search
Back to results

Perioperative Vs. Preoperative Chemotherapy With Surgery in the Squamous Carcinoma of Esophagus

Primary Purpose

Squamous Carcinoma of Esophagus, Esophagus Disorders

Status
Completed
Phase
Phase 1
Locations
China
Study Type
Interventional
Intervention
Paclitaxel; Cisplatin; 5-Fluorouracil
Paclitaxel; Cisplatin; 5-Fluorouracil; Capecitabine
Sponsored by
Health Science Center of Xi'an Jiaotong University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Squamous Carcinoma of Esophagus

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Signed informed consent
  • histologically confirmed esophageal cancer (squamous carcinoma) measurable, non-metastatic disease
  • no previous cancer therapy (chemotherapy, radiotherapy or resection)
  • life expectancy > 3 months
  • age > 18 years
  • WHO Status ≤ 1
  • Intended curative resection according to evaluation of an experienced surgeon
  • Negative pregnancy blood test at screening but not earlier than 72 hours prior to start of chemotherapy for women with child bearing potential
  • Adequate haematologic function and liver and renal function: neutrophils > 1.5×109/L; thrombocytes > 100×109/L; haemoglobin > 10 g/dl, creatinine clearance > 60 ml/min (calculated according to Cockroft and Gault), total bilirubin < 1.0×UNL; AST and ALT < 1.5×UNL, AP < 2.5×UNL
  • Complete staging within 3 weeks prior to start of treatment (CT-scan of thorax and abdomen, endosonography, gastroscopy)
  • Ability to keep appointments and follow the study protocol
  • By CT-scan, endoscopy or endosonography measurable or evaluable disease

Exclusion Criteria:

  • Former therapy of cancer (operation, chemo- or radiotherapy)
  • Diagnosis of another cancer in the last 5 years prior to study entry which has not been cured by operation only (exception in-situ-carcinoma of the cervix or cured non-melanomatose skin cancer)
  • Known contraindication to the planned chemotherapeutics
  • Presence of distant metastases
  • Anamnestic known serious disease or other concomitant diseases that affect participation in this study, such as:

oInstable cardiac disease: symptomatic heart failure, symptomatic coronary artery disease, ventricular cardiac arrhythmia not well controlled with medication, myocardial infarction or resuscitation within 6 month before study oActive infection necessitating systemic therapy or uncontrolled infection oInterstitial lung diseases (for example: pneumonitis or fibrosis of the lung) and indication for interstitial lung disease in chest x-ray or CT-scan respectively oActive inflammatory bowel disease or other bowel diseases which provoke chronic diarrhea (defined as > 4 bowel movements per day) oNeurological or psychiatric disease including dementia, epilepsy or untreated, symptomatic brain metastases oLimited hearing ability

  • Presence of upper GI obstruction, leading to inability to swallow ground tablets
  • Presence of acute or chronic systemic infection
  • Presence of a bowel obstruction within the last 30 days
  • Pregnant or lactating women or women with child bearing potential and men without adequate contraception (high effective contraception, defined as Pearl Index < 1) like birth control pill, hormone spiral, hormone implant, transdermal patch, a combination of two barrier methods (condom and diaphragm), realized sterilization or sexual abstinence during the study and at least for 3 months after the last infusion
  • Any other situation which may lead to an unacceptable high risk for the patient, when he participates in the study
  • Parallel treatment in another clinical study or prior participation in this study
  • Treatment with any other therapy against the tumor or any parallel radiation
  • Symptomatic peripheral neuropathy NCI-CTCAE degree > 2
  • Intolerance to the study medication
  • Detention in a psychiatric unit or imprisonment

Sites / Locations

  • First Affiliated Hospital of College of Medicine of Xi'an Jiao Tong University

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Preoperative chemotherapy followed by surgery

Perioperative chemotherapy with surgery

Arm Description

Outcomes

Primary Outcome Measures

Overall survival rate
Progression-free survival

Secondary Outcome Measures

Pathological remission rate
Resectability rate
Operative and postoperative complication rate
30-day mortality
Toxicity of preoperative and postoperative chemotherapy
Rate of local recurrences and metastasis

Full Information

First Posted
October 19, 2010
Last Updated
October 20, 2010
Sponsor
Health Science Center of Xi'an Jiaotong University
search

