Clinical Trials /

Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer

NCT01196390

Description:

This randomized phase III trial studies how well radiation therapy, paclitaxel, and carboplatin with or without trastuzumab work in treating patients with esophageal cancer. Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as paclitaxel and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Monoclonal antibodies, such as trastuzumab, may interfere with the ability of tumor cells to grow and spread. It is not yet known whether giving radiation therapy and combination chemotherapy together with or without trastuzumab is more effective in treating esophageal cancer.

Related Conditions:
  • Adenocarcinoma of the Gastroesophageal Junction
  • Esophageal Carcinoma
  • Gastric Adenocarcinoma
Recruiting Status:

Active, not recruiting

Phase:

Phase 3

Trial Eligibility

Document

Title

  • Brief Title: Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer
  • Official Title: A Phase III Trial Evaluating the Addition of Trastuzumab to Trimodality Treatment of HER2-Overexpressing Esophageal Adenocarcinoma

Clinical Trial IDs

  • ORG STUDY ID: NCI-2011-02601
  • SECONDARY ID: NCI-2011-02601
  • SECONDARY ID: CDR0000683717
  • SECONDARY ID: RTOG-1010
  • SECONDARY ID: RTOG-1010
  • SECONDARY ID: RTOG-1010
  • SECONDARY ID: U10CA180830
  • SECONDARY ID: U10CA180868
  • SECONDARY ID: U10CA021661
  • NCT ID: NCT01196390

Conditions

  • Esophageal Adenocarcinoma
  • Gastroesophageal Junction Adenocarcinoma
  • Stage IB Esophageal Cancer AJCC v7
  • Stage IIA Esophageal Cancer AJCC v7
  • Stage IIB Esophageal Cancer AJCC v7
  • Stage IIIA Esophageal Cancer AJCC v7
  • Stage IIIB Esophageal Cancer AJCC v7

Interventions

DrugSynonymsArms
CarboplatinBlastocarb, Carboplat, Carboplatin Hexal, Carboplatino, Carboplatinum, Carbosin, Carbosol, Carbotec, CBDCA, Displata, Ercar, JM-8, Nealorin, Novoplatinum, Paraplatin, Paraplatin AQ, Paraplatine, Platinwas, RibocarboArm I (radiotherapy, chemotherapy, trastuzumab)
PaclitaxelAnzatax, Asotax, Bristaxol, Praxel, Taxol, Taxol KonzentratArm I (radiotherapy, chemotherapy, trastuzumab)
TrastuzumabABP 980, ALT02, Anti-c-ERB-2, Anti-c-erbB2 Monoclonal Antibody, Anti-ERB-2, Anti-erbB-2, Anti-erbB2 Monoclonal Antibody, Anti-HER2/c-erbB2 Monoclonal Antibody, Anti-p185-HER2, c-erb-2 Monoclonal Antibody, HER2 Monoclonal Antibody, Herceptin, Herceptin Biosimilar PF-05280014, Herceptin Trastuzumab Biosimilar PF-05280014, Herzuma, Kanjinti, MoAb HER2, Monoclonal Antibody c-erb-2, Monoclonal Antibody HER2, Ogivri, Ontruzant, PF-05280014, rhuMAb HER2, RO0452317, SB3, Trastuzumab Biosimilar ABP 980, Trastuzumab Biosimilar ALT02, trastuzumab biosimilar EG12014, Trastuzumab Biosimilar HLX02, Trastuzumab Biosimilar PF-05280014, Trastuzumab Biosimilar SB3, Trastuzumab Biosimilar SIBP-01, Trastuzumab-anns, Trastuzumab-dkst, Trastuzumab-dttb, Trastuzumab-pkrb, Trastuzumab-qyyp, TrazimeraArm I (radiotherapy, chemotherapy, trastuzumab)

Purpose

This randomized phase III trial studies how well radiation therapy, paclitaxel, and carboplatin with or without trastuzumab work in treating patients with esophageal cancer. Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as paclitaxel and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Monoclonal antibodies, such as trastuzumab, may interfere with the ability of tumor cells to grow and spread. It is not yet known whether giving radiation therapy and combination chemotherapy together with or without trastuzumab is more effective in treating esophageal cancer.

Detailed Description

      PRIMARY OBJECTIVES:

      l. To determine if trastuzumab increases disease-free survival when combined with trimodality
      treatment (radiation plus chemotherapy followed by surgery) for patients with human epidermal
      growth factor receptor 2 (HER2)-overexpressing esophageal adenocarcinoma.

