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Cetuximab, Cisplatin, and Irinotecan in Treating Patients With Metastatic Esophageal Cancer, Gastroesophageal Junction Cancer, or Gastric Cancer That Did Not Respond to Previous Irinotecan and Cisplatin

Phase II Trial of Cetuximab Plus Cisplatin and Irinotecan in Patients With Irinotecan and Cisplatin-Refractory Metastatic Esophageal and Gastric Cancer

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00397904
Enrollment
16
Registered
2006-11-10
Start date
2006-10-31
Completion date
2010-09-30
Last updated
2015-11-25

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Esophageal Cancer, Gastric Cancer

Keywords

adenocarcinoma of the esophagus, squamous cell carcinoma of the esophagus, recurrent esophageal cancer, recurrent gastric cancer, adenocarcinoma of the stomach, stage IV esophageal cancer, stage IV gastric cancer

Brief summary

RATIONALE: Monoclonal antibodies, such as cetuximab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Cetuximab may also stop the growth of tumor cells by blocking some of the enzymes needed for their growth. Drugs used in chemotherapy, such as cisplatin and irinotecan, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Giving cetuximab together with cisplatin and irinotecan may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving cetuximab together with cisplatin and irinotecan works in treating patients with metastatic esophageal cancer, gastroesophageal junction cancer, or gastric cancer that did not respond to previous irinotecan and cisplatin.

Detailed description

OBJECTIVES: Primary * Determine the response rate in patients with irinotecan hydrochloride- and cisplatin-refractory metastatic esophageal, gastroesophageal junction, or gastric cancer treated with cetuximab, cisplatin, and irinotecan hydrochloride. Secondary * Determine the median survival of patients treated with this regimen. * Determine the tolerability of this regimen in these patients. * Determine the adverse event profiles in patients treated with this regimen. * Assess epidermal growth factor receptor expression in tumor tissue from patients treated with this regimen. OUTLINE: This is an open-label, nonrandomized study. Patients receive cetuximab IV over 60-120 minutes on days 1, 8, and 15 and cisplatin IV over 30 minutes and irinotecan hydrochloride IV over 30-90 minutes on days 1 and 8. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo tumor biopsy at baseline to evaluate epidermal growth factor receptor by immunohistochemistry. After completion of study treatment, patients are followed every 3 months for up to 1 year.

Interventions

BIOLOGICALcetuximab
DRUGcisplatin
DRUGirinotecan hydrochloride
OTHERimmunohistochemistry staining method
OTHERlaboratory biomarker analysis
PROCEDUREbiopsy

Sponsors

National Cancer Institute (NCI)
CollaboratorNIH
Memorial Sloan Kettering Cancer Center
Lead SponsorOTHER

Study design

Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 120 Years
Healthy volunteers
No

Inclusion criteria

DISEASE CHARACTERISTICS: * Histologically or cytologically confirmed diagnosis of 1 of the following: * Adenocarcinoma or squamous cell carcinoma of the esophagus * Adenocarcinoma of the gastroesophageal junction * Adenocarcinoma of the stomach * Metastatic disease * Measurable disease by diagnostic CT scan or MRI * Failed prior treatment with cisplatin and irinotecan hydrochloride, defined by the following: * Radiographic progression within 12 weeks\* from the last dose of prior cisplatin and irinotecan hydrochloride, administered either as adjuvant or neoadjuvant therapy, OR as therapy for metastatic disease NOTE: \*Prior irinotecan hydrochloride and cisplatin must have been administered within the past 12 weeks; other chemotherapy regimens may have been administered between the time of disease progression or prior irinotecan hydrochloride/cisplatin and study entry * Pathologic tissue available for immunohistochemistry (IHC) staining for the epidermal growth factor receptor (EGFR) * Positive or negative EGFR by IHC allowed PATIENT CHARACTERISTICS: * ECOG performance status (PS) 0-1 OR Karnofsky PS 70-100% * Life expectancy \> 3 months * WBC ≥ 3,000/mm³ * Absolute neutrophil count ≥ 1,500/mm³ * Platelet count ≥ 100,000/mm³ * Hemoglobin ≥ 9 g/dL * Bilirubin normal * AST and ALT \< 2.5 times upper limit of normal (ULN) (5 times ULN if liver metastases are present) * Creatinine ≤ 2.0 mg/dL * Not pregnant or nursing * Negative pregnancy test * Fertile patients must use effective contraception * No prior severe infusion reaction to a monoclonal antibody * No history of allergic reactions to compounds of similar chemical or biologic composition to irinotecan hydrochloride, cisplatin, or other study agents * No prior intolerance to irinotecan hydrochloride or cisplatin despite prior dose attenuations * No uncontrolled illness including, but not limited to, any of the following: * Ongoing or active infection requiring parenteral antibiotics * Symptomatic congestive heart failure * Unstable angina pectoris * Uncontrolled hypertension * Clinically significant cardiac arrhythmia * Myocardial infarction within the past 6 months * HIV infection * Psychiatric illness or social situations that would preclude study compliance * No history of Gilbert's disease * No medical condition or reason that would preclude study treatment PRIOR CONCURRENT THERAPY: * See Disease Characteristics * More than 3 weeks since prior chemotherapy or radiotherapy and recovered * No more than 2 prior treatment regimens for metastatic disease * No prior therapy specifically and directly targeting the epidermal growth factor receptor pathway * No prior anticancer murine or chimeric monoclonal antibody therapy * Prior humanized monoclonal antibody therapy allowed * No concurrent antiseizure medications known to affect the metabolism of irinotecan hydrochloride, including phenytoin or phenobarbital * No other concurrent investigational agents * No other concurrent anticancer agents or therapies

Design outcomes

Primary

MeasureTime frame
Complete and Partial Response Rate2 years

Countries

United States

Participant flow

Participants by arm

ArmCount
Cetuximab, Cisplatin, and Irinotecan
Cetuximab will be combined with weekly irinotecan and cisplatin. Patients will receive cetuximab 400 mg/m2 on day 1, week 1. Following this loading dose, patients will receive weekly cetuximab 250 mg/m2 (day 8, 15, 22, etc.) until disease progression or unacceptable toxicity. Patients will continue to receive irinotecan and cisplatin weekly on day 1 and day 8, on an every 21 day cycle. The standard maximum doses are irinotecan 65 mg/m2 and cisplatin 30 mg/m2.
16
Total16

Baseline characteristics

CharacteristicCetuximab, Cisplatin, and Irinotecan
Age, Categorical
<=18 years
0 Participants
Age, Categorical
>=65 years
4 Participants
Age, Categorical
Between 18 and 65 years
12 Participants
Region of Enrollment
United States
16 participants
Sex: Female, Male
Female
4 Participants
Sex: Female, Male
Male
12 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
16 / 16
serious
Total, serious adverse events
7 / 16

Outcome results

Primary

Complete and Partial Response Rate

Time frame: 2 years

ArmMeasureGroupValue (NUMBER)
Cetuximab, Cisplatin, and IrinotecanComplete and Partial Response RateComplete Response0 participants
Cetuximab, Cisplatin, and IrinotecanComplete and Partial Response RatePartial Response1 participants
Cetuximab, Cisplatin, and IrinotecanComplete and Partial Response RateStable Disease4 participants
Cetuximab, Cisplatin, and IrinotecanComplete and Partial Response RateProgression of Disease11 participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026