Erbitux Combined With Chemo-radiotherapy in Esophageal Squamous Cell Carcinoma

NCT ID: NCT00815308

Last Updated: 2011-02-08

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

55 participants

Study Classification

INTERVENTIONAL

Study Start Date

2009-01-31

Study Completion Date

2010-07-31

Brief Summary

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The purpose of this study is to determine whether the treatment of locally advanced esophageal squamous cell carcinoma (ESCC)with cetuximab in combination with paclitaxel, cisplatin and radiation improve clinical outcomes.

Detailed Description

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Esophageal cancer is the sixth leading cause of cancer death worldwide.

Over the past 2 decades, well-designed clinical trials have documented the clinical benefits of combination of chemotherapy and radiation for localized esophageal cancer, either as primary therapy or in neoadjuvant setting.

Paclitaxel, a radiation sensitizer, has important single-agent activity in esophageal cancer. Paclitaxel-based chemoradiation has been the framework for the recent Radiation Therapy Oncology Group (RTOG) trials of nonoperative management of esophageal cancer.

Accumulating clinical evidence suggests that epidermal growth factor receptor (EGFR) represents a viable target in the treatment of esophageal cancer. EGFR expression is associated with poor prognosis. Cetuximab, a monoclonal antibody, binds specifically to EGFR on both normal and tumor cells and competitively inhibits the binding of EGF and other ligands, such as transforming growth factor (TGF)-α.

Preclinical models have suggested synergy between cetuximab, paclitaxel, cisplatin and radiation. For patients with locally advanced head and neck cancer, the combination of cetuximab and radiation has demonstrated both response and survival benefit.

With all these, the investigators hypothesize that treatment of locally advanced esophageal squamous cell carcinoma (ESCC)with cetuximab in combination with paclitaxel, cisplatin and radiation may further improve clinical outcomes. This trial results will be important as it may support further studies for setting the new treatment standard for ESCC.

Conditions

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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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cetuximab, concurrent chemo-radiotherapy

Cetuximab, injection, loading dose400 mg/m\^2,(Day1 in Week1) followed by 250 mg/m\^2(Day1, every week for Weeks 2-8) Paclitaxel, injection,45 mg/m\^2 (Day 1, every week for Weeks 2-8) Cisplatin, injection,20 mg/m\^2 (Day 1, every week for Weeks 2-8) radiation therapy, 59.4 Gy, 1.8 Gy/33 fractions,1 fraction daily, Days 1-5 every week for Weeks 2-7, and Days 1-3 for Week 8

Group Type EXPERIMENTAL

cetuximab (Erbitux)

Intervention Type DRUG

Cetuximab,injection,loading dose400 mg/m\^2,(Day1 in Week1) followed by 250 mg/m\^2(Day1, every week for Weeks 2-8)

Paclitaxel

Intervention Type DRUG

Paclitaxel,injection,loading dose 45 mg/m\^2,(Day1 in every week for Weeks 2-8)

Cisplatin

Intervention Type DRUG

Cisplatin,injection,loading dose 20 mg/m\^2,(Day1 in every week for Weeks 2-8)

Radiation

Intervention Type RADIATION

Radiation, External beam therapy, total 59.4 Gy , 33 fractions, 1.8 Gy per fraction.(Day 1-Day 5 in every week 2-week 8).

Interventions

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cetuximab (Erbitux)

Cetuximab,injection,loading dose400 mg/m\^2,(Day1 in Week1) followed by 250 mg/m\^2(Day1, every week for Weeks 2-8)

Intervention Type DRUG

Paclitaxel

Paclitaxel,injection,loading dose 45 mg/m\^2,(Day1 in every week for Weeks 2-8)

Intervention Type DRUG

Cisplatin

Cisplatin,injection,loading dose 20 mg/m\^2,(Day1 in every week for Weeks 2-8)

Intervention Type DRUG

Radiation

Radiation, External beam therapy, total 59.4 Gy , 33 fractions, 1.8 Gy per fraction.(Day 1-Day 5 in every week 2-week 8).

Intervention Type RADIATION

Other Intervention Names

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erbitux Conformal Radiotherapy Intensity Modulated Radiotherapy

Eligibility Criteria

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Inclusion Criteria

* Inpatients or outpatients, ≥ 18 years of age
* Histologically confirmed primary (non-recurrent) ESCC fulfilling one of the following criteria (AJCC Staging System)

