Docetaxel, Oxaliplatin, Capecitabine, Fluorouracil, and Radiation Therapy in Treating Patients With Locally Advanced Cancer of the Esophagus or Gastroesophageal Junction

This study has suspended participant recruitment.
Sponsor:
Collaborator:
Information provided by:
National Cancer Institute (NCI)
ClinicalTrials.gov Identifier:
NCT00938470
First received: July 10, 2009
Last updated: December 18, 2012
Last verified: August 2012
  Purpose

RATIONALE: Drugs used in chemotherapy, such as docetaxel, oxaliplatin, capecitabine, and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving more than one drug (combination chemotherapy) together with radiation therapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed.

PURPOSE: This randomized phase II trial is studying giving docetaxel together with oxaliplatin, capecitabine, fluorouracil, and radiation therapy to see how well it works compared with giving fluorouracil together with oxaliplatin and radiation therapy in treating patients with locally advanced cancer of the esophagus or gastroesophageal junction.


Condition Intervention Phase
Adenocarcinoma of the Gastroesophageal Junction
Esophageal Cancer
Gastric Cancer
Drug: capecitabine
Drug: docetaxel
Drug: fluorouracil
Drug: oxaliplatin
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Masking: Open Label
Primary Purpose: Treatment
Official Title: Randomized Phase II Trial of Extended Neoadjuvant Therapy for Locally Advanced Adenocarcinoma of the Esophagus, Gastroesophageal Junction, and Gastric Cardia

Resource links provided by NLM:


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

Primary Outcome Measures:
  • Pathologic complete response rate [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Overall survival [ Designated as safety issue: No ]
  • Disease-free survival [ Designated as safety issue: No ]
  • Adverse events [ Designated as safety issue: Yes ]
  • Clinical tumor response (complete and partial response) [ Designated as safety issue: No ]
  • Pharmacogenetic and proteomic marker measures [ Designated as safety issue: No ]
  • PET measure profiles including standardized uptake values and %-injected dose of tumor volume [ Designated as safety issue: No ]

Estimated Enrollment: 96
Study Start Date: February 2010
Estimated Primary Completion Date: March 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Arm I
Patients receive docetaxel IV over 1 hour and oxaliplatin IV over 2 hours on day 1. Patients also receive oral capecitabine twice daily on days 1-14. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. After completion of the second course, patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy 5 days a week for 5.5 weeks in the absence of disease progression or unacceptable toxicity. Approximately 4-12 weeks after completion of radiotherapy, patients undergo surgery.
Drug: capecitabine
Given orally
Drug: docetaxel
Given intravenously
Drug: fluorouracil
Given intravenously
Drug: oxaliplatin
Given intravenously
Active Comparator: Arm II
Patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy 5 days a week for 5.5 weeks in the absence of disease progression or unacceptable toxicity. Approximately 4-12 weeks after completion of radiotherapy, patients undergo surgery.
Drug: fluorouracil
Given intravenously
Drug: oxaliplatin
Given intravenously

Detailed Description:

OBJECTIVES:

Primary

  • Assess and compare the pathologic complete response rate of sequential docetaxel, oxaliplatin, and capecitabine followed by fluorouracil, oxaliplatin, and radiotherapy versus fluorouracil, oxaliplatin, and radiotherapy alone in patients with potentially resectable advanced adenocarcinoma of the esophagus, gastroesophageal junction, or gastric cardia.

Secondary

  • Assess the adverse event profile and safety of these regimens in this patient population.
  • Assess and compare the overall survival of patients treated with these regimens.
  • Assess and compare the disease-free survival between treatment arms.
  • Assess and compare the clinical tumor response rate of these proposed regimens when administered before surgery between treatment arms.
  • Evaluate the profiles of pharmacogenetic and proteomic marker measures over time, and assess the association of changes in these biomarkers induced by these proposed regimens with pathologic tumor response and other outcomes of interest.
  • Evaluate the profiles of FDG PET/CT measures, including standardized uptake values and % injected dose in the tumor volume over time, and assess the correlation of changes in PET measures with pathologic tumor response and other outcomes of interest.

OUTLINE: This is a multicenter study. Patients are stratified according to ECOG performance status (0-1 vs 2), and disease stage (II vs III/IVA). Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive docetaxel IV over 1 hour and oxaliplatin IV over 2 hours on day 1. Patients also receive oral capecitabine twice daily on days 1-14. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity. After completion of the second course, patients receive fluorouracil* IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy** 5 days a week for 5.5 weeks in the absence of disease progression or unacceptable toxicity. Approximately 4-12 weeks after completion of radiotherapy, patients undergo surgery.
  • Arm II: Patients receive fluorouracil IV continuously on days 1-5 and oxaliplatin IV over 2 hours on days 1, 15, and 29. Patients also undergo radiotherapy and then surgery as in arm I.* NOTE: * Fluorouracil continuous IV infusion begins within 24 hours of radiotherapy and ends within 24 hours of radiotherapy completion.

