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Trial of Lapatinib Versus Lapatinib With Capecitabine in Her2+ Metastatic Gastro-Esophageal Cancer (GastroLap)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01145404
Recruitment Status : Terminated (Changes of SoC for third line therapy resulting in poor recruitment)
First Posted : June 16, 2010
Last Update Posted : July 2, 2014
Information provided by (Responsible Party):
National Center for Tumor Diseases, Heidelberg

Brief Summary:

Combining Erb inhibitors, such lapatinib, and TS inhibitors, such as capecitabine, may be a beneficial contribution to current treatment paradigms since preclinical data suggest that lapatinib alone can decrease TS mRNA and is synergistic with capecitabine in some cell lines, which may contribute to clinical benefit. The study described in this protocol has been designed to establish the anti-tumor activity of Lapatinib with or without capecitabine in the treatment of Her2 overexpressing metastatic gastric- and gastro-esophageal cancer, and to search for molecular correlates that may be associated with response to this compound.

The majority of patients with metastatic gastric and gastro-esophageal cancer undergo first-line combined chemotherapy (e.g. platin derivates and fluoropyrimidines, sometimes combined to a taxane), but the role of second-line chemotherapy has not yet been defined. Therefore, progression during or shortly after first-line chemotherapy is a medical condition no standard medical approach exists. The overexpression of EGFR and Her2 in gastric and gastroesophageal cancer make these indications prime candidate for treatment with the dual ErbB1/2 tyrosine kinase inhibitor (TKI) Lapatinib.

Condition or disease Intervention/treatment Phase
GastroEsophageal Cancer Drug: Lapatinib Drug: Lapatinib plus capecitabine Phase 2

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 76 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Lapatinib Versus Lapatinib With Capecitabine as Second-line Treatment in Her2-Overexpressing Metastatic Gastro-Esophageal Cancer: A Randomized Phase II Trial
Study Start Date : June 2010
Actual Primary Completion Date : February 2013
Actual Study Completion Date : October 2013

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Arm A: Lapatinib
Lapatinib (Tyverb) po 1500mg daily d1-21, new cycle will be started on day 22 until progression.
Drug: Lapatinib
Lapatinib (Tyverb) po 1500mg daily d1-21, new cycle will be started on day 22 until progression.
Other Name: Tyverb

Experimental: Arm B
Lapatinib po 1250mg daily d1-21; new cycle will be started on day 22 until progression
Drug: Lapatinib plus capecitabine
Lapatinib po 1250mg daily d1-21; new cycle will be started on day 22 until progression
Other Name: Tyverb, Xeloda

Primary Outcome Measures :
  1. Objective response rate (ORR) [ Time Frame: about 10 month (until progression) ]

    Objective response rate (ORR, complete and partial remission according to RECIST criteria

    - all to be confirmed by at least two consecutive tumor response assessments within no shorter than 4 weeks)

Secondary Outcome Measures :
  1. Time to tumor progression [ Time Frame: about 10 month (until tumor progression) ]
    Time to tumor progression

  2. Overall survival [ Time Frame: about 16 month (6 month after progression) ]
    Overall survival

  3. Safety and tolerability of study treatment (for parameters see description) [ Time Frame: about 10 month (until progression) ]
    recording of AEs/SAEs, vital signs, ECG, LVEF, physical exams, lab values

  4. Biomarker analysis [ Time Frame: 1 month (during screening period) ]
    the definition of biomarkers that are associated with response or resistance to treatment

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Histologically confirmed adenocarcinoma of the stomach, including adenocarcinoma of the gastroesophageal junction and esophagus
  • Metastatic disease
  • Measurable disease (according to RECIST criteria)
  • At least one prior chemotherapy for metastatic disease with progression during or no later than 6 months after last administration of chemotherapy. Chemotherapy must have contained a platinum compound (cisplatin or oxaliplatin)
  • Her2 overexpression measured by FISH (amplification or increased gene copy number). Immunohistochemistry (ICH) 3+ can be included in case of an uncertain FISH test.
  • Patient willing to allow for biomarker analyses on his tumor tissue.
  • Written informed consent given prior to any protocol specific procedures according to the local regulatory requirements
  • Age >= 18 years
  • Eastern Cooperative Oncology Group Performance Status (ECOG-PS) <= 2
  • Life expectancy > 3 months
  • Adequate hematological, hepatic and renal function defined by: Hematology: Neutrophils >1.5x109/L; Platelets >100x109/L; Hemoglobin >8g/dL Hepatic function: Total bilirubin <=1.5xULN; ASAT (SGOT) and ALAT (SGPT) <= 2.5xULN; Alkaline phosphatase <5xULN. Renal function: The calculated creatinine clearance should be .60 mL/min
  • Eligibility of patients receiving medications or substances known to affect, or with the potential to affect the activity or pharmacokinetics of lapatinib will be determined following review of their use by the local Principal Investigator. A list of medications and substances known or with the potential to interact with CYP450 isoenzymes is provided in: Cytochrome P-450 Enzymes and Drug metabolism. In: Lacy CF, Armstrong LL, Goldman MP, Lance LL eds. Drug Information Handbook 8TH ed. Hudson, OH; LexiComp Inc. 2000: 1364-1371
  • Able to swallow and retain oral medication
  • Negative pregnancy test (urine or serum) within 28 days prior to randomization for all women of childbearing potential (has to be verified within 7 days prior to randomization and during the study according the judgement of the investigator)
  • Willingness to perform double-barrier contraception during study and 6 months after end of treatment
  • Ability to understand and the willingness to sign a written informed consent document
  • Willing and able to comply with scheduled visits, treatment plan, laboratory tests, and other study procedures.