1. Study Identification

Unique Protocol Identification Number
NCT01225523
Brief Title
Perioperative Vs. Preoperative Chemotherapy With Surgery in the Squamous Carcinoma of Esophagus
Official Title
Perioperative Versus Preoperative Chemotherapy With Surgery in Patients With Locoregional Squamous Carcinoma of Esophagus
Study Type
Interventional

2. Study Status

Record Verification Date
September 2010
Overall Recruitment Status
Completed
Study Start Date
January 1997 (undefined)
Primary Completion Date
December 2008 (Actual)
Study Completion Date
January 2010 (Actual)

3. Sponsor/Collaborators

Name of the Sponsor
Health Science Center of Xi'an Jiaotong University

4. Oversight

5. Study Description

Brief Summary
To assess whether or not a perioperative therapy with surgery can improve the outcomes among patients with potentially curable squamous carcinoma of esophagus as compared to a preoperative chemotherapy followed by surgery
Detailed Description
Perioperative chemotherapy has been shown to significantly improve the R0 resection rate, the disease free survival and the overall survival in patients with adenocarcinoma of the esophagus, the gastroesophageal junction and the stomach. Therefore, perioperative chemotherapy is the new therapeutic standard (Cunningham NEJM 2006, MRC, Lancet 2002, Boige ASCO 2007). The best-evaluated regime is the combination of Epirubicin, Cisplatin and 5-FU (ECF) (Cunningham, NEJM 2007). Cisplatin and 5-FU are considered to be the most important components to form the cornerstone of this regime. Paclitaxel is a new and highly active cytotoxic agent. In a randomized phase II study, the dual combination of Paclitaxel and 5-FU seemed to show similar effects as ECF, administered as first line treatment. The triplet combination of Paclitaxel, Cisplatin and 5-FU has significantly superior efficacy than a combination of Cisplatin und 5-FU (Van Cutsem, JCO 2007). It has been shown that Capecitabine is more active than 5-FU and can replace intravenous 5-FU in the combination with Cisplatin in the treatment of esophageal cancer. Capecitabine therefore is FDA approved for esophageal cancer (Cunningham, ASCO 2006, Kang ASCO 2006).It seems reasonable to optimize perioperative chemotherapy by including this modern chemotherapeutics. In this study, patients with squamous carcinoma of esophagus and gastroesophageal junction who seem operable with curative intent according to oncological and surgical assessment are treated with 2 preoperative cycles of PCF followed by surgical resection, followed by 2 postoperative cycles of PCF. Among patients with no responses to preoperative chemotherapy, Capecitabine 625 mg/m² twice-daily dose is defined as alternatives to infused 5-Fluorouracil in the postoperative chemotherapy regimen Postoperative chemotherapy will start within 4-6 weeks after the operation. 3 weeks after the end of the last chemotherapy the final investigation (end of study visit) will be done.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Squamous Carcinoma of Esophagus, Esophagus Disorders

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Masking
Investigator
Allocation
Randomized
Enrollment
350 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Preoperative chemotherapy followed by surgery
Arm Type
Active Comparator
Arm Title
Perioperative chemotherapy with surgery
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
Paclitaxel; Cisplatin; 5-Fluorouracil
Intervention Description
Two preoperative cycles with Paclitaxel 200 mg/m² d1, Cisplatin 60 mg/m² d1, 5-Fluorouracil 700 mg/m² d1-5 repeated every 3 weeks followed by resection
Intervention Type
Drug
Intervention Name(s)
Paclitaxel; Cisplatin; 5-Fluorouracil; Capecitabine
Intervention Description
Two postoperative cycles with Paclitaxel 200 mg/m²/day d1, Cisplatin 60 mg/m²/day d1, 5-Fluorouracil 700 mg/m²/day d1-5 repeated every 3 weeks Among patients with no responses to preoperative chemotherapy, Capecitabine 625 mg/m² twice-daily dose as alternatives to infused 5-Fluorouracil in the postoperative chemotherapy regimen
Primary Outcome Measure Information:
Title
Overall survival rate
Time Frame
5 years
Title
Progression-free survival
Time Frame
3 years
Secondary Outcome Measure Information:
Title
Pathological remission rate
Time Frame
After 2 cycles of preoperative chemotherapy (2 month)
Title
Resectability rate
Time Frame
After 2 cycles of preoperative chemotherapy (2 month)
Title
Operative and postoperative complication rate
Time Frame
Within 30 days after surgery
Title
30-day mortality
Time Frame
After date of surgery
Title
Toxicity of preoperative and postoperative chemotherapy
Title
Rate of local recurrences and metastasis

