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Combination Chemotherapy With or Without Bevacizumab in Treating Patients With Previously Untreated Stomach Cancer or Gastroesophageal Junction Cancer That Can Be Removed by Surgery
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), June 2009
First Received: March 20, 2007   Last Updated: October 6, 2009   History of Changes
Sponsor: Medical Research Council
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00450203
  Purpose

RATIONALE: Drugs used in chemotherapy, such as epirubicin, cisplatin, and capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. Giving combination chemotherapy together with bevacizumab may kill more tumor cells.

PURPOSE: This randomized phase II/III trial is studying the side effects and how well giving combination chemotherapy together with bevacizumab works compared with combination chemotherapy alone in treating patients with previously untreated stomach cancer or gastroesophageal junction cancer that can be removed by surgery.


Condition Intervention Phase
Gastric Cancer
Biological: bevacizumab
Drug: capecitabine
Drug: cisplatin
Drug: epirubicin hydrochloride
Procedure: adjuvant therapy
Procedure: conventional surgery
Procedure: neoadjuvant therapy
Phase II
Phase III

Study Type: Interventional
Study Design: Treatment, Randomized, Open Label, Active Control
Official Title: A Randomized Controlled Phase II/III Trial of Peri-Operative Chemotherapy With or Without Bevacizumab in Operable Adenocarcinoma of the Stomach and Gastro Oesophageal Junction

Resource links provided by NLM:


Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Safety [ Designated as safety issue: Yes ]
  • Efficacy [ Designated as safety issue: No ]
  • Overall survival [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Feasibility [ Designated as safety issue: No ]
  • Treatment-related morbidity [ Designated as safety issue: No ]
  • Response rates to pre-operative treatment [ Designated as safety issue: No ]
  • Surgical resection rates [ Designated as safety issue: No ]
  • Disease-free survival [ Designated as safety issue: No ]
  • Quality of life [ Designated as safety issue: No ]
  • Cost-effectiveness [ Designated as safety issue: No ]

Estimated Enrollment: 1100
Study Start Date: October 2007
Detailed Description:

OBJECTIVES:

Primary

  • Assess the safety and efficacy of neoadjuvant and adjuvant chemotherapy comprising epirubicin hydrochloride, cisplatin, and capecitabine with or without bevacizumab in patients with previously untreated, resectable gastric or gastroesophageal junction cancer.

OUTLINE: This is a multicenter, randomized, open-label, controlled study. Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive epirubicin hydrochloride IV and cisplatin IV over 4 hours on day 1 and capecitabine orally twice daily on days 1-21. Treatment repeats every 21 days for up to 3 courses in the absence of disease progression or unacceptable toxicity.

Patients undergo surgery 5-6 weeks after completion of chemotherapy. Patients then receive 3 additional courses of chemotherapy beginning 6-10 weeks after surgery.

  • Arm II: Patients receive bevacizumab IV over 30-90 minutes, epirubicin hydrochloride IV, and cisplatin IV over 4 hours on day 1 and capecitabine orally twice daily on days 1-21. Treatment repeats every 21 days for up to 3 courses in the absence of disease progression or unacceptable toxicity.

Patients undergo surgery 5-8 weeks after completion of chemotherapy. Patients then receive 3 additional courses of chemotherapy and bevacizumab beginning 6-10 weeks after surgery. Patients then receive maintenance therapy comprising bevacizumab IV over 30-90 minutes on day 1. Maintenance therapy repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.

Quality of life is assessed at baseline, during treatment, and during the follow-up period.

After completion of study treatment, patients are followed at 9, 18, and 27 weeks after the start of course 4, 1 year post surgery, every 6 months for 2 years, and then annually thereafter.

PROJECTED ACCRUAL: A total of 1,100 patients will be accrued for this study.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed gastric or type III gastroesophageal junction adenocarcinoma

    • Stage IB (T1, N1 or T2a/b, N0), II, III (with no evidence of distant metastases), or IV (T4, N1 or N2, M0) disease
    • Resectable disease
  • Previously untreated disease

PATIENT CHARACTERISTICS:

  • WHO performance status 0 or 1
  • Absolute neutrophil count ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3
  • Hemoglobin ≥ 9 g/dL (can be post transfusion)
  • WBC ≥ 3,000/mm^3
  • Glomerular filtration rate ≥ 60 mL/min
  • Proteinuria ≤ 1 g by 24-hour urine collection
  • Bilirubin ≤ 1.5 times upper limit of normal (ULN)
  • ALT and AST ≤ 2.5 times ULN
  • Alkaline phosphatase ≤ 3 times ULN (in the absence of liver metastases)
  • INR ≤ 1.5
  • PTT ≤ 1.5 times ULN
  • FEV_1 ≥ 1.5 L
  • Cardiac ejection fraction ≥ 50% by MUGA scan or echocardiogram
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • Must be fit enough to receive protocol treatment
  • No other malignancies within the past 5 years except for curatively treated basal cell carcinoma of the skin and/or in situ carcinoma of the cervix
  • No prior or concurrent significant medical conditions, including any of the following:

