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Oxaliplatin, Gefitinib, and Radiation Therapy in Treating Patients With Locally Advanced or Metastatic Esophageal Cancer

Primary Purpose

Esophageal Cancer

Status
Terminated
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
gefitinib
oxaliplatin
conventional surgery
neoadjuvant therapy
radiation therapy
Sponsored by
Roswell Park Cancer Institute
About
Eligibility
Locations
Outcomes
Full info

About this trial

This is an interventional treatment trial for Esophageal Cancer focused on measuring adenocarcinoma of the esophagus, recurrent esophageal cancer, stage II esophageal cancer, stage III esophageal cancer, stage IV esophageal cancer, squamous cell carcinoma of the esophagus

Eligibility Criteria

18 Years - 120 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

DISEASE CHARACTERISTICS: Histologically confirmed adenocarcinoma or squamous cell carcinoma of the esophagus or gastroesophageal (GE) junction Locally advanced or metastatic disease by clinical staging, including esophagogastroduodenoscopy and esophageal ultrasound Stage T2, N0 disease and beyond Bulk of tumor must be in the esophagus of patients with GE junction tumor Bronchoscopy is required if primary esophageal tumor is < 26 cm from the incisors No brain metastases PATIENT CHARACTERISTICS: Age Over 18 Performance status ECOG 0-1 Life expectancy At least 4 months Hematopoietic WBC ≥ 3,000/mm^3 Granulocyte count ≥ 1,500/mm^3 Platelet count > 100,000/mm^3 Hepatic Bilirubin normal ALT and AST ≤ 2.5 times upper limit of normal (ULN) Alkaline phosphatase ≤ 2.5 times ULN Renal Not specified Cardiovascular No symptomatic congestive heart failure No unstable angina pectoris No cardiac arrhythmia Pulmonary No clinically active interstitial lung disease Patients with chronic stable asymptomatic radiographic changes are eligible Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective double-method (including barrier) contraception during and for 3 months after study participation No peripheral neuropathy ≥ grade II No severe hypersensitivity to gefitinib or any of its excipients No history of allergy to platinum-based compounds or antiemetics administered with protocol-directed chemotherapy No active or ongoing infection No other uncontrolled illness No other significant clinical disorder or laboratory finding that would preclude study participation PRIOR CONCURRENT THERAPY: Biologic therapy No concurrent colony-stimulating factors during course 1 of study therapy Chemotherapy More than 4 weeks since prior chemotherapy Endocrine therapy Concurrent steroid therapy allowed Radiotherapy More than 4 weeks since prior radiotherapy Surgery Not specified Other More than 30 days since prior non-approved or investigational drugs No concurrent administration of any of the following: Phenytoin Carbamazepine Rifampin Barbiturates Highly-active antiretroviral therapy (HAART) Hypericum perforatum (St. John's wort) No other concurrent investigational agents or therapy

Sites / Locations

  • Roswell Park Cancer Institute

Outcomes

Primary Outcome Measures

Maximum tolerated dose (phase I)
Response (phase II)

Secondary Outcome Measures

Survival
Quality of life
Safety and toxicity
Immunohistochemistry

Full Information

First Posted
October 6, 2004
Last Updated
October 5, 2015
Sponsor
Roswell Park Cancer Institute
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1. Study Identification

Unique Protocol Identification Number
NCT00093652
Brief Title
Oxaliplatin, Gefitinib, and Radiation Therapy in Treating Patients With Locally Advanced or Metastatic Esophageal Cancer
Official Title
ZD1839 (IRESSA®) With Oxaliplatin and Radiotherapy for Esophageal Carcinoma. A Phase I/II Study With Biologic Correlates
Study Type
Interventional

2. Study Status

Record Verification Date
October 2015
Overall Recruitment Status
Terminated
Study Start Date
May 2003 (undefined)
Primary Completion Date
May 2006 (Actual)
Study Completion Date
undefined (undefined)

