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Study of Oxaliplatin and Sorafenib Combination to Treat Gastric Cancer Relapsed After a Cisplatin Based Treatment

Primary Purpose

Advanced or Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma (Relapsed After a Cisplatin Based Treatment)

Status
Completed
Phase
Phase 2
Locations
Spain
Study Type
Interventional
Intervention
Oxaliplatin
Sorafenib
Sponsored by
Grupo Espanol Multidisciplinario del Cancer Digestivo
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Advanced or Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma (Relapsed After a Cisplatin Based Treatment) focused on measuring adenocarcinoma, gastric, gastroesophageal junction, Relapsed, sorafenib, oxaliplatin

Eligibility Criteria

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

Inclusion Criteria:

  1. Gastric or gastroesophageal junction adenocarcinoma confirmed by cytology or biopsy, with unresectable or metastatic disease which have progressed to a cisplatin-fluoropyrimidine based scheme (excluded neoadjuvant treatment administered with or without concomitant radiotherapy)
  2. Older than 18 years at the moment of informed consent form signature
  3. Age > 18 years
  4. ECOG 0-2
  5. Measurable disease by RECIST criteria. Lesions have to be measured by CT-scan or MRI
  6. Life expectancy > 12 weeks
  7. Adequate medullary reserve and hepatic and renal function, defined according to the following parameters:

    1. Hemoglobin ≥ 9g/dl
    2. Neutrophils ≥ 1,5 x 10^9/L
    3. Platelets ≥100 x 10^9/L
    4. Total bilirubin ≤ 1,5 times the upper limit of normal (ULN)
    5. ALT (GTP) and AST (GOT) ≤ 2,5 times the upper limit of normal (ULN) (≤ 5 times the ULN in patients with hepatic metastasis)
    6. PT-INR-PTT ≤ 1,5 times the ULN. (The patients under anticoagulant treatment with dicumarin or heparin can be included if there is no previous evidence of alteration in these parameters)
    7. Creatinine clearance > 30ml/min
  8. The patients have to be able to understand the meaning of their participation in the trial and voluntary give their participation consent signing the informed consent form

Exclusion Criteria:

  1. More than one line for the treatment of locally advanced disease
  2. Active ischemic cardiopathy. History of cardiac disease defined as follow:

    1. Congestive cardiac failure > class 2 from the NYHA
    2. Active coronary disease. The recruitment of patients with solved myocardial infarction is allowed, if diagnosed at least 6 months before the trial start
    3. Cardiac arrhythmia requiring treatment with antiarrhythmic drugs. (The treatment with beta-adrenergic antagonists or digoxin is allowed)
    4. Non-controlled arterial hypertension
  3. Non-controlled intercurrent illness
  4. Symptomatic sensitive peripheral neuropathy
  5. Another malignant disease diagnosed in the past 5 years, except in situ cervix carcinoma adequately treated, non-melanoma skin carcinoma, superficial bladder tumor (Ta, Tis and T1), or any tumor treated in a curative way until 3 years prior to the recruitment
  6. Pregnant or breastfeeding women. Women will have to undergo a pregnancy test within 7 days prior to the recruitment. Both men and women recruited in the trial will have to use appropriate barrier contraceptive methods during their sexual relations during the trial period and at least until two weeks after its completion. Men participating in this trial will have to continue using this contraceptive methods at least until 3 months after the treatment completion
  7. Chronic diseases: AIDS, Hepatitis B and/or Hepatitis C
  8. Clinically active severe infection (Grade 2 NCI-CTC version 3.0)
  9. Cerebral metastasis or meningeal tumor
  10. Patients requiring chronic corticosteroid treatment or high doses of corticosteroids or any other immunosuppressive treatment
  11. Patients having undergone a major surgery within the 4 weeks prior to the trial start
  12. Patients having completed a chemotherapy or radiotherapy treatment within the 4 weeks prior to the clinical trial start (except palliative radiotherapy, within the 2-weeks prior to the clinical trial start)
  13. Previous treatment using a RAS pathway inhibitor
  14. Any medical or severe psychiatric condition or drug consumption involving a serious risk for the patient if taking part in the clinical trial or that can prevent the signature of the informed consent form
  15. Patients unable to swallow medication

Sites / Locations

  • Hospital Clinic de Barcelona
  • Hospital Sant Pau
  • H. Josep Trueta
  • Centro Oncológico M.D. Anderson Spain
  • Hospital de Fuenlabrada
  • Hospital La Paz
  • Hospital Althaia
  • Clínica Universitaria de Navarra
  • Hospital Parc Taulí
  • Hospital General de Valencia

