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Testing av tilsetning av paclitaxel administrert i bukhulen kombinert med cellegift for pasienter med gastrisk kreft spredt til bukhulen (STOPGAP II)

11. november 2026 oppdatert av: ECOG-ACRIN Cancer Research Group

Protokoll EA2234: En randomisert fase II/III -studie av intraperitoneal paclitaxel pluss systemisk behandling vs systemisk behandling alene i gastrisk karsinomatose - stopgap 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.

Studieoversikt

Status

Rekruttering

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

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.

Studietype

Intervensjonell

Registrering (Antatt)

148

Fase

  • Fase 2
  • Fase 3

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

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

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

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

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Aktiv komparator: 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.
Legemiddel: 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.

Andre navn:
  • velferdstandard
  • standard terapi
  • beste praksis
Fremgangsmåte: 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.

Andre navn:
  • Biologisk prøvesamling
  • Bioprøve samlet
  • Prøvesamling
Fremgangsmåte: 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.

Andre navn:
  • CT
  • KATT
  • CAT-skanning
  • Beregnet aksial tomografi
  • Datastyrt aksialtomografi
  • Datastyrt tomografi
  • CT skann
  • tomografi
  • Datastyrt aksial tomografi (prosedyre)
  • Datastyrt tomografi (CT) skanning
Fremgangsmåte: 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.

Fremgangsmåte: 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.

Andre navn:
  • MR
  • Magnetisk resonans
  • Magnetic Resonance Imaging Scan
  • Medisinsk bildebehandling, magnetisk resonans / kjernemagnetisk resonans
  • MR Imaging
  • MR-skanning
  • NMR-avbildning
  • NMRI
  • Kjernemagnetisk resonansavbildning
  • Magnetisk resonanstomografi (MR)
  • sMRI
  • Magnetisk resonansavbildning (prosedyre)
  • MR-er
  • Strukturell MR
Eksperimentell: 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.
Legemiddel: 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.

Andre navn:
  • velferdstandard
  • standard terapi
  • beste praksis
Fremgangsmåte: 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.

Andre navn:
  • Biologisk prøvesamling
  • Bioprøve samlet
  • Prøvesamling
Fremgangsmåte: 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.

Andre navn:
  • CT
  • KATT
  • CAT-skanning
  • Beregnet aksial tomografi
  • Datastyrt aksialtomografi
  • Datastyrt tomografi
  • CT skann
  • tomografi
  • Datastyrt aksial tomografi (prosedyre)
  • Datastyrt tomografi (CT) skanning
Fremgangsmåte: 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.

Fremgangsmåte: 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.

Andre navn:
  • MR
  • Magnetisk resonans
  • Magnetic Resonance Imaging Scan
  • Medisinsk bildebehandling, magnetisk resonans / kjernemagnetisk resonans
  • MR Imaging
  • MR-skanning
  • NMR-avbildning
  • NMRI
  • Kjernemagnetisk resonansavbildning
  • Magnetisk resonanstomografi (MR)
  • sMRI
  • Magnetisk resonansavbildning (prosedyre)
  • MR-er
  • Strukturell MR
Fremgangsmåte: 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.

Legemiddel: 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.

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Progression free survival (Phase II)
Tidsramme: 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)
Tidsramme: 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

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Incidence of adverse events
Tidsramme: 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

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

ECOG-ACRIN Cancer Research Group

Samarbeidspartnere

National Cancer Institute (NCI)

Etterforskere

  • Hovedetterforsker: Maheswari Senthil, ECOG-ACRIN Cancer Research Group

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

24. oktober 2025

Primær fullføring (Antatt)

30. mai 2030

Studiet fullført (Antatt)

30. mai 2031

Datoer for studieregistrering

Først innsendt

23. mai 2025

Først innsendt som oppfylte QC-kriteriene

23. mai 2025

Først lagt ut (Faktiske)

3. juni 2025

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

13. november 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

11. november 2026

Sist bekreftet

1. november 2026

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • EA2234
  • U10CA180820 (U.S. NIH-stipend/kontrakt)
  • EA2234 (Annen identifikator: CTEP)
  • NCI-2025-01831 (Registeridentifikator: CTRP (Clinical Trial Reporting Program))
  • EA2234 (Annen identifikator: ECOG-ACRIN Cancer Research Group)

Plan for individuelle deltakerdata (IPD)

Planlegger du å dele individuelle deltakerdata (IPD)?

UBESLUTTE

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

produkt produsert i og eksportert fra USA

Nei

Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .

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