Oxaliplatin, Capecitabine, and Radiation Therapy in Patients Undergoing Surgery for Stage II, III, IV Esophageal Cancer

NCT ID: NCT00470184

Last Updated: 2013-11-25

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

41 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-11-30

Brief Summary

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RATIONALE: Drugs used in chemotherapy, such as oxaliplatin and capecitabine, 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 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 phase II trial is studying how well giving oxaliplatin and capecitabine together with radiation therapy works in treating patients undergoing surgery for stage II, stage III, or stage IV esophageal cancer.

Detailed Description

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OBJECTIVES:

Primary

* Determine the complete pathologic response (complete response \[CR\]) rate in patients with stage II-IVA esophageal cancer treated with neoadjuvant oxaliplatin, capecitabine, and radiotherapy.

Secondary

* Determine the clinical efficacy and toxicity of this regimen in these patients.
* Determine the quality of life of patients treated with this regimen.
* Identify basal expression and changes in gene expression that relate to CR, relapse, and survival of patients treated with this regimen.

OUTLINE:

* Neoadjuvant chemoradiotherapy: Patients receive oxaliplatin IV over 2 hours on days 1, 15, and 29 (weeks 1, 3, and 5). Patients also undergo radiotherapy on days 1-5, 8-12, 15-19, 22-26, 29-33, and 36-38 and receive oral or enteral capecitabine twice daily on the same days they undergo radiotherapy.
* Surgery: At 4-6 weeks after completion of neoadjuvant chemoradiotherapy, patients who are eligible undergo esophagectomy.
* Adjuvant chemotherapy: Beginning 4-6 weeks after surgery, patients receive oxaliplatin IV over 2 hours on days 1, 15, and 29 and oral or enteral capecitabine twice daily on days 1-5, 8-12, 15-19, 22-26, and 29. Treatment repeats approximately every 14 days for up to 2 courses in the absence of disease progression or unacceptable toxicity.

Patients undergo tumor biopsies periodically. Collected samples are analyzed by gene expression studies, microarray analysis, and real-time quantitative reverse transcriptase-PCR to identify basal expression and changes in gene expression.

Quality of life is assessed periodically.

After completion of study treatment, patients are followed periodically for 5 years.

PROJECTED ACCRUAL: A total of 36 patients will be accrued for this study.

Conditions

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Esophageal Cancer

Keywords

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adenocarcinoma of the esophagus squamous cell carcinoma of the esophagus stage II esophageal cancer stage III esophageal cancer stage IV esophageal cancer

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Chemo

Oxaliplatin 85 mg/m2 will be administered IV on days 1, 15 and 29. Capecitabine 1250 mg/m2 will be administered in 2 divided daily doses P0 or via enteral tube, on radiation days only (Monday- Friday/ weekly). Capecitabine will be continued until the final dose of radiotherapy

Group Type EXPERIMENTAL

capecitabine

Intervention Type DRUG

Oral

oxaliplatin

Intervention Type DRUG

IV

gene expression analysis

Intervention Type GENETIC

Correlative Study

microarray analysis

Intervention Type GENETIC

Correlative Study

reverse transcriptase-polymerase chain reaction

Intervention Type GENETIC

Correlative Study

adjuvant therapy

Intervention Type PROCEDURE

Metastatic growth control

biopsy

Intervention Type PROCEDURE

Examination of tissue type

conventional surgery

Intervention Type PROCEDURE

Tissue removal

neoadjuvant therapy

Intervention Type PROCEDURE

Tumor shrinkage

quality-of-life assessment

Intervention Type PROCEDURE

Correlative Study

radiation therapy

Intervention Type RADIATION

Undergoing radiation therapy

Interventions

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capecitabine

Oral

Intervention Type DRUG

oxaliplatin

IV

Intervention Type DRUG

gene expression analysis

Correlative Study

Intervention Type GENETIC

microarray analysis

Correlative Study

Intervention Type GENETIC

reverse transcriptase-polymerase chain reaction

Correlative Study

Intervention Type GENETIC

adjuvant therapy

Metastatic growth control

Intervention Type PROCEDURE

biopsy

Examination of tissue type

Intervention Type PROCEDURE

conventional surgery

Tissue removal

Intervention Type PROCEDURE

neoadjuvant therapy

Tumor shrinkage

Intervention Type PROCEDURE

quality-of-life assessment

Correlative Study

Intervention Type PROCEDURE

radiation therapy

Undergoing radiation therapy

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

DISEASE CHARACTERISTICS:

* Diagnosis of squamous cell carcinoma of the esophagus or adenocarcinoma of the esophagus

* Stage II-IVA disease as determined by clinical staging, including endoscopy and CT scan with or without endoscopic ultrasound
* Bulk of gastroesophageal junction tumor should be in the esophagus
* Bronchoscopy with biopsy and cytology required if primary esophageal cancer is \< 26 cm from incisors
* No known brain metastases

PATIENT CHARACTERISTICS:

* ECOG performance status 0-1
* Life expectancy \> 4 months
* WBC \> 4,000/mm³
* ANC \> 1,500/mm³
* Platelet count \> 100,000/mm³
* Hemoglobin \> 9 g/dL
* Bilirubin normal
* Creatinine normal
* AST \< 2.5 times upper limit of normal (ULN)
* Alkaline phosphatase ≤ 3 times ULN
* Able to take oral medication or undergo enteral administration of medication
* No peripheral neuropathy ≥ grade 2
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception during and for 90 days after completion of study treatment
* No hypersensitivity to platinum compounds, fluoropyrimidines, or antiemetics administered in combination with protocol-directed chemotherapy
* No concurrent uncontrolled illness, including, but not limited to, any of the following:

* Ongoing or active infection
* Symptomatic congestive heart failure
* Unstable angina pectoris
* Cardiac arrhythmia
* Psychiatric illness or social situation that would preclude study compliance
* No history of second malignancy except for curatively treated carcinoma in situ of the cervix or nonmelanoma skin cancer

* Other cured tumors allowed at discretion of the principal investigator
* No known HIV or hepatitis B or C (active and/or previously treated)

PRIOR CONCURRENT THERAPY:

* No prior therapy for esophageal cancer
* No other concurrent investigational agents
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Comprehensive Cancer Network

NETWORK

Sponsor Role collaborator

Roswell Park Cancer Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nikhil Khushalani, MD

Role: PRINCIPAL_INVESTIGATOR

Roswell Park Cancer Institute

Locations

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Roswell Park Cancer Institute

Buffalo, New York, United States

Site Status

Countries

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United States

Other Identifiers

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RPCI-I-64105

Identifier Type: OTHER

Identifier Source: secondary_id

CDR0000543376

Identifier Type: -

Identifier Source: org_study_id