Metabolomic and BH3 Profiling of Esophageal Cancers: Identification of Novel Assessment Methods of Treatment Response for Precision Therapy<TAB>
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|ClinicalTrials.gov Identifier: NCT03223662|
Recruitment Status : Recruiting
First Posted : July 21, 2017
Last Update Posted : February 14, 2018
The number of patients with esophageal cancer keeps rising. For many patients, a combination of surgery, chemotherapy, and radiation is necessary to completely treat the disease. Usually, patients receive chemotherapy and radiation at the same time followed by surgery to remove the part of the esophagus with the tumor (Neoadjuvant chemoradiotherapy nCRT). Researchers want to learn how to make this treatment more effective.
To see if biopsies before treatment can show which patients will do the best with a combination of chemotherapy, radiation, and surgery.
Adults at least 18 years old with esophageal adenocarcinoma or squamous cell carcinoma who should be treated with chemotherapy, radiation, and surgery.
Patients will undergo standard testing that is routine for all patients with this disease. These tests include:
Physical exam with activity and nutritional assessment
Standard lab tests
Imaging studies including a CAT scan and PET scan
Breathing test into a machine to measure size and function of lungs.
Biopsy for a small sample of tumor is removed by EGD: A tube inserted into the mouth under anesthesia
Endoscopic ultrasound is performed in some but not all patients.
Patients will have nCRT at the clinic or with their local doctor.
In 6 -12 weeks after nCRT, patients will undergo surgery with:
- A robotically-assisted, minimally-invasive esophagectomy
- Or, a traditional, open approach.
After surgery, patients are usually in the hospital for 2 weeks and have a feeding tube for at least 2 weeks and potentially longer until they are eating enough to not lose weight.
Patients will return for follow-up visits with labs and CAT scans every 6 months for the first two years then every year afterwards.
|Condition or disease||Intervention/treatment||Phase|
|Esophageal Cancer Esophageal Adenocarcinoma Esophageal Squamous Cell Cancer Esophageal Neoplasms Squamous Cell Carcinoma||Other: Chemoradiotherapy Procedure: Esophagectomy||Phase 2|
- The incidence of esophageal cancer continues to increase with an estimated 16,900 new cases and 15,700 deaths in 2016. Esophageal adenocarcinoma (EAC) is the dominant histology in the United States and accounts for the rising incidence; the incidence of esophageal squamous cell cancer (ESCC) remains stable.
- Neoadjuvant chemoradiotherapy (nCRT) followed by esophagectomy is now a standard approach for locally advanced, operable esophageal cancer.
- A survival advantage compared to surgery alone was demonstrated in the phase III Chemo
Radiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) trial.
- Patients who experience a pathological complete response (pCR) following neoadjuvant therapy are most likely to have long-term survival.
- Presently, accurate assessment of pathologic response requires esophagectomy. Positronemissions tomography (FDG-PET) and endoscopic evaluation with biopsies fail to detect cancer in a significant percentage of patients with residual disease following neoadjuvant therapy.
- Currently there are no validated tissue or serologic biomarkers which can be used to guide surgical management of esophageal cancer patients based on response to nCRT.
-To determine whether a metabolomic signature in tumor, blood, or urine or whether BH3 profiling of pre-neoadjuvant tumor biopsies correlates with the outcome of pathological complete response after neoadjuvant chemoradiotherapy for patients with esophageal adenocarcinoma or squamous cell carcinoma.
-Patients with locally-advanced, histologically confirmed EAC or ESCC who are candidates for nCRT and esophagectomy.
- Patients will receive standard of care nCRT either at the NCI or at referring institutions.
- Specimens of plasma, urine, and esophageal tumor with matched normal esophagus will be obtained before neoadjuvant therapy for metabolomic profiling and BH3 profiling.
Blood, urine, normal esophagus, and tumor (if present) will be obtained after neoadjuvant therapy.
- Patients will undergo an esophagectomy as a robotically-assisted, minimally-invasive esophagectomy (RAMIE) or a traditional open approach for contraindications to minimally-invasive approaches or based on institutional expertise.
- Following esophagectomy, patients will be stratified into two cohorts (pCR or non-pCR).
- Analysis will be performed to determine if pCR after CRT correlates with pretreatment metabolomic signatures or BH3 profiling in tumor, blood or urine.
- Patients with EAC and ESCC will be evaluated independently.
- The accrual ceiling will be set to 120 patients for the entire study - 80 patients for EAC and 40 patients for ESCC to allow for unevaluable patients. The accrual is expected to be completed in 4 years.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||120 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Metabolomic and BH3 Profiling of Esophageal Cancers: Identification of Novel Assessment Methods of Treatment Response for Precision Therapy|
|Actual Study Start Date :||October 31, 2017|
|Estimated Primary Completion Date :||December 31, 2021|
|Estimated Study Completion Date :||December 31, 2027|
All patient will have same procedures
Chemotherapy: Carboplatin (AUC=2)x5 and Paclitaxel (50 mg/m2)x5 for two cycles. Radiation: a total dose of 40.4 Gy will be given in 23 fractions of 1.8 Gy, 5 fractions per week, starting the first day of the first cycle of chemotherapy.Procedure: Esophagectomy
Minimally-invasive esophagectomy (RAMIE)or traditional open approach if necessary.
- Correlation between a metabolomic signature in tumor, blood, or urine and outcome of pathological complete response after neoadjuvant chemoradiotherapy in patients with esophageal adenocarcinoma or squamous cell carcinoma [ Time Frame: 10 years ]
- Correlation between BH3 profiling of pre-neoadjuvant tumor biopsy and outcome of pathological complete response after neoadjuvant chemoradiotherapy in patients with esophageal adenocarcinoma or squamous cell carcinoma [ Time Frame: 10 years ]
- Evaluation of metabolomic profiles and Bcl-2 homology domain-3 (BH-3) profiling in resectable esophageal adenocarcinomas (EAC) and esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (nCRT) [ Time Frame: 10 years ]
- Correlation (if any) between metabolomic signatures or BH3 profiling in tumor, blood, or urine of EAC and ESCC with major responses (Mandard score of 1 and 2) versus minimal response (Mandard score 3-5) [ Time Frame: 10 years ]
- Correlation between tumor and systemic metabolomic signatures and disease-free survival (DFS) or Overall survival (OS) in EAC and ESCC patients undergoing nCRT and esophagectomy [ Time Frame: 10 years ]
- Correlation between p53 mutational status and the metabolomic profiles [ Time Frame: 10 years ]
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): NCT03223662
|Contact: Cara M Kenney, R.N.||(240) firstname.lastname@example.org|
|United States, Maryland|
|National Institutes of Health Clinical Center||Recruiting|
|Bethesda, Maryland, United States, 20892|
|Contact: For more information at the NIH Clinical Center contact National Cancer Institute Referral Office 888-624-1937|
|Principal Investigator:||Robert T Ripley, M.D.||National Cancer Institute (NCI)|