    • Cerebrovascular disease (including transient ischemic attack and stroke) within the past year
    • Cardiovascular disease, including the following:

      • Myocardial infarction within the past year
      • Uncontrolled hypertension while receiving chronic medication
      • Unstable angina
      • New York Heart Association class II-IV congestive heart failure
      • Serious cardiac arrhythmia requiring medication
    • Major trauma within the past 28 days
    • Serious nonhealing wound, ulcer, or bone fracture
    • Evidence of bleeding diathesis or coagulopathy
    • Recent history of any active gastrointestinal inflammatory condition (e.g., peptic ulcer disease, diverticulitis, or inflammatory bowel disease)

      • If patients have a known diagnosis of any of the above, evidence of disease control is required by negative endoscopy within the past 28 days
  • No severe tinnitus
  • No lack of physical integrity of the upper gastrointestinal tract, malabsorption syndrome, or inability to take oral medication
  • No known peripheral neuropathy ≥ 1 (absence of deep tendon reflexes as the sole neurological abnormality does not render the patient ineligible)
  • No known dihydropyrimidine dehydrogenase deficiency
  • No known allergy to any of the following:

    • Chinese hamster ovary cell proteins
    • Other recombinant human or humanized antibodies
    • Any excipients of bevacizumab formulation or platinum compounds
    • Any other components of the study drugs

PRIOR CONCURRENT THERAPY:

  • No prior anthracycline
  • More than 28 days since prior major surgery or open biopsy
  • More than 10 days since prior thrombolytic therapy
  • No concurrent thrombolytic therapy
  • No concurrent dipyridamole or allopurinol
  • No concurrent capecitabine or sorivudine (or sorivudine analogues [e.g., brivudine])
  • No chronic, daily high-dose acetylsalicylic acid (> 325 mg/day) or nonsteroidal anti-inflammatory drugs
  • No chronic corticosteroids (≥ 10 mg/day methylprednisolone equivalent)

    • Inhaled steroids allowed
  • No other concurrent cytotoxic agents
  • No other concurrent investigational drugs
  • No concurrent radiotherapy
  • Low molecular weight heparin allowed
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00450203

