Adenocarcinoma of the Gastroesophageal Junction, Diffuse Adenocarcinoma of the Stomach, Intestinal Adenocarcinoma of the Stomach, Mixed Adenocarcinoma of the Stomach, Recurrent Gastric Cancer, Stage IIIA Gastric Cancer, Stage IIIB Gastric Cancer, Stage IIIC Gastric Cancer, Stage IV Gastric Cancer
Conditions
Brief summary
Drugs used in chemotherapy, such as oxaliplatin, irinotecan, and capecitabine, work in different ways to stop tumor cells from dividing so they stop growing or die. Giving more than one chemotherapy drug may kill more tumor cells. This phase II trial is studying how well giving oxaliplatin together with irinotecan and capecitabine works in treating patients with metastatic or inoperable locally advanced gastric cancer or gastroesophageal junction adenocarcinoma (cancer).
Detailed description
PRIMARY OBJECTIVES: I. To assess the total response rate of the oxaliplatin, irinotecan and capecitabine drug combination in advanced gastric/esophageal junction carcinoma. II. To assess the duration of total responses of the oxaliplatin, irinotecan and capecitabine drug combination in advanced gastric/esophageal junction carcinoma. OUTLINE: This is a multicenter study. Patients receive oxaliplatin IV over 2 hours and irinotecan IV over 30 minutes on days 1, 8, 15, and 22 and oral capecitabine twice daily on days 1-5, 8-12, 15-19, and 22-26. Courses repeat every 42 days in the absence of disease progression or unacceptable toxicity. Patients are followed annually. PROJECTED ACCRUAL: A total of 40-80 patients will be accrued for this study within 18 months.
Interventions
DRUGoxaliplatin
Given IV
DRUGirinotecan hydrochloride
Given IV
DRUGcapecitabine
Given orally
Sponsors
National Cancer Institute (NCI)
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients must have histologically or cytologically confirmed gastric adenocarcinoma or adenocarcinoma of the gastroesophageal junction. Patients must have metastatic or inoperable locally advanced disease; GE Junction tumor location should be documented in the patient's medical record chart using the Siewert classification below: * Type I: Adenocarcinoma of the distal esophagus which usually arises from an area with specialized intestinal metaplasia of the esophagus and which may infiltrate the GE junction from above Type II: True carcinoma of the cardia arising from the cardiac epithelium or short segments with intestinal metaplasia at the GE junction Type III: Subcardial gastric carcinoma which infiltrates the GE junction and distal esophagus from below * Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as \>= 20 mm with conventional techniques or as \>= 10 mm with spiral CT scan * No prior chemotherapy for metastatic or recurrent disease is allowed; one course of neoadjuvant chemotherapy and/or adjuvant chemotherapy with or without radiation therapy as primary treatment is acceptable; at least 4 weeks must have elapsed since prior radiation therapy; patients must have been off previous anti-cancer therapy for at least 4 weeks * Life expectancy of \>= 12 weeks * ECOG performance status 0-2 * Hemoglobin \>= 9.5 g/dL * Absolute neutrophil count \>= 1,500/uL * Platelets \>= 100,000/uL * Total bilirubin =\< 1.5 mg/dL * Creatinine =\< 1.5 mg/dL OR creatinine clearance \>= 60 mL/min/1.73 m\^2 for patients with creatinine levels above institutional normal * The effects of oxaliplatin, irinotecan, and capecitabine on the developing human fetus at the recommended therapeutic dose are unknown; for this reason and because these drugs are known to be teratogenic, women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately * Ability to understand and the willingness to sign a written informed consent document
Exclusion criteria
* Patients who have had chemotherapy or radiotherapy within 4 weeks prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier * Patients may not be receiving any other investigational agents * Patients with known brain metastases should be excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events; patients should have no greater than grade 2 neuropathy * History of allergic reactions attributed to compounds of similar chemical or biologic composition to oxaliplatin, irinotecan and capecitabine * Patients with NYHA classification III or IV heart disease are ineligible * Patients must not have a known hypersensitivity to 5-fluorouracil * Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements * Pregnant women are excluded from this study because the study drugs have the potential to cause teratogenic or abortifacient effects; because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with the study drugs, breastfeeding should be discontinued if the mother is treated with oxaliplatin, irinotecan or capecitabine * Patients with immune deficiency are at increased risk of lethal infections when treated with marrow-suppressive therapy; therefore, HIV-positive patients receiving combination anti-retroviral therapy are excluded from the study because of possible pharmacokinetic interactions with the study drugs; appropriate studies will be undertaken in patients receiving combination anti-retroviral therapy when indicated * Patients who are unable to take oral medications are not eligible
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Response Rates (RR) in Metastatic Gastric/GE Junction Tumors | at 12 weeks (after 2 cycles of treatment) | Response is defined as the number of patients with a CR (Complete Response) or PR (Partial Response) per Response Evaluation Criteria in Solid Tumor (RECIST criteria). Possible evaluations include: CR: Disappearance of all target lesions. PR: At least a 30% decrease in the size of target lesions. Progressive Disease (PD): At least a 20% increase in the size of the target lesions or appearance of one or more new lesions. Stable Disease (SD): Neither sufficient shrinkage or increase of target lesions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Complete Response (CR) and Partial Response (PR) Duration | at 40 months from study activation | The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started). |
| Overall Survival | at 40 months from study activation | Length of time patients survived after treatment |
Countries
United States
Participant flow
Recruitment details
This was a multi-center single treatment arm study involving four sites. Patients were recruited February 2004 through February 2007.
