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腹腔に化学療法と組み合わせた腹腔に投与されたパクリタキセルの添加のテスト胃癌患者の腹腔内に広がっている (STOPGAP II)

2026年10月1日 更新者：ECOG-ACRIN Cancer Research Group

プロトコルEA2234：腹腔内癌のランダム化第II/III試験と全身治療対胃癌における全身治療のみ - 停止II

This study is being done to answer the following questions:

Can we lower the chance of your gastric cancer from growing or spreading by administering paclitaxel chemotherapy directly into your abdominal cavity in addition to chemotherapy given through a vein in your arm? Will administering paclitaxel chemotherapy directly into your abdominal cavity, in addition to chemotherapy given through a vein in your arm help you live longer? We are doing this study because we want to find out if this approach is better or worse than the usual approach for your gastric cancer. The usual approach is defined as care most people get for gastric cancer.

If you decide to take part in this study, you will first receive a surgical procedure called a diagnostic laparoscopy. This will help the study doctors learn more about your gastric cancer. Laparoscopy is a minimally invasive surgery for which you will be placed under general anesthesia. Then the surgeon will make small incisions (5mm) on your belly through which a camera and thin instruments are introduced to evaluate the abdomen. This procedure takes about 1 hour to complete. Your study group will be assigned during the surgery. The study groups are described further in the 'What are the study groups?' section below.

If you are placed into the study group 1, you will not have an intraperitoneal port (a small device which is placed under the skin and fat of your upper abdomen and a tube that is placed into the abdomen).

If you are placed into the study group 2, you will have an intraperitoneal port placed. The reason is that in addition to standard chemotherapy, which is given through a vein in your arm, this port will be used to deliver the medication paclitaxel directly inside your abdomen when you are ready to start study treatment.

It is important to know that you will not know your study group until after the surgery is over. This is because information that is learned during the surgery will help determine which study group you are put in.

Once you have fully healed from this surgery, you will start study treatment. Depending on which study group you are assigned, you will either receive a standard chemotherapy regimen (the regimen will be chosen by you and your doctor) if you are in study group 1, or paclitaxel through a tube in your belly plus chemotherapy given through a vein in your arm if you are in study group 2. All participants will get treatment for three (3) months after which you will undergo reevaluation. If the disease is under control or responding to treatment, you may continue the assigned treatment until your disease gets worse, the side effects become too severe, or you may be offered a surgical procedure to remove the cancer if the amount of disease is low and can be completely removed as determined by a surgeon.

There is a very small chance that during the laparoscopy surgical procedure, the doctor might find something called "intra-abdominal adhesions". These are areas where the stomach has healed previously and created scar tissue. If this scar tissue prevents the surgeon from being able to place a port in the correct area, you would be ineligible to receive the study treatment. If this happens, you may still receive standard of care therapy after your surgery, but you will not be able to continue on the study. If you have more questions about this, you can ask your surgeon or the study team to help.

After you finish your study treatment, your doctor or study team will watch you for side effects. They will continue to follow your condition every three (3) months during the first two (2) years, then every six (6) months until year 5. You may be reevaluated with Chest/Abdomen/Pelvis scans every three-six (3-6) months for up to five (5) years if decided by your doctor.

調査の概要

状態

募集

条件

介入・治療

詳細な説明

PRIMARY OBJECTIVES:

I. In the phase II portion, to determine the progression free survival (PFS) from randomization.

II. In the phase III portion, to determine overall survival (OS) from randomization.

SECONDARY OBJECTIVE:

I. To compare the safety and tolerability of the intraperitoneal chemotherapy + systemic therapy regimen vs the systemic therapy alone regimen.

OUTLINE:

STEP 0: Patients undergo diagnostic laparoscopy within 4 weeks of study registration.

STEP 1: Patients are randomized to 1 of 2 arms at the time of Step 0 diagnostic laparoscopy.

ARM A: Patients receive standard of care systemic therapy per physician's choice. Patients with stable disease or a response after 12 weeks may continue to receive standard of care treatment in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection and computed tomography (CT) and/or magnetic resonance imaging (MRI) throughout the study and may undergo additional diagnostic laparoscopies as clinically indicated.

ARM B: Patients undergo placement of an intraperitoneal port. Patients receive leucovorin calcium intravenously (IV) over 15-30 minutes, fluorouracil IV push, paclitaxel IV over 1-2 hours and paclitaxel intraperitoneally (IP) on days 1 and 8 of each cycle. Cycles repeat every 21 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity. Patients with stable disease or a response after 12 weeks may continue to receive treatment in the absence of disease progression or unacceptable toxicity. Patients undergo blood sample collection and CT and/or MRI throughout the study and may undergo additional diagnostic laparoscopies as clinically indicated.

After completion of study treatment, patients are followed up every 3 months for 2 years then every 6 months for up to 5 years after Step 1 randomization.

