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A Study of Second-line Treatment of Postoperative Recurrence and Metastasis of Esophageal Cancer Treated With Apatinib

Primary Purpose

Esophageal Neoplasms

Status
Withdrawn
Phase
Phase 2
Locations
Study Type
Interventional
Intervention
Apatinib
The chemotherapeutic drug chosen by the investigator.
Sponsored by
The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Esophageal Neoplasms

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Pathological/histological diagnosis of esophageal squamous cell carcinoma; and at least one measurable lesion according to RECIST criteria (version 1.1);
  • Patients who have undergone radical resection of esophageal cancer and who have failed after first-line systemic chemotherapy (which may include platinum, taxane or fluorouracil) after recurrence (recurrence of postoperative adjuvant chemotherapy within 6 months) Considered as first-line treatment, and the same progress in the field of radiation can be seen as recurrence;
  • Age: 18-75 years old; both men and women;
  • ECOG PS Rating: 0-1 points;
  • Estimated survival period ≥ 3 months;
  • ≥ 4 weeks from the last cytotoxic drug;
  • The main organs function normally, that is, meet the following criteria:

    • Blood routine examination:

      • HB≥90 g/L; (no blood transfusion within 14 days)
      • ANC ≥ 1.5 × 109 / L;
      • PLT ≥ 80 × 109 / L;
    • Biochemical examinations must meet the following criteria:

      • ALT and AST < 2.5 ULN; if there is liver metastasis, ALT and AST < 5 ULN;
      • TBIL ≤ 1.5ULN;
      • Plasma Cr≤1.5ULN or creatinine clearance (CCr)≥60ml/min
  • Subjects volunteered to participate in the study, signed informed consent, and were well-adhered to follow-up.
  • Women of childbearing age should agree to use contraceptives (such as intrauterine devices, contraceptives or condoms) during the study period and within 6 months of the end of the study; negative serum or urine pregnancy tests within seven days prior to study enrollment And must be non-lactating patients; males should agree to patients who must use contraception during the study period and within 6 months after the end of the study period.

Exclusion Criteria:

  • Those who have used anti-tumor angiogenesis drugs to treat failure;
  • Patients with residual esophagus, residual stomach or anastomotic recurrence;
  • Unable to swallow, chronic diarrhea and intestinal obstruction, which obviously affect the taking and absorption of drugs;
  • Patients with brain metastases with symptoms or symptoms controlled for less than 3 months;
  • Long-term unhealed wounds and fractures;
  • Have clear gastrointestinal bleeding concerns (such as local active ulcer lesions, fecal occult blood above ++), history of gastrointestinal bleeding within 6 months; coagulation abnormalities (PT>16 s, APTT>43 s, TT>21 s, Fbg< 2 g/L), with bleeding tendency or undergoing thrombolytic or anticoagulant therapy;
  • Overactive/venous thrombosis occurred within 6 months, such as cerebrovascular accidents (including transient ischemic attacks), deep vein thrombosis, and pulmonary embolism;
  • Imaging shows that the tumor has invaded the important perivascular circumference or that the patient is likely to invade the important blood vessels during the follow-up study and cause fatal bleeding.
  • Persons with a history of psychotropic substance abuse who are unable to resolve or have a mental disorder;
  • Participated in other clinical trials of anti-tumor drugs within four weeks;
  • Have a history of immunodeficiency, including HIV positive or other acquired, congenital immunodeficiency disease, or a history of organ transplantation;
  • According to the investigator's judgment, there are serious concomitant illnesses that compromise the safety of the patient or affect the patient's completion of the study.
  • Patients with any severe and/or uncontrolled diseases, including:

    • Blood pressure control is unreasonable (retraction pressure >150mmHg, diastolic pressure >100mmHg) Patients: I have myocardial ischemia or myocardial infarction above grade I, arrhythmia (including QT interval >440ms) and grade I cardiac insufficiency;
    • Active or uncontrolled serious infections;
    • Liver diseases such as cirrhosis, decompensated liver disease, chronic active hepatitis;
    • Poor diabetes control (fasting blood glucose FBG>10mmol/L);
    • Urine routine indicates urinary protein >++, and confirmed 24-hour urine protein quantitation >1.0g.
  • The investigator believes that it is not suitable for inclusion.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    experimental group

    Control group

    Arm Description

    It is recommended that the initial dose of apatinib is 500mg po qd. Adjust the dose to 750mg po qd or maintain the original dose according to the patient's medication response for about 2 weeks. If there is grade III or above, or grade II and above non-hematologic toxicity, allow the dose to be lowered 2 times.

