Individualized Intraperitoneal and System Chemotherapy Versus System Chemotherapy as First-line Chemotherapy for AGC

NCT ID: NCT03061058

Last Updated: 2017-09-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE3

Total Enrollment

240 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-04-01

Study Completion Date

2019-12-31

Brief Summary

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Tumor messenger ribonucleic acid (mRNA) expression levels may have a promising role as potential predictive biomarkers for chemotherapy.

Peritoneal carcinomatosis appears to be the most common pattern of metastasis or recurrence and is associated with poor prognosis in gastric cancer patients. Intraperitoneal chemotherapy is widely accepted strategy in the treatment of peritoneal dissemination.

In this study, our aim is to evaluate the impact of individualized selection of chemotherapeutics and intraperitoneal combined with system chemotherapy on overall survival, disease free survival, response rate, and safety of advanced gastric cancer patients.

Detailed Description

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Conditions

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Stomach Neoplasms Chemotherapy Effect Chemotherapeutic Toxicity

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Individualized Group

mRNA levels of BRCA1, topoisomerase I (TOPO1), and thymidylate synthase (TS) were assessed in tumor tissue. Chemotherapeutic agents were selected based on the mRNA levels.

Patients with high level BRCA1 will receive intraperitoneal docetaxel (15mg/m\^2, d1, d15, q4w), intravenous docetaxel (30mg/m\^2, d1, d15, q4w), and oral S-1 (40mg/m\^2, d1-14, q4w).

Patients with low level BRCA1 will receive intraperitoneal cisplatin (25mg/m\^2, d1, d15, q4w), intravenous oxaliplatin (75mg/m\^2, d1, d15, q4w), and oral S-1 (40mg/m\^2, d1-14, q4w).

Patients with middle level BRCA1 and high level TOPO1 will receive intraperitoneal irinotecan (45mg/m\^2, d1, d15, q4w), intravenous docetaxel (90mg/m\^2, d1, d15, q4w), and oral S-1 (40mg/m\^2, d1-14, q4w).

Patients with middle level BRCA1, low or middle level TOPO1, and low level TS will receive intraperitoneal pemetrexed (150mg/m\^2, d1, q3w), and intravenous pemetrexed (350mg/m\^2, d1, q3w).

Group Type EXPERIMENTAL

Docetaxel

Intervention Type DRUG

intraperitoneal and/or intravenous

Oxaliplatin

Intervention Type DRUG

intravenous

Cisplatin

Intervention Type DRUG

intraperitoneal

Irinotecan

Intervention Type DRUG

intraperitoneal and/or intravenous

Pemetrexed

Intervention Type DRUG

intraperitoneal and/or intravenous

S1

Intervention Type DRUG

oral

Control Group

mRNA levels of BRCA1, TOPO1, and TS were assessed in tumor tissue for every enrolled patients.

Patients in control group will receive intravenous docetaxel (45mg/m\^2, d1, d15, q4w), and oral S-1 (40mg/m\^2, d1-14, q4w).

Group Type ACTIVE_COMPARATOR

Docetaxel

Intervention Type DRUG

intraperitoneal and/or intravenous

S1

Intervention Type DRUG

oral

Interventions

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Docetaxel

intraperitoneal and/or intravenous

Intervention Type DRUG

Oxaliplatin

intravenous

Intervention Type DRUG

Cisplatin

intraperitoneal

Intervention Type DRUG

Irinotecan

intraperitoneal and/or intravenous

Intervention Type DRUG

Pemetrexed

intraperitoneal and/or intravenous

Intervention Type DRUG

S1

oral

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patients must have histologically confirmed adenocarcinoma of the stomach or gastro-oesophageal junction with inoperable locally advanced or metastatic disease, not amenable to curative therapy.
* Patients must have measurable disease, according to the Response Evaluation Criteria in Solid Tumors (RECIST, v1.1), assessed using imaging techniques (CT or MRI).
* Patients must have enough tumor tissue for mRNA expression test.
* Women of childbearing potential must be non-pregnant (negative pregnancy test within 72 hours prior to chemotherapy, postmenopausal woman must have been amenorrheic for at least 12 months to be considered of non-childbearing potential) and nonlactating, and men and women must be willing to exercise an effective form of birth control (abstinence/contraception) while on study and for 6 months after therapy completed
* Eastern Cooperative Oncology Group (ECOG) Performance status 0, 1 or 2.
* Absolute neutrophil count (ANC) \>=1,500/ul
* Platelets (PLT) \>=75,000/ul
* Serum bilirubin \<= 1.5 × upper limit of normal (ULN)
* Aspartate transaminase (AST) or alanine aminotransferase (ALT) \<= 2.5 × ULN (or \<= 5 × ULN in patients with liver metastases)
* Alkaline phosphatase \<= 2.5 × ULN (or \<= 5 × ULN in patients with liver metastases, or \<= 10 × ULN in patients with bone but no liver metastases)
* Albumin \>= 25 g/L.
* Creatinine clearance \>= 60 mL/min.
* Life expectancy of at least 3 months.
* Signed informed consent.