      SECONDARY OBJECTIVES:

      I. To evaluate if the addition of trastuzumab to trimodality treatment increases the
      pathologic complete response rate and overall survival for patients with HER2-overexpressing
      esophageal adenocarcinoma.

      II. To develop a tissue bank of tumor tissue from patients with non-metastatic esophageal
      adenocarcinoma.

      III. To determine molecular correlates of complete pathologic response, disease-free
      survival, and overall survival for patients with HER2-overexpressing esophageal
      adenocarcinoma treated with neoadjuvant and maintenance trastuzumab.

      IV. To evaluate predictors of cardiotoxicity in patients with esophageal cancer treated with
      trastuzumab and chemoradiation.

      V. To evaluate adverse events associated with the addition of trastuzumab to trimodality
      treatment for patients with non-metastatic esophageal adenocarcinoma.

      PATIENT-REPORTED QUALITY OF LIFE OBJECTIVES:

      I. To determine if the addition of trastuzumab to trimodality treatment improves the
      patient-reported Functional Assessment of Cancer Therapy for Esophageal Cancer (FACT-E)
      Esophageal Cancer Subscale (ECS) score.

      II. To determine if an improvement in the FACT-E ECS score at 6-8 weeks post completion of
      neoadjuvant chemoradiation correlates with pathologic complete response.

      III. To determine if pathologic complete response correlates with the FACT-E ECS score at 1
      year and/or 2 years from the start of chemoradiation.

      IV. To determine if the addition of trastuzumab to trimodality treatment improves the Swallow
      Index and Eating Index Subscale scores of the FACT-E.

      V. To determine if the addition of trastuzumab to paclitaxel, carboplatin, and radiation
      impacts quality-adjusted survival.

      OUTLINE: Patients are randomized to 1 of 2 treatment arms.

      ARM I: Patients undergo radiotherapy once daily 5 days a week for 5.5 weeks. Patients also
      receive trastuzumab intravenously (IV) over 30-90 minutes on days 1, 8, 15, 22, 29, 36, and
      57 and paclitaxel IV over 60 minutes and carboplatin IV over 30-60 minutes on days 1, 8, 15,
      22, 29, and 36. Beginning 21-56 days after surgery, patients receive trastuzumab IV over
      30-90 minutes. Treatment repeats every 21 days for 13 courses in the absence of disease
      progression or unacceptable toxicity.

      ARM II: Patients undergo radiotherapy once daily 5 days a week for 5.5 weeks. Patients also
      receive paclitaxel IV over 60 minutes and carboplatin IV over 30-60 minutes on days 1, 8, 15,
      22, 29, and 36.

      Within 5-8 weeks after completion of radiotherapy, all patients undergo surgery.

      After completion of study therapy, patients are followed up every 4 months for 2 years and
      then yearly thereafter.
    

Trial Arms

NameTypeDescriptionInterventions
Arm I (radiotherapy, chemotherapy, trastuzumab)ExperimentalPatients undergo radiotherapy once daily 5 days a week for 5.5 weeks. Patients also receive trastuzumab IV over 30-90 minutes on days 1, 8, 15, 22, 29, 36, and 57 and paclitaxel intravenously IV over 60 minutes and carboplatin IV over 30-60 minutes on days 1, 8, 15, 22, 29, and 36. Beginning 21-56 days after surgery, patients receive trastuzumab IV over 30-90 minutes. Treatment repeats every 21 days for 13 courses in the absence of disease progression or unacceptable toxicity.
  • Carboplatin
  • Paclitaxel
  • Trastuzumab
Arm II (radiotherapy and chemotherapy)ExperimentalPatients undergo radiotherapy once daily 5 days a week for 5.5 weeks. Patients also receive paclitaxel IV over 60 minutes and carboplatin IV over 30-60 minutes on days 1, 8, 15, 22, 29, and 36.
  • Carboplatin
  • Paclitaxel

Eligibility Criteria

        Inclusion Criteria:

          -  Pathologically confirmed primary adenocarcinoma of the esophagus that involves the mid
             (up to 25 cm), distal, or esophagogastric junction; the cancer may involve the stomach
             up to 5 cm