研究の種類

介入

入学 (推定)

148

段階

  • フェーズ2
  • フェーズ 3

連絡先と場所

このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。

研究場所

  • アメリカ
    • California
      • Irvine、California、アメリカ、92612
        • 募集
        • UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
        • コンタクト：
          • Site Public Contact
          • 電話番号：877-827-8839
          • メール：ucstudy@uci.edu
        • 主任研究者：
          • Maheswari Senthil
      • Los Angeles、California、アメリカ、90048
        • 募集
        • Cedars-Sinai Medical Center
        • 主任研究者：
          • Alexandra Gangi
        • コンタクト：
      • Orange、California、アメリカ、92868
        • 募集
        • UC Irvine Health/Chao Family Comprehensive Cancer Center
        • コンタクト：
          • Site Public Contact
          • 電話番号：877-827-8839
          • メール：ucstudy@uci.edu
        • 主任研究者：
          • Maheswari Senthil
      • Palo Alto、California、アメリカ、94304
        • 募集
        • Stanford Cancer Institute Palo Alto
        • コンタクト：
        • 主任研究者：
          • Byrne Lee
    • Colorado
      • Aurora、Colorado、アメリカ、80045
        • 募集
        • UCHealth University of Colorado Hospital
        • コンタクト：
          • Site Public Contact
          • 電話番号：720-848-0650
        • 主任研究者：
          • Sunnie S. Kim
    • Connecticut
      • Derby、Connecticut、アメリカ、06418
        • 募集
        • Smilow Cancer Hospital-Derby Care Center
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
      • Fairfield、Connecticut、アメリカ、06824
        • 募集
        • Smilow Cancer Hospital Care Center-Fairfield
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
      • Greenwich、Connecticut、アメリカ、06830
        • 募集
        • Smilow Cancer Hospital Care Center at Greenwich
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
      • Guilford、Connecticut、アメリカ、06437
        • 募集
        • Smilow Cancer Hospital Care Center - Guilford
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
      • New Haven、Connecticut、アメリカ、06520
        • 募集
        • Yale University
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
      • North Haven、Connecticut、アメリカ、06473
        • 募集
        • Yale-New Haven Hospital North Haven Medical Center
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
      • Stamford、Connecticut、アメリカ、06902
        • 募集
        • Smilow Cancer Hospital Care Center at Long Ridge
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
      • Torrington、Connecticut、アメリカ、06790
        • 募集
        • Smilow Cancer Hospital-Torrington Care Center
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
      • Trumbull、Connecticut、アメリカ、06611
        • 募集
        • Smilow Cancer Hospital Care Center-Trumbull
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
      • Waterbury、Connecticut、アメリカ、06708
        • 募集
        • Smilow Cancer Hospital-Waterbury Care Center
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
      • Waterford、Connecticut、アメリカ、06385
        • 募集
        • Smilow Cancer Hospital Care Center - Waterford
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
    • Florida
      • Gainesville、Florida、アメリカ、32610
        • 募集
        • UF Health Cancer Institute - Gainesville
        • コンタクト：
          • Site Public Contact
          • 電話番号：352-273-8010
        • 主任研究者：
          • Lakshmi Balasubramanian
    • Georgia
      • Atlanta、Georgia、アメリカ、30322
        • 募集
        • Emory University Hospital/Winship Cancer Institute
        • コンタクト：
          • Site Public Contact
          • 電話番号：404-778-1868
        • 主任研究者：
          • Seth Concors
      • Atlanta、Georgia、アメリカ、30308
        • 募集
        • Emory University Hospital Midtown
        • コンタクト：
          • Site Public Contact
          • 電話番号：888-946-7447
        • 主任研究者：
          • Seth Concors
      • Atlanta、Georgia、アメリカ、30342
        • 募集
        • Emory Saint Joseph's Hospital
        • コンタクト：
          • Site Public Contact
          • 電話番号：404-851-7115
        • 主任研究者：
          • Seth Concors
    • Illinois
      • Chicago、Illinois、アメリカ、60637
        • 募集
        • University of Chicago Comprehensive Cancer Center
        • コンタクト：
        • 主任研究者：
          • Mecker G. Moller
      • Chicago、Illinois、アメリカ、60611
        • 募集
        • Northwestern University
        • コンタクト：
        • 主任研究者：
          • Brett L. Ecker
      • Chicago、Illinois、アメリカ、60641
        • 募集
        • Northwestern Medicine Cancer Center Old Irving Park
        • コンタクト：
        • 主任研究者：
          • Brett L. Ecker
      • DeKalb、Illinois、アメリカ、60115
        • 募集
        • Northwestern Medicine Cancer Center Kishwaukee
        • コンタクト：
        • 主任研究者：
          • Brett L. Ecker
      • Geneva、Illinois、アメリカ、60134
        • 募集
        • Northwestern Medicine Cancer Center Delnor
        • コンタクト：
        • 主任研究者：
          • Brett L. Ecker
      • Oak Brook、Illinois、アメリカ、60523
      • Shiloh、Illinois、アメリカ、62269
        • 募集
