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S1201: Combination Chemo for Patients W/Advanced or Metastatic Esophageal, Gastric, or Gastroesophageal Junction Cancer

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ClinicalTrials.gov Identifier: NCT01498289
Recruitment Status : Completed
First Posted : December 23, 2011
Results First Posted : August 29, 2019
Last Update Posted : November 7, 2019
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Southwest Oncology Group

Study Description
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Brief Summary:

RATIONALE: Drugs used in chemotherapy, such as oxaliplatin, leucovorin calcium, fluorouracil, irinotecan hydrochloride, and docetaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Combining more than one drug may kill more tumor cells. It is not yet known which regimen of combination chemotherapy is more effective in treating tumor cells.

PURPOSE: This randomized phase II trial studies how well oxaliplatin, leucovorin calcium, and fluorouracil work compared to irinotecan hydrochloride and docetaxel in treating patients with esophageal cancer, gastric cancer, or gastroesophageal junction cancer.


Condition or disease Intervention/treatment Phase
Adenocarcinoma of the Gastroesophageal Junction Esophageal Cancer Gastric Cancer Drug: FOLFOX regimen Drug: docetaxel Drug: fluorouracil Drug: irinotecan hydrochloride Drug: leucovorin calcium Drug: oxaliplatin Phase 2

Detailed Description:

OBJECTIVES:

  • To assess progression-free survival of high-excision repair cross-complementing 1(ERCC1) patients with advanced or metastatic cancer of the esophagus, stomach, or gastroesophageal junction (GEJ) treated with FOLFOX comprising oxaliplatin, leucovorin calcium, and fluorouracil compared to those treated with irinotecan hydrochloride plus docetaxel.
  • To assess progression-free survival of low-ERCC1 patients with advanced or metastatic cancer of the esophagus, stomach, or GEJ treated with FOLFOX compared to those treated with irinotecan hydrochloride plus docetaxel.
  • To assess progression-free survival of low-ERCC1 patients with advanced or metastatic cancer of the esophagus, stomach, or GEJ treated with FOLFOX compared to high-ERCC1 patients treated with FOLFOX.
  • To assess overall survival of and toxicities in each of the two treatment arms in this group of patients.
  • To assess the response probability (confirmed and unconfirmed, complete and partial responses) in the subset of patients with measurable disease in each of the two treatment arms.
  • To explore whether there is evidence of interaction between treatment arm and ERCC1 expression in this group of patients. (Exploratory)
  • To bank tissue and blood for future translational medicine studies; a) To explore the relationship of ERCC-1 and ERCC-2 single nucleotide polymorphism (SNP) genotypes with clinical outcome in these patients; and b) To explore the association between germline variations in these SNPs and ERCC-1 mRNA expression in these patients. (Exploratory)

OUTLINE: This is a multicenter study. Patients are stratified according to ERCC1 expression (high [≥ 1.7] vs low [< 1.7]), and disease site (esophageal vs gastric/gastroesophageal junction). Patients are randomized to 1 of 2 treatment arms.

  • Arm I (FOLFOX): Patients receive oxaliplatin IV over 2 hours and leucovorin calcium IV over 2 hours on day 1, and fluorouracil IV over 46-48 hours on days 1-2. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity.
  • Arm II: Patients receive irinotecan hydrochloride IV over 90 minutes and docetaxel IV over 30-60 minutes on days 1 and 8. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Blood and tumor tissue samples may be collected for ERCC1 expression analysis and future research studies.

After completion of study treatment, patients are followed up every 3 months for up to 3 years.

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 213 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomized Phase II Pilot Study Prospectively Evaluating Treatment for Patients Based on ERCC1(Excision Repair Cross-Complementing 1) for Advanced/Metastatic Esophageal, Gastric or Gastroesophageal Junction (GEJ) Cancer
Actual Study Start Date : February 2012
Actual Primary Completion Date : March 2018
Actual Study Completion Date : September 19, 2019

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Arm I
FOLFOX regimen: Patients receive oxaliplatin IV over 2 hours and leucovorin calcium IV over 2 hours on day 1, and fluorouracil IV over 46-48 hours on days 1-2. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity.
 Drug: FOLFOX regimen
Given IV. Fluorouracil, oxaliplatin, & leucovorin calcium.

Drug: fluorouracil
400 mg/m^2, IV bolus on Day 1 of each 14 day cycle; 2400 mg/m^2 IV over 46-48 hours on Days 1-2 of each 14 day cycle.
Other Names:
  • 5-fluorouracil
  • 5-FU
  • NSC-19893

Drug: leucovorin calcium
400 mg/m^2, IV over 2 hours on Day 1 of every 14 day cycle.
Other Name: NSC-3590

Drug: oxaliplatin
85 mg/m^2, IV over 2 hours on Day 1 of every 14 day cycle.
Other Names:
  • Eloxatin
  • NSC-266046
Experimental: Arm II
Patients receive irinotecan hydrochloride IV over 90 minutes and docetaxel IV over 30-60 minutes on days 1 and 8. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
 Drug: docetaxel
30 mg/m^2, IV over 30 minutes on Day 1,8 of each 21 day cycle.
Other Names:
  • Taxotere
  • RP56976
  • NSC-628503

Drug: irinotecan hydrochloride
65 mg/m^2, IV over 90 minutes on Days 1 & 8 of every 21 day cycle.
Other Names:
  • CPT-11
  • NSC-616348


Outcome Measures
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Primary Outcome Measures :
  1. Progression-free Survival (PFS) in High-ERCC1 Patients [ Time Frame: Up to 3 years after registration ]
    Progression-free survival is the length of time between protocol registration and disease progression or death, whichever occurs first.

