Clinical trial NCT00827671: Study of Combination of Cetuximab and Radiotherapy Added to the Standard Treatment for Oesophageal Adenocarcinoma
Official title: Multi-Modality Treatment of Resectable Oesophageal Adenocarcinoma Using Peri-operative Chemotherapy With Additional Pre-operative Combined Radiotherapy and Cetuximab
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: PHASE2
Conditions: Resectable Esophageal Cancer
Lead sponsor: UMC Utrecht
Sponsor class: OTHER
Collaborators: name: Merck KGaA, Darmstadt, Germany
First posted: 2009-01-23
Enrollment: 12
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to determine whether the addition of the combination between cetuximab and radiotherapy to the standard chemotherapy for resectable oesophageal cancer is safe and adds efficacy.

Detailed description: This study aims at developing a novel strategy to optimize the treatment of oesophageal adenocarcinoma and gastro-oesophageal junctional tumors with curative intent. Surgery in combination with peri-operative chemotherapy, using the combination epirubicin, cisplatin and 5-FU, as defined by the recent MAGIC trial, results in 13% increase in 5-yr survival. To improve the outcome of patients with this disease we hypothesize that the addition of pre-operative combined cetuximab-radiotherapy (cetux-RT) treatment could improve the outcome of this patient category through better local control.

Eligibility criteria: Inclusion Criteria:

* Histologically proven resectable adenocarcinoma of the lower oesophagus and gastric-oesophageal junction
* Tumour stage: T2-3 N0-1 M0, as assessed by endoscopic ultrasound and CT-scan of thorax and abdomen and ultrasound neck region. For the patients treated in this study the gastro-oesophageal junctional tumors will be staged as oesophageal tumors with respect to their lymphnode metastases.
* Age \>18y and written informed consent after at least 4 days of deliberation time from the moment the patient information has been given and has been explained.
* Weight loss \< 10% in 0.5 yr
* WHO performance status 0-1
* No prior radiotherapy or chemotherapy for the adenocarcinoma of the oesophagus

Exclusion Criteria:

* Previous malignancy other than basal cell carcinoma of the skin or local resection for cervical carcinoma in situ.
* Inadequate organ function as defined by:
* Inadequate haematology (Hb \< 5,5 mmol/L (red blood cell transfusions are allowed to increase the Hb at the discretion of the investigator) - neutrophils \< 1,5 109/L -platelets \<100\*109/L),
* Liver enzyme elevation (bili \> 1,5\*ULN - ASAT \> 2,5\*ULN - ALAT \> 2,5\*ULN) or
* Impaired renal function (creatinine clearance by cockcroft \< 60 cc/min)
* Proteinuria \>1,0gr/24hr
* Tumour stage: M1a and/or tumour length \> 8 cm and/or \> 5 cm radially
* Major surgery within 4 weeks prior to the start of study treatment
* Bleeding disorder
* Known allergy to one of the study drugs used
* Use of any substance known to interfere with the chemotherapy clearance
* Previous radiotherapy to the chest
* Significant concomitant diseases preventing the safe administration of study drugs or likely to interfere with study assessments
* Uncontrolled angina pectoris; cardiac failure or clinically significant arrhythmias
* Continuous use of immunosuppressive agents
* Concurrent use of the antiviral agent sorivudine or chemically related analogues, such as brivudine
* Prior exposure to anti-EGFR targeting agents.
* Hearing loss \> 25 dB under normal
* Neurotoxicity \> CTC grade 1
* Pregnancy or breast feeding
* Patients (M/F) with reproductive potential not implementing adequate contraceptive measures

Primary outcomes:
measure: pathological complete remission
timeFrame: 1 month
measure: Resectability rate defined as the number of patients abke to undergo resection after neo-adjuvant treatment
timeFrame: 6 months
Secondary outcomes:
measure: Adverse events during neo-adjuvant treatment as defined by NIH CTCAE v3.0
timeFrame: 5 months
measure: Complications in the post-operative period (defined as 4 weeks after surgery) that can be attributed to surgical procedures
timeFrame: 4 weeks
measure: Progression free survival and overall survival
timeFrame: 5 years
measure: Define local (locoregional lymphnode metastasis as defined by TNM classification/ malignant peritonitis/ solid masses within the anatomic region of the esophagus) vs distant metastases as first manifestation of recurrence
timeFrame: 5 years
measure: The number of R0 resection determined by the pathologist
timeFrame: after surgery
Other outcomes:
Locations:
city: Utrecht
country: Netherlands
facility: UMC Utrecht
Study officials:
affiliation: UMC Utrecht
name: M. P. Lolkema, MD/PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Ubink I, van der Sluis P, Schipper M, Reerink O, Voest E, Borel-Rinkes I, Wijrdeman H, Vleggaar F, Agterof M, Overkleeft E, Siersema P, van Hillegersberg R, Lolkema MP. Adding preoperative radiotherapy plus cetuximab to perioperative chemotherapy for resectable esophageal adenocarcinoma: a single-center prospective phase II trial. Oncologist. 2014 Jan;19(1):32-3. doi: 10.1634/theoncologist.2013-0254. Epub 2013 Dec 12.