        • Memorial Hospital East
        • コンタクト：
        • 主任研究者：
          • Ramon Jin
      • Warrenville、Illinois、アメリカ、60555
        • 募集
        • Northwestern Medicine Cancer Center Warrenville
        • コンタクト：
        • 主任研究者：
          • Brett L. Ecker
    • Kentucky
      • Lexington、Kentucky、アメリカ、40536
        • 募集
        • University of Kentucky/Markey Cancer Center
        • コンタクト：
          • Site Public Contact
          • 電話番号：859-257-3379
        • 主任研究者：
          • Prakash K. Pandalai
    • Louisiana
      • New Orleans、Louisiana、アメリカ、70112
        • 募集
        • University Medical Center New Orleans
        • コンタクト：
        • 主任研究者：
          • Kevin M. Sullivan
    • Maryland
      • Baltimore、Maryland、アメリカ、21201
        • 募集
        • University of Maryland/Greenebaum Cancer Center
        • コンタクト：
          • Site Public Contact
          • 電話番号：800-888-8823
        • 主任研究者：
          • Jeremy L. Davis
    • Michigan
      • Ann Arbor、Michigan、アメリカ、48109
        • 募集
        • University of Michigan Rogel Cancer Center
        • 主任研究者：
          • Thomas Enzler
        • コンタクト：
      • Detroit、Michigan、アメリカ、48202
        • 募集
        • Henry Ford Hospital
        • コンタクト：
        • 主任研究者：
          • Rupen Shah
      • Grand Rapids、Michigan、アメリカ、49503
        • 募集
        • Corewell Health Grand Rapids Hospitals - Butterworth Hospital
        • コンタクト：
        • 主任研究者：
          • Kathleen Y. Butler
      • Kalamazoo、Michigan、アメリカ、49007
        • 募集
        • West Michigan Cancer Center
        • コンタクト：
        • 主任研究者：
          • Kathleen Y. Butler
    • Minnesota
      • Rochester、Minnesota、アメリカ、55905
        • 募集
        • Mayo Clinic in Rochester
        • コンタクト：
          • Site Public Contact
          • 電話番号：855-776-0015
        • 主任研究者：
          • Travis E. Grotz
    • Missouri
      • City of Saint Peters、Missouri、アメリカ、63376
        • 募集
        • Siteman Cancer Center at Saint Peters Hospital
        • コンタクト：
        • 主任研究者：
          • Ramon Jin
      • Creve Coeur、Missouri、アメリカ、63141
        • 募集
        • Siteman Cancer Center at West County Hospital
        • コンタクト：
        • 主任研究者：
          • Ramon Jin
      • St Louis、Missouri、アメリカ、63110
        • 募集
        • Washington University School of Medicine
        • コンタクト：
        • 主任研究者：
          • Ramon Jin
      • St Louis、Missouri、アメリカ、63129
        • 募集
        • Siteman Cancer Center-South County
        • コンタクト：
        • 主任研究者：
          • Ramon Jin
      • St Louis、Missouri、アメリカ、63136
        • 募集
        • Siteman Cancer Center at Christian Hospital
        • コンタクト：
        • 主任研究者：
          • Ramon Jin
    • New Jersey
      • Basking Ridge、New Jersey、アメリカ、07920
        • 募集
        • Memorial Sloan Kettering Basking Ridge
        • コンタクト：
          • Site Public Contact
          • 電話番号：212-639-7592
        • 主任研究者：
          • George Z. Li
      • Middletown、New Jersey、アメリカ、07748
        • 募集
        • Memorial Sloan Kettering Monmouth
        • コンタクト：
          • Site Public Contact
          • 電話番号：212-639-7592
        • 主任研究者：
          • George Z. Li
      • Montvale、New Jersey、アメリカ、07645
        • 募集
        • Memorial Sloan Kettering Bergen
        • コンタクト：
          • Site Public Contact
          • 電話番号：212-639-7592
        • 主任研究者：
          • George Z. Li
      • New Brunswick、New Jersey、アメリカ、08903
        • 募集
        • Rutgers Cancer Institute of New Jersey
        • コンタクト：
          • Site Public Contact
          • 電話番号：732-235-7356
        • 主任研究者：
          • Haejin In
    • New Mexico
      • Albuquerque、New Mexico、アメリカ、87106
        • 募集
        • University of New Mexico Cancer Center
        • 主任研究者：
          • Alissa Greenbaum
        • コンタクト：
    • New York
      • Commack、New York、アメリカ、11725
        • 募集
        • Memorial Sloan Kettering Commack
        • コンタクト：
          • Site Public Contact
          • 電話番号：212-639-7592
        • 主任研究者：
          • George Z. Li
      • Harrison、New York、アメリカ、10604
        • 募集
        • Memorial Sloan Kettering Westchester
        • コンタクト：
          • Site Public Contact
          • 電話番号：212-639-7592
        • 主任研究者：
          • George Z. Li
      • Mineola、New York、アメリカ、11501
        • 募集
        • NYU Langone Hospital - Long Island
        • コンタクト：
        • 主任研究者：
          • Zachary J. Brown
      • New York、New York、アメリカ、10065
        • 募集
        • Memorial Sloan Kettering Cancer Center
        • コンタクト：
          • Site Public Contact
          • 電話番号：212-639-7592
        • 主任研究者：
          • George Z. Li
      • New York、New York、アメリカ、10016
        • 募集
        • Laura and Isaac Perlmutter Cancer Center at NYU Langone
        • コンタクト：
        • 主任研究者：
          • Zachary J. Brown
      • Uniondale、New York、アメリカ、11553
        • 募集
        • Memorial Sloan Kettering Nassau
        • コンタクト：
          • Site Public Contact
