV

Andre navne:
  • Imfinzi
  • MEDI-4736
  • MEDI4736
  • MEDI 4736
  • Immunoglobulin G1
  • Anti-(Human Protein B7-H1) (Human Monoklonal MEDI4736 Heavy Chain)
  • Disulfid med Human Monoklonal MEDI4736 Kappa-kæde

Undergo EGD

Andre navne:
  • EGD
  • Øvre endoskopi

Undergo CT and PET/CT scan

Andre navne:
  • CT
  • KAT
  • CAT-scanning
  • Beregnet aksial tomografi
  • Computerstyret aksial tomografi
  • Computerstyret tomografi
  • CT-scanning
  • tomografi
  • Computerstyret aksial tomografi (procedure)
  • Computerstyret tomografi (CT) scanning

Undergo EUS

Andre navne:
  • endosonografi
  • EUS

Undergo PET and PET/CT scan

Andre navne:
  • KÆLEDYR
  • PET-scanning
  • Positron Emission Tomografi Scan
  • Positron-emissionstomografi
  • proton magnetisk resonans spektroskopisk billeddannelse
  • PT
  • Medicinsk billeddannelse
  • Positron emissionstomografi (procedure)

Hvad måler undersøgelsen?

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

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

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Efterforskere

  • Ledende efterforsker: Christopher L. Hallemeier, MD, Mayo Clinic in Rochester

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

21. november 2023

Primær færdiggørelse (Anslået)

25. maj 2029

Studieafslutning (Anslået)

25. maj 2029

Datoer for studieregistrering

Først indsendt

3. oktober 2023

Først indsendt, der opfyldte QC-kriterier

9. oktober 2023

Først opslået (Faktiske)

12. oktober 2023

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

1. oktober 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

29. september 2026

Sidst verificeret

1. september 2026

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

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)

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Ja

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ingen

produkt fremstillet i og eksporteret fra U.S.A.

Ingen

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .