Clinical Trials /

Folfox+Irinotecan+Chemort In Esophageal Cancer

NCT04656041

Description:

In this research study, is studying how Liposomal Irinotecan in combination with the standard of care interventions FOLFOX, carboplatin paclitaxel, and radiation therapy affect gastroesophageal junction or esophagogastric cancer This research study involves the following study intervention: - Liposomal irinotecan

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

Not yet recruiting

Phase:

Phase 2

Trial Eligibility

Document

Title

  • Brief Title: Folfox+Irinotecan+Chemort In Esophageal Cancer
  • Official Title: A Phase II Study of Neoadjuvant NAPOX Followed by Chemoradiation With Paclitaxel and Carboplatin in Locally Advanced Esophagogastric Cancer

Clinical Trial IDs

  • ORG STUDY ID: 20-452
  • NCT ID: NCT04656041

Conditions

  • Gastroesophageal Junction Adenocarcinoma
  • Esophagogastric Cancer

Interventions

DrugSynonymsArms
FOLFOX/ nal-IRIFOLFOX/ nal-IRI
PaclitaxelAbraxane®.FOLFOX/ nal-IRI
CarboplatinParaplatinFOLFOX/ nal-IRI

Purpose

In this research study, is studying how Liposomal Irinotecan in combination with the standard of care interventions FOLFOX, carboplatin paclitaxel, and radiation therapy affect gastroesophageal junction or esophagogastric cancer This research study involves the following study intervention: - Liposomal irinotecan

Detailed Description

      The research study procedures include screening for eligibility and study treatment including
      evaluations and follow up visits.

      This research study involves the following standard of care interventions:

        -  FOLFOX (leucovorin calcium, 5-Fluorouracil, and oxaliplatin)

        -  Carboplatin

        -  Paclitaxel

        -  Radiation therapy

      This research study involves the following study intervention:

      - Liposomal irinotecan

      It is expected that about 40 people will take part in this research study.

      This research study is a Phase II clinical trial. Phase II clinical trials test the safety
      and effectiveness of an investigational intervention to learn whether the intervention works
      in treating a specific disease. "Investigational" means that the intervention is being
      studied. The U.S. Food and Drug Administration (FDA) has not approved liposomal irinotecan
      for your specific disease but it has been approved for other uses. The FDA has approved
      FOLFOX, carboplatin, and paclitaxel as treatment options for this disease.
    

Trial Arms

NameTypeDescriptionInterventions
FOLFOX/ nal-IRIExperimentalTreatment will be administered on an outpatient basis. FOLFOX with nal-IRI for eight two-week cycles (16 weeks total) Chemoradiation with proton or photon radiation therapy concurrent with weekly Paclitaxel and Carboplatin for 5 weeks Surgery
  • FOLFOX/ nal-IRI
  • Paclitaxel
  • Carboplatin

Eligibility Criteria

        Inclusion Criteria:

          -  Participants must meet all the following criteria in order to be eligible to
             participate in the study:

          -  Histologically or cytologically confirmed T 3/4 or N+ (> 1 cm in size or FDG avid)
             Siewart 1-3 gastroesophageal (GE) junction or esophagogastric cancer. Diagnosis must
             be confirmed by a DF/HCC institution pathology department prior to registration.

          -  Age 18 years or older. There will be no upper age restriction.

          -  ECOG performance status ≤ 1

          -  Life expectancy of greater than 3 months

          -  Participants must have adequate organ and marrow function as defined below:

               -  absolute neutrophil count ≥ 1,500 cells/mm3

               -  platelets ≥ 75,000 cells/mm3

               -  total bilirubin ≤ 1.5 x upper limit of normal OR for patients who have undergone
                  biliary stenting, total bilirubin of ≤ 2.0 x upper limit of normal OR two down
                  trending values.

               -  AST(SGOT) ≤ 2.5 x upper limit of normal

               -  ALT (SGPT) ≤ 2.5 x upper limit of normal

               -  creatinine ≤ 1.5 mg/dL OR creatinine clearance ≥ 30 mL/min/1.73 m2 for
                  participants with creatinine levels above institutional normal.

          -  The effects of both radiation therapy and the chemotherapy agents used in this trial
             are known to be teratogenic. Therefore, women of child-bearing potential and men must
             agree to use adequate contraception (hormonal or barrier method of birth control;
             abstinence) prior to study entry and for the duration of study participation plus 30
             days from the last date of study drug administration. Should a woman become pregnant
             or suspect she is pregnant while she or her partner is participating in this study,
             she should inform her treating physician immediately.

          -  Female subject of childbearing potential should have a negative urine or serum
             pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG). If the urine
             test is positive or cannot be confirmed as negative, a serum pregnancy test will be
             required.

          -  Ability to understand and the willingness to sign a written informed consent document.

        Exclusion Criteria:

          -  Participants who fulfill any of the following criteria will be excluded from the
             study:

          -  Evidence of metastatic disease as determined by chest CT scan, abdomen/pelvis CT scan
             (or MRI with gadolinium and/or manganese) within six weeks of study entry. Distant
             nodal disease is allowed if it is in the radiation port.

          -  Any prior chemotherapy, targeted/biologic therapy, or radiation for treatment of the
             participant's esophagogastric cancer.

          -  Treatment of other invasive carcinomas within the last five years with greater than 5%
             risk of recurrence at time of eligibility screening. Carcinoma in-situ and basal cell
             carcinoma/ squamous cell carcinoma of the skin are allowed.

          -  Receipt of any other investigational agents within 4 weeks preceding the start of
             study treatment.

          -  Serious concomitant systemic disorders incompatible with the study (at the discretion
             of the investigator), such as significant cardiac or pulmonary morbidity
             (e.g.congestive heart failure, symptomatic coronary artery disease and/or cardiac
             arrhythmias not well controlled with medication) or myocardial infarction within the
             last 12 months, or ongoing infection as manifested by fever.

          -  History of uncontrolled seizures, central nervous system disorders or psychiatric
             disability judged by the investigator to be clinically significant, precluding
             informed consent, or interfering with compliance or drug intake.

          -  Pregnant women are excluded from this study because radiation therapy and the
             chemotherapy agents to be used have the potential for teratogenic or abortifacient
             effects. Because there is an unknown but potential risk for adverse events in nursing
             infants secondary to treatment of the mother with these agents, breastfeeding should
             be discontinued while the mother is receiving protocol therapy.

          -  Major surgery, excluding laparoscopy, within 4 weeks of the start of study treatment,
             without complete recovery.

          -  No concurrent administration of cimetidine (as it can decrease the clearance of 5-FU).
             Another H2-blocker or proton pump inhibitor may be substituted before study entry.

          -  Known, existing uncontrolled coagulopathy.

          -  Prior systemic fluoropyrimidine therapy (unless given in an adjuvant setting and at
             least six months earlier). Prior topical fluoropyrimidine use is allowed.

          -  Known hypersensitivity to 5-fluorouracil or known DPD deficiency.

          -  History of allergic reaction(s) attributed to compounds of similar chemical or
             biologic composition to 5-fluorouracil, irinotecan, or oxaliplatin.
      
Maximum Eligible Age:N/A
Minimum Eligible Age:18 Years
Eligible Gender:All
Healthy Volunteers:No

Primary Outcome Measures

Measure:Pathologic Complete Response Rate
Time Frame:38 Weeks
Safety Issue:
Description:All patients will undergo a full pathological review of their surgical specimen according to the AJCC Staging Classification, 6th. Initial gross evaluation and identification of resection margins will be performed jointly by the surgeon and the pathologist. Pathological complete response will be defined as the absence of any viable tumor cells within the pathologic specimen.

Secondary Outcome Measures

Measure:Number of Participants with Treatment Related Adverse Events as Assessed by CTCAE v5.0
Time Frame:first dose of protocol therapy until 5 years after the end of protocol therapy
Safety Issue:
Description:Toxicity associated with neoadjuvant FOLFOX/ nal-IRI and chemoradiation will be summarized by category and grade according to the CTCAE version 5.0 Acute and late toxicities will be scored using Common Toxicity Criteria (CTCAE) version 5. Toxicities will be noted and recorded in protocol-specific case reports from the time of first dose of protocol therapy until 5 years after the end of protocol therapy
Measure:Clinical Response
Time Frame:8 Weeks
Safety Issue:
Description:The rate of objective clinical response to induction FOLFOX/ nal-IRI and chemoradiation will be reported as the proportion of eligible patients starting protocol therapy who achieve a complete or partial response as the best overall response
Measure:Clinical Response
Time Frame:16 Weeks
Safety Issue:
Description:The rate of objective clinical response to induction FOLFOX/ nal-IRI and chemoradiation will be reported as the proportion of eligible patients starting protocol therapy who achieve a complete or partial response as the best overall response
Measure:Clinical Response
Time Frame:25 Weeks
Safety Issue:
Description:The rate of objective clinical response to induction FOLFOX/ nal-IRI and chemoradiation will be reported as the proportion of eligible patients starting protocol therapy who achieve a complete or partial response as the best overall response
Measure:Progression-Free Survival (PFS)
Time Frame:duration from the first date of protocol therapy to the earliest date of disease progression up 5 years
Safety Issue:
Description:Progression-free survival (PFS) is defined as the duration from the first date of protocol therapy to the earliest date of disease progression per RECIST criteria or death due to any cause. PFS time will be censored at the date of last follow-up for patients still alive with no documentation of progressive disease. The PFS rate will be estimated using the Kaplan-Meier method with 95% confidence intervals based on the complementary log-log transformation.
Measure:Overall Survival
Time Frame:first date of protocol therapy to the date of death due to any cause and will be censored at the date of last follow-up for patients still alive up to 5 years
Safety Issue:
Description:Overall survival (OS) is defined as the duration from the first date of protocol therapy to the date of death due to any cause and will be censored at the date of last follow-up for patients still alive. The OS rate will be estimated using the Kaplan-Meier method with 95% confidence intervals based on the complementary log-log transformation

Details

Phase:Phase 2
Primary Purpose:Interventional
Overall Status:Not yet recruiting
Lead Sponsor:Massachusetts General Hospital

Trial Keywords

  • Gastroesophageal Junction Adenocarcinoma
  • Esophagogastric cancer

Last Updated

December 7, 2020