          • 電話番号：212-639-7592
        • 主任研究者：
          • George Z. Li
    • North Carolina
      • Chapel Hill、North Carolina、アメリカ、27599
        • 募集
        • UNC Lineberger Comprehensive Cancer Center
        • コンタクト：
        • 主任研究者：
          • Ashwin Somasundaram
      • Hillsborough、North Carolina、アメリカ、27278
        • 募集
        • University of North Carolina-Hillsborough Campus
        • コンタクト：
        • 主任研究者：
          • Ashwin Somasundaram
      • Winston-Salem、North Carolina、アメリカ、27157
        • 募集
        • Wake Forest University Health Sciences
        • 主任研究者：
          • Edward A. Levine
        • コンタクト：
          • Site Public Contact
          • 電話番号：336-713-6771
    • North Dakota
      • Fargo、North Dakota、アメリカ、58122
    • Ohio
      • Columbus、Ohio、アメリカ、43210
        • 募集
        • Ohio State University Comprehensive Cancer Center
        • コンタクト：
        • 主任研究者：
          • Pamela W. Lu
    • Oregon
      • Portland、Oregon、アメリカ、97239
        • 募集
        • Oregon Health and Science University
        • コンタクト：
          • Site Public Contact
          • 電話番号：503-494-1080
          • メール：trials@ohsu.edu
        • 主任研究者：
          • Divya Sood
    • Pennsylvania
      • Philadelphia、Pennsylvania、アメリカ、19107
        • 募集
        • Thomas Jefferson University Hospital
        • コンタクト：
        • 主任研究者：
          • Nader Hanna
      • Pittsburgh、Pennsylvania、アメリカ、15237
        • 募集
        • UPMC-Passavant Hospital
        • コンタクト：
          • Site Public Contact
          • 電話番号：412-367-6454
        • 主任研究者：
          • Mohammad Haroon A. Choudry
      • Pittsburgh、Pennsylvania、アメリカ、15232
        • 募集
        • UPMC Hillman Cancer Center
        • コンタクト：
          • Site Public Contact
          • 電話番号：412-647-8073
        • 主任研究者：
          • Mohammad Haroon A. Choudry
    • Rhode Island
      • Westerly、Rhode Island、アメリカ、02891
        • 募集
        • Smilow Cancer Hospital Care Center - Westerly
        • コンタクト：
        • 主任研究者：
          • Raghav Sundar
    • Tennessee
      • Nashville、Tennessee、アメリカ、37232
        • 募集
        • Vanderbilt University/Ingram Cancer Center
        • コンタクト：
          • Site Public Contact
          • 電話番号：800-811-8480
        • 主任研究者：
          • Deepa Magge
    • Texas
      • Dallas、Texas、アメリカ、75390
        • 募集
        • UT Southwestern/Simmons Cancer Center-Dallas
        • コンタクト：
        • 主任研究者：
          • Alex C. Kim
      • Dallas、Texas、アメリカ、75235
        • 募集
        • Parkland Memorial Hospital
        • コンタクト：
        • 主任研究者：
          • Alex C. Kim
      • Dallas、Texas、アメリカ、75237
        • 募集
        • UT Southwestern Simmons Cancer Center - RedBird
        • 主任研究者：
          • Alex C. Kim
        • コンタクト：
      • Fort Worth、Texas、アメリカ、76104
        • 募集
        • UT Southwestern/Simmons Cancer Center-Fort Worth
        • コンタクト：
        • 主任研究者：
          • Alex C. Kim
      • Richardson、Texas、アメリカ、75080
        • 募集
        • UT Southwestern Clinical Center at Richardson/Plano
        • コンタクト：
        • 主任研究者：
          • Alex C. Kim
    • Utah
      • Salt Lake City、Utah、アメリカ、84112
        • 募集
        • Huntsman Cancer Institute/University of Utah
        • コンタクト：
        • 主任研究者：
          • Erin P. Ward
    • Wisconsin
      • Madison、Wisconsin、アメリカ、53792
        • 募集
        • University of Wisconsin Carbone Cancer Center - University Hospital
        • 主任研究者：
          • Nataliya V. Uboha
        • コンタクト：
      • Madison、Wisconsin、アメリカ、53718
        • 募集
        • University of Wisconsin Carbone Cancer Center - Eastpark Medical Center
        • 主任研究者：
          • Nataliya V. Uboha
        • コンタクト：
      • Marshfield、Wisconsin、アメリカ、54449
      • Menomonee Falls、Wisconsin、アメリカ、53051
        • 募集
        • Froedtert Menomonee Falls Hospital
        • コンタクト：
          • Site Public Contact
          • 電話番号：262-257-5100
        • 主任研究者：
          • Ugwuji N. Maduekwe
      • Milwaukee、Wisconsin、アメリカ、53226
        • 募集
        • Medical College of Wisconsin
        • コンタクト：
          • Site Public Contact
          • 電話番号：414-805-3666
        • 主任研究者：
          • Ugwuji N. Maduekwe
      • New Berlin、Wisconsin、アメリカ、53151
        • 募集
        • Froedtert and MCW Moorland Reserve Health Center
        • コンタクト：
          • Site Public Contact
          • 電話番号：414-805-0505
        • 主任研究者：
          • Ugwuji N. Maduekwe
      • Oak Creek、Wisconsin、アメリカ、53154
        • 募集
        • Drexel Town Square Health Center
        • コンタクト：
          • Site Public Contact
          • 電話番号：414-805-0505
        • 主任研究者：
          • Ugwuji N. Maduekwe
      • West Bend、Wisconsin、アメリカ、53095
        • 募集
        • Froedtert West Bend Hospital/Kraemer Cancer Center
        • コンタクト：
          • Site Public Contact
          • 電話番号：414-805-0505
        • 主任研究者：
          • Ugwuji N. Maduekwe
      • Weston、Wisconsin、アメリカ、54476