          -  Endoscopy with biopsy

          -  PRIOR TO STEP 1 REGISTRATION BUT WITHIN 56 DAYS PRIOR TO STEP 2 REGISTRATION

          -  Intent to submit tissue for central HER2 testing

          -  Stage T1N1-2, T2-3N0-2, according to the American Joint Committee on Cancer (AJCC) 7th
             edition staging, based on the following minimum diagnostic work-up:

               -  Chest/abdominal/pelvic computed tomography (CT) or whole-body positron emission
                  tomography (PET)/CT (NOTE: if CT is performed at this time point, whole-body
                  PET/CT will be required prior to step 2 registration; PET/CT of skull base to
                  mid-thigh is acceptable) (NOTE: if adenopathy is noted on CT or whole-body PET/CT
                  scan, an endoscopic ultrasound is not required prior to STEP 2 registration as
                  long as adequate tissue has been obtained for central HER2 testing)

               -  Patients may have regional adenopathy including para-esophageal, gastric,
                  gastrohepatic and celiac nodes; if celiac adenopathy is present, it must be =< 2
                  cm

               -  Patients with tumors at the level of the carina or above must undergo
                  bronchoscopy to exclude fistula

          -  Zubrod performance status 0-2

          -  Absolute neutrophil count (ANC) >= 1,500 cells/mm^3

          -  Platelets >= 100,000 cells/mm^3

          -  Hemoglobin >= 8.0 g/dL (note: the use of transfusion or other intervention to achieve
             hemoglobin [Hgb] >= 8.0 g/dL is acceptable)

          -  Creatinine =< 2 times upper limit of normal

          -  Bilirubin =< 1.5 times upper limit of normal

          -  Aspartate aminotransferase (AST) =< 3.0 times upper limit of normal

          -  For women of childbearing potential, a negative serum or urine pregnancy test

          -  Patients must sign a study-specific informed consent prior to study entry

          -  CONDITIONS FOR PATIENT ELIGIBILITY PRIOR TO STEP 2 REGISTRATION (HER2-POSITIVE
             PATIENTS ONLY)

          -  HER2 expressing adenocarcinoma of the esophagus centrally

          -  Surgical consultation to confirm that patient will be able to undergo curative
             resection after completion of chemoradiation within 56 days prior to step 2
             registration

          -  Radiation oncology consultation to confirm that disease can be encompassed in a
             radiotherapy field within 56 days prior to step 2 registration

          -  Consultation with a medical oncologist within 56 days prior to step 2 registration

          -  Stage T1N1-2, T2-3N0-2, according to the AJCC 7th edition staging, based upon the
             following minimum diagnostic work-up:

               -  History/physical examination, with documentation of the patient's weight, within
                  14 days prior to step 2 registration

               -  Whole-body PET/CT scan within 56 days prior to step 2 registration (if only CT
                  performed prior to step 1 registration)

               -  Endoscopic ultrasound within 56 days prior to step 2 registration, unless the
                  patient is found to have adenopathy per CT or whole-body PET/CT scan

               -  Electrocardiogram (EKG) within 56 days prior to step 2 registration

               -  Serum creatinine =< 2 x the upper limit or normal within 14 days prior to step 2
                  registration

          -  Zubrod performance status 0-2 within 14 days prior to step 2 registration

          -  For women of childbearing potential, a negative serum pregnancy test within 14 days
             prior to step 2 registration

          -  Left ventricular ejection fraction (LVEF) >= institutional lower limit of normal by
             cardiac echocardiogram (echo) or multi gated acquisition (MUGA) scan within 56 days
             prior to step 2 registration

          -  Women of childbearing potential and sexually active male participants must agree to
             practice adequate contraception while on study and for at least 60 days following the
             last dose of chemotherapy or trastuzumab

        Exclusion Criteria:

          -  Patients with cervical esophageal carcinoma

          -  Patients with T1N0 disease, T4 disease, and proximal esophageal cancers (15-24 cm)

          -  Prior systemic chemotherapy for esophageal cancer; note that prior chemotherapy for a
             different cancer is allowable

          -  Prior radiation therapy for esophageal cancer or prior chest radiotherapy

          -  Prior anthracycline or taxane

          -  Evidence of tracheoesophageal fistula or invasion into the trachea or major bronchi

          -  Prior invasive malignancy (except non-melanomatous skin cancer), unless disease free
             for a minimum of 2 years (e.g., carcinoma in situ of the breast, oral cavity, or
             cervix are permissible)

          -  Medical contraindications to esophagectomy

          -  Prior therapy with any agent targeting the HER2 pathway or human epidermal growth
             factor receptor 1 (HER1) (epidermal growth factor receptor [EGFR]) pathway