    The chemotherapeutic drug chosen by the investigator (if not used in the previous treatment regimen, it cannot be selected). The choice of chemotherapy regimen is based on the medication habits of the drug delivery doctor and the specific circumstances of the patient. In addition, the following regimens may be selected as monotherapy or combination: docetaxel 60-75 mg/m2d1 q3w; irinotecan 150-180 mg/m2 d1 q2w until disease progression or patient decease. If the adverse event grade 3 and above Or non-hematologic toxicity of grade II and above appeared, allowing the dose to be lowered twice.

    Outcomes

    Primary Outcome Measures

    PFS
    progression-free survival

    Secondary Outcome Measures

    OS
    Overall Survival
    DCR
    disease control rate
    ORR
    Objective Response Rate

    Full Information

    First Posted
    December 20, 2018
    Last Updated
    April 11, 2022
    Sponsor
    The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School
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    1. Study Identification

    Unique Protocol Identification Number
    NCT03787251
    Brief Title
    A Study of Second-line Treatment of Postoperative Recurrence and Metastasis of Esophageal Cancer Treated With Apatinib
    Official Title
    Randomized, Open, Positive Drug Control, Multicenter Clinical Study of Second-line Treatment of Postoperative Recurrence and Metastasis of Esophageal Squamous Cell Carcinoma With Chemotherapy in Patients Treated With Apatinib Mesylate
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    January 2019
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    In China, apatinib has been approved as an indication drug for esophageal squamous cell carcinoma, which makes it very difficult for our clinical trial to enroll patients. We regret that we failed to implement the design as planned.
    Study Start Date
    January 1, 2019 (Anticipated)
    Primary Completion Date
    December 31, 2020 (Anticipated)
    Study Completion Date
    December 31, 2021 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No

    5. Study Description

    Brief Summary
    A study of second-line treatment of postoperative recurrence and metastasis of esophageal squamous cell carcinoma after chemotherapy with apatinib mesylate
    Detailed Description
    This is a randomized, open-label, multi-center, phase II clinical trial initiated by a investigator to observe and evaluate the efficacy of apatinib in the treatment of patients with failed first-line treatment after recurrence and metastasis of esophageal squamous cell carcinoma. Effectiveness and security.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Esophageal Neoplasms

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 2
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    experimental group
    Arm Type
    Experimental
    Arm Description
    It is recommended that the initial dose of apatinib is 500mg po qd. Adjust the dose to 750mg po qd or maintain the original dose according to the patient's medication response for about 2 weeks. If there is grade III or above, or grade II and above non-hematologic toxicity, allow the dose to be lowered 2 times.
    Arm Title
    Control group
    Arm Type
    Active Comparator
    Arm Description
    The chemotherapeutic drug chosen by the investigator (if not used in the previous treatment regimen, it cannot be selected). The choice of chemotherapy regimen is based on the medication habits of the drug delivery doctor and the specific circumstances of the patient. In addition, the following regimens may be selected as monotherapy or combination: docetaxel 60-75 mg/m2d1 q3w; irinotecan 150-180 mg/m2 d1 q2w until disease progression or patient decease. If the adverse event grade 3 and above Or non-hematologic toxicity of grade II and above appeared, allowing the dose to be lowered twice.
    Intervention Type
    Drug
    Intervention Name(s)
    Apatinib
    Intervention Description
    It is recommended that the initial dose of apatinib is 500mg po qd. Adjust the dose to 750mg po qd or maintain the original dose according to the patient's medication response for about 2 weeks. If there is grade III or above, or grade II and above non-hematologic toxicity, allow the dose to be lowered 2 times.
    Intervention Type
    Drug
    Intervention Name(s)
    The chemotherapeutic drug chosen by the investigator.
    Intervention Description
    The choice of chemotherapy regimen is based on the medication habits of the drug delivery doctor and the specific circumstances of the patient. In addition, the following regimens may be selected as monotherapy or combination: docetaxel 60-75 mg/m2d1 q3w; irinotecan 150-180 mg/m2 d1 q2w until disease progression or patient death. If grade 3 and above or non-hematologic toxicity of grade II and above adverse event appeared, allowing the dose to be lowered twice.
    Primary Outcome Measure Information:
    Title
    PFS
    Description
    progression-free survival
    Time Frame
    One year from admission
    Secondary Outcome Measure Information:
    Title
    OS
    Description
    Overall Survival
    Time Frame
    One year from admission
    Title
    DCR
    Description
    disease control rate
    Time Frame
    One year from admission
    Title
    ORR
    Description
    Objective Response Rate
    Time Frame
    One year from admission