参加基準

研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。

適格基準

就学可能な年齢

18年歳以上 (大人、高齢者)

健康ボランティアの受け入れ

いいえ

受講資格のある性別

全て

説明

STEP 0 REGISTRATION:

  • Patient must be at least 18 years of age

  • Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1

  • Patient must have histologically or cytologically confirmed microsatellite stable (MSS) or mismatch repair (MMR) protein expression proficient primary gastric or gastroesophageal adenocarcinoma (Siewert 3) with synchronous cytology positive disease (cyt+) OR peritoneal carcinomatosis detected by imaging, laparoscopy or laparotomy. Patients with microsatellite instability-high (MSI-H/dMMR) mismatch repair deficient disease are not eligible

  • Patient must have received a minimum of 3 months and a maximum of 6 months of first line systemic treatment

  • Patient must be registered to Step 0 within 4 weeks of the last dose of first line systemic therapy. Patient must not have any ongoing significant adverse events that would prohibit them from undergoing a diagnostic laparoscopy procedure followed by further systemic and intraperitoneal therapy

  • Patient must have no evidence of small or large bowel obstruction other than gastric outlet obstruction due to primary malignancy

  • Patient must have no evidence of solid organ metastases except for ovarian metastases. Baseline imaging must be done within 30 days prior to Step 0 registration

  • Patient must have no evidence of clinically significant radiologic peritoneal disease progression during first line systemic therapy

  • Patient must have no evidence of extensive retroperitoneal lymph node metastases not amenable to resection during gastrectomy

  • Patient must have no history of prior surgery that would preclude safe diagnostic laparoscopy and port placement

  • Patient must have no evidence of massive ascites on imaging or history of two therapeutic paracentesis with drainage of more than 1.0 liter of ascites each time in 30 days prior to Step 0 registration

  • Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class II or better

  • Patient must not have any uncontrolled intercurrent illness or any other significant condition(s) that would make this protocol unreasonably hazardous

  • Patient must not have any known contraindications or drug allergies to the protocol treatment agents: paclitaxel, 5-fluorouracil, or leucovorin

  • Leukocytes ≥ 2,000/uL (≤ 30 days prior to Step 0 registration)

  • Absolute neutrophil count (ANC) ≥ 1,500/uL (≤ 30 days prior to Step 0 registration)

  • Platelets ≥ 75,000/uL (≤ 30 days prior to Step 0 registration)

  • Total bilirubin ≤ 1.5 institutional upper limit of normal (ULN). If patient has Gilbert's syndrome, total bilirubin must be < 2.0 mg/dL (≤ 30 days prior to Step 0 registration)

  • Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT)(serum glutamic pyruvic transaminase [SGPT]) ≤ 3.0 x institutional ULN (≤ 30 days prior to Step 0 registration)

  • Creatinine clearance ≥ 30 mL/min (estimated using Cockcroft and Gault formula or measured) (≤ 30 days prior to Step 0 registration)

