Oxaliplatin, Fluorouracil, Erlotinib Hydrochloride, and Radiation Therapy Before Surgery and Erlotinib Hydrochloride After Surgery in Treating Patients With Locally Advanced Cancer of the Esophagus or Gastroesophageal Junction

NCT ID: NCT01561014

Last Updated: 2018-07-02

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE1
• Total Enrollment: 9 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2007-04-30
• Study Completion Date: 2009-03-31

Brief Summary

This phase I trial is studying the side effects and best dose of erlotinib hydrochloride when given together with oxaliplatin, fluorouracil, and radiation before surgery and alone after surgery in treating patients with locally advanced cancer of the esophagus and gastroesophageal junction. Drugs used in chemotherapy, such as oxaliplatin and fluorouracil, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving combination chemotherapy together with erlotinib hydrochloride and radiation therapy before surgery may make the tumor smaller and reduce the amount of normal tissue that needs to be removed. Giving erlotinib hydrochloride after surgery may kill any tumor cells that remain after surgery

Detailed Description

OBJECTIVES:

I. The primary aim of this phase I study is to evaluate the safety of multi-drug chemotherapy (with the addition of an anti-epidermal growth factor receptor [EGFR] agent erlotinib [erlotinib hydrochloride]) and concomitant radiotherapy followed by resection and consolidative erlotinib for the treatment of locally advanced esophageal cancer as judged by the dose limiting toxicities. Correlative endpoints include an analysis of pre-treatment tumor cyclin D1 expression and EGFR expression/amplification.

III. Correlate pathologic complete response with changes in fludeoxyglucose F 18 (FDG)-positron emission tomography (PET)-computed tomography (CT) - pre and post-chemoradiation.

OUTLINE: This is a dose escalation study of erlotinib hydrochloride

CHEMORADIOTHERAPY: Patients undergo radiation therapy once daily (QD), 5 days a week and receive fluorouracil intravenously (IV) continuously and erlotinib hydrochloride orally (PO) QD on days 1-38. Patients also receive oxaliplatin IV over 2 hours on days 1, 15, and 29.

SURGERY: Within 4-8 weeks after completion of chemoradiotherapy, patients with potentially resectable disease (i.e., complete response, partial response, or stable disease) undergo surgery to remove the tumor.

CONSOLIDATION CHEMOTHERAPY: Within 2-4 weeks after surgery, patients with tumors that demonstrate positive immunohistochemistry for EGFR and/or cyclin D1 (in the pretreatment biopsy or in the residual tumor in the esophagectomy specimen) receive consolidation chemotherapy comprising erlotinib hydrochloride PO QD for 12 weeks.

After completion of study treatment, patients are followed every 3 months for 2 years, every 6 months for 2 years, and then annually thereafter.

Conditions

Adenocarcinoma of the Esophagus; Adenocarcinoma of the Gastroesophageal Junction; Adenocarcinoma of the Stomach; Squamous Cell Carcinoma of the Esophagus; Stage II Esophageal Cancer; Stage II Gastric Cancer; Stage III Esophageal Cancer; Stage III Gastric Cancer

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Treatment (chemotherapy, enzyme inhibitor therapy)

CHEMORADIOTHERAPY: Patients undergo radiation therapy QD, 5 days a week and receive fluorouracil IV continuously and erlotinib hydrochloride PO QD on days 1-38. Patients also receive oxaliplatin IV over 2 hours on days 1, 15, and 29.

SURGERY: Within 4-8 weeks after completion of chemoradiotherapy, patients with potentially resectable disease (i.e., complete response, partial response, or stable disease) undergo surgery to remove the tumor.

CONSOLIDATION CHEMOTHERAPY: Within 2-4 weeks after surgery, patients with tumors that demonstrate positive immunohistochemistry for EGFR and/or cyclin D1 (in the pretreatment biopsy or in the residual tumor in the esophagectomy specimen) receive consolidation chemotherapy comprising erlotinib hydrochloride PO QD for 12 weeks.

