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FDG-PET Directed Treatment in Improving Response in Patients With Locally Advanced Stomach or Gastroesophageal Junction Cancer

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02485834
Recruitment Status : Terminated (Poor accrual)
First Posted : June 30, 2015
Results First Posted : September 11, 2019
Last Update Posted : September 11, 2019
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Alliance for Clinical Trials in Oncology

Brief Summary:
This randomized phase II trial studies how well fludeoxyglucose F-18 (FDG)/positron emission tomography (PET) directed treatment improves response in patients with stomach or gastroesophageal junction cancer that has not spread past the stomach and is not responding to the usual treatment. PET scans are a different way to take pictures of cancer and can be used to look at how much energy (such as glucose) is being used by the cancer. Using PET scans early to monitor the success of treatment may allow doctors to measure response and change treatment accordingly.

Condition or disease Intervention/treatment Phase
Adenocarcinoma of the Gastroesophageal Junction Gastric Adenocarcinoma Gastric Cancer Procedure: FDG-PET Procedure: surgery Drug: 5-FU Drug: capecitabine Drug: docetaxel Drug: Irinotecan Radiation: 3D-CRT Radiation: IMRT Phase 2

Detailed Description:

Pre-registered patients receive standard pre-operative chemotherapy comprising epirubicin intravenously 50mg/m^2 (IV) on day 1; oxaliplatin 130 mg/m^2 IV or cisplatin 60 mg/m^2 IV on day 1; and capecitabine 625 mg/m^2 orally (PO) twice daily (BID) or fluorouracil 200 mg/m^2/day IV continuously on days 1-21; and undergo FDG-PET following course 1 (days 15-19). Patients defined as FDG-PET non-responders are registered and randomized to 1 of 2 treatment arms.

Primary objective

To assess and compare the overall survival (OS) of patients with locally advanced gastric cancer classified as FDG-PET non-responders after one cycle of pre-operative chemotherapy randomly assigned to receive either salvage chemotherapy before and after surgery or immediate surgery followed by fluorouracil sensitized radiotherapy.

Secondary objectives

  1. To assess and compare progression-free survival (PFS) between the treatment arms (Arms A and B).
  2. To assess and compare R0 resection rate between the treatment arms (Arms A and B).
  3. To assess and compare pathologic complete response (pCR) rate between the treatment arms (Arms A and B).
  4. To assess the adverse events (AE) profile and safety of each treatment arm (Arms A and B), including post-operative mortality rate, 30-day post-operative targeted adverse events (i.e., dehiscence, significant infection, and re-operation rate).
  5. To examine the changes of FDG-PET SUV induced by pre-operative chemotherapy at different time points (from baseline to completion of one cycle of treatment before randomization, and 2 cycles of salvage treatment) in patients randomized to salvage treatment arm (Arm B).
  6. To collect measurement of fatigue and overall perception of QOL at registration of the study (Alliance registration QOL assessment study).

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 5 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Impact of Early FDG-PET Directed Intervention on Preoperative Therapy for Locally Advanced Gastric Cancer: A Random Assignment Phase II Study
Actual Study Start Date : August 2015
Actual Primary Completion Date : August 2018
Actual Study Completion Date : August 2018

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: Arm A - surgery, chemotherapy and radiation therapy
Patients undergo surgery within 42 days of completion of pre-registration chemotherapy. Beginning within 49 days of surgery, patients receive 5-FU IV continuously and capecitabine PO BID on days 1-7, and undergo 3D-CRT or IMRT QD on days 1-5. Treatment continues for 5 weeks in the absence of disease progression or unacceptable toxicity.
Procedure: surgery
Drug: 5-FU
200 mg/m^2/day IV

Drug: capecitabine
oral 800 mg/m^2 BID

Radiation: 3D-CRT
Radiation: IMRT
Experimental: Arm B - surgery, chemotherapy and FDG-PET
Beginning within 28 days of day 1 of pre-registration chemotherapy, patients receive docetaxel IV and irinotecan IV on days 1 and 8. Treatment repeats every 3 weeks for 2 courses. Beginning within 42 days of completion of docetaxel and irinotecan, patients undergo surgery. Patients also undergo FDG-PET within 14 days of planned surgery. Beginning within 60 days after surgery, patients receive 3 additional courses of docetaxel and irinotecan hydrochloride courses in the absence of disease progression or unacceptable toxicity.
Procedure: FDG-PET
Procedure: surgery
Drug: docetaxel
30 mg/m^2 IV

Drug: Irinotecan
50 mg/m^2 IV

Primary Outcome Measures :
  1. Overall Survival [ Time Frame: Up to 3 years ]
    Overall survival is defined as the time from date of randomization to death due to any cause.

Secondary Outcome Measures :
  1. Progression-free Survival [ Time Frame: Up to 3 years ]
    Progression free survival (PFS) is defined as the time from the date of randomization to the date of disease progression or death resulting from any cause, whichever comes first. Progression is defined according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions. The median and 95% confidence intervals are estimated using the Kaplan-Meier estimator.

  2. Number of Patients Achieved R0 Resection During Surgery [ Time Frame: At time of surgery ]
    The number of patients achieved R0 resection during surgery

  3. Number of Patients Had Pathologic Complete Response [ Time Frame: Up to 3 years ]
    The number of patients had pathologic complete response (pCR). (pCR is defined as no gross or microscopic tumor identified with the surgical specimen. All lymph nodes should be free of tumor to document a PCR. If no gross tumor is visible, section around the area of inflammation (nodularity) should be made every 2-3 cm and specimens examined.)

