Description:
To seek the efficacy signals of trastuzumab in combination with chemotherapy in pretreated
patients of HER2 positive, relapse or metastatic carcinoma of digestive system as response
rate (RR) determined by the Investigator using RECIST 1.1, and provide evidence for phase III
clinical trial.
Title
- Brief Title: Anti-HER2 Therapy in Patients of HER2 Positive Metastatic Carcinoma of Digestive System
- Official Title: Multicenter, Phase II Study of Chemotherapy in Combination With Trastuzumab in Patients of Pretreated, HER2 Positive, Relapse or Metastatic Carcinoma of Digestive System
Clinical Trial IDs
- ORG STUDY ID:
CGOG2006
- NCT ID:
NCT03185988
Conditions
- Targeted Therapy
- HER2
- Biliary Tract Cancer
- Esophageal Squamous Cell Carcinoma
- Colorectal Cancer
Interventions
Drug | Synonyms | Arms |
---|
chemotherapy in combination with trastuzumab for arm1 | | GI tumor beyond CRC, ESCC, BTC,GC&GEJA |
chemotherapy in combination with trastuzumab for arm2 | | Esophageal squamous cell carcinoma |
chemotherapy in combination with trastuzumab for arm3 | | Biliary tract cancer |
chemotherapy in combination with trastuzumab for arm4 | | Colorectal cancer |
Purpose
To seek the efficacy signals of trastuzumab in combination with chemotherapy in pretreated
patients of HER2 positive, relapse or metastatic carcinoma of digestive system as response
rate (RR) determined by the Investigator using RECIST 1.1, and provide evidence for phase III
clinical trial.
Detailed Description
Human epidermal growth factor receptor 2, (HER2) is overexpressed /amplified in multiple
carcinomas, for example, gastric cancer(GC), gastroesophageal junction
adenocarcinoma(GEJA),and breast cancer.And HER2 is closely related to tumor proliferation
&metastases.About 90% Chinese esophagus cancer are squamous cell origin. The reported HER2
overexpression ranged from 5-30%, Beijing cancer hospital reported an 11% positive rate. The
variety of HER2 positive rate may because of the absence of standard HER2 testing criteria.
The current treatment for metastatic Esophageal squamous Cell Carcinoma (ESCC) is not
satisfactory. Fluorouracil and platinum are considered as first line standard of care (SOC)
with a 20-30% RR and 7-9 months overall survival (OS). In second line setting, there is no
SOC in china. And the efficacy is not satisfactory. Esophageal adenocarcinoma has a higher
HER2 positive rate of 14%, but no data reported of using trastuzumab in these patients in
China. Biliary tract cancer (BTC), including intrahepatic/extrahepatic cholangiocarcinoma and
Gallbladder cancer (GBC) is very aggressive, total 5y survival is less than 5% for
unresectable patients. GBC is account for approximately 2/3 of BTC, and it's estimated the
incidence in china is 52800 and the mortality is 40700 in 2015. Most patients are diagnosed
in advanced stage and lose the opportunity of surgery. However, there is no SOC for
unresectable BTC, gemcitabine plus platinum provided a 30% RR and 10 month OS. In second line
treatment, no differences were seen between various experimental agents. The reported HER2
positive rate range from 5.1% to 57% in biliary duct cancer and 4.7% to 64% in GBC.
Researchers reported her2 amplification is related to tumor stage and lymph nodes metastasis
in 221 BTC patients. Another study reported a 16.6% positive rate and worse prognosis with a
sample size of 230 GBC patients. Meanwhile, HER2 pathway mutation rate reached 37%. All imply
that BTC may be the potential anti HER therapy population. Besides, other digestive system
tumor has low HER2 positive rate (Small intestinal cancer 0.9-3%; hepatocellular carcinoma
2.4%; Pancreatic cancer 3%; etc.). However, the patient pool is large and has no SOC in
second Line. Whether these HER2 + patients can gain benefit form anti- her treatment is worth
investigating. In 2016 American Society of Clinical Oncology (ASCO), a study reported that
using trastuzumab and pertuzumab combination, 35% metastatic colorectal cancer (CRC) and 50%
BTC patients who heavily pretreated had objective response. However, china doesn't have
studies for these patients. .