  2. PFS in Low-ERCC1 Participants [ Time Frame: Up to 3 years after registration ]
    Progression-free survival is the length of time between protocol registration and disease progression or death, whichever occurs first.

  3. Overall Survival (OS) [ Time Frame: Up to 3 years after registration ]
    OS is the length of time between protocol registration and patient death


Secondary Outcome Measures :
  1. Overall Response Rate (ORR) [ Time Frame: Up to 3 years after registration ]

    ORR (complete response, unconfirmed complete response, partial response, unconfirmed partial response) in patients with measurable disease were assessed in each arm and compared between arms using Chi-squared test.

    Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.


  2. PFS Variation by ERCC1 [ Time Frame: up to 3 years after registration ]

    Progression-free survival is the length of time between protocol registration and disease progression or death, whichever occurs first.

    Participants were divided into subgroups according to ERCC1 quartiles to assess whether the differences in PFS between the two treatment arms varied by ERCC1 levels.


  3. Number of Participants With Gr 3 Through 5 Adverse Events That Are Related to Study Drugs [ Time Frame: Duration of treatment and follow up until death or 3 years post registration ]
    Adverse Events (AEs) are reported by CTCAE Version 4.0. Only adverse events that are possibly, probably or definitely related to study drug are reported.


Eligibility Criteria
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Ages Eligible for Study:   18 Years to 120 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Patients must have unresectable advanced or metastatic histologically or cytologically confirmed adenocarcinoma of the esophagus, stomach, or gastroesophageal junction (GEJ)

    • Patients must not have received treatment for metastatic or unresectable disease
    • Patients must not have brain metastases
  • Patients must have measurable and/or non-measurable disease
  • Patients who have had HER-2 expression testing prior to patient consent to this study must be HER-2 negative; if HER-2 expression has not been tested prior to patient consent to this study, a second specimen must be submitted for HER-2 expression; if the specimen is HER-2 positive (or if HER-2 could not be evaluated), the patient will not be randomized
  • Patients must have completed any prior neoadjuvant and adjuvant therapy for resectable disease at least 180 days prior to registration

PATIENT CHARACTERISTICS:

  • Zubrod performance status of 0-1
  • Hemoglobin ≥ 9 g/dL
  • Absolute neutrophil count (ANC) ≥ 1,500/mcL
  • Platelets ≥ 100,000/mcL
  • Total bilirubin ≤ 1.5 mg/dL regardless of whether patients have liver involvement secondary to tumor
  • AST and ALT both ≤ 3 times institutional upper limit of normal (IULN) unless the liver is involved with tumor, in which case both AST and ALT must be ≤ 5 times IULN
  • Serum creatinine < 1.5 mg/dL within 28 days prior to registration AND/OR calculated creatinine clearance > 60 mL/min
  • Patients must not have motor or sensory neuropathy > Grade 1 using CTCAE version 4.0
  • Patients must not be pregnant or nursing; women and men of reproductive potential must have agreed to use an effective contraceptive method
  • No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease-free for five years

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • All palliative radiation therapy alone must be completed at least 14 days prior to registration
  • Patient must have no plans to receive concurrent chemotherapy, hormonal therapy, radiotherapy, immunotherapy, or any other type of therapy for treatment of cancer while on this protocol treatment
Contacts and Locations
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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 ClinicalTrials.gov identifier (NCT number): NCT01498289


Locations
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Sponsors and Collaborators
Southwest Oncology Group
National Cancer Institute (NCI)
Investigators
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Principal Investigator: Syma Iqbal, MD University of Southern California
  Study Documents (Full-Text)

Documents provided by Southwest Oncology Group:
Study Protocol, Statistical Analysis Plan, and Informed Consent Form  [PDF] April 28, 2014

More Information
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Responsible Party: Southwest Oncology Group
ClinicalTrials.gov Identifier: NCT01498289    
Other Study ID Numbers: S1201
S1201 ( Other Identifier: SWOG )
U10CA032102 ( U.S. NIH Grant/Contract )
NCI-2012-00096 ( Other Identifier: CTRP )
First Posted: December 23, 2011    Key Record Dates
Results First Posted: August 29, 2019
Last Update Posted: November 7, 2019
Last Verified: October 2019
Keywords provided by Southwest Oncology Group:
recurrent esophageal cancer
stage IV esophageal cancer
recurrent gastric cancer
stage IV gastric cancer
adenocarcinoma of the gastroesophageal junction
stage IIIB gastric cancer
 stage IIIC gastric cancer
stage IIIB esophageal cancer
stage IIIC esophageal cancer
adenocarcinoma of the esophagus
adenocarcinoma of the stomach
Additional relevant MeSH terms:
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Adenocarcinoma
Stomach Neoplasms
Esophageal Neoplasms
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Gastrointestinal Diseases
Stomach Diseases
Head and Neck Neoplasms
Esophageal Diseases
 Leucovorin
Docetaxel
Fluorouracil
Oxaliplatin
Irinotecan
Calcium
Levoleucovorin
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Calcium-Regulating Hormones and Agents
Physiological Effects of Drugs
Antimetabolites