RESTAGE (REpurposing STAtins to Improve Outcomes in GastroEsophageal Cancer) Trial (RESTAGE)
RESTAGE (REpurposing STAtins to Improve Outcomes in GastroEsophageal Cancer) Trial: A Phase II Randomized Open-Label Trial of Perioperative Simvastatin Plus Standard-of-Care Systemic Therapy in Gastroesophageal Adenocarcinoma
Esophageal and gastroesophageal junction cancers are serious diseases with limited cure rates, even when patients receive chemotherapy and surgery. New ways to improve treatment are urgently needed.
This study will test whether adding a commonly used cholesterol-lowering medication, simvastatin, to standard cancer treatment can improve outcomes. Simvastatin is widely used, safe, and inexpensive. Research suggests that it may also slow cancer growth by blocking pathways that cancer cells rely on for survival.
In this trial, patients will receive standard chemotherapy (with or without immunotherapy) before surgery. Half of the patients will also take simvastatin daily for up to two years. Researchers will compare how well tumors respond to treatment and whether patients remain cancer-free longer.
If successful, this approach could offer a simple and accessible way to improve survival for patients with these cancers without adding significant side effects or cost.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 2
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Lorenzo Edwin Ferri, MD, PhD
- Telefonnummer: 42835 514-934-1934
- E-mail: lorenzo.ferri@mcgill.ca
Studiesteder
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-
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Montreal, Canada
- McGill University Health Center
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Kontakt:
- Lorenzo Edwin Ferri, MD, PhD
- Telefonnummer: 42835 514-934-1934
- E-mail: lorenzo.ferri@mcgill.ca
-
-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
Inclusion Criteria:
- Signed, informed consent.
- Age, 18 years or older.
- Histological diagnosis of adenocarcinoma or poorly differentiated carcinoma of the esophagus or EGJ.
- The tumour must be deemed potentially resectable by the surgical team. This assessment is based on complete staging imaging studies (detailed below) - clinical staging of the tumor and ruling out metastatic disease.
- Locally advanced disease as defined per AJCC/UICC 8th edition37: stage IIA, IIB, III, IVA (T1-4a N2-3).
- Eligibility for standard-of-care perioperative systemic therapy with FLOT+/-D.
- Life expectancy greater than 3 months.
- ECOG performance status < 2.
Exclusion Criteria:
- Prior esophageal or gastric malignancy.
- History of allergic reactions to simvastatin or atorvastatin or similar chemical or biological compounds.
- Ongoing cholesterol-lowering therapy (statins, fibrates, ezetimibe, PCSK9 inhibitors), in which case the patient is offered enrollment in the observational arm.
- Hepatic dysfunction (alanine aminotransferase level more than three times the upper limit of the normal range) or renal dysfunction (creatinine level more than three times the upper limit of the normal range).
- Predisposing factors for rhabdomyolysis: hypothyroidism, reduced renal function, muscle disease, or excessive alcohol consumption AND creatine kinase up to less than five times the upper limit (measured in the presence of predisposing factors).
- Concurrent medication with potent CYP3A4-inhibitors, e.g. ketokonazole, erythromycin, gemfibrozil, cyclosporine, or danazol.
- Pre-existing medical conditions precluding treatment, including any contraindication systemic chemotherapy or major surgery.
- Psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule, discussed before registration in the trial.
- Pregnant and breastfeeding women.
- Unwillingness to undergo per-protocol investigations or treatments.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Aktiv komparator: Control
SOC neoadjuvant FLOT (or FLOT-D)
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Standard of care neoadjuvant FLOT
Standard of care Durvalumab added to FLOT regimen.
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Eksperimentel: Experimental
SOC neoadjuvant FLOT (or FLOT-D) + simvastatin
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Standard of care neoadjuvant FLOT
Standard of care Durvalumab added to FLOT regimen.
Investigational drug added to standard of care FLOT or FLOT+D
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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MPR
Tidsramme: From enrolment to surgical pathology assessment, 16 weeks
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Major Pathological Response
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From enrolment to surgical pathology assessment, 16 weeks
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Statin-enhanced toxicity of standard-of-care regimen, specifically grade 3 or 4 adverse events
Tidsramme: Start of neoadjuvant therapy to the end of adjuvant therapy (weeks 2-28)
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Statin-enhanced toxicity of standard-of-care regimen, specifically grade 3 or 4 adverse events, as per Common Terminology Criteria for Adverse Events (CTCAE) version 6.0, warranting dosage modification or stoppage of interventional drug or chemotherapy.
CTCAE grading is from 1 to 5, while grade 1 is the least severe (mild) and grade 5 is the most severe (death).
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Start of neoadjuvant therapy to the end of adjuvant therapy (weeks 2-28)
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2-year EFS
Tidsramme: Elapsed time from date of randomization to date of recurrence or death, within 2 years from resection
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2-year event-free-survival (EFS), defined as elapsed time from date of randomization to date of recurrence (local or distant) or death, occurring after resection
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Elapsed time from date of randomization to date of recurrence or death, within 2 years from resection
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
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
- Neoplasmer efter sted
- Neoplasmer
- Gastrointestinale neoplasmer
- Neoplasmer i fordøjelsessystemet
- Sygdomme i fordøjelsessystemet
- Gastrointestinale sygdomme
- Neoplasmer i hoved og hals
- Esophageale sygdomme
- Esophageale neoplasmer
- Organiske kemikalier
- Kulbrinter
- Kulbrinter, cyklisk
- Naphthalenes
- Polycykliske aromatiske kulbrinter
- Kulbrinter, aromatisk
- Polycykliske forbindelser
- Lovastatin
- Simvastatin
- Durvalumab
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- THOR-ESO-2026-01
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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