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Oxaliplatin + Sorafenib

Arm Description

Outcomes

Primary Outcome Measures

Progression free survival
Measurements according to RECIST criteria (Response Evaluation Criteria in Solid Tumors). Main techniques: CT-scan and Magnetic Resonance Imaging (MRI)

Secondary Outcome Measures

Tumoral response
Measurements according to RECIST criteria (Response Evaluation Criteria in Solid Tumors). Main techniques: CT-scan and Magnetic Resonance Imaging (MRI)
Response duration
Duration of the partial or total response to the treatment. Evaluation and classification according to RECIST criteria (Response Evaluation Criteria in Solid Tumors)
Overall survival
Toxicity

Full Information

First Posted
December 16, 2010
Last Updated
November 8, 2012
Sponsor
Grupo Espanol Multidisciplinario del Cancer Digestivo
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1. Study Identification

Unique Protocol Identification Number
NCT01262482
Brief Title
Study of Oxaliplatin and Sorafenib Combination to Treat Gastric Cancer Relapsed After a Cisplatin Based Treatment
Official Title
A Phase 2 Trial of Oxaliplatin and Sorafenib Combination in Patients With Locally Advanced or Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma, Relapsed After a Cisplatin Based Treatment
Study Type
Interventional

2. Study Status

Record Verification Date
December 2010
Overall Recruitment Status
Completed
Study Start Date
October 2008 (undefined)
Primary Completion Date
October 2011 (Actual)
Study Completion Date
December 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Grupo Espanol Multidisciplinario del Cancer Digestivo

