Patient case: 64-year-old female with Lung adenocarcinoma. Genetic variant: ALK Fusion. Other conditions: Emphysema.

Clinical trial: Combination Chemotherapy in Treating Patients With Esophageal Cancer

Summary: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells. It is not yet known which regimen of combination chemotherapy is more effective in treating esophageal cancer.
  PURPOSE: Randomized phase III trial to compare the effectiveness of two regimens of combination chemotherapy in treating patients who are undergoing surgery for esophageal cancer.

Detailed description: OBJECTIVES:
  -  Compare survival and quality of life of patients with resectable adenocarcinoma of the esophagus treated prior to surgery with standard chemotherapy comprising cisplatin and fluorouracil versus prolonged infusional chemotherapy comprising cisplatin, epirubicin, and fluorouracil.
  OUTLINE: This is a randomized, multicenter study. Patients are randomized to one of two treatment arms.
  -  Arm I (Standard chemotherapy): Patients receive cisplatin IV over 4 hours on days 1-4 and fluorouracil IV continuously on days 1-4. Treatment repeats every 21 days for 2 courses in the absence of disease progression or unacceptable toxicity.
  -  Arm II (Infusional chemotherapy): Patients receive cisplatin IV over 4 hours on day 1, epirubicin IV on day 1, and fluorouracil IV continuously. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.
  Patients undergo surgery 4-6 weeks after the last dose of fluorouracil in arm I or anytime after the fluorouracil infusion is completed in arm II.
  Quality of life is assessed at baseline, immediately before starting the last course of chemotherapy, immediately before surgery, 6 weeks post-operatively, and at 6, 9, 12, 18, and 24 months after randomization.
  Patients are followed every 3 months for 1 year, every 6 months for 5 years, and then annually thereafter.
  Peer Reviewed and Funded or Endorsed by Cancer Research UK
  PROJECTED ACCRUAL: Approximately 1,300 patients (650 per treatment arm) will be accrued for this study.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed adenocarcinoma of the esophagus or type 1 or 2 tumors of the gastroesophageal junction
  -  Stage IIB or greater by spiral or multi-slice CT scan and endoscopic ultrasound
  -  Amenable to primary surgery with curative intent
  -  No para-aortic/celiac lymphadenopathy greater than 1 cm on CT scan and/or greater than 6 mm on endoscopic ultrasound
  -  No disease invading the airways, aorta, pericardium, or lung
  -  No liver, lung, or other distant metastases
  PATIENT CHARACTERISTICS:
  Age:
  -  Not specified
  Performance status:
  -  WHO 0-1
  Life expectancy:
  -  Not specified
  Hematopoietic:
  -  WBC greater than 3,000/mm3
  -  Platelet count greater than 100,000/mm3
  Hepatic:
  -  Liver function tests no greater than 1.5 times normal
  Renal:
  -  Glomerular filtration rate greater than 60 mL/min
  Cardiovascular:
  -  Ejection fraction greater than 50% OR
  -  Normal echocardiograph
  Pulmonary:
  -  FEV1 greater than 1.5 L
  Other:
  -  Not pregnant or nursing
  -  No prior primary malignancy
  -  No significant medical condition that would preclude study
  PRIOR CONCURRENT THERAPY:
  Biologic therapy:
  -  Not specified
  Chemotherapy:
  -  Not specified
  Endocrine therapy:
  -  Not specified
  Radiotherapy:
  -  Not specified
  Surgery:
  -  See Disease Characteristics

Relevance to patient case: not relevant