  4. Number of Participants Who Reported Grade 3 or Higher Adverse Events [ Time Frame: Up to 30 days after completion of protocol treatment ]
    The number of patients who reported grade 3 or higher Adverse Events according to Common Terminology Criteria for Adverse Events version 4.0.

Other Outcome Measures:
  1. Change in FDG-PET SUV Measures [ Time Frame: Up to 14 days prior to surgery ]

Information from the National Library of Medicine

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, Learn About Clinical Studies.

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

Pre-Registration Eligibility Criteria

  1. Documentation of Disease

    1.1 Histologically confirmed adenocarcinoma of the stomach or gastroesophageal junction (Siewert type II, III)

    1.2 Pre-treatment clinical stage of T3-4N any M0 or T any N positive M0 as determined by laparoscopy, CT scan (or PET/CT), or endoscopic ultrasound (histologic confirmation of lymph involvement is not required). Therefore, patients can have measurable or non-measurable disease.

    1.3 Patients with T1-2N0M0 tumors or patients with metastatic disease are NOT eligible.

  2. Patients must be eligible for curative intent surgical resection.
  3. FDG Avid malignancy - Patients must have an FDG avid tumor(s). FDG avid tumors are defined as a primary tumor with an increased uptake in the region of the tumor that has an SUV of > 5.0 or a tumor:liver SUV ratio of > 1.5.
  4. No prior history of congestive heart failure - NYHA class I to IV or known DPD deficiency
  5. No current grade 2, 3, or 4 of neuropathy.
  6. No known hypersensitivity to epirubicin, oxaliplatin and cisplatin, capecitabine and 5-flurouracil, docetaxel or irinotecan.
  7. Not pregnant and not nursing, because this study involves an agent that has known genotoxic, mutagenic and teratogenic effects.

    7.1 Therefore, for women of childbearing potential only, a negative serum pregnancy test pregnancy test done ≤ 7 days prior to pre-registration is required.

    7.2 A female of childbearing potential is a sexually mature female who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months).

  8. Age ≥ 18 years
  9. ECOG Performance Status 0 or 1
  10. Required Initial Laboratory Values:

    • Absolute Neutrophil Count (ANC) ≥ 1,500/mm^3
    • Platelet Count ≥ 100,000/mm^3
    • Creatinine ≤ 1.5 x upper limit of normal (ULN)
    • Total Bilirubin ≤ 1.5 x ULN, except in patients with Gilbert's disease
    • AST and ALT ≤ 2.5 x ULN
    • Alkaline Phosphatase ≤ 2.5 x ULN

Registration Eligibility Criteria to Treatment Arms A or B

  1. Patient must continue to be eligible for curative intent surgical resection.
  2. Disease Progression: FDG avid malignancy that is classified as an FDG PET non- responder. PET non-responders are defined as having < 35% reduction in the FDG uptake of the primary tumor when compared to baseline.
  3. Concomitant Medications -

    3.1 Chronic concomitant treatment with strong inhibitors of CYP3A4 is not allowed on this trial. Patients on strong CYP3A4 inhibitors must discontinue the drug 14 days prior to the start of study treatment.

    3.2 Chronic concomitant treatment with strong CYP3A4 inducers is not allowed. Patients must discontinue the drug 14 days prior to the start of study treatment.

  4. Patient must have received only one cycle of the following regimens during the pre-registration time period and no other therapy for gastric or gastroesophageal junction cancer:

    • Epirubicin, Oxaliplatin, and Capecitabine
    • Epirubicin, Oxaliplatin, and Fluorouracil
    • Epirubicin, Cisplatin, and Capecitabine
    • Epirubicin, Cisplatin, and Fluorouracil
  5. Toxicity recovery should include the following:

    • Grade ≤ 2 neuropathy
    • Grade ≤ 2 diarrhea
    • Grade ≤ 2 mucositis
  6. Pre-registration chemotherapy given within 42 days of treatment (treatment meaning surgery if Arm A, chemotherapy if Arm B)

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 identifier (NCT number): NCT02485834

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Sponsors and Collaborators
Alliance for Clinical Trials in Oncology
National Cancer Institute (NCI)
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Study Chair: Manish Shah, MD Weill Medical College of Cornell University
  Study Documents (Full-Text)

Documents provided by Alliance for Clinical Trials in Oncology:
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Responsible Party: Alliance for Clinical Trials in Oncology Identifier: NCT02485834    
Other Study ID Numbers: A021302
U10CA180821 ( U.S. NIH Grant/Contract )
NCI-2014-02566 ( Registry Identifier: NCI Clinical Trials Reporting Office )
First Posted: June 30, 2015    Key Record Dates
Results First Posted: September 11, 2019
Last Update Posted: September 11, 2019
Last Verified: September 2019
Additional relevant MeSH terms:
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Stomach Neoplasms
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Gastrointestinal Diseases
Stomach Diseases
Antineoplastic Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Antimetabolites, Antineoplastic
Topoisomerase I Inhibitors
Topoisomerase Inhibitors
Enzyme Inhibitors