* cervical esophageal carcinoma, stage Ⅱ-Ⅲ
* upper thoracic esophageal carcinoma, stage Ⅱ-Ⅲ, or mid-thoracic esophageal carcinoma, stage Ⅱ-Ⅲ,which is medically unfit for surgery, surgery been refused and patient medically able to tolerate chemo-radiation.
* Evidence of unidimensional measurable disease as per Response Evaluation Criteria in Solid Tumours (RECIST).
* ECOG Performance status of 0-1
* Effective contraception for both male and female patients if the risk of conception exists
* Adequate bone marrow reserves: neutrophil (ANC) count ≥ 1500 /mm\^3, platelet count ≥ 100,000 /mm\^3, hemoglobin ≥ 9 g/dl
* Adequate renal function: serum creatinine ≤ 1.5 mg/dl and/or calculated creatinine clearance ≥ 60 ml/min
* Adequate hepatic function: bilirubin level ≤ 1.5 x ULN, ASAT \& ALST ≤ 1.5 x ULN
* Tumor tissue available for KRAS biomarker test
* Signed written informed consent prior to study entry

Exclusion Criteria

* Previous chest radiotherapy, systemic chemotherapy, and major esophageal surgery
* Concurrent chronic systemic immune therapy, targeted therapy not indicated in this study protocol
* Multiple primary carcinomas of the esophagus
* Pregnancy (confirmed by serum or urine β-HCG) or lactation period;
* Uncontrolled diabetes, hypertension, and severe cardiac or pulmonary disease
* Unable to comprehend the study requirements or who are not likely to comply with the study parameters;
* Distant metastasis
* Second malignancy, except for curable non-melanoma skin cancer, cervical cancer in situ, or malignant disease, free for ≥ 5 years
* Known grade 3 or 4 allergic reaction to any of the study treatment
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Chinese Academy of Medical Sciences

OTHER

Sponsor Role collaborator

Peking University Cancer Hospital & Institute

OTHER

Sponsor Role collaborator

Hebei Fourth Hospital

UNKNOWN

Sponsor Role collaborator

Jiangsu Cancer Institute & Hospital

OTHER

Sponsor Role collaborator

RenJi Hospital

OTHER

Sponsor Role collaborator

The Affiliated Cancer Hospital of Zhengzhou University

UNKNOWN

Sponsor Role collaborator

West China Hospital

OTHER

Sponsor Role collaborator

Shandong Cancer Hospital and Institute

OTHER

Sponsor Role lead

Responsible Party

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Shandong Cancer Hospital and Institute

Principal Investigators

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Jin Ming Yu, PH.D, M.D

Role: STUDY_CHAIR

Shandong Cancer Hospital and Institute

Locations

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Department of Radiation Oncology, Shandong Cancer Hospital and Institute

Jinan, Shandong, China

Site Status

Countries

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China

References

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Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol. 2001 Jan 15;19(2):305-13. doi: 10.1200/JCO.2001.19.2.305.

Reference Type RESULT
PMID: 11208820 (View on PubMed)

Kelsen DP, Ginsberg R, Pajak TF, Sheahan DG, Gunderson L, Mortimer J, Estes N, Haller DG, Ajani J, Kocha W, Minsky BD, Roth JA. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med. 1998 Dec 31;339(27):1979-84. doi: 10.1056/NEJM199812313392704.

Reference Type RESULT
PMID: 9869669 (View on PubMed)

Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, Lozach P, Ollier JC, Pavy JJ, Mercier M, Sahmoud T. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med. 1997 Jul 17;337(3):161-7. doi: 10.1056/NEJM199707173370304.

Reference Type RESULT
PMID: 9219702 (View on PubMed)

Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996 Aug 15;335(7):462-7. doi: 10.1056/NEJM199608153350702.

Reference Type RESULT
PMID: 8672151 (View on PubMed)

Herskovic A, Martz K, al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, Cooper J, Byhardt R, Davis L, Emami B. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992 Jun 11;326(24):1593-8. doi: 10.1056/NEJM199206113262403.

Reference Type RESULT
PMID: 1584260 (View on PubMed)

Raben D, Helfrich B, Bunn PA Jr. Targeted therapies for non-small-cell lung cancer: biology, rationale, and preclinical results from a radiation oncology perspective. Int J Radiat Oncol Biol Phys. 2004;59(2 Suppl):27-38. doi: 10.1016/j.ijrobp.2004.01.054.

Reference Type RESULT
PMID: 15142632 (View on PubMed)

Langer CJ. Emerging role of epidermal growth factor receptor inhibition in therapy for advanced malignancy: focus on NSCLC. Int J Radiat Oncol Biol Phys. 2004 Mar 1;58(3):991-1002. doi: 10.1016/j.ijrobp.2003.09.099.

Reference Type RESULT
PMID: 14967461 (View on PubMed)

Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J, Ove R, Kies MS, Baselga J, Youssoufian H, Amellal N, Rowinsky EK, Ang KK. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006 Feb 9;354(6):567-78. doi: 10.1056/NEJMoa053422.

Reference Type RESULT
PMID: 16467544 (View on PubMed)

Other Identifiers

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SDRTC-0901

Identifier Type: -

Identifier Source: org_study_id

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