Locations
United Kingdom, England
Addenbrooke's Hospital Recruiting
Cambridge, England, United Kingdom, CB2 2QQ
Contact: Hugo Ford, MD     44-1223-245-151        
Aintree University Hospital Recruiting
Liverpool, England, United Kingdom, L9 7AL
Contact: David Smith, MD     44-151-525-5980        
Berkshire Cancer Centre at Royal Berkshire Hospital Recruiting
Reading, England, United Kingdom, RG1 5AN
Contact: Joss Adams, MD     44-118-322-7878        
Bradford Royal Infirmary Recruiting
Bradford, England, United Kingdom, BD9 6RJ
Contact: Sue Cheeseman, MD     44-1274-542-200        
Bristol Haematology and Oncology Centre Recruiting
Bristol, England, United Kingdom, BS2 8ED
Contact: Stephen J. Falk, MD     44-117-928-3074     stephen.falk@ubht.nhs.uk    
Christie Hospital Recruiting
Manchester, England, United Kingdom, M20 4BX
Contact: Was Mansoor, MD     44-845-226-3000        
Clatterbridge Centre for Oncology Recruiting
Merseyside, England, United Kingdom, CH63 4JY
Contact: David Smith, MD     44-151-334-1155     david.smith@ccotrust.nhs.uk    
Lincoln County Hospital Recruiting
Lincoln, England, United Kingdom, LN2 5QY
Contact: Zuzana Stokes     44-1522-512-512        
Derriford Hospital Recruiting
Plymouth, England, United Kingdom, PL6 8DH
Contact: Sarah Pascoe, MD     44-175-277-7111        
Doncaster Royal Infirmary Recruiting
Doncaster, England, United Kingdom, DN2 5LT
Contact: Jonathan Wadsley     44-1302-366-666        
Dorset Cancer Centre Recruiting
Poole Dorset, England, United Kingdom, BH15 2JB
Contact: Richard Osborne, MD, FRCP     44-1-202-448-265        
Huddersfield Royal Infirmary Recruiting
Huddersfield, West Yorks, England, United Kingdom, HD3 3EA
Contact: Jo Dent     44-1484-342-000        
Leeds Cancer Centre at St. James's University Hospital Recruiting
Leeds, England, United Kingdom, LS9 7TF
Contact: Matthew T. Seymour, MA, MD, FRCP     44-113-206-6400        
Cumberland Infirmary Recruiting
Carlisle, England, United Kingdom, CA2 7HY
Contact: Jonathan J. Nicoll, MD     44-122-881-4688     jonathan.nicoll@ncumbria-acute.nhs.uk    
Mid Kent Oncology Centre at Maidstone Hospital Recruiting
Maidstone, England, United Kingdom, ME16 9QQ
Contact: Justin Waters, MD     44-1622-729-000        
Northern Centre for Cancer Treatment at Newcastle General Hospital Recruiting
Newcastle-Upon-Tyne, England, United Kingdom, NE4 6BE
Contact: Fareeda Coxon, MD     44-191-256-3551     fareeda.coxon@nuth.nhs.uk    
Rochdale Infirmary Recruiting
Rochdale, England, United Kingdom, 0L12 0NB
Contact: Khurshid Akhtar, MD     44-170-637-7777        
Royal Bournemouth Hospital NHS Trust Recruiting
Bournemouth, England, United Kingdom, BH7 7DW
Contact: Tom Geldart     44-1202-726-088        
Salisbury District Hospital Recruiting
Salisbury, England, United Kingdom, SP2 8BJ
Contact: Tim J. Iveson, MD     44-1722-336-262 ext. 4688        
Saint Bartholomew's Hospital Recruiting
London, England, United Kingdom, EC1A 7BE
Contact: Sarah Slater, MD     44-20-7601-8391        
Royal Marsden - Surrey Recruiting
Sutton, England, United Kingdom, SM2 5PT
Contact: David Cunningham, MD     44-20-8661-3279     david.cunningham@rmh.nhs.uk    
Southampton General Hospital Recruiting
Southampton, England, United Kingdom, SO16 6YD
Contact: Tim J. Iveson, MD     44-23-8079-6802     t.iveson@soton.ac.uk    
St. George's Hospital Recruiting
London, England, United Kingdom, SW17 0QT
Contact: Tim Benepal, MD     44-208-725-2995        
St. Luke's Cancer Centre at Royal Surrey County Hospital Recruiting
Guildford, England, United Kingdom, GU2 7XX
Contact: Gary W. Middleton     44-1483-570-122     gmiddleton@royalsurrey.nhs.uk    
St. Mary's Hospital Recruiting
London, England, United Kingdom, W2 1NY
Contact: Danielle Power, MD     44-20-7886-7690     danielle.power@st-marys.nhs.uk    
Wexham Park Hospital Recruiting
Slough, Berkshire, England, United Kingdom, SL2 4HL
Contact: Marcia Hall, MD     44-1753-634-364     marcia.hall@nhs.net.uk    
United Kingdom, Scotland
Aberdeen Royal Infirmary Recruiting
Aberdeen, Scotland, United Kingdom, AB25 2ZN
Contact: Russell Petty, MD     44-84-5456-6000        
United Kingdom, Wales
Velindre Cancer Center at Velindre Hospital Recruiting
Cardiff, Wales, United Kingdom, CF14 2TL
Contact: Tom Crosby, MD     44-29-2031-6292        
Sponsors and Collaborators
Medical Research Council
Investigators
Study Chair: David Cunningham, MD Royal Marsden NHS Foundation Trust
  More Information

Additional Information:
No publications provided

Study ID Numbers: CDR0000536013, MRC-ST03, EU-20710, ISRCTN46020948, EUDRACT-2006-000811-12, CTA-00316/0221/001
Study First Received: March 20, 2007
Last Updated: October 6, 2009
ClinicalTrials.gov Identifier: NCT00450203     History of Changes
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
adenocarcinoma of the stomach
stage I gastric cancer
stage II gastric cancer
stage III gastric cancer
stage IV gastric cancer

Additional relevant MeSH terms:
Antimetabolites
Antimetabolites, Antineoplastic
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents
Gastrointestinal Diseases
Physiological Effects of Drugs
Bevacizumab
Antibiotics, Antineoplastic
Stomach Diseases
Neoplasms by Site
Cisplatin
Stomach Neoplasms
Therapeutic Uses
Angiogenesis Modulating Agents
Growth Inhibitors
Capecitabine
Digestive System Neoplasms
Growth Substances
Epirubicin
Angiogenesis Inhibitors
Pharmacologic Actions
Neoplasms
Digestive System Diseases
Radiation-Sensitizing Agents
Gastrointestinal Neoplasms

ClinicalTrials.gov processed this record on February 08, 2010