Esophageal Cancer
Conditions
Keywords
adenocarcinoma of the esophagus, squamous cell carcinoma of the esophagus, stage I esophageal cancer, stage II esophageal cancer, stage III esophageal cancer, stage IV esophageal cancer
Brief summary
RATIONALE: Erlotinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving erlotinib together with radiation therapy may kill more tumor cells. PURPOSE: This phase II trial is studying how well giving erlotinib together with radiation therapy works in treating older patients with stage I, stage II, stage III, or stage IV esophageal cancer.
Detailed description
OBJECTIVES: Primary * Assess the overall survival of older patients with stage I-IV squamous cell carcinoma or adenocarcinoma of the esophagus or gastroesophageal junction treated with erlotinib hydrochloride in combination with radiotherapy. Secondary * Assess the proportion of patients achieving mucosal complete response after treatment with this regimen. * Determine the progression-free survival of patients treated with this regimen. * Assess the effect of this regimen on dysphagia control, performance status, and overall quality of life of these patients. * Investigate the correlation between smoking status and overall survival of these patients. * To correlate the Epidermal growth factor receptor (EGFR) and phosphor Epidermal growth factor receptor (pEGFR) expression by IHC and EGFR mutation status with clinical outcomes. OUTLINE: This is a multicenter study. Patients receive oral erlotinib hydrochloride once daily for 1 year in the absence of disease progression or unacceptable toxicity. Patients undergo external beam radiotherapy 5 days a week in weeks 1-4 or 5 days a week for the first 5.5 weeks. Tumor tissue samples are analyzed by IHC for the expression of E-cadherin, P-cadherin, vimentin, cytokeratin, phospho-S6, and Ki67. After completion of study treatment, patients are followed at 30 days and annually thereafter.
Interventions
Oral
Correlative Study
Radiation Treatment
Sponsors
Study design
Eligibility
Inclusion criteria
DISEASE CHARACTERISTICS: * Biopsy-proven primary squamous cell carcinoma or adenocarcinoma of the esophagus or gastroesophageal (GE) junction * GE junction tumors with 50% or more tumor located in the esophagus determined by radiologic or endoscopic evaluation * Stage I-IVA disease determined by CT scan or MRI of the chest and abdomen * Stage IVB disease allowed if metastases to distant regional lymph nodes (celiac or cervical) only and no other sites * Not a surgical candidate and ineligible for chemotherapy due to any of the following: * Neuropathy * Cardiac disease * Performance status 2 * General overall condition felt by the investigator to be a contraindication to platinum-based therapy * Bronchoscopy with biopsy and cytology required if primary esophageal cancer is \< 26 cm from incisors * No evidence of clinically active interstitial lung disease (patients who are asymptomatic with chronic, stable, radiographic lung changes allowed) PATIENT CHARACTERISTICS: * ECOG performance status 0-2 * Life expectancy \> 4 months * WBC ≥ 3,000/mm³ * ANC ≥ 1,500/mm³ * Platelet count \> 100,000/mm³ * Bilirubin ≤ 1.3 mg/dL * ALT and AST ≤ 2.5 times upper limit of normal (ULN) * Alkaline phosphatase ≤ 2.5 times ULN * No prior malignancies except basal cell or squamous cell skin cancer, in situ cervical cancer, or superficial transitional cell bladder cancer, unless diagnosed and/or treated \> 2 years prior to current study and are without evidence of recurrence * No history of allergy to erlotinib or any of its excipients * No serious, uncontrolled, concurrent infection * No clinically serious, uncontrolled medical conditions that the investigator feels might compromise study participation * No lack of physical integrity of the upper gastrointestinal tract or malabsorption syndrome * No unwillingness to participate or inability to comply with the protocol for the duration of the study PRIOR CONCURRENT THERAPY: * No prior chemotherapy or radiotherapy for this tumor * No prior resection or attempted resection of esophageal cancer * No prior anti-epidermal growth factor receptor therapy (unless given in an adjuvant setting and completed at least 12 months earlier) * No participation in any investigational drug study within the past 4 weeks * No HIV-positive patients receiving antiretroviral therapy * No concurrent CYP3A4/5 inducers or inhibitors
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Overall Survival | 5 years |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Response by Phosphor Epidermal Growth Factor Receptor (pEGFR) Expression | Radiologic evaluation every 3 months, up to 5 years | — |
| Response by EGFR Mutation Status | Radiologic evaluation every 3 months, up to 5 years | — |
| Complete Response | 4-8 weeks after completion of radiation. | Response assessment by CT scans and upper endoscopy performed between 4-8 weeks after completion of radiation. Complete Response (CR) is defined as absence of viable tumor in endoscopic evaluation post chemoradiation, with four-quadrant biopsies taken at 1 cm intervals throughout length of original tumor. |
| Progresssion-Free Survival | Every 3 months, up to 5 years | Progression is defined as at least a 20% increase in the sum of long distance of target lesions taking as reference the smallest sum long distance recorded since the treatment started or the appearance of one or more new lesions, or appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions. |
| Effect of Study Therapy on Overall Quality of Life as Assessed by FACT-E Scale | Baseline and Week 3 | Functional Assessment of Cancer Therapy-Esophagus (FACT-E) is a health-related quality of life instrument validated in esophageal cancer patients. All of the scales and single-item measures range in score from 0 to 4. The ranges of average quality of life scores was from 0 to 4 and was adjusted as lower scores indicate better outcomes |
| Correlation of Smoking Status With Overall Survival | 5 years | — |
| Response by Epidermal Growth Factor Receptor (EGFR) Expression | Radiologic evaluation every 3 months, up to 5 years | — |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Erlotinib in Combination With Radiotherapy Erlotinib (150 mg) administered orally once daily starting day 1 and continued with radiotherapy (RT) and through day 365 (one year therapy duration). RT will be administered day 1-28 (Mon-Fri) in dose of 1.8 Gy per fraction. | 17 |
| Total | 17 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Adverse Event | 4 |
| Overall Study | Death | 1 |
| Overall Study | Disease progression | 6 |
| Overall Study | Not treated (became ineligible) | 4 |
| Overall Study | Not treated (changed mind) | 1 |
| Overall Study | Other | 1 |
| Overall Study | Patient refused | 2 |
Baseline characteristics
| Characteristic | Erlotinib in Combination With Radiotherapy |
|---|---|
| Age, Continuous | 79.94 years STANDARD_DEVIATION 6.44 |
| Sex: Female, Male Female | 6 Participants |
| Sex: Female, Male Male | 11 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 17 / 17 |
| serious Total, serious adverse events | 9 / 17 |
Outcome results
Overall Survival
Time frame: 5 years
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Erlotinib in Combination With Radiotherapy | Overall Survival | 7.3 months |
Complete Response
Response assessment by CT scans and upper endoscopy performed between 4-8 weeks after completion of radiation. Complete Response (CR) is defined as absence of viable tumor in endoscopic evaluation post chemoradiation, with four-quadrant biopsies taken at 1 cm intervals throughout length of original tumor.
