Trial of S-1 Maintenance Therapy in Metastatic Esophagogastric Cancer

NCT ID: NCT02128243

Last Updated: 2021-03-26

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE2
• Total Enrollment: 242 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-09-30
• Study Completion Date: 2020-10-08

Brief Summary

The aim is to assess the relative efficacy of S-1 de-escalation therapy vs. continuation of chemotherapy after induction therapy in patients with metastatic esophagogastric cancer in terms of overall survival.

Detailed Description

Open-label, multi-center, controlled, randomized, parallel-group phase II trial in patients with metastatic esophagogastric cancer having received induction chemotherapy.

Patients will be registered before or after application of a three-months induction chemotherapy . This 12-week induction therapy will consist of one of the following regimens: FLO/mod. Folfox-6, Cisplatin/5-FU, Cisplatin/S-1, FLOT, EOX/EOF or XP. Regarding dose adjustments, Investigators should refer to Section 6.3 and to the summary of product characteristics of the chemotherapeutical agents. Patients having finished the preplanned induction therapy without tumor progression (i.e. with complete remission (CR), partial remission (PR), stable disease (SD) or non-CR/non-PD in patients with non-measurable disease only according to RECIST Criteria Version 1.1) at week 12, being able to swallow capsules and having Eastern Cooperative Oncology Group (ECOG) performance score of 0-1 will be randomized in a 2:1 ratio to receive Arm A or B.

In Arm A patients will continue with S-1 de-escalation phase starting at week 13 until disease progression, toxicities requiring discontinuation, withdrawal of consent, pregnancy, death or lost to follow up whichever occurs first. In patients with drug-related severe toxicity S-1 dose will be adjusted or study treatment will be terminated.

In Arm B patients will continue to receive the same polychemotherapy as during induction therapy until tumor progression, toxicities requiring discontinuation, withdrawal of consent, pregnancy, death or loss to follow up whichever occurs first.

Conditions

Unresectable, Locally Advanced or Metastatic, Adenocarcinoma of the Stomach, or of the Gastro Esophageal Junction; Gastric Neoplasm; Gastroesophageal Junction Adenocarcinoma; Esophageal Adenocarcinoma; Gastric Adenocarcinoma; Esophageal Neoplasms

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Arm A: De-escalation therapy

Patients in Arm A will continue with S-1 de-escalation phase starting at week 13 until disease progression, toxicities requiring discontinuation, withdrawal of consent, pregnancy, death or lost to follow up whichever occurs first. In patients with drug-related severe toxicity S-1 dose will be adjusted or study treatment will be terminated.

Group Type: EXPERIMENTAL

S-1 de-escalation

Intervention Type: DRUG

S-1 30 mg/m² bid d1-14 q21d

Arm B: Chemotherapy by Investigator's choice

Patients in Arm B will continue to receive the same polychemotherapy as during induction therapy until tumor progression, toxicities requiring discontinuation, withdrawal of consent, pregnancy, death or loss to follow up whichever occurs first.

Group Type: EXPERIMENTAL

Chemotherapy by Investigator's choice

Intervention Type: DRUG

Polychemotherapy administration as in induction therapy consists of a platinum and fluoropyrimidine compound as well as optional a taxane / an anthracycline compound.

Two-Drug combinations:

FLO / mod. FOLFOX-6; Cisplatin, S-1; Cisplatin, 5-FU; Cisplatin, Capecitabine (XP)

Three-drug combinations:

EOX/EOF FLOT

Interventions

S-1 de-escalation

S-1 30 mg/m² bid d1-14 q21d

Intervention Type: DRUG

Chemotherapy by Investigator's choice

Polychemotherapy administration as in induction therapy consists of a platinum and fluoropyrimidine compound as well as optional a taxane / an anthracycline compound.

Two-Drug combinations:

FLO / mod. FOLFOX-6; Cisplatin, S-1; Cisplatin, 5-FU; Cisplatin, Capecitabine (XP)

Three-drug combinations:

EOX/EOF FLOT

Intervention Type: DRUG

Other Intervention Names

Teysuno; FLO regimen; - Oxaliplatin 85 mg/m²; - Leucovorin 200 mg/m²; - 5-Fluorouracil 2600 mg/m²; mod. FOLFOX-6 regimen; - Leucovorin 400 mg/m²; - 5-Fluorouracil 400 mg/m²; - 5-Fluorouracil 2400 mg/m²; Cisplatin / S-1; - Cisplatin 75 mg/m²; - S-1 25mg/m²; EOX/EOF; - Epirubicin 50 mg/m²; - Oxaliplatin 130 mg/m²; - Capecitabine 625 mg/m²; FLOT; - Docetaxel 50 mg/m²; - Leucovorin 200 mg/mg²; Cisplatin, 5-FU; - Cisplatin 75 (-100) mg/m²; - 5-FU 800 (-1000) mg/m²; Cisplatin / Capecitabine (XP); - Cisplatin 80 mg/m²; - Capecitabine 1000 mg/m²

Eligibility Criteria

Inclusion Criteria

1. Signed written informed consent incl. participation in translational research

2. Male or female patient 18 years or older

3. Histologically confirmed metastatic or locally advanced unresectable gastric adenocarcinoma or adenocarcinoma of the esophagus or the esophagogastric junction (Her-2/neu negative or with unknown Her-2/neu status)

4. Adjuvant/neoadjuvant or perioperative chemotherapy or (chemo-)radiotherapy must have been finished at least 6 months before start of the induction therapy

5. For patients enrolled before induction therapy: No previous systemic treatment (i.e. chemotherapy) for metastatic disease