The concurrent basket trial will explore the efficacy and safety of trastuzumab with
chemotherapy in Chinese patients of pretreated, HER2 positive, relapse or metastatic
carcinoma of digestive system.
Trial Arms
Name | Type | Description | Interventions |
---|
GI tumor beyond CRC, ESCC, BTC,GC&GEJA | Experimental | HER2 positive GI tumor beyond CRC, ESCC, BTC,GC&GEJA | - chemotherapy in combination with trastuzumab for arm1
|
Esophageal squamous cell carcinoma | Experimental | HER2 positive Esophageal squamous cell carcinoma | - chemotherapy in combination with trastuzumab for arm2
|
Biliary tract cancer | Experimental | HER2 positive Biliary tract cancer | - chemotherapy in combination with trastuzumab for arm3
|
Colorectal cancer | Experimental | HER2 positive and RAS/BRAF wild type colorectal cancer | - chemotherapy in combination with trastuzumab for arm4
|
Eligibility Criteria
Inclusion Criteria:
- Signed informed consent.
- Male and female patients aged from 18 to 75 years
- Histologically confirmed Colorectal cancer,Esophagus squamous cell carcinoma, biliary
tract cancer, and digestive system tumor beyond CRC and GC&GEJA with the following
specifications:
- genetic testing conformed KRAS/NRAS/BRAF all wild type for colorectal cancer
- Detection of a carcinoma with HER2 3+ (IHC) or HER2 2+ (IHC) with amplification
proven by fluorescence in situ hybridization(FISH), silver in situ
hybridization(SISH) or chromogenic in situ hybridization(CISH) using gastric
cancer criteria by an accredited local pathologist.
- Relapse or metastatic diseases, at least one measurable lesion according to
RECIST 1.1, anticipated survival ≥ 12 weeks.
- ECOG Performance status 0-1.
- Patients who failed at least first line systemic therapy.
- Adequate organ function as determined by the following laboratory results:
- Absolute neutrophil count ≥1500 cells/mm3,
- Platelet count ≥ 90,000 cells/mm3,
- Hemoglobin ≥9.0 g/dL
- Total bilirubin ≤ 1.5 upper limit of normal (ULN).
- serum glutamate oxaloacetate transaminase(SGOT,AST), serum glutamate pyruvate
transaminase(SGPT,ALT) < 2.5 ULN without liver metastases; < 5 ULN with liver
metastases.
- serum creatinine < 1.5
- ULN OR creatinine clearance ≥ 40 mL/ min.
- If able to reproduce, patients must be willing to use highly effective methods of
contraception during treatment and for 7 months after the end of treatment.
Exclusion Criteria:
- Known hypersensitivity against treatment regimen.
- Baseline left ventricular ejection fraction(LVEF) < 50% (measured by echocardiography
or MUGA).
- Previous anti-her treatment.
- Immune therapy, biological therapy or any participation in clinical trial in previous
two weeks.
- Surgery and not recovered in previous three weeks
- Clinical evidence of brain metastases, or uncontrolled epilepsy.
- Serious uncontrolled systemic intercurrent illness, e.g. infections or poorly
controlled diabetes.
- Other malignancy within the last 5 years, except for carcinoma in situ of the cervix,
or basal cell carcinoma.
- Clinically significant active coronary heart disease, cardiomyopathy or congestive
heart failure, New York Heart Association(NYHA) III-IV; poorly controlled hypertension
(systolic BP > 180 mmHg or diastolic BP > 100 mmHg); clinically significant valvular
heart disease; unstable angina pectoris, myocardial infarction or high risk
uncontrollable arrhythmias.
- Long term or high dose corticosteroids administration ( inhalation or short term oral
administration for antiemesis and orexigenic is allowed)
- Patients of legally incapacity or of medical and ethical reasons not fit for study.
- Pregnant or lactating, or intending to become pregnant during the study.
- Jaundice, ascites, and / or alkaline phosphatase ≥3 × ULN; and / or ≥3 grade (CTC-AE)
of persistent proteinuria, urinary protein / creatinine ratio> 3.5g / 24 hours or
renal failure need blood or peritoneal dialysis.