3. Sponsor/Collaborators

Name of the Sponsor
Roswell Park Cancer Institute

4. Oversight

5. Study Description

Brief Summary
RATIONALE: Drugs used in chemotherapy, such as oxaliplatin, work in different ways to stop tumor cells from dividing so they stop growing or die. Gefitinib may stop the growth of tumor cells by blocking the enzymes necessary for their growth. Radiation therapy uses high-energy x-rays to damage tumor cells. Combining oxaliplatin and gefitinib with radiation therapy may kill more tumor cells. PURPOSE: This phase I/II trial is studying the side effects and best dose of oxaliplatin when given together with gefitinib and radiation therapy and to see how well they work in treating patients with locally advanced or metastatic esophageal cancer.
Detailed Description
OBJECTIVES: Primary Determine the maximum tolerated dose of oxaliplatin when administered with gefitinib and radiotherapy in patients with locally advanced or metastatic adenocarcinoma or squamous cell carcinoma of the esophagus or gastroesophageal junction. (Phase I) Determine the response rate in patients treated with this regimen. (Phase II) Secondary Determine time to tumor progression and median survival in patients treated with this regimen. Determine quality of life in patients treated with this regimen. Determine the safety of this regimen in these patients. OUTLINE: This is a phase I, open-label, dose-escalation study of oxaliplatin followed by a phase II study. Phase I: Patients receive oxaliplatin IV over 2 hours on days 1, 15, and 29. Beginning on day 1, patients undergo radiotherapy once daily, 5 days a week, for 5.5 weeks. Patients also receive oral gefitinib once daily on days 1-365. Treatment continues in the absence of disease progression or unacceptable toxicity Approximately 3-6 weeks after the completion of chemoradiotherapy, patients are evaluated. Some patients undergo surgical resection* and possibly receive a second course of oxaliplatin (IV over 2 hours on days 1, 15, and 29) 4-8 weeks after surgery. If surgery is not indicated, some patients may receive an additional course of oxaliplatin. Cohorts of 3-6 patients receive escalating doses of oxaliplatin until the maximum tolerated dose is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Phase II: Patients receive oxaliplatin, gefitinib, and radiotherapy as in phase I at the MTD. Some patients then either undergo surgical resection* and/or begin a second course of oxaliplatin as in phase I. NOTE: *Oral gefitinib is discontinued ≥ 7 days before surgery and is restarted when the patient has recovered. Quality of life is assessed at baseline, 5-6 weeks, and then every 2-3 months for 1 year. Patients are followed every 2-3 months for 1 year. PROJECTED ACCRUAL: Approximately 15-45 patients (3-12 for phase I and 12-33 for phase II) will be accrued for this study within 2 years.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Esophageal Cancer
Keywords
adenocarcinoma of the esophagus, recurrent esophageal cancer, stage II esophageal cancer, stage III esophageal cancer, stage IV esophageal cancer, squamous cell carcinoma of the esophagus

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Masking
None (Open Label)

8. Arms, Groups, and Interventions

Intervention Type
Drug
Intervention Name(s)
gefitinib
Intervention Type
Drug
Intervention Name(s)
oxaliplatin
Intervention Type
Procedure
Intervention Name(s)
conventional surgery
Intervention Type
Procedure
Intervention Name(s)
neoadjuvant therapy
Intervention Type
Radiation
Intervention Name(s)
radiation therapy
Primary Outcome Measure Information:
Title
Maximum tolerated dose (phase I)
Title
Response (phase II)
Secondary Outcome Measure Information:
Title
Survival
Title
Quality of life
Title
Safety and toxicity
Title
Immunohistochemistry

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
120 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed adenocarcinoma or squamous cell carcinoma of the esophagus or gastroesophageal (GE) junction Locally advanced or metastatic disease by clinical staging, including esophagogastroduodenoscopy and esophageal ultrasound Stage T2, N0 disease and beyond Bulk of tumor must be in the esophagus of patients with GE junction tumor Bronchoscopy is required if primary esophageal tumor is < 26 cm from the incisors No brain metastases PATIENT CHARACTERISTICS: Age Over 18 Performance status ECOG 0-1 Life expectancy At least 4 months Hematopoietic WBC ≥ 3,000/mm^3 Granulocyte count ≥ 1,500/mm^3 Platelet count > 100,000/mm^3 Hepatic Bilirubin normal ALT and AST ≤ 2.5 times upper limit of normal (ULN) Alkaline phosphatase ≤ 2.5 times ULN Renal Not specified Cardiovascular No symptomatic congestive heart failure No unstable angina pectoris No cardiac arrhythmia Pulmonary No clinically active interstitial lung disease Patients with chronic stable asymptomatic radiographic changes are eligible Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective double-method (including barrier) contraception during and for 3 months after study participation No peripheral neuropathy ≥ grade II No severe hypersensitivity to gefitinib or any of its excipients No history of allergy to platinum-based compounds or antiemetics administered with protocol-directed chemotherapy No active or ongoing infection No other uncontrolled illness No other significant clinical disorder or laboratory finding that would preclude study participation PRIOR CONCURRENT THERAPY: Biologic therapy No concurrent colony-stimulating factors during course 1 of study therapy Chemotherapy More than 4 weeks since prior chemotherapy Endocrine therapy Concurrent steroid therapy allowed Radiotherapy More than 4 weeks since prior radiotherapy Surgery Not specified Other More than 30 days since prior non-approved or investigational drugs No concurrent administration of any of the following: Phenytoin Carbamazepine Rifampin Barbiturates Highly-active antiretroviral therapy (HAART) Hypericum perforatum (St. John's wort) No other concurrent investigational agents or therapy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Milind Javle, MD
Organizational Affiliation
Roswell Park Cancer Institute
Official's Role
Principal Investigator
Facility Information:
Facility Name
Roswell Park Cancer Institute
City
Buffalo
State/Province
New York
ZIP/Postal Code
14263-0001
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
18845990
Citation
Javle M, Pande A, Iyer R, Yang G, LeVea C, Wilding G, Black J, Nava H, Nwogu C. Pilot study of gefitinib, oxaliplatin, and radiotherapy for esophageal adenocarcinoma: tissue effect predicts clinical response. Am J Clin Oncol. 2008 Aug;31(4):329-34. doi: 10.1097/COC.0b013e318161dc04.
Results Reference
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Oxaliplatin, Gefitinib, and Radiation Therapy in Treating Patients With Locally Advanced or Metastatic Esophageal Cancer

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