6. For patients enrolled after induction therapy: Having finished a three-months induction therapy (6 cycles of a bi-weekly regimen, 4 cycles of a three-weekly regimens or 3 cycles of a four-weekly regimen) without tumor progression or limiting toxicity

7. ECOG Performance Score 0-1 (Karnofsky Performance status >= 80%)

8. Ability for oral intake of the study drug, patients with tumor-related problems with oral intake might be registered if the symptom is expected to be improved during induction therapy (e.g. due to a tumor stenosis)

9. Female patient of childbearing potential (i.e. did not undergo surgical sterilization - hysterectomy, bilateral tubal ligation, or bilateral oophorectomy - and is not post-menopausal for at least 24 consecutive months) with a negative pregnancy test

10. Hematology and biochemistry laboratory results within the limits normally expected for the patient population, defined by the following:

• Absolute neutrophil count ≥ 1500/µl
• Platelet count ≥ 100000/µl
• Leukocyte count > 3000/µl
• Hemoglobin ≥ 9 g/dL or 5.59 mmol/l, previous transfusions (>3 days) of erythrocytes are allowed
• Total bilirubin ≤ 1.5 times the upper limit of normal (ULN), in patients with known Meulengracht syndrom ≤3 x ULN
• AST ≤ 3xULN in absence of liver metastases, or ≤5xULN in presence of liver metastases
• ALT ≤ 3xULN in absence of liver metastases, or ≤5xULN in presence of liver metastases
• Creatinine clearance ≥30 mL/min according to Cockcroft-Gault formula

Exclusion Criteria

1. Previous major sugery within the last 28 days before the start of the induction treatment. The implantation of a central venous access (e.g. porth-a cath system) is allowed.

2. History of other malignant tumors within the last 5 years before start of induction treatment, except basal cell carcinoma or curatively excised cervical carcinoma in situ

3. Known brain metastases

4. Concurrent radiotherapy involving target lesions used for this study. Concurrent palliative radiation for non-target lesions is allowed if other target lesions are available outside the involved field; previous radiotherapy including target lesions must have been finished at least 28 days before start of induction treatment.

5. For patients enrolled before the induction therapy: Previous systemic treatment (i.e. chemotherapy) for metastatic disease

6. Known active HBV, HCV infection or documented HIV infection

7. Serious concomitant disease or medical condition that by judgment of the Investigator renders the patient at high risk of treatment complications

8. Clinically relevant coronary artery disease (NYHA functional angina classification III/IV), congestive heart failure (NYHA III/IV), clinically relevant cardiomyopathy, history of myocardial infarction in the last 3 months, or high risk of uncontrolled arrhythmia

9. Female patient pregnant or breast feeding

10. Female patient of childbearing potential (i.e. did not undergo surgical sterilization - hysterectomy, bilateral tubal ligation, or bilateral oophorectomy - and is not post-menopausal for at least 24 consecutive months) not willing to use an adequate method of contraception to avoid pregnancy throughout the study and for up to 26 weeks after the end of treatment. Male patient not willing to use an adequate method of contraception to avoid conception throughout the study and for up to 26 weeks after the end of treatment in such a manner that the risk of pregnancy is minimized.

11. Concurrent treatment with other experimental drugs or participation in another clinical trial with any investigational drug within 60 days prior to start of induction (e.g. one of the allowed standard chemotherapies (see above) with or without additional placebo within a clinical trial is allowed)

12. Chronic diarrhea or short bowel syndrome

13. Known hypersensitivity to S-1, other fluoropyrimidines or platinum compounds. Contraindication to receive S-1 or the polychemotherapy (induction & arm B) chosen for this patient as per current Summary of Product Characteristics. Known DPD deficiency

14. For patients enrolled before the induction therapy: Grade ≥2 peripheral neuropathy

15. Known drug abuse/alcohol abuse

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

Sponsors

Taiho Pharmaceutical Co., Ltd.

INDUSTRY

Sponsor Role: collaborator

Nordic Pharma SAS

INDUSTRY

Sponsor Role: collaborator

AIO-Studien-gGmbH

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Georg Martin Haag, Dr.

Role: PRINCIPAL_INVESTIGATOR

NCT-Med. Onkologie

Locations

NCT-Med. Onkologie

Heidelberg, Baden-Wurttemberg, Germany

Countries

Germany

References

Stocker G, Lorenzen S, Ettrich T, Herz AL, Longo F, Kiani A, Venerito M, Trojan J, Mahlberg R, Moosmann N, Chibaudel B, Kubicka S, Greil R, Daum S, Geissler M, Larcher-Senn J, Keller G, Lordick F, Haag GM. S-1 maintenance therapy in Caucasian patients with metastatic esophagogastric adenocarcinoma-final results of the randomized AIO MATEO phase II trial. ESMO Open. 2023 Jun;8(3):101572. doi: 10.1016/j.esmoop.2023.101572. Epub 2023 Jun 2.

Reference Type: DERIVED

PMID: 37270871 (View on PubMed)

Haag GM, Stocker G, Quidde J, Jaeger D, Lordick F. Randomized controlled trial of S-1 maintenance therapy in metastatic esophagogastric cancer - the multinational MATEO study. BMC Cancer. 2017 Jul 31;17(1):509. doi: 10.1186/s12885-017-3497-9.

Reference Type: DERIVED

PMID: 28760152 (View on PubMed)

Related Links

http://www.aio-portal.de

Working Group for Medical Oncology (AIO) from the German Cancer Society (DKG)

Other Identifiers

2013-002742-37

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

AIO-YMO-0111

Identifier Type: -

Identifier Source: org_study_id