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
In Spain, the gastric carcinoma is the 5th most frequent malignant tumor in women and the 6th in men, and represents the 3rd cause of cancer-related deaths amongst women and the 4th amongst men. The average of 5-year survival rate in Spain is under 30%. The main reason of it is that, despite carrying out an adjuvant treatment, more than the 50% will present relapsed disease. Sorafenib has been the first RAF inhibitor, both of RAF-1 and B-rRAF and its b-RAF variant V600E. Moreover, it has shown its ability to inhibit other tyrosin-quinase receptors as VEGFR 2 and 3, c-kit, Flt-3 or PDGFR. Its activity has been clearly proven in clear cell renal carcinoma. The mechanism by which Sorafenib seems to act is not because of the existence of a mutation of RAS or RAF, but because as there is a VHL shortage the HIP produces a VEGF, bFGF or TGF overexpression that produces in turn a hyper-stimulation on the RAF/ERK/MEK pathway. The RAF/MEK/ERK pathway and angiogenesis seem to be clearly involved in the gastric carcinoma tumorigenesis and progression. Because of that, it seems interesting to associate Sorafenib to an oxaliplatin-based chemotherapy, which has shown its effectiveness in relapsed patients after receiving cisplatin-based schemes. Moreover, there is a phase 1 trial confirming the tolerance of the oxaliplatin and Sorafenib association, describing partial responses amongst gastric cancer patients previously treated with cisplatin.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Advanced or Metastatic Gastric or Gastroesophageal Junction Adenocarcinoma (Relapsed After a Cisplatin Based Treatment)
Keywords
adenocarcinoma, gastric, gastroesophageal junction, Relapsed, sorafenib, oxaliplatin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
41 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Oxaliplatin + Sorafenib
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Oxaliplatin
Intervention Description
130 mg/m2, IV during 2 hours on day 1 of each 21 day cycle. Number of cycles: until progression, intolerance or unacceptable toxicity develops, or until patient or investigator decide to stop the treatment.
Intervention Type
Drug
Intervention Name(s)
Sorafenib
Intervention Description
400mg, orally, 2 times per day. Until progression, intolerance or unacceptable toxicity develops, or until patient or investigator decide to stop the treatment.
Primary Outcome Measure Information:
Title
Progression free survival
Description
Measurements according to RECIST criteria (Response Evaluation Criteria in Solid Tumors). Main techniques: CT-scan and Magnetic Resonance Imaging (MRI)
Time Frame
anticipated 3 years
Secondary Outcome Measure Information:
Title
Tumoral response
Description
Measurements according to RECIST criteria (Response Evaluation Criteria in Solid Tumors). Main techniques: CT-scan and Magnetic Resonance Imaging (MRI)
Time Frame
anticipated 3 years
Title
Response duration
Description
Duration of the partial or total response to the treatment. Evaluation and classification according to RECIST criteria (Response Evaluation Criteria in Solid Tumors)
Time Frame
anticipated 3 years
Title
Overall survival
Time Frame
anticipated 3 years
Title
Toxicity
Time Frame
anticipated 3 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Gastric or gastroesophageal junction adenocarcinoma confirmed by cytology or biopsy, with unresectable or metastatic disease which have progressed to a cisplatin-fluoropyrimidine based scheme (excluded neoadjuvant treatment administered with or without concomitant radiotherapy) Older than 18 years at the moment of informed consent form signature Age > 18 years ECOG 0-2 Measurable disease by RECIST criteria. Lesions have to be measured by CT-scan or MRI Life expectancy > 12 weeks Adequate medullary reserve and hepatic and renal function, defined according to the following parameters: Hemoglobin ≥ 9g/dl Neutrophils ≥ 1,5 x 10^9/L Platelets ≥100 x 10^9/L Total bilirubin ≤ 1,5 times the upper limit of normal (ULN) ALT (GTP) and AST (GOT) ≤ 2,5 times the upper limit of normal (ULN) (≤ 5 times the ULN in patients with hepatic metastasis) PT-INR-PTT ≤ 1,5 times the ULN. (The patients under anticoagulant treatment with dicumarin or heparin can be included if there is no previous evidence of alteration in these parameters) Creatinine clearance > 30ml/min The patients have to be able to understand the meaning of their participation in the trial and voluntary give their participation consent signing the informed consent form Exclusion Criteria: More than one line for the treatment of locally advanced disease Active ischemic cardiopathy. History of cardiac disease defined as follow: Congestive cardiac failure > class 2 from the NYHA Active coronary disease. The recruitment of patients with solved myocardial infarction is allowed, if diagnosed at least 6 months before the trial start Cardiac arrhythmia requiring treatment with antiarrhythmic drugs. (The treatment with beta-adrenergic antagonists or digoxin is allowed) Non-controlled arterial hypertension Non-controlled intercurrent illness Symptomatic sensitive peripheral neuropathy Another malignant disease diagnosed in the past 5 years, except in situ cervix carcinoma adequately treated, non-melanoma skin carcinoma, superficial bladder tumor (Ta, Tis and T1), or any tumor treated in a curative way until 3 years prior to the recruitment Pregnant or breastfeeding women. Women will have to undergo a pregnancy test within 7 days prior to the recruitment. Both men and women recruited in the trial will have to use appropriate barrier contraceptive methods during their sexual relations during the trial period and at least until two weeks after its completion. Men participating in this trial will have to continue using this contraceptive methods at least until 3 months after the treatment completion Chronic diseases: AIDS, Hepatitis B and/or Hepatitis C Clinically active severe infection (Grade 2 NCI-CTC version 3.0) Cerebral metastasis or meningeal tumor Patients requiring chronic corticosteroid treatment or high doses of corticosteroids or any other immunosuppressive treatment Patients having undergone a major surgery within the 4 weeks prior to the trial start Patients having completed a chemotherapy or radiotherapy treatment within the 4 weeks prior to the clinical trial start (except palliative radiotherapy, within the 2-weeks prior to the clinical trial start) Previous treatment using a RAS pathway inhibitor Any medical or severe psychiatric condition or drug consumption involving a serious risk for the patient if taking part in the clinical trial or that can prevent the signature of the informed consent form Patients unable to swallow medication
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marta Martin Richard, MD
Organizational Affiliation
Grupo Espanol Multidisciplinario del Cancer Digestivo
Official's Role
Study Chair
Facility Information:
Facility Name
Hospital Clinic de Barcelona
City
Barcelona
Country
Spain
Facility Name
Hospital Sant Pau
City
Barcelona
Country
Spain
Facility Name
H. Josep Trueta
City
Girona
Country
Spain
Facility Name
Centro Oncológico M.D. Anderson Spain
City
Madrid
Country
Spain
Facility Name
Hospital de Fuenlabrada
City
Madrid
Country
Spain
Facility Name
Hospital La Paz
City
Madrid
Country
Spain
Facility Name
Hospital Althaia
City
Manresa
Country
Spain
Facility Name
Clínica Universitaria de Navarra
City
Pamplona
Country
Spain
Facility Name
Hospital Parc Taulí
City
Sabadell
Country
Spain
Facility Name
Hospital General de Valencia
City
Valencia
Country
Spain

12. IPD Sharing Statement

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Study of Oxaliplatin and Sorafenib Combination to Treat Gastric Cancer Relapsed After a Cisplatin Based Treatment

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