Group Type: EXPERIMENTAL

erlotinib hydrochloride

Intervention Type: DRUG

Given PO

oxaliplatin

Intervention Type: DRUG

Given IV

fluorouracil

Intervention Type: DRUG

Given IV

radiation therapy

Intervention Type: RADIATION

Undergo radiotherapy

conventional surgery

Intervention Type: PROCEDURE

Undergo surgical resection

immunohistochemistry staining method

Intervention Type: OTHER

Correlative study

positron emission tomography

Intervention Type: PROCEDURE

Correlative study

computed tomography

Intervention Type: PROCEDURE

Correlative study

laboratory biomarker analysis

Intervention Type: PROCEDURE

Correlative study

gene expression analysis

Intervention Type: GENETIC

Correlative study

fludeoxyglucose F 18

Intervention Type: RADIATION

Undergo F18 PET and CT scan

Interventions

erlotinib hydrochloride

Given PO

Intervention Type: DRUG

oxaliplatin

Given IV

Intervention Type: DRUG

fluorouracil

Given IV

Intervention Type: DRUG

radiation therapy

Undergo radiotherapy

Intervention Type: RADIATION

conventional surgery

Undergo surgical resection

Intervention Type: PROCEDURE

immunohistochemistry staining method

Correlative study

Intervention Type: OTHER

positron emission tomography

Correlative study

Intervention Type: PROCEDURE

computed tomography

Correlative study

Intervention Type: PROCEDURE

laboratory biomarker analysis

Correlative study

Intervention Type: PROCEDURE

gene expression analysis

Correlative study

Intervention Type: GENETIC

fludeoxyglucose F 18

Undergo F18 PET and CT scan

Intervention Type: RADIATION

Other Intervention Names

CP-358,774; erlotinib; OSI-774; 1-OHP; Dacotin; Dacplat; Eloxatin; L-OHP; 5-fluorouracil; 5-Fluracil; 5-FU; irradiation; radiotherapy; therapy, radiation; surgery, conventional; immunohistochemistry; FDG-PET; PET; PET scan; tomography, emission computed; tomography, computed; 18FDG; FDG

Eligibility Criteria

Inclusion Criteria

• Newly diagnosed patients with locally advanced esophageal cancer with either squamous or adenocarcinoma histology; patients should have evidence of extension of disease into or through the wall of the esophagus (T2-4) and/or regional nodal metastasis (N1)
• Eastern Cooperative Oncology Group (ECOG) performance status 0-2
• Non-pregnant; patients of childbearing potential and their partners must agree to use an effective form of contraception during the study and for 90 days following the last dose of study medication (an effective form of contraception is an oral contraceptive or a double barrier method); nursing mothers are also ineligible
• Prior treatment: Greater than one week shall have elapsed since any major surgery; no prior chemotherapy or radiotherapy is allowed
• Adequate whole blood cell (WBC) and platelets (Plt) as determined by medical oncology
• Serum creatinine =< 1.5 mg/dl
• Creatinine clearance >= 60 ml/min
• Hemoglobin (Hgb) >= 9.0 gm/dl
• Absolute neutrophil count >= 1,500/uL
• Serum total bilirubin =< 1.5 mg/dL
• Alkaline phosphatase =< 3X the upper limit of normal (ULN) for the reference lab
• Alanine aminotransferase (ALT)/aspartate aminotransferase (AST) less than 2X ULN for the reference laboratory
• Patients must be told of the investigational nature of the study and must sign a written informed consent
• No serious medical or psychiatric illnesses which would prevent informed consent or otherwise limit survival to less than two years; no history of refractory congestive heart failure or cardiomyopathy
• Patients should be evaluated by medical oncology, radiation oncology, and surgery, and felt to by all to be suitable for trimodality therapy

Exclusion Criteria

Patients with an active infection or with a fever >= 38.5 degrees Celsius (C) within 3 days of the first scheduled day of protocol treatment

• History of prior malignancy within the past 5 years except for curatively treated basal cell carcinoma of the skin, cervical intra-epithelial neoplasia, or localized prostate cancer with a current prostate surface antigen (PSA) of < 1.0 mg/dL on 2 successive evaluations, at least 3 months apart, with the most recent evaluation no more than 4 weeks prior to entry
• Patients with known hypersensitivity to any of the components of oxaliplatin
• Patients who are receiving concurrent investigational therapy or who have received investigational therapy within 30 days of the first scheduled day of protocol treatment (investigational therapy is defined as treatment for which there is currently no regulatory authority approved indication)
• Peripheral neuropathy >= Grade 2
• History of allogeneic transplant
• Known human immunodeficiency virus (HIV) or Hepatitis B or C (active, previously treated or both)
• Pregnancy

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Cancer Institute (NCI)

NIH

Sponsor Role: collaborator

Wake Forest University Health Sciences

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Arthur Blackstock

Role: PRINCIPAL_INVESTIGATOR

Wake Forest University Health Sciences

Locations

Wake Forest University Health Sciences

Winston-Salem, North Carolina, United States

Countries

United States

Other Identifiers

NCI-2009-01447

Identifier Type: REGISTRY

Identifier Source: secondary_id

CCCWFU 60106

Identifier Type: OTHER

Identifier Source: secondary_id

IRB00007063

Identifier Type: -

Identifier Source: org_study_id

NCT00499564

Identifier Type: -

Identifier Source: nct_alias