Biomarker-Integrated Umbrella, Advanced Gastric Cancer
Gastric Cancer
About this trial
This is an interventional treatment trial for Gastric Cancer
Eligibility Criteria
Inclusion Criteria:
- Histologically or cytologically confirmed locally advanced or metastatic gastric cancer and gastroesophageal junction cancer
- Eastern Cooperative Oncology Group performance status of 0 to 1
- Male or female; ≥ 19 years of age
- On or progression after 1st line palliative chemotherapy
- Subjects with evaluable lesion (using RECIST 1.1 criteria)
Subjects who meet the following criteria:
- Absolute neutrophil count ≥ 1000 /µL
- Platelet count ≥ 75,000/ µL
- Serum creatinine < 1.5 x upper limit of normal or Creatinine clearance ≥60 mL/min
- aspartate aminotransferase and alanine transaminase 3 x upper limit of normal
Exclusion Criteria:
- Evidence of any other significant clinical disorder or laboratory finding that makes it undesirable for the patient to participate in the study
Sites / Locations
- Severance Hospital, Yonsei University Health System, Yonsei Cancer Center
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
biomarker group
control group
400 Her-2 (-) metastatic/recurrent gastric cancer patients will be centrally screened for druggable targets [Epstein-Barr virus, Microsatellite instability, HER2, EGFR, c-MET, and PTEN] by immunohistochemistry and in situ hybridization during first line chemotherapy. At the time of second line treatment, patients will be randomized to the biomarker vs control group as 4: 1 ratio. The biomarker group will be offered for entry into a specific protocol based on their molecular cohort and treated with specific targeted agents in combination with weekly paclitaxel; 1) EGFR cohort (EGFR 2+ or EGFR 3+) for pan-ERBB inhibitor (afatinib), 2)PTEN loss cohort (PTEN score less than 100) for PIK3CB inhibitor (GSK2636771), 3) PD-L1 positive, MSI-high, or EBV positive cases for nivolumab, 4) none for weekly paclitaxel.
Patients will be randomized to the biomarker vs control group (standard of care; paclitaxel) as 4:1 ratio.