Pralatrexate and Docetaxel in Treating Patients With Stage IV Esophageal or Gastroesophageal Cancer Who Have Failed Platinum-Based Therapy

Study Overview
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Brief Summary
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RATIONALE: Pralatrexate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as docetaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving pralatrexate together with docetaxel may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving pralatrexate together with docetaxel works in treating patients with stage IV esophageal or gastroesophageal cancer who have failed platinum-based therapy.

Detailed Description
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PRIMARY OBJECTIVES: I. To evaluate overall response rate CR & PR(Complete Response + Partial Response)as assessed by RECIST (Response Evaluation Criteria in Solid Tumors v 1.1) of the combination of pralatrexate and docetaxel in patients with advanced esophageal and gastroesophageal carcinomas. SECONDARY OBJECTIVES: I. Evaluation of progression free survival and overall survival. II. Correlation of FDG(fludeoxyglucose)PET(positron emission tomography)response defined as a 35% reduction in SUV(standard uptake value)during the early course of chemotherapy to progression free and overall survival in addition to radiographic response as measured by RECIST v 1.1 criteria on CT imaging. OUTLINE: Patients receive pralatrexate IV over 3-5 minutes and docetaxel IV on day 1. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity.

Official Title
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Phase II Study of Pralatrexate and Docetaxel in Patients With Advanced Esophageal and Gastroesophageal Carcinoma Who Have Failed Prior Platinum-based Therapy.

Conditions
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Adenocarcinoma of the Esophagus, Adenocarcinomas of the Gastroesophageal Junction, Recurrent Esophageal Cancer, Squamous Cell Carcinoma of the Esophagus, Stage IV Esophageal Cancer

Intervention / Treatment
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* Drug: pralatrexate
* Drug: docetaxel
* Radiation: fludeoxyglucose F 18
* Procedure: positron emission tomography


Participation Criteria
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Eligibility Criteria
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Inclusion Pathologically confirmed unresectable advanced or metastatic carcinoma of the esophagus or gastroesophageal junction Established histological confirmation of squamous cell carcinoma or adenocarcinoma of the esophagus or gastroesophageal junction Stage IV disease Must have received platinum-based therapy; this includes definitive, adjuvant and metastatic treatments No more than 3 chemotherapeutic treatment regimens permitted; this includes concurrent chemoradiation Radiation therapy allowed if > 4 weeks have elapsed Must be off therapy for 4 weeks prior to enrollment Measurable disease as defined by RECIST v 1.1 criteria ECOG (Eastern Cooperative Oncology Group)PS(Performance status)of 0 to 2 Predicted life expectancy of at least 12 weeks Patients with reproductive potential must use an effective method to avoid pregnancy for the duration of the trial and for three months after completion of treatment Marrow: ANC(absolute neutrophil count)> 1,000/mm^3 Marrow: Hemoglobin > 9.0 g/dl Marrow: Platelet Count > 100,000/mm^3 Renal: Serum creatinine =< 1.5 g/dL Hepatic: Serum bilirubin < 1.5 x ULN(upper limit of normal) and AST (aspartate aminotransferase) and ALT (Alanine aminotransferase)=< 2.5 x ULN Prior minor surgeries (such as laparoscopies) must have occurred at least 14 days prior to study enrollment; prior minor procedures such as biopsies and mediport placement must have occurred at least 48 hours prior to study enrollment All patients must have signed an informed consent indicating that they are aware of the neoplastic nature of their disease and have been informed of the procedures of the protocol, the experimental nature of the therapy, alternatives, potential benefits, side effects, risks, and discomforts History of allergic reactions attributed to compounds of similar chemical composition to agents used in the study Exclusion Pregnant or lactating women Patients with any severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for study entry Any malignant condition for which one has received treatment in the last two years excluding squamous or basal cell carcinomas Patients with untreated brain metastases Patients must not have grade 2 or higher baseline peripheral neuropathy, according to CTCAE v 4.0 Patients must have NO continuing acute toxic effects (except alopecia) of any prior radiotherapy, chemotherapy, or surgical procedures; all such effects must have resolved to Common Terminology Criteria for Adverse Events (CTCAE v 4.0) Grade =< 1 prior to study 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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm I<br>Patients receive pralatrexate IV over 3-5 minutes and docetaxel IV on day 1. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity. | Drug: pralatrexate<br>* IVP(intravenous push)over 3-5 minutes on day 1 at a dose of 120 mg/m2.<br>* Other names: PDX;Drug: docetaxel<br>* Given Intravenous Piggyback (IVPB)as one-hour infusion at a dose of 3 mg/m2 on day 1 of a cycle. cycle defined as 14 days.<br>* Other names: TXT;Radiation: fludeoxyglucose F 18<br>* Correlative studies<br>* Other names: fluorodeoxyglucose F 18;Procedure: positron emission tomography<br>* Correlative studies<br>* Other names: tomography, emission computed;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall Response | Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), >=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR | Approximately three years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Progression-free Survival (PFS) | Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions | Approximately three years | 
| Overall Survival (OS) | OS was determined from the date of start of therapy to death frm any cause. | Approximately five years | 
| Correlation of FDG PET Response With Response Rate | Radiological assessment of tumor response was performed by computed tomography (CT) and positron emission tomography (PET) every four cycles of therapy and responses were measured according to RECIST and PERCIST criteria. | Approximately three years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Gastroesophageal Cancer, Gastroesophageal Carcinoma, Adenocarcinoma