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    75 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Pathological/histological diagnosis of esophageal squamous cell carcinoma; and at least one measurable lesion according to RECIST criteria (version 1.1); Patients who have undergone radical resection of esophageal cancer and who have failed after first-line systemic chemotherapy (which may include platinum, taxane or fluorouracil) after recurrence (recurrence of postoperative adjuvant chemotherapy within 6 months) Considered as first-line treatment, and the same progress in the field of radiation can be seen as recurrence; Age: 18-75 years old; both men and women; ECOG PS Rating: 0-1 points; Estimated survival period ≥ 3 months; ≥ 4 weeks from the last cytotoxic drug; The main organs function normally, that is, meet the following criteria: Blood routine examination: HB≥90 g/L; (no blood transfusion within 14 days) ANC ≥ 1.5 × 109 / L; PLT ≥ 80 × 109 / L; Biochemical examinations must meet the following criteria: ALT and AST < 2.5 ULN; if there is liver metastasis, ALT and AST < 5 ULN; TBIL ≤ 1.5ULN; Plasma Cr≤1.5ULN or creatinine clearance (CCr)≥60ml/min Subjects volunteered to participate in the study, signed informed consent, and were well-adhered to follow-up. Women of childbearing age should agree to use contraceptives (such as intrauterine devices, contraceptives or condoms) during the study period and within 6 months of the end of the study; negative serum or urine pregnancy tests within seven days prior to study enrollment And must be non-lactating patients; males should agree to patients who must use contraception during the study period and within 6 months after the end of the study period. Exclusion Criteria: Those who have used anti-tumor angiogenesis drugs to treat failure; Patients with residual esophagus, residual stomach or anastomotic recurrence; Unable to swallow, chronic diarrhea and intestinal obstruction, which obviously affect the taking and absorption of drugs; Patients with brain metastases with symptoms or symptoms controlled for less than 3 months; Long-term unhealed wounds and fractures; Have clear gastrointestinal bleeding concerns (such as local active ulcer lesions, fecal occult blood above ++), history of gastrointestinal bleeding within 6 months; coagulation abnormalities (PT>16 s, APTT>43 s, TT>21 s, Fbg< 2 g/L), with bleeding tendency or undergoing thrombolytic or anticoagulant therapy; Overactive/venous thrombosis occurred within 6 months, such as cerebrovascular accidents (including transient ischemic attacks), deep vein thrombosis, and pulmonary embolism; Imaging shows that the tumor has invaded the important perivascular circumference or that the patient is likely to invade the important blood vessels during the follow-up study and cause fatal bleeding. Persons with a history of psychotropic substance abuse who are unable to resolve or have a mental disorder; Participated in other clinical trials of anti-tumor drugs within four weeks; Have a history of immunodeficiency, including HIV positive or other acquired, congenital immunodeficiency disease, or a history of organ transplantation; According to the investigator's judgment, there are serious concomitant illnesses that compromise the safety of the patient or affect the patient's completion of the study. Patients with any severe and/or uncontrolled diseases, including: Blood pressure control is unreasonable (retraction pressure >150mmHg, diastolic pressure >100mmHg) Patients: I have myocardial ischemia or myocardial infarction above grade I, arrhythmia (including QT interval >440ms) and grade I cardiac insufficiency; Active or uncontrolled serious infections; Liver diseases such as cirrhosis, decompensated liver disease, chronic active hepatitis; Poor diabetes control (fasting blood glucose FBG>10mmol/L); Urine routine indicates urinary protein >++, and confirmed 24-hour urine protein quantitation >1.0g. The investigator believes that it is not suitable for inclusion.

    12. IPD Sharing Statement

    Learn more about this trial

    A Study of Second-line Treatment of Postoperative Recurrence and Metastasis of Esophageal Cancer Treated With Apatinib

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