Exclusion Criteria

* Previous chemotherapy for advanced/metastatic disease (prior adjuvant/neoadjuvant therapy is allowed if at least 6 months has elapsed between completion of adjuvant/neoadjuvant therapy and enrolment into the study; the total dose of cisplatin should be less than 300mg/m\^2).
* Patients with active (significant or uncontrolled) gastrointestinal bleeding.
* Residual relevant toxicity resulting from previous therapy (with the exception of alopecia), e.g. neurological toxicity ≥ grade 2 NCI-CTCAE 4.0.
* Other malignancy within the last 5 years, except for carcinoma in situ of the cervix, or basal cell carcinoma.
* History of documented congestive heart failure; angina pectoris requiring medication;evidence of transmural myocardial infarction on ECG; poorly controlled hypertension (systolic BP \> 180 mmHg or diastolic BP \> 100 mmHg); clinically significant valvular heart disease; or high risk uncontrollable arrhythmias.
* Baseline left ventricular ejection fraction (LVEF) \< 50% (measured by echocardiography or MUGA).
* Patients with dyspnoea at rest due to complications of advanced malignancy or other disease, or who require supportive oxygen therapy.
* Patients receiving chronic or high dose corticosteroid therapy. (Inhaled steroids and short courses of oral steroids for anti-emesis or as an appetite stimulant are allowed).
* Clinically significant hearing abnormality.
* Known dihydropyrimidine dehydrogenase (DPD) deficiency.
* History or clinical evidence of brain metastases.
* Serious uncontrolled systemic intercurrent illness, e.g. infections or poorly controlled diabetes.
* Positive serum pregnancy test in women of childbearing potential.
* Received any investigational drug treatment within 4 weeks of start of study treatment.
* Radiotherapy within 4 weeks of start of study treatment (2 week interval allowed if palliative radiotherapy given to bone metastatic site peripherally and patient recovered from any acute toxicity;prior adjuvant radiotherapy is allowed if complete at least 6 months ).
* Major surgery within 4 weeks of start of study treatment, without complete recovery.
* Patients with known active infection with HIV, hepatitis B virus (HBV), or hepatitis C virus (HCV).
* Known hypersensitivity to any of the study drugs.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School

OTHER

Sponsor Role lead

Responsible Party

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Yang Yang

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Ma'anshan People's Hospital

Ma’anshan, Anhui, China

Site Status RECRUITING

Jiangyin People's Hospital

Jiangyin, Jiangsu, China

Site Status RECRUITING

Nanjing Gaochun People's Hospital

Nanjing, Jiangsu, China

Site Status RECRUITING

Nanjing Lishui People's Hospital

Nanjing, Jiangsu, China

Site Status RECRUITING

The Comprehensive Cancer Center of Nanjing Drum Tower Hospital

Nanjing, Jiangsu, China

Site Status RECRUITING

Suqian People's Hospital

Suqian, Jiangsu, China

Site Status RECRUITING

Xuzhou Central Hospital

Xuzhou, Jiangsu, China

Site Status RECRUITING

Affiliated Hospital of Jiangsu University

Zhenjiang, Jiangsu, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Yang Yang, MD,PhD,MSCR

Role: CONTACT

0086-18602568379

Baorui Liu, MD, PhD

Role: CONTACT

0086-13770621908

Facility Contacts

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Fenglin Zhang, MD

Role: primary

Fangbo Cui, MD

Role: backup

Weisheng Shen, MD

Role: primary

Lei Xi, MD

Role: backup

Rongfu Wei, MD

Role: primary

Yajun Xin, MD

Role: backup

Chunlan Nie, MD

Role: primary

Hui Xu, MD

Role: backup

Yang Yang, MD,PhD,MSCR

Role: primary

0086-18602568379

Baorui Liu, MD, PhD

Role: backup

0086-13770621908

Chuanwen You, MD

Role: primary

Qing Zhu, MD

Role: backup

Sanyuan Sun, MD

Role: primary

Yuan Yuan, MD

Role: backup

Xiaoqing Li, MD

Role: primary

Meilian Cheng, MD

Role: backup

Other Identifiers

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AGC-PC

Identifier Type: -

Identifier Source: org_study_id