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Pre-operative Chemo (CPT11, Cisplatin), Radiotherapy, Plus Surgery for Resectable Esophageal Cancer

Primary Purpose

Esophageal Cancer

Status
Completed
Phase
Phase 2
Locations
Canada
Study Type
Interventional
Intervention
Irinotecan hydrochloride trihydrate
Cisplatin
Sponsored by
University Health Network, Toronto
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Esophageal Cancer focused on measuring esophageal, esophagus, irinotecan, CPT11, cisplatin

Eligibility Criteria

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

Inclusion Criteria: Histologically proven squamous or adenocarcinoma or the esophagus >20 cm from the incisors, including GE junction tumors (unless of gastric origin). GE junction tumors are defined as tumors that have their center within 5 cm proximal and distal of the anatomical cardia Clinical T1 N1 M0, T2-3 N0-1 M0, T1-3 N0-1 M1a Performance status ECOG 0-2 Medically fit for chemotherapy, radiation and esophagectomy Adequate bone marrow, hepatic and renal function as evidenced by the following: Hematology: Neutrophils > 1.5 x 109/L Platelets > 100 x 109/L Hepatic function: Total bilirubin < 1.25x ULN AST (SGOT) and ALT (SGPT) < 2.5 x ULN Alkaline phosphatase <2.5 x ULN Renal function: Serum creatinine < 160 umol/L or creatinine clearance > 60 ml/min (actual or calculated by the Cockcroft-Gault method as follows): weight (kg) x (140 - age) K x serum creatinine* for serum creatinine in *mol/L, K=0.814 in man, K=0.96 in woman No prior history of malignancy unless > 5 years disease free, or adequately treated nonmelanotic skin cancer or in situ carcinoma of the cervix Tumor technically resectable (as defined in Section 5.4.3) Exclusion Criteria: In situ or clinical T1N0M0 Cervical esophageal tumors (within 20 cm of the incisors) Positive cytology of the pleura, peritoneum or pericardium Supraclavicular lymph node involvement Invasion of tracheobronchial tree proven by bronchoscopy including but not limited to tracheo-esophageal fistula Prior treatment for this malignancy except esophageal stenting Gilbert's disease Age < 18 Participation in another concurrent clinical study involving study drug(s) or treatment with study drug within thirty days prior to the treatment on this study. Concurrent treatment with other experimental drugs or anticancer therapy Known hypersensitivity to either of study drugs or to any of their excipients. Pregnant or lactating women. Men and women of reproductive potential (and women < 12 months after menopause) may not participate unless they have agreed to use an effective contraceptive method while on study Known or suspected alcohol or drug abuse Other serious or concurrent illnesses that may interfere with subject compliance, adequate informed consent, determination of causality of adverse events and which in the judgement of the Investigator, would make the patient inappropriate for entry into the study Life expectancy < 3 months Peripheral neuropathy > Grade 2 (using CTC Version 2) Patients receiving phenytoin or phenobarbital

Sites / Locations

  • University Health Network

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Cisplatin, Irinotecan

Arm Description

Outcomes

Primary Outcome Measures

pathological complete response

Secondary Outcome Measures

acute and late toxicities
postoperative mortality
disease free survival
overall survival
Quality of life (FACT-E)
clinical complete response rate
tumor microvessel density (pathological)
perfusion CT parameters (radiological)
PET scan parameters (radiological)

Full Information

First Posted
September 8, 2005
Last Updated
May 3, 2017
Sponsor
University Health Network, Toronto
Collaborators
Pfizer
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1. Study Identification

Unique Protocol Identification Number
NCT00160875
Brief Title
Pre-operative Chemo (CPT11, Cisplatin), Radiotherapy, Plus Surgery for Resectable Esophageal Cancer
Official Title
A Phase II Study to Assess the Efficacy of Combined Pre-operative Chemo (CPT11, Cisplatin), Radiotherapy (External Beam, Brachytherapy), Plus Surgery for Potentially Resectable Thoracic Esophageal Cancer
Study Type
Interventional

2. Study Status

Record Verification Date
May 2017
Overall Recruitment Status
Completed
Study Start Date
April 2009 (undefined)
Primary Completion Date
March 2011 (Actual)
Study Completion Date
March 2011 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University Health Network, Toronto
Collaborators
Pfizer

