Combination Chemotherapy and Surgery in Treating Patients With Locally Advanced Stomach Cancer

Study Overview
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Brief Summary
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RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one chemotherapy drug with surgery may kill more tumor cells. It is not yet known if chemotherapy followed by surgery is more effective than surgery followed by chemotherapy for stomach cancer. PURPOSE: This randomized phase III trial is studying surgery followed by combination chemotherapy to see how well it works compared to combination chemotherapy followed by surgery in treating patients with locally advanced stomach cancer.

Detailed Description
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OBJECTIVES: Compare, by intention to treat analysis, feasibility and efficacy of 4 courses of docetaxel, cisplatin, and fluorouracil as preoperative or postoperative chemotherapy in patients with locally advanced operable gastric carcinoma. Evaluate the predictive values of some biological and molecular tumor parameters on response to chemotherapy, metastasis and survival in this patient population. OUTLINE: This is a randomized, open label, multicenter study. Patients are stratified according to study center, tumor site (affecting the Z-line (cardia carcinoma Siewart II and III) vs rest of the stomach), and nodal status (positive vs negative). Patients are randomized to either preoperative chemotherapy followed by surgery (arm I) or surgery followed by postoperative chemotherapy (arm II). Arm I: Patients receive docetaxel IV over 1 hour followed by cisplatin IV over 4 hours on day 1, and fluorouracil IV continuously on days 1-14 every 3 weeks. Patients are evaluated after 2 courses and patients with progressive disease proceed to immediate surgery. Otherwise, treatment continues for a total of 4 courses in the absence of unacceptable toxicity or disease progression. Between 3-5 weeks following day 1 of the last course of chemotherapy, patients undergo gastric resection. Arm II: Patients undergo immediate gastric resection. Beginning 3-6 weeks after surgery, patients receive 4 courses of docetaxel, cisplatin, and fluorouracil as in arm I. Quality of life is assessed before the first and third courses of chemotherapy, before and after surgery, and then at 1, 3, and 6 months. Patients are followed every 3 months for 3 years, every 6 months for 2 years, and then annually thereafter. PROJECTED ACCRUAL: Approximately 240 patients (120 per arm) will be accrued for this study.

Official Title
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A Phase III Trial of Preoperative vs. Postoperative Chemotherapy With Taxotere-Cisplatin-5FU (TCF) in Patients With Locally Advanced Operable Gastric Carcinoma

Conditions
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Gastric Cancer

Intervention / Treatment
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* Drug: Taxotere-Cisplatin-5FU
* Drug: Immediate surgery


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically confirmed locally advanced gastric carcinoma that is considered operable T3-4, Nx, M0 OR Tx, N+, M0 Lymph nodes considered positive by sonography should be at least 2 of the following: Round Echopoor Sharp borders At least 0.5 cm No distant metastases, including peritoneal carcinomatosis CT scan and peritoneal lavage mandatory PATIENT CHARACTERISTICS: Age: 18 to 75 Performance status: 0-2 Life expectancy: Greater than 12 weeks Hematopoietic: WBC at least 4,000/mm^3 Platelet count at least 100,000/mm^3 Hepatic: Bilirubin normal AST or ALT no greater than 1.5 times upper limit of normal (ULN) Alkaline phosphatase no greater than 2.5 times ULN Renal: Adequate renal function within limits to allow for treatment with cisplatin Cardiovascular: No unstable cardiac disease requiring treatment No congestive heart failure or angina pectoris even if medically controlled No significant arrhythmias No myocardial infarction within past 6 months Ejection fraction greater than 50% on cardiac sonography or MUGA scan Other: Not pregnant or nursing Fertile patients must use effective contraception No other prior malignancy except basal cell carcinoma of the skin or adequately treated carcinoma in situ of the cervix No grade 2 or greater peripheral neuropathy of any origin (e.g., alcohol, diabetic) No history of anaphylaxis No other serious concurrent illness or medical condition that would preclude study therapy No history of significant neurologic or psychiatric disorders (e.g., psychotic disorders, dementia, or seizures) PRIOR CONCURRENT THERAPY: Biologic therapy: No concurrent biologic therapy for gastric carcinoma Chemotherapy: No other concurrent chemotherapy for gastric carcinoma Endocrine therapy: No concurrent endocrine therapy for gastric carcinoma Radiotherapy: No concurrent radiotherapy for gastric carcinoma Surgery: See Disease Characteristics Other: At least 30 days since prior treatment in a clinical trial No other concurrent experimental drugs No other concurrent anticancer therapy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 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: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Taxotere-Cisplatin-5FU preoperatively<br>TCF preoperatively | Drug: Taxotere-Cisplatin-5FU<br>* Preoperatively<br>|
| Active Comparator: Immediate surgery followed by TCF<br>Surgery followed by Taxotere-Cisplatin-5FU | Drug: Immediate surgery<br>* Immediate surgery followed by Taxotere-Cisplatin-5FU<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Event-free survival |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall survival |  |  | 
| Time to treatment failure measured after completion of study treatment |  |  | 
| Toxicity measured after completion of study treatment |  |  | 
| Rate of complete resection (RO) and postoperative mortality as measured after surgery |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stage II gastric cancer, stage III gastric cancer