  • Hemoglobin ≥ 8 g/dL (≤ 30 days prior to Step 0 registration)

  • Serum albumin ≥ 2.5 g/dL (≤ 30 days prior to Step 0 registration)

  • Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months of Step 0 registration are eligible for this trial

  • For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated

  • Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load

  • Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial

  • Patient must not be pregnant or breast-feeding due to the potential harm to an unborn fetus and possible risk for adverse events in nursing infants with the treatment regimens being used

    • All patients of childbearing potential must have a blood test or urine study within 14 days prior to Step 0 registration to rule out pregnancy
    • A patient of childbearing potential is defined as anyone, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy; or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)

  • Patient must not expect to conceive or father children by using accepted and effective method(s) of contraception (or by abstaining from sexual intercourse) for the duration of their participation in the study. Arm A patients must adhere to the contraceptive requirements outlined in the product specific package inserts while on protocol treatment. Arm B patients must continue contraceptive measures for at least 3 months after the last dose of protocol treatment. In addition, both Arm A and Arm B patients who continue with targeted agents must adhere to the contraceptive requirements outlined in the product specific package inserts while on protocol treatment

  • Patient must have the ability to understand and the willingness to sign a written informed consent document. Patients with impaired decision-making capacity (IDMC) who have a legally authorized representative (LAR) or caregiver and/or family member available will also be considered eligible

STEP 1 RANDOMIZATION:

  • Patient must have undergone a diagnostic laparoscopy with peritoneal lavage performed and aspiration for cytology obtained
  • The extent of peritoneal disease burden must have been assessed during the diagnostic laparoscopy with the Peritoneal Cancer Index (PCI) available
  • Patient must not have extensive intraabdominal adhesions that preclude safe placement of the intraperitoneal port

研究計画

このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。

研究はどのように設計されていますか？

デザインの詳細

  • 主な目的：処理
  • 割り当て：ランダム化
  • 介入モデル：並列代入
  • マスキング：なし（オープンラベル）

武器と介入

参加者グループ / アーム
介入・治療
アクティブコンパレータ：Step 1, Arm A (standard systemic therapy)

Patients on Arm A will start systemic therapy with physician's choice of any standard-of-care systemic regimen for gastric/GEJ adenocarcinoma. Patients on Arm A will start systemic therapy as early as the day after Step 1 randomization and must start within 30 calendar days (including holidays) after Step 1 randomization. After 12 weeks (+/- 2 weeks) of standard of care treatment, patients will undergo a restaging assessment as outlined in Section 5.2 (restaging will occur at this timepoint, regardless of if the patient completed all 4 cycles or not). Patients who are found to have stable disease or a response may continue assigned standard of care treatment and will undergo restaging every 12 weeks (+/- 2 weeks) as outlined in Section 5.2. Treatment will continue until progression (radiographic progression or clinical progression as defined in Section 6), intolerance (unacceptable toxicity), or cytoreduction.
薬：Standard of Care Chemotherapy

The most common regimens are FOLFOX, CAPOX, FLOT, CF, and CX. Other local institutional standard of care regimens as well as targeted agents for gastric/GEJ adenocarcinoma are allowed.

他の名前：
  • 標準治療
  • ベストプラクティス
手順：Biospecimen Collection

Plasma is to be submitted at baseline and every three months for the first year or until progression, whichever comes first. For patients who have progression, their last plasma sample should be at time of progression.

他の名前：
  • 生物学的サンプルの収集
  • 採取された生体試料
  • 標本収集
手順：Computed Tomography

Restaging imaging with CT and/or diffusion weighted MRI with contrast will be obtained after completion of 12 weeks (+/- 2 weeks) of assigned treatment (restaging will occur at this timepoint, regardless of if the patient completed all 4 cycles or not). At this point, patients with stable disease or a response will continue assigned treatment. In the absence of radiological or clinical progression, if clinically indicated by treatment team, patients may undergo diagnostic laparoscopy to assess surgical candidacy at which time a PCI assessment and biopsies of peritoneal nodules, peritoneal lavage could be performed. Cytoreduction can be offered to patients with a PCI < 7 and if complete cytoreduction is feasible based on treating surgeon's discretion. If deemed a candidate for surgical cytoreduction, surgery should be performed within 6 weeks of the last study treatment in both arms.

他の名前：
  • CT
  • 猫
  • CATスキャン
  • コンピューター断層撮影
  • コンピュータ化されたアキシャルトモグラフィー
  • CTスキャン
  • トモグラフィー
  • コンピューター断層撮影 (手順)
  • コンピューター断層撮影 (CT) スキャン
手順：Diagnostic Laparoscopy

After induction of general anesthesia, administration of preoperative antibiotics and placement of appropriate laparoscopic ports, peritoneal lavage will be performed by instillation of 200 ml of normal saline in the left upper quadrant and allowed to dwell for 5 minutes after which it will be aspirated for cytology. Extent of peritoneal disease burden will be ascertained as per the Peritoneal Cancer Index (PCI) scoring system as outlined in Appendix V.