Participants by arm
| Arm | Count |
|---|---|
| Treatment (Oxaliplatin, Irinotecan, Capecitabine) Patients receive oxaliplatin IV over 2 hours and irinotecan IV over 30 minutes on days 1, 8, 15, and 22 and oral capecitabine twice daily on days 1-5, 8-12, 15-19, and 22-26. Courses repeat every 42 days in the absence of disease progression or unacceptable toxicity. | 39 |
| Total | 39 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Lack of Efficacy | 1 |
| Overall Study | Protocol Violation | 1 |
| Overall Study | Withdrawal by Subject | 7 |
Baseline characteristics
| Characteristic | Treatment (Oxaliplatin, Irinotecan, Capecitabine) |
|---|---|
| Age, Continuous | 57.8 years |
| Region of Enrollment United States | 39 participants |
| Sex: Female, Male Female | 10 Participants |
| Sex: Female, Male Male | 29 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 35 / 39 |
| serious Total, serious adverse events | 7 / 39 |
Outcome results
Primary
Response Rates (RR) in Metastatic Gastric/GE Junction Tumors
Response is defined as the number of patients with a CR (Complete Response) or PR (Partial Response) per Response Evaluation Criteria in Solid Tumor (RECIST criteria). Possible evaluations include: CR: Disappearance of all target lesions. PR: At least a 30% decrease in the size of target lesions. Progressive Disease (PD): At least a 20% increase in the size of the target lesions or appearance of one or more new lesions. Stable Disease (SD): Neither sufficient shrinkage or increase of target lesions.
Time frame: at 12 weeks (after 2 cycles of treatment)
Population: Patients that completed at least 2 cycles of treatment
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Treatment (Oxaliplatin, Irinotecan, Capecitabine) | Response Rates (RR) in Metastatic Gastric/GE Junction Tumors | Progressive Disease (PD) | 3 participants |
| Treatment (Oxaliplatin, Irinotecan, Capecitabine) | Response Rates (RR) in Metastatic Gastric/GE Junction Tumors | Stable Disease (SD) | 16 participants |
| Treatment (Oxaliplatin, Irinotecan, Capecitabine) | Response Rates (RR) in Metastatic Gastric/GE Junction Tumors | Complete Response (CR) | 2 participants |
| Treatment (Oxaliplatin, Irinotecan, Capecitabine) | Response Rates (RR) in Metastatic Gastric/GE Junction Tumors | Partial Response (PR) | 9 participants |
Secondary
Complete Response (CR) and Partial Response (PR) Duration
The duration of overall response is measured from the time measurement criteria are met for CR or PR (whichever is first recorded) until the first date that recurrent or progressive disease is objectively documented (taking as reference for progressive disease the smallest measurements recorded since the treatment started).
Time frame: at 40 months from study activation
Population: Patients that achieved either a CR or PR.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Treatment (Oxaliplatin, Irinotecan, Capecitabine) | Complete Response (CR) and Partial Response (PR) Duration | 5.95 months |
Secondary
Overall Survival
Length of time patients survived after treatment
Time frame: at 40 months from study activation
Population: All patients enrolled in study
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Treatment (Oxaliplatin, Irinotecan, Capecitabine) | Overall Survival | 8.98 months |