Time frame: 4-8 weeks after completion of radiation.
Population: Patients Treated with Study Therapy
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Erlotinib in Combination With Radiotherapy | Complete Response | 11.76 percentage of participants |
Correlation of Smoking Status With Overall Survival
Time frame: 5 years
Population: Patients Treated with Study Therapy
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Erlotinib in Combination With Radiotherapy | Correlation of Smoking Status With Overall Survival | 2.4 months |
| Erlotinib in Combination With Radiotherapy at Week 3 | Correlation of Smoking Status With Overall Survival | 7.2 months |
| Never Smokers | Correlation of Smoking Status With Overall Survival | 16.6 months |
Effect of Study Therapy on Overall Quality of Life as Assessed by FACT-E Scale
Functional Assessment of Cancer Therapy-Esophagus (FACT-E) is a health-related quality of life instrument validated in esophageal cancer patients. All of the scales and single-item measures range in score from 0 to 4. The ranges of average quality of life scores was from 0 to 4 and was adjusted as lower scores indicate better outcomes
Time frame: Baseline and Week 3
Population: Patients Treated with Study Therapy and with FACT-E scores available
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Erlotinib in Combination With Radiotherapy | Effect of Study Therapy on Overall Quality of Life as Assessed by FACT-E Scale | 1.05 FACT-E Score |
| Erlotinib in Combination With Radiotherapy at Week 3 | Effect of Study Therapy on Overall Quality of Life as Assessed by FACT-E Scale | 1.36 FACT-E Score |
Progresssion-Free Survival
Progression is defined as at least a 20% increase in the sum of long distance of target lesions taking as reference the smallest sum long distance recorded since the treatment started or the appearance of one or more new lesions, or appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.
Time frame: Every 3 months, up to 5 years
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Erlotinib in Combination With Radiotherapy | Progresssion-Free Survival | 4.5 months |
Response by EGFR Mutation Status
Time frame: Radiologic evaluation every 3 months, up to 5 years
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Erlotinib in Combination With Radiotherapy | Response by EGFR Mutation Status | Nonresponder | 9 participants |
| Erlotinib in Combination With Radiotherapy | Response by EGFR Mutation Status | Responder | 3 participants |
| Erlotinib in Combination With Radiotherapy at Week 3 | Response by EGFR Mutation Status | Nonresponder | 2 participants |
| Erlotinib in Combination With Radiotherapy at Week 3 | Response by EGFR Mutation Status | Responder | 2 participants |
Response by Epidermal Growth Factor Receptor (EGFR) Expression
Time frame: Radiologic evaluation every 3 months, up to 5 years
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Erlotinib in Combination With Radiotherapy | Response by Epidermal Growth Factor Receptor (EGFR) Expression | Non-responder | 6 participants |
| Erlotinib in Combination With Radiotherapy | Response by Epidermal Growth Factor Receptor (EGFR) Expression | Responder | 2 participants |
| Erlotinib in Combination With Radiotherapy at Week 3 | Response by Epidermal Growth Factor Receptor (EGFR) Expression | Non-responder | 5 participants |
| Erlotinib in Combination With Radiotherapy at Week 3 | Response by Epidermal Growth Factor Receptor (EGFR) Expression | Responder | 3 participants |
Response by Phosphor Epidermal Growth Factor Receptor (pEGFR) Expression
Time frame: Radiologic evaluation every 3 months, up to 5 years
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Erlotinib in Combination With Radiotherapy | Response by Phosphor Epidermal Growth Factor Receptor (pEGFR) Expression | Non-responder | 5 participants |
| Erlotinib in Combination With Radiotherapy | Response by Phosphor Epidermal Growth Factor Receptor (pEGFR) Expression | Responder | 3 participants |
| Erlotinib in Combination With Radiotherapy at Week 3 | Response by Phosphor Epidermal Growth Factor Receptor (pEGFR) Expression | Non-responder | 6 participants |
| Erlotinib in Combination With Radiotherapy at Week 3 | Response by Phosphor Epidermal Growth Factor Receptor (pEGFR) Expression | Responder | 2 participants |