- Presence of > grade 2(CTC-AE) persistent infection; unhealed wounds, ulcer or
fracture, or patients with a history of organ transplant.
- Evidence of coagulation disorders. Like presence ≥grade 3 (CTC-AE) bleeding events.
- Known HIV or hepatitis B virus(HBV), hepatitis C virus(HCV) infection.
- Any > grade 1 unresolved toxicity due to previous treatment (CTC-AE), except for
alopecia, anemia and hypothyroidism).
- Not suitable for the study evaluated by investigators
- Known dihydropyrimidine dehydrogenase (DPD) deficiency.
- History of exposure to the following cumulative doses of anthracyclines:
- Doxorubicin > 500 mg/m2 OR Epirubicin > 720 mg/m2.
- If another anthracycline or more than one anthracycline has been used, then
the cumulative dose must not exceed the equivalent of 500 mg/m2 doxorubicin.
Maximum Eligible Age: | 75 Years |
Minimum Eligible Age: | 18 Years |
Eligible Gender: | All |
Healthy Volunteers: | No |
Primary Outcome Measures
Measure: | Response Rate(RR) for each cohort in intent to treat (ITT) population |
Time Frame: | baseline up to death or disease progression,which ever occurs first(up to approximately 8.5 years) |
Safety Issue: | |
Description: | The percentage of patients, whose tumor volume in first time shrink to pre-defined criteria, including CR and PR |
Secondary Outcome Measures
Measure: | Disease control rate |
Time Frame: | baseline up to death or disease progression,which ever occurs first(up to approximately 8.5 years) |
Safety Issue: | |
Description: | The percentage of patients who achieve complete remission(CR) or partial remission (PR) or stable disease(SD) determined by the RECIST v1.1 criteria. |
Measure: | best overall response |
Time Frame: | 10-30 weeks |
Safety Issue: | |
Description: | The percentage of patients who achieve either a CR or PR as determined by the RECIST v1.1 criteria based on investigator's assessment that is confirmed by a repeat assessment performed no less than 4 weeks after the criteria for response are first met. |
Measure: | Progression free survival |
Time Frame: | baseline up to death or disease progression,which ever occurs first(up to approximately 8.5 years) |
Safety Issue: | |
Description: | Defined as the initiation of treatment to the day of first documentation of PD or date of death, whichever occurs first. |
Measure: | Overall survival |
Time Frame: | baseline up to death or disease progression,which ever occurs first(up to approximately 8.5 years) |
Safety Issue: | |
Description: | Is the time from the initiation of treatment to the date of death from any cause. |
Measure: | time to response |
Time Frame: | 6-30 weeks |
Safety Issue: | |
Description: | Defined as the initiation of treatment to the day of first documentation of response.
Only patients who achieve an objective response will be included in the analysis. |
Measure: | duration of response |
Time Frame: | 6-30 weeks |
Safety Issue: | |
Description: | Defined as the time from the date of the first documented objective response to the date of first documented PD or death, whichever occurs first. Only patients who achieve an objective response will be included in the analysis. |
Measure: | time to progression(TTP) |
Time Frame: | 6-30 weeks |
Safety Issue: | |
Description: | Defined as the initiation of treatment to the day of first documentation of PD. |
Measure: | Quality of Life by Eastern Cooperative Oncology Group(ECOG)performance status( PS) scoring criteria |
Time Frame: | Day 1 of each 21-day treatment cycle up to 28 days and 60-90 days after Day 1 of last treatment cycle(up to approximately 8.5 years) |
Safety Issue: | |
Description: | |
Measure: | Number of participants with treatment-related adverse events as assessed by CTCAE v4.03 |
Time Frame: | baseline up to approximately 8.5 years |
Safety Issue: | |
Description: | |
Details
Phase: | Phase 2 |
Primary Purpose: | Interventional |
Overall Status: | Recruiting |
Lead Sponsor: | Shen Lin |
Trial Keywords
- Human epidermal growth factor receptor 2
- Biliary tract cancer
- Esophageal squamous cell carcinoma
- Targeted therapy
- colorectal cancer
Last Updated
July 19, 2019