Exclusion Criteria:

  • Previous non curatively treated malignant disease other than the current gastroesophageal cancer with a disease-free survival of less than 5 years
  • History of significant neurological or psychiatric disorders including psychotic disorders, dementia or seizures that would prohibit the understanding and giving of informed consent
  • History of active Hepatitis B or C or history of an HIV infection
  • Active uncontrolled infection
  • Treatment within any other clinical trial parallel to the treatment phase of the current study within 30 days prior to randomisation.
  • Concurrent treatment with any other anti-cancer drug. Presence of other medication that may interfere with study treatment or the action of the investigational product or confuse the assessment of study results
  • History of allergic reactions attributed to compounds of similar chemical or biologic composition to lapatinib or to any excipients
  • History of allergic reactions attributed to compounds of similar chemical composition to capecitabine, fluorouracil or to any excipients
  • Known DPD deficiency
  • Concomitant requirement for medication classified as CYP3A4 inducers or inhibitors
  • Current active hepatic or biliary disease (with exception of patients with Gilbert's syndrome, asymptomatic gallstones, liver metastases or stable chronic liver disease per investigator assessment)
  • Active cardiac disease, defined as:

    • History of uncontrolled or symptomatic angina
    • History of arrhythmias requiring medications, or clinically significant, with the exception of asymptomatic atrial fibrillation requiring anticoagulation

      • Myocardial infarction < 6 months from randomization
      • Uncontrolled or symptomatic congestive heart failure (> New York Heart Association score 2)
      • Ejection fraction below the institutional normal limit
      • Any other cardiac condition, which in the opinion of the treating physician, would make this protocol unreasonably hazardous for the patient
  • Pregnancy and lactation
  • History of hypersensitivity to the investigational medicinal product or to any drug with similar chemical structure or to any excipient present in the pharmaceutical form of the investigational medicinal product

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01145404

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CHARITÉ CAMPUS, VIRCHOW-KLINIKUM, UNIVERSITÄTSMEDIZIN BERLIN, Centrum 14, Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie
Berlin, Germany, 13353
Evangelisches Krankenhaus Bielefeld gGmbH, Klinik für Innere Medizin, Hämatologie/Onkologie und Palliativmedizin
Bielefeld, Germany, 33611
Medizinische Uniklinik, Knappschaftskrankenhaus Bochum
Bochum, Germany, 44892
Evangelische Kliniken Bonn gGmbH, Johanniter-Krankenhaus
Bonn, Germany, 53113
Städtisches Klinikum Braunschweig gGmbH
Braunschweig, Germany, 38114
Kliniken Essen Mitte, Department of Medical Oncology and Hematology
Essen, Germany, 45136
Klinikum Esslingen, Klinik für Allgemeine Innere Medizin, Onkologie und Gastroenterologie
Esslingen, Germany, 73730
Krankenhaus Nord West
Frankfurt, Germany, 60488
Universitätsklinikum Halle, Klinik für Innere Medizin IV
Halle, Germany, 06120
OncoResearch Lerchenfeld UG
Hamburg, Germany, 22081
Medizinische Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie, Endokrinologie
Hannover, Germany, 30625
NCT Heidelberg
Heidelberg, Germany, 69120
I. Med. Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität
Mainz, Germany, 55101
Universitätsklinikum Gießen und Marburg GmbH
Marburg, Germany, 35043
Klinikum rechts der Isar
München, Germany, 81675
Klinikum Regensburg, Klinik und Poliklinik für Innere Medizin I
Regensburg, Germany, 93042
Sponsors and Collaborators
National Center for Tumor Diseases, Heidelberg
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Study Director: Florian Lordick, MD Städtisches Klinikum Braunschweig
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: National Center for Tumor Diseases, Heidelberg Identifier: NCT01145404    
Other Study ID Numbers: NCT-2008-11-01-1015
First Posted: June 16, 2010    Key Record Dates
Last Update Posted: July 2, 2014
Last Verified: July 2014
Keywords provided by National Center for Tumor Diseases, Heidelberg:
Her2 Gastro Gastric Esophageal Cancer
Additional relevant MeSH terms:
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Esophageal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Head and Neck Neoplasms
Digestive System Diseases
Esophageal Diseases
Gastrointestinal Diseases
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors