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Pharmacogenomically Selected Treatment for Gastric and Gastroesophageal Junction (GEJ) Tumors

This study has been completed.
University of Alabama at Birmingham
University of North Carolina
Washington University School of Medicine
Information provided by (Responsible Party):
Craig Lockhart, Vanderbilt University Identifier:
First received: August 9, 2007
Last updated: May 30, 2014
Last verified: May 2014

This study is for patients who have stomach cancer or cancer of the lower part of the esophagus that has spread to other organs. There are many different chemotherapy treatments for this type of cancer. At the present time, there is no general agreement on the way to choose the most beneficial therapy for an individual patient. Patients with different genetic backgrounds may respond differently to the same chemotherapy treatments. In this study the investigators will use a certain genetic difference in an important gene (thymidylate synthase or TS gene) to see whether treating patients who have a particular type of that gene will respond better to a standard chemotherapy regimen. The investigators are hoping that by treating patients according to their genes, that they may respond to treatment of their cancer better and it will help the investigators choose cancer treatments better in the future.

Condition Intervention Phase
Stomach Neoplasms
Esophageal Neoplasms
Drug: Chemotherapy
Phase 2

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Pharmacogenomically Selected Treatment for Gastric and Gastroesophageal (GEJ) Tumors: A Phase II Study

Resource links provided by NLM:

Further study details as provided by Vanderbilt University:

Primary Outcome Measures:
  • Response rate [ Time Frame: 2 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Overall survival [ Time Frame: 4 years ] [ Designated as safety issue: No ]
  • Tumor specific changes that may alter treatment outcomes [ Time Frame: 4 years ] [ Designated as safety issue: No ]
  • Genetic polymorphisms that may alter treatment outcomes [ Time Frame: 4 years ] [ Designated as safety issue: No ]

Enrollment: 26
Study Start Date: August 2007
Study Completion Date: November 2013
Primary Completion Date: August 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Treatment
"Good risk" patients with the TSER*2/*2 or *2/*3 genotype or low TS expression genotype
Drug: Chemotherapy
5-FU, leucovorin and oxaliplatin (FOLFOX)

Detailed Description:

Gastric and gastroesophageal junction (GEJ) cancers are a leading cause of cancer mortality. Despite the development of newer chemotherapies, the response rates and median survival in patients with these tumors has remained essentially stagnant. Defining host and molecular/biologic tumor characteristics to customize treatment may lead to improved survival outcomes. Retrospective studies have identified genetic markers that predict treatment outcome. However, there have been no prospective studies in gastric and GEJ cancer evaluating the clinical utility of these genetic factors. We hypothesize that genomically based treatment will improve the expected response rate in patients with gastric and GEJ cancers. We propose a prospective, multi-institutional Phase II clinical trial testing a germline polymorphism in the thymidylate synthase (TS) gene, the number of tandem repeats in the TS enhancer region (TSER) as a treatment selection marker. The polymorphic variant conferring three tandem repeats (TSER*3) has been associated with 5-FU resistance due to high tumor TS expression in comparison to the TSER*2 variant (two tandem repeats). The TSER*3 polymorphism is common (allelic frequency of 0.5-0.8). In the proposed study, we will prospectively genotype patients with gastric and GEJ cancers. Patients who are expected to be 5-FU sensitive (carrying a TSER*2 allele) will receive a 5-FU containing regimen (5-FU, leucovorin, oxaliplatin). Patients who are expected to be 5-FU resistant (homozygous for TSER*3) will not be included in the study. In completing this study, we will determine whether treatment selection based on germline TSER polymorphism status improves the response rate in patients with metastatic gastric and GEJ tumors. Additional correlative studies are proposed to identify confounding factors that may alter the expected outcomes of this treatment approach.


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

Inclusion Criteria:

  • Patients must have histologically or cytologically confirmed adenocarcinoma of the stomach or gastroesophageal junction.
  • Patients must have measurable disease.
  • No prior therapy for metastatic disease. Prior neo-adjuvant or adjuvant therapy is permitted if the disease free interval has been longer than 6 months.
  • Age ≥18 years.
  • Life expectancy of greater than 3 months.
  • ECOG performance status greater than 2 (Karnofsky greater than 60%).
  • Patients must have normal organ and marrow function.
  • Not pregnant. Not breast feeding.
  • Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

  • Patients may not be receiving any other chemotherapy agents.
  • Patients with known active brain metastases. Patients with treated brain metastases are permitted if stable off steroids for at least 30 days.
  • History of allergic reactions to 5-FU or oxaliplatin.
  • Uncontrolled intercurrent illness.
  • Patients with immune deficiency.
  Contacts and Locations
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Please refer to this study by its identifier: NCT00515216

United States, Alabama
University of Alabama at Birmingham
Birmingham, Alabama, United States, 35294
United States, Missouri
Washington University School of Medicine
St. Louis, Missouri, United States, 63110
United States, North Carolina
University of North Carolina
Chapel Hill, North Carolina, United States, 27599
United States, Tennessee
Vanderbilt University Medical Center
Nashville, Tennessee, United States, 37232
Sponsors and Collaborators
Vanderbilt University
University of Alabama at Birmingham
University of North Carolina
Washington University School of Medicine
Principal Investigator: Albert C. Lockhart, MD Washington University School of Medicine
Principal Investigator: Laura Goff, MD Vanderbilt University
Principal Investigator: Richard Goldberg, MD University of North Carolina
Principal Investigator: James Posey, MD University of Alabama at Birmingham
  More Information

Additional Information:
No publications provided by Vanderbilt University

Additional publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Craig Lockhart, Associate Professor, Vanderbilt University Identifier: NCT00515216     History of Changes
Other Study ID Numbers: 070433, R21CA123881
Study First Received: August 9, 2007
Last Updated: May 30, 2014
Health Authority: United States: Institutional Review Board

Keywords provided by Vanderbilt University:
Phase II
Gastric cancer
Gastroesophageal cancer
Thymidylate synthase

Additional relevant MeSH terms:
Esophageal Neoplasms
Stomach Neoplasms
Digestive System Diseases
Digestive System Neoplasms
Esophageal Diseases
Gastrointestinal Diseases
Gastrointestinal Neoplasms
Head and Neck Neoplasms
Neoplasms by Site
Stomach Diseases processed this record on February 25, 2015