NOTE: ** Radiotherapy should begin within 2-6 weeks after completion of 2 courses of docetaxel, oxaliplatin, and capecitabine.

Blood samples are collected at baseline and periodically during study for pharmacogenetic (genetic polymorphisms along with drug target pathways) and proteomic markers (microRNA and mRNA expression) studies. Tumor tissue samples from biopsy and surgery are also collected for pharmacogenetic and proteomic markers studies and future correlative studies.

After completion of study therapy, patients are followed up every 3-6 months for 2 years.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Histologically confirmed locally advanced adenocarcinoma of the esophagus, gastroesophageal (GE) junction, or gastric cardia

    • Surgically resectable disease

      • T4N0M0 tumors that are potentially resectable allowed
      • T1N0M0 or T2N0M0 tumors not allowed
  • Nodal involvement:

    • Involvement of celiac nodes (stations 15-20) allowed if the primary lesion is mid-thoracic, distal esophagus, or GE junction
    • Supraclavicular node involvement allowed with upper thoracic-esophagus primary lesions
    • No palpable supraclavicular nodes, biopsy-proven involvement of supraclavicular nodes, or radiographically involved supraclavicular nodes (> 1.5 cm in greatest dimension) for lesions in mid-thoracic, distal thoracic, or GE junction
  • No evidence of distant metastases

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2
  • ANC ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3
  • Hemoglobin ≥ 9.0 g/dL
  • Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
  • AST ≤ 3 times ULN
  • Creatinine ≤ 1.5 times ULN
  • Creatinine clearance ≥ 60 mL/min
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception
  • Able to swallow pills
  • Willing to return to NCCTG enrolling institution for follow-up
  • Willing to provide mandatory tissue and blood samples for research purposes
  • Willing to undergo FDG PET/CT scans for mandatory research purposes
  • No co-morbid systemic illnesses or other severe concurrent disease that, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens
  • Not immunocompromised unless related to the use of corticosteroids

    • No known HIV positivity
  • No uncontrolled intercurrent illness including, but not limited to, the following conditions:

    • Ongoing or active infection
    • Symptomatic congestive heart failure
    • Unstable angina pectoris
    • Cardiac arrhythmia
    • Psychiatric illness and/or social situations that would limit compliance with study requirements
  • No uncontrolled diabetes
  • No other active malignancy, except for non-melanoma skin cancer or carcinoma in-situ of the cervix, unless curatively treated with no evidence of disease within the past 5 years and not on concurrent specific treatment for cancer other than hormonal therapy

PRIOR CONCURRENT THERAPY:

  • No prior radiotherapy to ≥ 30% of the marrow cavity
  • No prior or other concurrent treatment for this malignancy
  • No concurrent intensity-modulated radiotherapy
  Contacts and Locations
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, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00938470

  Show 187 Study Locations
Sponsors and Collaborators
North Central Cancer Treatment Group
Investigators
Study Chair: Steven R. Alberts, MD Mayo Clinic
  More Information

Additional Information:
No publications provided

Responsible Party: Jan C. Buckner, North Central Cancer Treatment Group
ClinicalTrials.gov Identifier: NCT00938470     History of Changes
Other Study ID Numbers: CDR0000646724, NCCTG-N0849
Study First Received: July 10, 2009
Last Updated: December 18, 2012
Health Authority: United States: Federal Government

Keywords provided by National Cancer Institute (NCI):
adenocarcinoma of the esophagus
adenocarcinoma of the gastroesophageal junction
stage IIIA gastric cancer
stage IIIB gastric cancer
stage IIIC gastric cancer
stage IIIA esophageal cancer
stage IIIB esophageal cancer
stage IIIC esophageal cancer

Additional relevant MeSH terms:
Adenocarcinoma
Esophageal Neoplasms
Stomach Neoplasms
Carcinoma
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Head and Neck Neoplasms
Digestive System Diseases
Esophageal Diseases
Gastrointestinal Diseases
Stomach Diseases
Fluorouracil
Capecitabine
Oxaliplatin
Docetaxel
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Antimetabolites, Antineoplastic
Antineoplastic Agents
Therapeutic Uses
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Tubulin Modulators
Antimitotic Agents

ClinicalTrials.gov processed this record on August 28, 2014