手順：Magnetic Resonance Imaging

Restaging imaging with CT and/or diffusion weighted MRI with contrast will be obtained after completion of 12 weeks (+/- 2 weeks) of assigned treatment (restaging will occur at this timepoint, regardless of if the patient completed all 4 cycles or not). At this point, patients with stable disease or a response will continue assigned treatment. In the absence of radiological or clinical progression, if clinically indicated by treatment team, patients may undergo diagnostic laparoscopy to assess surgical candidacy at which time a PCI assessment and biopsies of peritoneal nodules, peritoneal lavage could be performed. Cytoreduction can be offered to patients with a PCI < 7 and if complete cytoreduction is feasible based on treating surgeon's discretion. If deemed a candidate for surgical cytoreduction, surgery should be performed within 6 weeks of the last study treatment in both arms.

他の名前：
  • MRI
  • 磁気共鳴
  • 磁気共鳴画像スキャン
  • 医用画像、磁気共鳴 / 核磁気共鳴
  • 氏
  • MRイメージング
  • MRI スキャン
  • NMRイメージング
  • NMRI
  • 核磁気共鳴イメージング
  • 磁気共鳴画像法 (MRI)
  • sMRI
  • 磁気共鳴画像法（手順）
  • 構造MRI
実験的：Step 1, Arm B (Systemic Therapy + Intraperitoneal Paclitaxel)

Patients on Arm B will start systemic therapy + intraperitoneal paclitaxel as early as the day after Step 1 randomization and must start within 30 calendar days (including holidays) after Step 1 randomization.

Therapy will be administered on Days 1 and 8 of a 21-day cycle for 4 cycles. After 12 weeks (+/- 2 weeks) of study treatment, patients will undergo restaging assessments as outlined in Section 5.2 (restaging will occur at this timepoint, regardless of if the patient completed all 4 cycles or not). Patients who are found to have stable disease or a response may continue assigned protocol treatment and will undergo restaging every 12 weeks (+/- 2 weeks) as outlined in Section 5.2. Treatment will continue until progression (radiographic progression or clinical progression as defined in Section 6), intolerance (unacceptable toxicity), or cytoreduction.
薬：Standard of Care Chemotherapy

The most common regimens are FOLFOX, CAPOX, FLOT, CF, and CX. Other local institutional standard of care regimens as well as targeted agents for gastric/GEJ adenocarcinoma are allowed.

他の名前：
  • 標準治療
  • ベストプラクティス
手順：Biospecimen Collection

Plasma is to be submitted at baseline and every three months for the first year or until progression, whichever comes first. For patients who have progression, their last plasma sample should be at time of progression.

他の名前：
  • 生物学的サンプルの収集
  • 採取された生体試料
  • 標本収集
手順：Computed Tomography

Restaging imaging with CT and/or diffusion weighted MRI with contrast will be obtained after completion of 12 weeks (+/- 2 weeks) of assigned treatment (restaging will occur at this timepoint, regardless of if the patient completed all 4 cycles or not). At this point, patients with stable disease or a response will continue assigned treatment. In the absence of radiological or clinical progression, if clinically indicated by treatment team, patients may undergo diagnostic laparoscopy to assess surgical candidacy at which time a PCI assessment and biopsies of peritoneal nodules, peritoneal lavage could be performed. Cytoreduction can be offered to patients with a PCI < 7 and if complete cytoreduction is feasible based on treating surgeon's discretion. If deemed a candidate for surgical cytoreduction, surgery should be performed within 6 weeks of the last study treatment in both arms.

他の名前：
  • CT
  • 猫
  • CATスキャン
  • コンピューター断層撮影
  • コンピュータ化されたアキシャルトモグラフィー
  • CTスキャン
  • トモグラフィー
  • コンピューター断層撮影 (手順)
  • コンピューター断層撮影 (CT) スキャン
手順：Diagnostic Laparoscopy

After induction of general anesthesia, administration of preoperative antibiotics and placement of appropriate laparoscopic ports, peritoneal lavage will be performed by instillation of 200 ml of normal saline in the left upper quadrant and allowed to dwell for 5 minutes after which it will be aspirated for cytology. Extent of peritoneal disease burden will be ascertained as per the Peritoneal Cancer Index (PCI) scoring system as outlined in Appendix V.

手順：Magnetic Resonance Imaging

Restaging imaging with CT and/or diffusion weighted MRI with contrast will be obtained after completion of 12 weeks (+/- 2 weeks) of assigned treatment (restaging will occur at this timepoint, regardless of if the patient completed all 4 cycles or not). At this point, patients with stable disease or a response will continue assigned treatment. In the absence of radiological or clinical progression, if clinically indicated by treatment team, patients may undergo diagnostic laparoscopy to assess surgical candidacy at which time a PCI assessment and biopsies of peritoneal nodules, peritoneal lavage could be performed. Cytoreduction can be offered to patients with a PCI < 7 and if complete cytoreduction is feasible based on treating surgeon's discretion. If deemed a candidate for surgical cytoreduction, surgery should be performed within 6 weeks of the last study treatment in both arms.