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Cancer of the esophagus is a very serious cancer. Studies have shown that using chemotherapy and radiation before surgery is the most promising treatment approach, with one quarter to one half of tumors shrinking by 50% or more in size after chemotherapy and radiation. In patients who have a very good response to this treatment, survival following esophagectomy has increased, although the amount of increase has varied quite a bit between the different studies. Older studies have used the drugs Cisplatin and 5-fluoruracil. Although this combination of drugs has been beneficial, we wish to use a newer combination of drugs which may be more effective for esophageal cancer. The chemotherapy drugs used in this study are Cisplatin and Irinotecan. We also want to find out what side effects these drugs cause when given with radiation, and how often these side effects occur.
Detailed Description
Historical surgical series have reported that the chance of cure with surgery alone is approximately one in four. Many phase II studies and some phase III studies have examined the role of induction (preoperative) chemotherapy and radiation. In general, these studies have demonstrated a trend to improved survival using an induction regimen with one phase III study reporting a significant improvement in survival. Two meta-analyses have failed to demonstrate a clear advantage of an induction regimen. When these trials are reviewed, it is apparent that there is a subgroup of patients who are found at the time of resection to have had a complete pathological response to their treatment, and these patients clearly experience improved survival. These previous trials have used older chemotherapy agents. Nevertheless, cisplatin remains one of the most active drugs available for treating solid tumours. Irinotecan is a newer drug that has demonstrated significant activity in colorectal cancer and more recently in esophageal cancer. A previous single institution trial of cisplatin and irinotecan in esophageal cancer demonstrated a significant response and acceptable toxicity. By giving one cycle of chemotherapy alone first, it is expected that the dysphagia usually experienced by these patients will improve sufficiently and that nutritional support, i.e. feeding tube, will not be required (as has been demonstrated in a previous study of this drug combination). The same drugs will then be given concurrently with external beam radiation in order to take advantage of the radiosensitizing properties of both these drugs. This will be followed by a boost dose of radiation, which will provide a total dose in the tumourcidal range. Surgery will follow the boost dose of radiation. This study proposes to combine two drugs with demonstrated activity in esophageal cancer, cisplatin and Irinotecan, with radiation prior to surgery, with the hypothesis that these more active agents will offer better control of distant metastatic disease. Their radiosensitizing properties, when combined with radiation, will improve local control and provide an increased rate of pathological complete response in patients with surgically resectable esophageal cancer.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Esophageal Cancer
Keywords
esophageal, esophagus, irinotecan, CPT11, cisplatin

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2, Phase 3
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
54 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Cisplatin, Irinotecan
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
Irinotecan hydrochloride trihydrate
Intervention Description
Irinotecan (65mg/m2) weeks 1-2, 4-5, 7-8
Intervention Type
Drug
Intervention Name(s)
Cisplatin
Intervention Description
Cisplatin (30 mg/m2) weeks 1-2, 4-5, 7-8
Primary Outcome Measure Information:
Title
pathological complete response
Time Frame
1 day
Secondary Outcome Measure Information:
Title
acute and late toxicities
Time Frame
5 yrs
Title
postoperative mortality
Time Frame
1 month
Title
disease free survival
Time Frame
5 yrs
Title
overall survival
Time Frame
5 yrs
Title
Quality of life (FACT-E)
Time Frame
5 yrs
Title
clinical complete response rate
Time Frame
2 months
Title
tumor microvessel density (pathological)
Time Frame
1 day
Title
perfusion CT parameters (radiological)
Time Frame
2 months
Title
PET scan parameters (radiological)
Time Frame
2 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Histologically proven squamous or adenocarcinoma or the esophagus >20 cm from the incisors, including GE junction tumors (unless of gastric origin). GE junction tumors are defined as tumors that have their center within 5 cm proximal and distal of the anatomical cardia Clinical T1 N1 M0, T2-3 N0-1 M0, T1-3 N0-1 M1a Performance status ECOG 0-2 Medically fit for chemotherapy, radiation and esophagectomy Adequate bone marrow, hepatic and renal function as evidenced by the following: Hematology: Neutrophils > 1.5 x 109/L Platelets > 100 x 109/L Hepatic function: Total bilirubin < 1.25x ULN AST (SGOT) and ALT (SGPT) < 2.5 x ULN Alkaline phosphatase <2.5 x ULN Renal function: Serum creatinine < 160 umol/L or creatinine clearance > 60 ml/min (actual or calculated by the Cockcroft-Gault method as follows): weight (kg) x (140 - age) K x serum creatinine* for serum creatinine in *mol/L, K=0.814 in man, K=0.96 in woman No prior history of malignancy unless > 5 years disease free, or adequately treated nonmelanotic skin cancer or in situ carcinoma of the cervix Tumor technically resectable (as defined in Section 5.4.3) Exclusion Criteria: In situ or clinical T1N0M0 Cervical esophageal tumors (within 20 cm of the incisors) Positive cytology of the pleura, peritoneum or pericardium Supraclavicular lymph node involvement Invasion of tracheobronchial tree proven by bronchoscopy including but not limited to tracheo-esophageal fistula Prior treatment for this malignancy except esophageal stenting Gilbert's disease Age < 18 Participation in another concurrent clinical study involving study drug(s) or treatment with study drug within thirty days prior to the treatment on this study. Concurrent treatment with other experimental drugs or anticancer therapy Known hypersensitivity to either of study drugs or to any of their excipients. Pregnant or lactating women. Men and women of reproductive potential (and women < 12 months after menopause) may not participate unless they have agreed to use an effective contraceptive method while on study Known or suspected alcohol or drug abuse Other serious or concurrent illnesses that may interfere with subject compliance, adequate informed consent, determination of causality of adverse events and which in the judgement of the Investigator, would make the patient inappropriate for entry into the study Life expectancy < 3 months Peripheral neuropathy > Grade 2 (using CTC Version 2) Patients receiving phenytoin or phenobarbital
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Darling E Gail, M.D., FRCSC
Organizational Affiliation
University Health Network, Toronto
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Knox J Jennifer, MD,MSc,FRCPC
Organizational Affiliation
University Health Network, Toronto
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Wong KS Rebecca, MSC, FRCSC
Organizational Affiliation
University Health Network, Toronto
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Health Network
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M5G 2M9
Country
Canada

12. IPD Sharing Statement

Learn more about this trial

Pre-operative Chemo (CPT11, Cisplatin), Radiotherapy, Plus Surgery for Resectable Esophageal Cancer

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