Erlotinib and Avastin in Patients With Cancer of the Esophagus or Gastroesophageal Junction

Study Overview
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Brief Summary
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Determine the time to progression for the combination of erlotinib and bevacizumab in patients with previously treated metastatic cancer of the esophagus or gastroesophageal junction

Detailed Description
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We postulate that the addition of bevacizumab may increase the efficacy of erlotinib in patients with metastatic esophageal cancer, without adding significant toxicity. The non-overlapping toxicity profiles may allow the administration of the maximum tolerated doses for both agents without additive toxicities with the goal of demonstrating synergistic clinical activity. This combination has been previously tested in two studies for other malignancies with good tolerance and encouraging results.

Official Title
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A Phase II Trial of Erlotinib and Avastin in Previously Treated Patients With Cancer of the Esophagus or Gastroesophageal Junction

Conditions
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Esophageal Neoplasms, Esophageal Diseases

Intervention / Treatment
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* Drug: Erlotinib
* Drug: Avastin


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Biopsy proven adenocarcinoma or squamous cell carcinoma of the esophagus or gastroesophageal junction. Metastatic or advanced inoperable disease previously treated with one prior chemotherapy regimen Age greater than 18 years. Performance status ECOG 0 to 1. Adequate hepatic and renal function, defined as: Serum creatinine <= 3.0 mg/dL; Creatinine clearance >= 45 mL/min. Bilirubin <= 1.5 x institutional normal; ALT/AST <= 3 x institutional normal. Patients must have measurable disease. Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension. The longest diameter of measurable lesions must be >= 20 mm with conventional techniques or >= 10 mm with spiral CT scan. Lesions that are not considered measurable include: bone lesions, leptomeningeal disease, brain lesions, ascites, pericardial or pleural effusion, and tumors situated in a previously irradiated area. Use of effective means of contraception for both male and female patients with child-bearing potential. A 1 month wash-out period is required for all patients entering this study from a previous treatment regimen Exclusion Criteria: Previous use of anti-EGFR or anti-VEGF therapy. Previous history of cancer. The patient with a prior malignancy is eligible for this study only if the patient meets the following criteria for a cancer survivor. A cancer survivor is eligible provided the following criteria are met: (1) patient has undergone potentially curative therapy for all prior malignancies, (2) patients have been considered disease free for at least 5 years (with the exception of basal cell or squamous cell carcinoma of the skin or carcinoma-in-situ of the cervix). Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to day 0; or anticipation of the need for major surgical procedure during the course of the study. (In the case of high risk procedures such as liver resection, thoracotomy, or neurosurgery, it is recommended that patient delay treatment with chemotherapy for at least 6 weeks and with bevacizumab at least 8 weeks after surgery). Radiation therapy within the last 2 weeks. Presence of central nervous system or brain metastases at any time. Serious, non-healing wound, ulcer, or bone fracture History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to day 0; and/or minor surgical procedures such as fine needle aspiration or core biopsies within 7 days prior to day 0. Presence of coagulopathy or clinical history of significant hematemesis, melena, or hemoptysis related to the diagnosis of esophageal cancer. Previous history of deep venous thrombosis or thromboembolic disease. Urine protein/urine creatinine ratio ≥ 1.0 at screening. Pregnant or lactating. Unstable angina or history of myocardial infarction within the last 6 months. History of stroke within the last 6 months. Uncontrolled hypertension with blood pressure persistently > 150/100 mmHg despite optimal antihypertensive therapy. Clinically significant peripheral vascular disease. Congestive heart failure with New York Heart Association grades III or IV (see appendix B). Inability to complete the study and follow-up procedures. Participation in therapeutic clinical trials or currently receiving other investigational treatment(s) within 30 days prior to enrollment

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Patients will be treated with erlotinib 150 mg oral daily and Avastin 15 mg/kg intravenously each cycle of therapy (each cycle is 21 days or every 3 weeks). The first infusion of Avastin will be administered over 90 minutes. If tolerated, the second infusion will be given over 60 minutes and in 30 minutes for the subsequent treatments. Treatment will be administered until disease progression or intolerable side effects. | Drug: Erlotinib<br> <br> * Other names: Avastin;Drug: Avastin<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to Progression (TTP) | TTP is defined as the time from initiation of treatment to the date of documented progression. The median of TTP with 95% confidence interval will be presented. Progressive disease (target lesions) is defined as at least a 20% increase in the sum of the longest diameter of the target lesions taking as reference the smallest sum longest diameter recorded since the treatment started or the appearance of one or more new lesions. Progressive disease (non-target lesions) is defined as appearance of one or more new lesions. Unequivocal progression of existing non-target lesions. | Median follow-up for TTP 6 weeks (6-18 weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Survival Rate (OS) | OS is defined as the time from initiation of treatment to the date of death for any reason. | Median followup time from completion of treatment 325.5 days (44-401 days) | 
| Response Rate (Complete Response (CR), Partial Response (PR), and CR+PR) | CR = disappearance of all target lesions PR = at least a 30% decrease in the sum of the LD of the target lesions taking as reference the baseline sum LD. | Median follow-up for response 6 weeks (6-18 weeks) | 
| Incidence and Severity of Toxicities | Grade 3 and higher toxicities using CTCAE Version 3.0. | Median follow-up time for toxicities 72 days (72 days-156 days) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Esophagus, Esophagogastric Junction, Avastin, Bevacizumab, Erlotinib