他の名前：
  • MRI
  • 磁気共鳴
  • 磁気共鳴画像スキャン
  • 医用画像、磁気共鳴 / 核磁気共鳴
  • 氏
  • MRイメージング
  • MRI スキャン
  • NMRイメージング
  • NMRI
  • 核磁気共鳴イメージング
  • 磁気共鳴画像法 (MRI)
  • sMRI
  • 磁気共鳴画像法（手順）
  • 構造MRI
手順：Intraperitoneal Port Placement

Patients assigned to Arm B will undergo placement of indwelling tunneled intraperitoneal port with Teflon cuff following Step 1 randomization and during the diagnostic laparoscopy procedure.

薬：Intraperitoneal Paclitaxel

Patients on Arm B will start systemic therapy + intraperitoneal paclitaxel as early as the day after Step 1 randomization and must start within 30 calendar days (including holidays) after Step 1 randomization as per the schedule shown in the table below.

Therapy will be administered on Days 1 and 8 of a 21-day cycle for 4 cycles.

この研究は何を測定していますか？

主要な結果の測定

結果測定
メジャーの説明
時間枠
Progression free survival (Phase II)
時間枠：From randomization to progression or death without documentation of progression, assessed up to 5 years.

For the Phase II portion, full information is expected to occur 12 months after accrual or 38 months after study activation. This power calculation is based on a stratified log rank test and accounts for a planned interim analysis at 50% information time. At 50% information time, futility test using Wieand rule would be conducted. If the study results show promising results for the investigational arm and reject the null hypothesis at interim efficacy analysis, the study will proceed to investigate Phase III portion without having a pause in accrual before starting Phase III. Otherwise, if the study is not futile at 50% information time (HR>1), then the study will proceed and wait for the data to reach 100% information, meaning that the study will wait until the data is mature for Phase II analysis (projected to wait 12 months after end of the accrual to collect 58 PFS events).
From randomization to progression or death without documentation of progression, assessed up to 5 years.
Overall survival (Phase III)
時間枠：From randomization to the date of death, of any cause, assessed up to 5 years

For the Phase III portion, a futility interim analysis is planned at 50% information time, projected to occur 4.3 years after study activation. However, because of the potential one year pause before starting Phase III portion, the futility interim analysis may occur early. Similar to the Phase II portion, the interim analysis for futility would use the Wieand rule to make sure the investigational arm is not doing worse than the control arm. For efficacy, interim analysis would start at 30% information time and be conducted every 6 months subsequently accordingly with the DSMC monitoring schedule. Approximately 1.5 additional years after completion of accrual, the OS analysis will reach 100% information time with 105 OS events.
From randomization to the date of death, of any cause, assessed up to 5 years

二次結果の測定

結果測定
メジャーの説明
時間枠
Incidence of adverse events
時間枠：Up to 30 days after the last day of protocol treatment

Safety and tolerability will be assessed by counting treatment-related grade 3 or higher toxicity events of the patients.
Up to 30 days after the last day of protocol treatment

協力者と研究者

ここでは、この調査に関係する人々や組織を見つけることができます。

スポンサー

ECOG-ACRIN Cancer Research Group

協力者

National Cancer Institute (NCI)

捜査官

  • 主任研究者：Maheswari Senthil、ECOG-ACRIN Cancer Research Group

研究記録日

これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。

主要日程の研究

研究開始 (実際)

2025年10月24日

一次修了 (推定)

2030年5月30日

研究の完了 (推定)

2031年5月30日

試験登録日

最初に提出

2025年5月23日

QC基準を満たした最初の提出物

2025年5月23日

最初の投稿 (実際)

2025年6月3日

学習記録の更新

投稿された最後の更新 (実際)

2026年10月5日

QC基準を満たした最後の更新が送信されました

2026年10月1日

最終確認日

2026年10月1日

詳しくは

本研究に関する用語

キーワード

追加の関連 MeSH 用語

その他の研究ID番号

  • EA2234
  • U10CA180820 (米国 NIH グラント/契約)
  • EA2234 (その他の識別子：CTEP)
  • NCI-2025-01831 (レジストリ識別子：CTRP (Clinical Trial Reporting Program))
  • EA2234 (その他の識別子：ECOG-ACRIN Cancer Research Group)

個々の参加者データ (IPD) の計画

個々の参加者データ (IPD) を共有する予定はありますか?

未定

医薬品およびデバイス情報、研究文書

米国FDA規制医薬品の研究

いいえ

米国FDA規制機器製品の研究

いいえ

米国で製造され、米国から輸出された製品。

いいえ

この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。

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