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Personalized Therapy for Esophagogastric Cancer Using Thymidylate Synthase Genetic Markers

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ClinicalTrials.gov Identifier: NCT02296671
Recruitment Status : Withdrawn (Was unable to accrue any patients)
First Posted : November 20, 2014
Last Update Posted : March 8, 2016
Sponsor:
Collaborator:
Gateway for Cancer Research
Information provided by (Responsible Party):
Washington University School of Medicine

Brief Summary:

In this study the investigators aim to: 1) confirm the objective response rate (ORR) observed in the investigators initial study for patients with the TSER*2/*2 genotype 2) determine whether PEMOX regimen is more worthy of future development for this patient genotype selected population than FOLFOX based on the data indicating that pemetrexed may be a better TS targeted agent than 5-FU.

Patients who are homozygous for the TSER*2 allele (TSER*2/*2) will be able to continue in the study and will be randomized. Patients with other TSER genotypes will not be included and will be considered screen fails.

The first 8 patients with the TSER*2/*2 genotype will be randomized 1:1 to receive treatment with either PEMOX or FOLFOX (4 in each group).

Analysis of the objective response rate (ORR) in each treatment arm will occur after the first 8 patients are enrolled. Using the proposed Bayesian design, subsequent patients will be preferentially assigned to the "better performing" treatment arm based on continuous real-time reassessments of ORR results.


Condition or disease Intervention/treatment Phase
Esophagogastric Cancer Drug: Pemetrexed Drug: Oxaliplatin Drug: Leucovorin Drug: Fluorouracil Genetic: Germline genotyping analyses for TSER Phase 2

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 0 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Personalized Therapy for Esophagogastric Cancer Using Thymidylate Synthase Genetic Markers
Study Start Date : February 2015
Estimated Primary Completion Date : September 2018
Estimated Study Completion Date : February 2022

Arm Intervention/treatment
Experimental: PEMOX

Pemetrexed will be given intravenously (IV) on an outpatient basis on Day 1 of each 14-day cycle over 10 minutes. Oxaliplatin will be given (IV) on an outpatient basis on Day 1 of each 14-day cycle at a dose over 120 minutes. Drugs may be given in either order.

-Oxaliplatin will be administered on Day 2 for Cycle 1 only. **

Drug: Pemetrexed
Other Name: Alimta®

Drug: Oxaliplatin
Other Name: Eloxatin®

Genetic: Germline genotyping analyses for TSER
Experimental: FOLFOX

The modified FOLFOX-6 regimen is the following drugs given every 14 days:

  • Oxaliplatin on Day 1 of each cycle
  • Leucovorin over 120 minutes on Day 1 of each cycle
  • 5-FU bolus and continuous infusion over 46 hours beginning on Day 1 of each cycle

    • Oxaliplatin will be administered on Day 2 for Cycle 1 only and the 5-FU infusion will be interrupted at 20 hours so that the FLT-PET scan can be performed (only for FLT-PET scan eligible patients).
Drug: Pemetrexed
Other Name: Alimta®

Drug: Oxaliplatin
Other Name: Eloxatin®

Drug: Leucovorin
Other Name: Wellcovorin

Drug: Fluorouracil
Other Names:
  • 5FU
  • 5-Fluorouracil
  • Adrucil®

Genetic: Germline genotyping analyses for TSER



Primary Outcome Measures :
  1. Objective response rate (ORR) [ Time Frame: Baseline, end of every 4th cycle, and end of treatment (estimated average of 6 months) ]

    ORR=complete response + partial response by RECIST criteria

    Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to <10 mm.

    Partial Response (PR): At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.



Secondary Outcome Measures :
  1. Overall survival (OS) [ Time Frame: Every 3 months for up to 4 years from the date of study registration or until death, whichever occurs first ]
    OS = The length of time from the start of treatment to time of death.

  2. Quality of life [ Time Frame: Baseline and Day 1 of each cycle through Cycle 5 Day 1 (approximately Day 70) ]
    Quality of life will be assessed by the EORTC QLQ-C30 and the EORTC QLQ-STO22



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

Inclusion Criteria:

Pre-Registration Inclusion Criteria

  • Histologically or cytologically confirmed unresectable or metastatic esophagogastric adenocarcinoma.
  • Measurable disease defined as lesions that can be accurately measured in at least one dimension (longest diameter to be recorded) as >10 mm with CT scan, as >20 mm by chest x-ray, or >10 mm with calipers by clinical exam. PET/CT scan is acceptable as a substitute for a CT scan if the CT portion of the PET/CT is of identical diagnostic quality to a diagnostic CT scan.
  • At least 18 years of age.
  • ECOG performance status < 2
  • Able to understand and willing to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable).

Registration Inclusion Criteria

  • TSER genotype *2/*2
  • ECOG performance status < 2
  • Normal bone marrow and organ function as defined below:

    • Absolute neutrophil count ≥ 1,500 cells/mm3
    • Platelets ≥ 100,000 cells/mm3
    • Total bilirubin < 1.5 x IULN
    • AST(SGOT)/ALT(SGPT) < 3.0 x IULN
    • Creatinine within normal institutional limits OR Creatinine clearance ≥ 45 mL/min/1.73 m2 for patients with creatinine levels above institutional normal
  • Women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control, abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while participating in this study, she must inform her treating physician immediately.

Exclusion Criteria:

Pre-Registration Exclusion Criteria

  • Prior therapy for this cancer.
  • A history of other malignancy ≤ 5 years previous with the exception of basal cell or squamous cell carcinoma of the skin which were treated with local resection only or carcinoma in situ of the cervix.
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  • Known HIV-positivity on combination antiretroviral therapy because of the potential for pharmacokinetic interactions with pemetrexed and/or oxaliplatin. In addition, these patients are at increased risk of lethal infections when treated with marrow-suppressive therapy. Appropriate studies will be undertaken in patients receiving combination antiretroviral therapy when indicated.

Registration Exclusion Criteria

  • Currently receiving any other investigational agents.
  • Known brain metastases. Patients with known brain metastases must be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events.
  • A history of allergic reactions attributed to compounds of similar chemical or biologic composition to pemetrexed, 5-FU, leucovorin or oxaliplatin, or other agents used for premedication in the study.
  • Pregnant and/or breastfeeding. Patient must have a negative pregnancy test within 14 days of study entry.

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): NCT02296671


Sponsors and Collaborators
Washington University School of Medicine
Gateway for Cancer Research
Investigators
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Principal Investigator: A. Craig Lockhart, M.D. Washington University School of Medicine
Additional Information:
Publications:
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Responsible Party: Washington University School of Medicine
ClinicalTrials.gov Identifier: NCT02296671    
Other Study ID Numbers: 201412051
First Posted: November 20, 2014    Key Record Dates
Last Update Posted: March 8, 2016
Last Verified: March 2016
Additional relevant MeSH terms:
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Leucovorin
Fluorouracil
Oxaliplatin
Pemetrexed
Antimetabolites
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Antineoplastic Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Antidotes
Protective Agents
Vitamin B Complex
Vitamins
Micronutrients
Nutrients
Growth Substances
Enzyme Inhibitors
Folic Acid Antagonists
Nucleic Acid Synthesis Inhibitors