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Signed informed consent histologically confirmed esophageal cancer (squamous carcinoma) measurable, non-metastatic disease no previous cancer therapy (chemotherapy, radiotherapy or resection) life expectancy > 3 months age > 18 years WHO Status ≤ 1 Intended curative resection according to evaluation of an experienced surgeon Negative pregnancy blood test at screening but not earlier than 72 hours prior to start of chemotherapy for women with child bearing potential Adequate haematologic function and liver and renal function: neutrophils > 1.5×109/L; thrombocytes > 100×109/L; haemoglobin > 10 g/dl, creatinine clearance > 60 ml/min (calculated according to Cockroft and Gault), total bilirubin < 1.0×UNL; AST and ALT < 1.5×UNL, AP < 2.5×UNL Complete staging within 3 weeks prior to start of treatment (CT-scan of thorax and abdomen, endosonography, gastroscopy) Ability to keep appointments and follow the study protocol By CT-scan, endoscopy or endosonography measurable or evaluable disease Exclusion Criteria: Former therapy of cancer (operation, chemo- or radiotherapy) Diagnosis of another cancer in the last 5 years prior to study entry which has not been cured by operation only (exception in-situ-carcinoma of the cervix or cured non-melanomatose skin cancer) Known contraindication to the planned chemotherapeutics Presence of distant metastases Anamnestic known serious disease or other concomitant diseases that affect participation in this study, such as: oInstable cardiac disease: symptomatic heart failure, symptomatic coronary artery disease, ventricular cardiac arrhythmia not well controlled with medication, myocardial infarction or resuscitation within 6 month before study oActive infection necessitating systemic therapy or uncontrolled infection oInterstitial lung diseases (for example: pneumonitis or fibrosis of the lung) and indication for interstitial lung disease in chest x-ray or CT-scan respectively oActive inflammatory bowel disease or other bowel diseases which provoke chronic diarrhea (defined as > 4 bowel movements per day) oNeurological or psychiatric disease including dementia, epilepsy or untreated, symptomatic brain metastases oLimited hearing ability Presence of upper GI obstruction, leading to inability to swallow ground tablets Presence of acute or chronic systemic infection Presence of a bowel obstruction within the last 30 days Pregnant or lactating women or women with child bearing potential and men without adequate contraception (high effective contraception, defined as Pearl Index < 1) like birth control pill, hormone spiral, hormone implant, transdermal patch, a combination of two barrier methods (condom and diaphragm), realized sterilization or sexual abstinence during the study and at least for 3 months after the last infusion Any other situation which may lead to an unacceptable high risk for the patient, when he participates in the study Parallel treatment in another clinical study or prior participation in this study Treatment with any other therapy against the tumor or any parallel radiation Symptomatic peripheral neuropathy NCI-CTCAE degree > 2 Intolerance to the study medication Detention in a psychiatric unit or imprisonment
Facility Information:
Facility Name
First Affiliated Hospital of College of Medicine of Xi'an Jiao Tong University
City
Xi'an
State/Province
Shaanxi
ZIP/Postal Code
710061
Country
China

12. IPD Sharing Statement

Citations:
PubMed Identifier
26287319
Citation
Zhao Y, Dai Z, Min W, Sui X, Kang H, Zhang Y, Ren H, Wang XJ. Perioperative versus Preoperative Chemotherapy with Surgery in Patients with Resectable Squamous Cell Carcinoma of Esophagus: A Phase III Randomized Trial. J Thorac Oncol. 2015 Sep;10(9):1349-1356. doi: 10.1097/JTO.0000000000000612.
Results Reference
derived

Learn more about this trial

Perioperative Vs. Preoperative Chemotherapy With Surgery in the Squamous Carcinoma of Esophagus

We'll reach out to this number within 24 hrs