          -  Prior therapy with trastuzumab

          -  Prior allergic reaction to the study drugs involved in this protocol or to a
             monoclonal antibody

          -  Previous history of congestive heart failure

          -  Severe, active comorbidity, defined as follows:

               -  Unstable angina in the last 6 months

               -  Transmural myocardial infarction within the last 6 months

               -  Acute bacterial or fungal infection requiring intravenous antibiotics at the time
                  of registration

               -  Acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease
                  Control and Prevention (CDC) definition; note, however that human
                  immunodeficiency virus (HIV) testing is not required for entry into this
                  protocol; protocol-specific requirements may also exclude immunocompromised
                  patients

          -  Pregnant or nursing women or women of childbearing potential and men who are sexually
             active and not willing/able to use medically acceptable forms of contraception
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Disease-free Survival (DFS)
Time Frame:From randomization to last follow-up. Maximum follow-up at time of analysis was 8.0 years.
Safety Issue:
Description:A disease event is defined as local/regional persistence or recurrence of the cancer under study, distant metastases, a new second primary cancer, or death due to any cause. Participants undergoing surgery who had an R2 resection and participants not undergoing surgery who had a positive endoscopic biopsy or no biopsy at all were considered to have local persistence of disease. Disease-free survival time is defined as time from randomization to the date of first disease event or last known follow-up (censored). Rates are estimated by the Kaplan-Meier method. Analysis was to occur after 162 events were reported.

Secondary Outcome Measures

Measure:Percentage of Participants With Pathologic Complete Response at Surgery
Time Frame:At the time of surgery, 5-8 weeks after completion of radiation therapy.
Safety Issue:
Description:Pathologic Complete Response (pCR) is evaluated after surgery and is based on the pathology review of the submitted surgical specimen. Pathologic Complete Response occurs if the pathologist determines that the resected esophageal specimen, accompanying lymph nodes, and surgical margins are all free of tumor.
Measure:Overall Survival
Time Frame:From randomization to last follow-up. Maximum follow-up at time of analysis was 8 years.
Safety Issue:
Description:Overall survival time is defined as time from randomization to the date of death from any cause or last known follow-up (censored). Rates are estimated by the Kaplan-Meier method. Analysis occurred after 109 deaths were reported.
Measure:Frequency of Highest Grade Adverse Event Per Participant
Time Frame:From randomization to last follow-up. Maximum follow-up at time of analysis was 8 years.
Safety Issue:
Description:Common Terminology Criteria for Adverse Events (version 4.0 before 4-1-2018; then version 5.0) grades adverse event severity from 1=mild to 5=death. Summary data provided is in this outcome measure; see Adverse Events Module for specific adverse event data.
Measure:Health-related Quality of Life (QOL)
Time Frame:Baseline, 6 weeks after end of radiation, 1 and 2 years from treatment start
Safety Issue:
Description:Measured by the Functional Assessment of Cancer Therapy-Esophageal (FACT-E). The FACT-E measures multidimensional quality of life in patients with esophagus cancer. Possible scores range from 0 to 68, with higher scores indicating a better outcome.
Measure:Quality-adjusted Survival
Time Frame:From randomization to last follow-up. Maximum follow-up at time of primary outcome measure analysis was 8 years.
Safety Issue:
Description:
Measure:Molecular Correlates of Efficacy
Time Frame:From randomization to last follow-up. Maximum follow-up at time of primary outcome measure analysis was 8 years.
Safety Issue:
Description:
Measure:Number of Participants With Any Cardiac Adverse Events Regardless of Attribution
Time Frame:From randomization to last follow-up. Maximum follow-up at time of analysis was 8 years.
Safety Issue:
Description:Common Terminology Criteria for Adverse Events (version 4.0) grades adverse event (AE) severity from 1=mild to 5=death. Logistic regression was used to evaluate treatment arm, clinical tumor stage (T stage), Zubrod Performance Status, gender, presence of adenopathy, and age as possible predictors of cardiac adverse events. Results of the final model are reported in the statistical analysis section. Summary adverse event data is provided in this outcome measure; see Adverse Events Module for specific adverse event data.

Details

Phase:Phase 3
Primary Purpose:Interventional
Overall Status:Active, not recruiting
Lead Sponsor:National Cancer Institute (NCI)

Last Updated

August 27, 2021